Understanding Self-Harm and Suicide in Older Adults

 
Self harm and Suicide in
older adults
 
Tier 3
 
Contents
 
Definition
The 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 person 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 is not used to refer to harm arising from such things as
overeating/ starvation or excessive alcohol or drugs.
 
Self harm in older adults is associated with a 
100 fold 
increase in risks
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 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
P
eople with physical health conditions
Pain
Previous self-harm history
Previous psychiatric history
Currently having treatment for psychiatric condition (depression)
Several studies have reported repeated contact with the third sector
in older 
adults 
who self-harm.
 
Staff approach to report of self-harm
 
Take all self‑harm seriously and listen carefully, in a calm and
compassionate way
Take a validating and non-judgemental approach
The person should have a psychosocial assessment of need as well as
assessment of their current risk of repetition or suicide.
Care and treatment should not be given according to a rating scale
but according to a personalised assessment of risks and needs
Bear in mind that if the person is cognitively impaired you will need to
ask more questions as they may have more difficulties in recalling the
event
Ask permission to talk to family members/friends
Help the person to identify their own coping strategies and support
network
Offer information about support services
 
Staff approach to report of self-harm
 
Inform your seniors immediately
Don’t think just because it was an ineffective method that it was not
serious
Ask about what the person expected to happen
Enquire about hopelessness as it is an important predictor of suicide
For patients who are at risk of suicide, the care plans will also need to
include a Safety Plan, co-produced with the patient.
This should have explicit reference to removal and/or mitigation of
means to harm themselves, list of activities and coping strategies, and
contain information on how to access social, psychological and
emergency support
 
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
 
It is important to refrain from expressing negative views towards
those engaging in self-harm.
I
dentify older adults who self-harm
S
eek to gain an 
understanding of  the individual’s motivations for self-
harm, so the appropriate support and/or referrals are put in place.
Every older person 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
Creating social connectedness which can help protect vulnerable
persons from suicide
 
Contents
 
Frequency
Method
Risk Factors
Warning signs
Responding to expresses suicidal ideas
Managing risk
Other individuals who need support
Preventative strategies
 
 
Methods used 
Methods used 
for
for
 suicides in older 
 suicides in older 
adults
adults
 
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, psychotic illness
Depression
Chronic pain
Alcohol/drug use
Bereavement
Stressful life events
Low socioeconomic status
 
Possible Warning signs
Possible Warning signs
 
Talking about suicidal feelings and suicide, sometimes
older adults may even describe how they intend to carry
out the attempt.
Talking about feeling worthless, hopeless, or a failure or
seeing no point in life
Becoming very withdrawn and uncommunicative
Reports of poor sleep, loss of appetite, loss of weight
 
Assessing suicide risk
 
If someone is distressed always assess their suicide risk
Don’t worry that asking will offend them or “put ideas in their head”
Take a step-wise approach:
Ideas: 
Have you ever felt so bad that you don’t want to carry on?
Intent: 
Have you ever thought about trying to harm
  yourself and hasten the end?
Plan and means
: “
Have you thought about what you might do this?
Reasons for living / protective factors: 
What has stopped you from acting
on those thoughts?
Bear in mind that if the person is cognitively impaired you will need to ask
more questions as they may have more difficulties in recalling their
thoughts
 
How to respond
How to respond
 
Avoid saying, “t
hings can't be that bad
”, or brushing them
aside.
Don't argue with the older person 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
Encourage the older person to accept help from someone
they trus
t
.
 
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
: explore if patient would like space to talk about
their feelings, what helps them cope, etc. Consider writing coping plan and key
crisis contacts (e.g. GP, A&E, Samaritans 08457 90 90 90). Also MH Liaison Nurse
or
Has significant thoughts about self-harm 
but no immediate risk: Ask GP for
urgent mental health review
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.
 
Other individuals who may need support
 
The family
The staff
The care team
Other residents if they are in group living
 
 
It is essential to meet with them to allow them space to talk about
the incident as soon as possible after the event
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 gain an understanding of the individual’s motivations for self-
harm, so the appropriate support and/or referrals are put in place.
Communities can provide social support to vulnerable individuals and
support follow-up care
Creating social connectedness can help protect vulnerable persons
from suicide
Fight stigma and support those bereaved by suicide
Every older person 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
Can take from 20 minutes- 40 minutes to complete
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: 
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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Self-harm and suicide in older adults present unique challenges due to factors like underreporting and stigma. The incidence of self-harm in this age group is significant, with specific risk factors and warning signs to consider. Proper staff approaches and preventative strategies are crucial in addressing these issues effectively.


