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Self-harm in the very old one year later: has anything changed?

Published online by Cambridge University Press:  27 June 2019

Anne Pamela Frances Wand Open the ORCID record for Anne Pamela Frances Wand [Opens in a new window] ,
Brian Draper ,
Henry Brodaty  and
Carmelle Peisah
Anne Pamela Frances Wand*
Affiliation:
Department of Aged Care Psychiatry, Prince of Wales Hospital, Sydney, NSW, Australia School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
Brian Draper
Affiliation:
Department of Aged Care Psychiatry, Prince of Wales Hospital, Sydney, NSW, Australia School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
Henry Brodaty
Affiliation:
Department of Aged Care Psychiatry, Prince of Wales Hospital, Sydney, NSW, Australia Dementia Centre for Research Collaboration and Centre for Healthy Brain Ageing, University of New South Wales, Sydney, NSW, Australia
Carmelle Peisah
Affiliation:
School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
*
Correspondence should be addressed to: Anne Wand, Department of Aged Care Psychiatry, Euroa Centre, Level 1, Prince of Wales Hospital, Barker St. Randwick, New South Wales, NSW 2213, Australia. Phone: +61 2 9382 3753; Facsimile: +61 2 9382 3039; Email: a.wand@unsw.edu.au.
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Abstract

Objectives:

To follow-up a cohort of older people who self-harmed, their carer, and general practitioner (GP) and examine their reflections on the self-harm, care experiences, and outcomes.

Design:

Qualitative in-depth interviews.

Setting:

Two teaching hospitals and associated community services.

Participants:

Twelve-month follow-up of participants aged 80 or older who self-harmed, their nominated carers, and GPs.

Measurements:

A geriatric psychiatrist gathered data through patient and carer interviews using a narrative inquiry approach and from medical records. Interviews were audio recorded and transcribed. N-VIVO facilitated data organization for thematic analysis. Questionnaires sent to the patient’s GP examined their perspectives and aspects of care relating to the self-harm.

Results:

Nineteen patients (63% baseline sample), 29 carers (90.6%), and 11 GPs (36.7%) were available at follow-up. Themes emerging from patients were “denial and secrets;” “endless suffering;” “more invalidation;” “being heard;” and “miserable in care.” Themes from carer interviews were “denial and secrets;” “patient’s persistent wish to die;” “abandonment by clinicians;” “unending burden for the carer;” and “distress regarding placement.” General practitioner themes were “the problem is fixed;” “the troops have arrived;” and “I understand.”

Conclusions:

Factors contributing to self-harm persisted at follow-up. Positive and negative responses were identified in the older person’s system, highlighting areas for potential intervention. A conceptual framework for understanding self-harm in the very old was derived that emphasized the importance of understanding individual needs, the interpersonal context of the older person, and carer burden. Interventions should improve communication, facilitate shared understanding of perspectives, and provide support at all levels.

Keywords

aged careself-mutilationsuicidecarersqualitative research

Information

Type
Original Research Article
Information
International Psychogeriatrics , Volume 31 , Issue 11: Issue Theme: Psychiatric Morbidity in Exceptionally Old People , November 2019 , pp. 1559 - 1568
Copyright
© International Psychogeriatric Association 2019 

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