Understanding Self-Harm and Suicide in Older Adults

 
Self harm and Suicide in
older adults
 
Tier 1
 
Contents
 
Definition and 
potential methods that can be used
 
T
he risk factors and warning signs in older 
adults
 to look out for
 
H
ow to respond if an older 
adult
 reports an attempt at self harm
 
Self harm preventative strategies
 
Definition
 
We are using the National Institute for Health and Care Excellence’s
(NICE’s) definition of self harm
Self-harm is any self-injurious act carried out by a person regardless
of intention
 
e.g. overdose (most common, cutting or burning)
 
Self-harm does not refer to harm arising from overeating/starvation
or excessive alcohol or drugs.
 
Self harm in older adults is associated with a 
100 fold 
increase in risk
of suicide so 
MUST
 be taken seriously
 
Self harm in Older adults
 
Overall incidence of self-harm in older adults aged 65 years and older
was
 
4.1 per 10 000 person-years 
in a study done in primary care
between 2001 to 2014
 
Self-harm rates might be under-estimated due to stigma and shame
resulting in lac
k of disclosure
 
Risk of repetition 
is
 high (17%)
 
Self harm in older adults is associated with less impulsivity and higher
levels of lethal intent
 
Risk factors  for self harm in older adults
 
Female sex
P
eople with physical health conditions
(
especially being in
pain
)
Alcohol and/or drug use
Previous self-harm history
Previous psychiatric history
Currently having treatment for a psychiatric condition (such
as depression)
 
Staff approach to report of self-harm
 
Take all self‑harm seriously and listen carefully, in a calm and
compassionate way
The adult should have a psychosocial assessment of their needs 
and
 an
assessment of their current risk of repetition or suicide
Bear in mind that if the adult is cognitively impaired they may have more
difficulties in recalling the event
Ask permission to talk to family members/friends
Inform your seniors immediately
Don’t think just because it was an ineffective method that it was not
serious
Enquire about what the person thought would happen
Hopelessness is an important predictor of suicide
Offer information about support services
 
Other individuals who may also need support
 
The family/friends
Any staff
The care team
 
 
Give them information of any local support groups / help lines
 
Responses to avoid
 
Staff should try to avoid the following responses towards an
individual who has self- harmed
Reacting with strong or negative emotions
Becoming irritated
Using terms such as ‘manipulative’ or ‘attention seeking’
Becoming frustrated
Focussing too much on the self‑harm itself, rather than the
underlying issues
 
Self harm prevention strategies
 
Avoid expressing negative views towards those engaging in self-harm
I
dentify older adults who self-harm
S
eek to understand the individual’s motivations for self-harm
Every older adult who self‑harms should have a 
Safety Plan
, which
gives specific personalised advice to care providers on how they can
reduce the individual’s risk of self‑harm
Communities play a critical role in prevention and are key to providing
social support to vulnerable individuals and supporting follow-up care
Social connectedness can help protect vulnerable people from
attempts at suicide
 
Suicide in Older Adults
 
Frequency
Method
Risk Factors
Warning signs
Responding to expresses suicidal ideas
Managing risk
Other individuals who need support
Preventative strategies
 
 
Methods used
Methods used
 
Methods used by older adults for suicide include:
Overdoses
Cutting with knife / razor
Drowning
Hanging
 
Any 
older adult
 who says they want to kill themselves 
must
be taken seriously
 
Risk factors for suicide
 
Self-harm is the leading risk factor for suicide
Male gender
Single
Living alone/isolation
Past psychiatric history esp. depression, anxiety
Depression
Chronic pain
Alcohol/drug use
Bereavement
Stressful life events
Low socioeconomic status
 
Possible Warning signs
Possible Warning signs
 
If an older adult starts talking about suicidal feelings and
suicide, sometimes they may even describe how they intend
to carry out the attempt
Talking about feeling worthless, hopeless, that they are a
failure, or see no point in life
Becoming very withdrawn and uncommunicative
Reported poor sleep, loss of appetite, loss of weight
 
How to respond
How to respond
 
If someone reports suicidal thoughts
Avoid saying, 
“Things can't be that bad
”, or brushing them
aside.
Don't argue with the older adult but reassure them that you
care about them.
Be patient and listen
It is difficult to support someone who is expressing suicidal
ideas on your own,
 so seek help from a senior
 
