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Troya MI, Lonergan C, Cassidy E, Griffin E, Lovejoy SA, Mughal F, Russell V, Arensman E. Healthcare practitioners' views of self-harm management practices in older adults in Ireland: A qualitative study. Int J Geriatr Psychiatry 2024; 39:e6116. [PMID: 38925890 DOI: 10.1002/gps.6116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES To explore healthcare practitioners' views on management practices of self-harm in older adults. METHODS Semi-structured interviews were conducted with healthcare practitioners, including consultant psychiatrists, general practitioners, clinical psychologists, psychotherapists, clinical nurse specialists and social workers. Purposeful sampling was used to recruit participants in the Republic of Ireland ensuring diverse perspectives of healthcare practitioners were included. Healthcare practitioners were recruited advertising via professional and clinical research networks, social media, and snowballing methods. Interviews were audio-recorded, transcribed verbatim, and analysed using reflexive thematic analysis. RESULTS We conducted interviews with 20 healthcare practitioners from April to July 2023. Three main themes were generated: first, a perceived greater risk of suicide, and increased awareness of complexity in older adults' self-harm presentations. Second, integrated care as an avenue for improving the management of self-harm in older adults. Third, the importance of safety planning in risk assessments of older adults. CONCLUSIONS Healthcare practitioners viewed self-harm in older adults as complex, challenging, and associated with high suicide risk, approaching patients with care and caution. The need for integrated support and improved collaboration between relevant healthcare practitioners was identified. Suggestions were made for primary care having a lead role in identifying and managing older adults after self-harm. Increased mental health promotion and awareness of mental health and self-harm in this age group would help address current stigma and shame.
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Affiliation(s)
- M Isabela Troya
- School of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Caoimhe Lonergan
- Department of Psychiatry and Neurobehavioral Science, University College Cork, Acute Mental Health Unit, Cork University Hospital, Wilton, Ireland
| | - Eugene Cassidy
- Department of Psychiatry and Neurobehavioral Science, University College Cork, Acute Mental Health Unit, Cork University Hospital, Wilton, Ireland
| | - Eve Griffin
- School of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Sally Ann Lovejoy
- National Clinical Programme for Self-Harm and Suicide-Related Ideation, Office of the National Clinical Advisor and Group Lead, Dr. Steevens Hospital, Dublin, Ireland
| | | | - Vincent Russell
- National Clinical Programme for Self-Harm and Suicide-Related Ideation, Office of the National Clinical Advisor and Group Lead, Dr. Steevens Hospital, Dublin, Ireland
| | - Ella Arensman
- School of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, University College Cork, Cork, Ireland
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
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Lascelles KM, Davey Z, Jackson D, Aveyard H. Experiences and needs of adult informal carers of adults at risk of suicide: A systematic review with mixed methods analysis. J Adv Nurs 2024; 80:1686-1718. [PMID: 38010822 DOI: 10.1111/jan.15940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 09/29/2023] [Accepted: 10/26/2023] [Indexed: 11/29/2023]
Abstract
AIM To systematically review and synthesize primary research on experiences and needs of adult informal caregivers of adults at risk of suicide. DESIGN Systematic review with a data-based convergent synthesis. DATA SOURCES MEDLINE, PsychINFO and CINAHL were searched in April 2022 and February 2023. English language research focusing on experiences of adult carers of adults was included. METHODS Articles were screened by title (n = 9077) and abstract (n = 132) with additional articles (n = 6) obtained via citation and hand searching. Thirty-one included studies were quality assessed using the Mixed Methods Appraisal Tool and study data were systematically extracted prior to thematic synthesis. RESULTS Five interconnected themes resulted: transitions; living with fear and uncertainty; changing relationships; interface with healthcare professionals and services; what carers need and want. Caring impacts mental, physical and social wellbeing. Relationships are affected in ways which might not be evident when caring for a minor. Repeated suicidal behaviour is particularly challenging with ongoing hypervigilance contributing to burden, burnout and interpersonal strain. Poor carer support exacerbates negative effects; carers need to feel informed, educated, involved and holistically supported. CONCLUSION Timely support for carers is essential. Interventions should address emotional responses, relational changes and effective care recipient support. Longitudinal research is required to understand effects of ongoing caring where there are multiple suicide attempts. IMPLICATIONS Nurses can provide carers with early support and information and longer term psychosocial interventions. If carers are adequately equipped and supported patient safety and wellbeing will be improved. IMPACT Findings of this systematic review include relational changes due to carer hypervigilance reducing autonomy and living with the possibility of suicide. Clinician awareness of the potential for relational shifts will help them prepare and support carers. PATIENT OR PUBLIC CONTRIBUTION There was no patient or public contribution.
