Older people who self-harm at highest risk of suicide
People over 65 who harm themselves are more likely to die by suicide than other age groups according to new research published in the Lancet Psychiatry by University of Manchester and Keele University academics.
The study analysed patient records using the Clinical Practice Research Datalink (CPRD) and found that 4,124 patients harmed themselves between 2001 and 2014, mostly by taking overdoses of medication.
It showed that people over 65 who self-harm are 20 times more likely to die an unnatural death and 145 times more likely to die by suicide than people of the same age who had not self-harmed.
The study also found that only 12% of older patients who self-harmed had a record of being referred to a mental health service for aftercare. National Institute of Health and Care Excellence (NICE) guidelines suggest that the involvement of mental health specialists is important because older people who self-harm may have higher suicidal intent than younger people.
Physical health problems were more common in older patients who had harmed themselves compared to those who had not.
Following a self-harm episode, over one in ten of those aged 65 and over were prescribed tricyclic antidepressants which can be toxic when taken in overdose.
Dr Cathy Morgan, who led the study and analysed the data said: “With the ageing population rising and a lack of research in this age group, this study - - the first of its kind conducted in primary care – has gone some way in highlighting the risks of self-harm in older people.
“This study emphasises the need for early intervention, careful alternative prescribing and better support for older people who may see their GP following an episode of self-harm or for other health problems.”
Professor Nav Kapur, one of the authors of the paper who chaired the NICE guidelines for self-harm said: “We sometimes think of self-harm as a problem in younger people and of course it is. But it effects older adults too and the concerning issue is the link with increased risk of suicide.
“Older people might be particularly vulnerable as they are uniquely exposed to issues such as bereavement, isolation and physical as well as mental illness.
“They also might fear the consequences of becoming a burden to their family or friends, or not being able to function from day to day.”
He added: “We hope our study will alert clinicians, service planners, and policy makers to the need to implement preventative measures for this potentially vulnerable group of people. Referral and management of mental health conditions are likely to be key”
Professor Carolyn Chew-Graham, from Keele University one of the research team and a practising GP said: “Since drug ingestion is one of the main methods of self-harm, we highlight the need to consider less toxic medication in older adults for the management of both mental illness and pain related conditions.
“We also recommend maintaining frequent medication reviews following self-harm.”
“GPs are after all in a unique position to intervene as older patients come to the surgery more frequently than younger adults.”
Reference: “Self-harm in a primary care cohort of older people: incidence, clinical management, and risk of suicide and other causes of death”. The Lancet Psychiatry, Volume 5, ISSUE 11, P905-912, 1 November 2018.
See also, “Self-harm in older adults: room to improve clinical care” at https://doi.org/10.1016/S2215-0366(18)30358-4
The study was funded by the NIHR Greater Manchester Patient Safety Translational Research Centre,
29 November 2018.