Managing risk
 
Document and share concerns: if there is a major risk, 
duty of care outweighs
confidentiality
If the person
Is distressed but no intent/plan: 
GP
or
Has significant thoughts about self-harm but no immediate risk: 
Ask GP for
urgent mental health review or Out of Hours GP
or
Has few /no reasons for living, and the person can’t assure you they will be safe
if left: 
Call GP/senior staff member urgently and don’t leave alone.  If all else fails
consider calling 999.
Bear in mind that if the 
adult
 is cognitively impaired they may have more
difficulties in recalling if they have any plans
 
Other individuals who need support
 
The family
The staff
The care team
 
 
It is essential to met with them to allow them space to talk about the
incident as soon as possible after the incident
Give them information of any local support groups / help lines
 
Self harm and suicide prevention strategies
 
I
dentify older adults who self-harm due to the increased risk of repetition
and suicide
S
eek to understand the individual’s motivations for self-harm
Communities can provide social support to vulnerable individuals and
support follow-up care
Creating social connectedness can help protect vulnerable persons from
suicide
Fighting stigma and supporting those bereaved by suicide
Every older adult who self‑harms and/or has suicidal thoughts should have
a 
Safety Plan
 
Safety Plan
 
Required for everyone who self-harms and/or has suicidal thoughts
Co-produced with the patient
Gives personalised advice to care providers on how they can reduce the
individual’s risk of self-harm and suicide
It should have explicit reference to:
Removal and/or mitigation of means to harm themselves
List of calming/distracting activities and coping strategies
Information on how to access social, psychological and emergency
support
 
Safety plan template: 
https://www.getselfhelp.co.uk/docs/SafetyPlan.pdf
 
Resources
 
Self-harm_and_suicide_prevention_competence_framework_-
_adults_and_older_adults_8th_oct_18.pdf (ucl.ac.uk)
 
Role of primary care in supporting older adults who self-harm: a
qualitative study in England | British Journal of General Practice
(bjgp.org)
 
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Resources
 
MPC_05_07 Suicide Risk And Prevention For Older People | Suicide
Risk And Prevention For Older People (mindedforfamilies.org.uk)
 
This is an easy to access website for older adults and their families
which has good advice about warning signs, responding in a crisis
along with practical step for family and friends
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Exploring the definition, risk factors, incidence rates, and staff approaches related to self-harm and suicide in older adults. It emphasizes the seriousness of self-harm in this demographic, the associated risk factors, and the importance of responding with compassion and support. The content delves into the incidence rates among older adults, highlighting the need for attentive care and preventative strategies in addressing self-harm and suicidal behaviors.


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  1. Self harm and Suicide in older adults Tier 1

  2. Contents Definition and potential methods that can be used The risk factors and warning signs in older adults to look out for How to respond if an older adult reports an attempt at self harm Self harm preventative strategies

  3. Definition We are using the National Institute for Health and Care Excellence s (NICE s) definition of self harm Self-harm is any self-injurious act carried out by a person regardless of intention e.g. overdose (most common, cutting or burning) Self-harm does not refer to harm arising from overeating/starvation or excessive alcohol or drugs. Self harm in older adults is associated with a 100 fold increase in risk of suicide so MUST be taken seriously

  4. Self harm in Older adults Overall incidence of self-harm in older adults aged 65 years and older was 4.1 per 10 000 person-years in a study done in primary care between 2001 to 2014 Self-harm rates might be under-estimated due to stigma and shame resulting in lack of disclosure Risk of repetition is high (17%) Self harm in older adults is associated with less impulsivity and higher levels of lethal intent

  5. Risk factors for self harm in older adults Female sex People with physical health conditions(especially being in pain) Alcohol and/or drug use Previous self-harm history Previous psychiatric history Currently having treatment for a psychiatric condition (such as depression)

  6. Staff approach to report of self-harm Take all self-harm seriously and listen carefully, in a calm and compassionate way The adult should have a psychosocial assessment of their needs and an assessment of their current risk of repetition or suicide Bear in mind that if the adult is cognitively impaired they may have more difficulties in recalling the event Ask permission to talk to family members/friends Inform your seniors immediately Don t think just because it was an ineffective method that it was not serious Enquire about what the person thought would happen Hopelessness is an important predictor of suicide Offer information about support services

