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Knowing the warning signs of self-neglect and suicidal behaviors can help prevention and early intervention

Wand A, Peisah C, Draper B, et al.  Understanding self-harm in older people: A systematic review of qualitative studies  Aging & Mental Health. 2017; 22(3): 289-298.

Review question

• What are the experiences of older adults who intentionally harm themselves?

Background

• Older adults generally have a higher rate of suicide and self-harm (both direct and indirect) than other age groups. Direct self-harm is defined as an intentional action of harm such as an overdose of medication. Indirect self-harm is defined as an act of omission or commission that causes self-harm, such as refusing to eat or drink.
• Existing literature focuses on identifying the risk factors for suicide by examining hospital charts and health records, as well as conducting ‘psychological autopsies’ (in other words, collecting and analyzing all available information on the deceased via structured interviews of family members, relatives or friends as well as attending care personnel).
• However, the literature does not present a full picture of the experience of older adults who intentionally harm themselves.
• The aim of this study was to systematically review the qualitative literature to present the experiences of older adults in order to examine the reasons why they intentionally harm themselves.

How the review was done

• A detailed search of a number of electronic databases for studies published from until 2016 was conducted. Qualitative studies that focused on self-harm, suicide and older adults were included in the review.
• A total of 1,457 studies were identified in searches, and eight were included in the review after assessments for eligibility.
• The authors did not acknowledge any funding sources for this review.

What the researchers found

• The review found a distinct difference between self-neglect and suicidal behaviour.
• For older adults, self-neglect often corresponded with responses to changes in personal control commonly seen in residential care facilities. Studies also found that self-neglect was associated with cognitive impairments caused by aging and distrust of care workers.
• As with self-neglect, suicidal behaviour among older adults was associated with a sense of powerlessness, loss of control and alienation, which caused an increase in the likelihood of suicidal thoughts and feeling worthless.

Conclusion

• A loss of control, a sense of meaninglessness and impaired coping skills for older adults greatly contribute to self-harm and suicidal behaviours.
• While many factors such as gender, age, mental and physical illness, pain, suicide ideation, and past suicide attempts have all been associated with suicidal behaviours, how such factors interact to contribute to a risk of self-harm provides an opportunity for future research.