Self-harm among older adults and seniors appears to be a growing problem, affecting not only the individual who harms him- or herself, but families, friends and society as a whole. A number of factors contribute to this trend including physical and mental health problems, troubled relationships, loneliness, dementia and financial stressors. Despite many older adults being seen by a healthcare professional within a month before self-harm occurs, more needs to be done to reduce or prevent this destructive behavior.
What is Self-Harm?
Although there are a number of ways to define self-harm, it generally means the act of injuring or poisoning one’s self regardless of motivation or intention, and does not include purposeful neglect, like refusing to eat or drink. Self-harm, according to many experts, is highly associated with suicide and mental health problems later in life. Of an important note, self-harm is a major risk factor for suicidal attempts and completions, and this is why more attention must be paid to this problem.
Influencing Factors Associated with Self-Harm
By far, the most common factors associated with self-harm among both older men and women are a history of self-harm behaviors and a previous or current psychiatric diagnosis, particularly a diagnosis of depression. Substance use or abuse is also closely related to the act of self-harm, in fact many cases involve drug or alcohol use during self-harm behaviors. Other factors include:
- Co-occurring physical health problems like chronic pain, arthritis, dementia, cancer, and terminal illness
- Mental health conditions including depression, schizophrenia and bipolar disorder
- Relationship problems, social isolation, and loneliness
- Loss of a loved one, traumatic loss, and grief and bereavement
- Perceived burden to family or caregivers, or lack of social support and caregivers
- Problems with mobility and freely getting around
Methods of Self-Harm
According to research, overdose is the most commonly used method of self-harm among both older men and women, although women have a higher risk for this, and involve the use of over-the-counter medications, antidepressants, benzodiazepines, and sleep medications. Older adult men and women also use cutting as a self-harm method and more men than women will self-harm through the act of hanging one’s self. Other methods of self-harm include:
- Hanging
- Use of firearms
- Car fumes
- Jumping from tall buildings/places
- Jumping in front of moving vehicles
- Immolation (setting one’s self on fire)
Some older adults will use more than one method of self-harm, such as the combination of alcohol, prescription medications and guns. Just like in the younger population, males use more lethal means of self-harm, such as using a gun, while females use pills and other substances.
Self-Harm Prevention and Intervention
Because self-harm is multifactorial and involves many risk factors and methods, it demands a comprehensive, multidisciplinary approach to reduce or prevent it altogether. Many older adults who self-harm visit their healthcare practitioner weeks prior to the act, so it is crucial for physicians, nurses and nurse practitioners, case managers and social workers to know their patient and conduct thorough assessments, taking into account the patient’s current problems, mental state, physical health, risk factors, and if he or she has means of support from family or friends. And, very importantly, the healthcare teams need to follow up with their patients in a timely fashion.
Final Thoughts on Self-Harm in Older Adults
Even more so than younger people, older adults and seniors engage in self-harm behaviors that at times may lead to suicidal attempts or completion. Many factors can influence the older adult to harm one’s self in a number of non-lethal ways. Depression and substance use are leading factors in self-harm and it is vital for healthcare practitioners to know their patients, understand their situation and provide the help they need and then follow up on a routine basis in efforts to reduce or eliminate such harmful behaviors.
References
- Troya, M. I., et al. 2019. Self-Harm in Older Adults: Systemic Review. The British Journal of Psychiatry, 214: 186-200.
- Waykar, V., et al. 2024. Older Adult Self-Harm: A Descriptive Study. Progress in Neurology and Psychiatry, 28:e12001.