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  1. Self harm and Suicide in older adults Tier 3

  2. Contents Definition The 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 person 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 is not used to refer to harm arising from such things as overeating/ starvation or excessive alcohol or drugs. Self harm in older adults is associated with a 100 fold increase in risks 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 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 People with physical health conditions Pain Previous self-harm history Previous psychiatric history Currently having treatment for psychiatric condition (depression) Several studies have reported repeated contact with the third sector in older adults who self-harm.

  6. Staff approach to report of self-harm Take all self-harm seriously and listen carefully, in a calm and compassionate way Take a validating and non-judgemental approach The person should have a psychosocial assessment of need as well as assessment of their current risk of repetition or suicide. Care and treatment should not be given according to a rating scale but according to a personalised assessment of risks and needs Bear in mind that if the person is cognitively impaired you will need to ask more questions as they may have more difficulties in recalling the event Ask permission to talk to family members/friends Help the person to identify their own coping strategies and support network Offer information about support services

  7. Staff approach to report of self-harm Inform your seniors immediately Don t think just because it was an ineffective method that it was not serious Ask about what the person expected to happen Enquire about hopelessness as it is an important predictor of suicide For patients who are at risk of suicide, the care plans will also need to include a Safety Plan, co-produced with the patient. This should have explicit reference to removal and/or mitigation of means to harm themselves, list of activities and coping strategies, and contain information on how to access social, psychological and emergency support

  8. 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

  9. 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

  10. Self harm prevention strategies It is important to refrain from expressing negative views towards those engaging in self-harm. Identify older adults who self-harm Seek to gain an understanding of the individual s motivations for self- harm, so the appropriate support and/or referrals are put in place. Every older person 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 Creating social connectedness which can help protect vulnerable persons from suicide

  11. Contents Frequency Method Risk Factors Warning signs Responding to expresses suicidal ideas Managing risk Other individuals who need support Preventative strategies

  12. Methods used for suicides in older adults Overdoses Cutting with knife / razor Drowning Hanging Any older adult who says they want to kill themselves must be taken seriously

  13. 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, psychotic illness Depression Chronic pain Alcohol/drug use Bereavement Stressful life events Low socioeconomic status

  14. Possible Warning signs Talking about suicidal feelings and suicide, sometimes older adults may even describe how they intend to carry out the attempt. Talking about feeling worthless, hopeless, or a failure or seeing no point in life Becoming very withdrawn and uncommunicative Reports of poor sleep, loss of appetite, loss of weight

  15. Assessing suicide risk If someone is distressed always assess their suicide risk Don t worry that asking will offend them or put ideas in their head Take a step-wise approach: Ideas: Have you ever felt so bad that you don t want to carry on? Intent: Have you ever thought about trying to harm yourself and hasten the end? Plan and means: Have you thought about what you might do this? Reasons for living / protective factors: What has stopped you from acting on those thoughts? Bear in mind that if the person is cognitively impaired you will need to ask more questions as they may have more difficulties in recalling their thoughts

  16. How to respond Avoid saying, things can't be that bad , or brushing them aside. Don't argue with the older person 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 Encourage the older person to accept help from someone they trust.

  17. 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: explore if patient would like space to talk about their feelings, what helps them cope, etc. Consider writing coping plan and key crisis contacts (e.g. GP, A&E, Samaritans 08457 90 90 90). Also MH Liaison Nurse or Has significant thoughts about self-harm but no immediate risk: Ask GP for urgent mental health review 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.

  18. Other individuals who may need support The family The staff The care team Other residents if they are in group living It is essential to meet with them to allow them space to talk about the incident as soon as possible after the event Give them information of any local support groups / help lines

  19. Self harm and suicide prevention strategies Identify older adults who self-harm due to the increased risk of repetition and suicide Seek to gain an understanding of the individual s motivations for self- harm, so the appropriate support and/or referrals are put in place. Communities can provide social support to vulnerable individuals and support follow-up care Creating social connectedness can help protect vulnerable persons from suicide Fight stigma and support those bereaved by suicide Every older person who self-harms and/or has suicidal thoughts should have a Safety Plan.

  20. Safety Plan Required for everyone who self-harms and/or has suicidal thoughts. Co-produced with the patient Can take from 20 minutes- 40 minutes to complete 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: https://www.getselfhelp.co.uk/docs/SafetyPlan.pdf

  21. 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

  22. 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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