  7. Other individuals who may also need support The family/friends Any staff The care team Give them information of any local support groups / help lines

  8. Responses to avoid Staff should try to avoid the following responses towards an individual who has self- harmed Reacting with strong or negative emotions Becoming irritated Using terms such as manipulative or attention seeking Becoming frustrated Focussing too much on the self-harm itself, rather than the underlying issues

  9. Self harm prevention strategies Avoid expressing negative views towards those engaging in self-harm Identify older adults who self-harm Seek to understand the individual s motivations for self-harm Every older adult who self-harms should have a Safety Plan, which gives specific personalised advice to care providers on how they can reduce the individual s risk of self-harm Communities play a critical role in prevention and are key to providing social support to vulnerable individuals and supporting follow-up care Social connectedness can help protect vulnerable people from attempts at suicide

  10. Suicide in Older Adults Frequency Method Risk Factors Warning signs Responding to expresses suicidal ideas Managing risk Other individuals who need support Preventative strategies

  11. Methods used Methods used by older adults for suicide include: Overdoses Cutting with knife / razor Drowning Hanging Any older adult who says they want to kill themselves must be taken seriously

  12. Risk factors for suicide Self-harm is the leading risk factor for suicide Male gender Single Living alone/isolation Past psychiatric history esp. depression, anxiety Depression Chronic pain Alcohol/drug use Bereavement Stressful life events Low socioeconomic status

  13. Possible Warning signs If an older adult starts talking about suicidal feelings and suicide, sometimes they may even describe how they intend to carry out the attempt Talking about feeling worthless, hopeless, that they are a failure, or see no point in life Becoming very withdrawn and uncommunicative Reported poor sleep, loss of appetite, loss of weight

  14. How to respond If someone reports suicidal thoughts Avoid saying, Things can't be that bad , or brushing them aside. Don't argue with the older adult but reassure them that you care about them. Be patient and listen It is difficult to support someone who is expressing suicidal ideas on your own, so seek help from a senior

  15. Managing risk Document and share concerns: if there is a major risk, duty of care outweighs confidentiality If the person Is distressed but no intent/plan: GP or Has significant thoughts about self-harm but no immediate risk: Ask GP for urgent mental health review or Out of Hours GP or Has few /no reasons for living, and the person can t assure you they will be safe if left: Call GP/senior staff member urgently and don t leave alone. If all else fails consider calling 999. Bear in mind that if the adult is cognitively impaired they may have more difficulties in recalling if they have any plans

  16. Other individuals who need support The family The staff The care team It is essential to met with them to allow them space to talk about the incident as soon as possible after the incident Give them information of any local support groups / help lines

  17. Self harm and suicide prevention strategies Identify older adults who self-harm due to the increased risk of repetition and suicide Seek to understand the individual s motivations for self-harm Communities can provide social support to vulnerable individuals and support follow-up care Creating social connectedness can help protect vulnerable persons from suicide Fighting stigma and supporting those bereaved by suicide Every older adult who self-harms and/or has suicidal thoughts should have a Safety Plan

  18. Safety Plan Required for everyone who self-harms and/or has suicidal thoughts Co-produced with the patient Gives personalised advice to care providers on how they can reduce the individual s risk of self-harm and suicide It should have explicit reference to: Removal and/or mitigation of means to harm themselves List of calming/distracting activities and coping strategies Information on how to access social, psychological and emergency support Safety plan template: https://www.getselfhelp.co.uk/docs/SafetyPlan.pdf

  19. Resources Self-harm_and_suicide_prevention_competence_framework_- _adults_and_older_adults_8th_oct_18.pdf (ucl.ac.uk) Role of primary care in supporting older adults who self-harm: a qualitative study in England | British Journal of General Practice (bjgp.org) Self-harm in a primary care cohort of older people: incidence, clinical management, and risk of suicide and other causes of death https://www.thelancet.com/journals/lanpsy/article/PIIS2215- 0366(18)30348-1/fulltext

  20. Resources MPC_05_07 Suicide Risk And Prevention For Older People | Suicide Risk And Prevention For Older People (mindedforfamilies.org.uk) This is an easy to access website for older adults and their families which has good advice about warning signs, responding in a crisis along with practical step for family and friends

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