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Affiliation(s)
| | - Zoe Davey
- Oxford Institute of Nursing Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK
| | - Debra Jackson
- University of Sydney, Sydney, New South Wales, Australia
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Van Hove L, Baetens I, Vanderstichelen S. Conceptualizing Self-Harm through the Experiences of Psychogeriatric Experts. Psychopathology 2024:1-9. [PMID: 38599197 DOI: 10.1159/000537809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 02/11/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Fewer studies thus far have focused on self-harm and its specific forms among older adults. Moreover, the limited available literature applies varying terminology. The categorization of self-harm used in younger populations may not be as appropriate for this population. This means that less is known about this phenomenon in older adults. The current study aimed to reduce this gap. METHODS Nine Flemish psychogeriatric experts participated in a semi-structured interview. Transcripts were thematically analyzed. RESULTS Themes emerging from the interviews suggest that self-harm in older adults may also include distinct elements, such as the omission of certain behaviours and engagement in indirect self-harm to cause bodily harm. According to the experts, self-harm may be engaged in to cope with emotions, express life fatigue, hasten death, and communicate a cry for help. DISCUSSION Self-harm is prevalent in older adults, and some characteristics may be specific to self-harm in an older age group. These findings may enable clinicians to be more alert to self-harm in older adults and consequently prevent serious suicidal behaviour. More research is needed to further uncover this phenomenon.
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Affiliation(s)
- Lisa Van Hove
- Brussels University Consultation Center (BRUCC), Department of Clinical Psychology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Imke Baetens
- Brussels University Consultation Center (BRUCC), Department of Clinical Psychology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Steven Vanderstichelen
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels/Ghent University, Ghent, Belgium
- Compassionate Communities Centre of Expertise (COCO), Vrije Universiteit Brussel, Brussels/Ghent University, Ghent, Belgium
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Wand AP, Karageorge A, Browne R, Jessop T, Peisah C. A qualitative study of multiple voices to inform aftercare services for older persons following self-harm. Int J Geriatr Psychiatry 2023; 38:e5876. [PMID: 36655812 PMCID: PMC10108272 DOI: 10.1002/gps.5876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/10/2023] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Self-harm and suicide are closely related in older adults, highlighting the opportunity for Aftercare interventions in targeted suicide prevention. The study aims were to explore strengths and shortfalls of current Aftercare services for older adults from the perspective of key stakeholders and researchers; and inform a set of guiding principles for older persons' Aftercare. METHODS Semi-structured interviews were undertaken with a convenience sample of older people with lived experience of self-harm, clinicians and suicide researchers (n = 22). Interviews were focussed on current practice (strengths and limitations), potential improvements, and identifying the core components of an acceptable Aftercare model. Interviews were audio-recorded, transcribed and subjected to a reflexive thematic analysis grounded in interpretive description. RESULTS Current practice strengths included validation, a person-centred approach and optimising aftercare delivery. Limitations included ageism, practical limitations (lack of service awareness, fragmented service provision, barriers to access, and traumatising approaches), and limited services, funding and training. Overarching themes included anti-ageism; anti-stigma; empowerment and agency; conveying hope; patience and pace; accessible; and finding purpose: connections and meaningful activity. CONCLUSIONS Older people who have self-harmed have complex, individualised needs. They sit within intersecting systems traversing healthcare, support services, family, and the social environment. Systemic, coordinated Aftercare founded upon core principles of anti-ageism, anti-stigma, partnership, empowerment, accessibility and provision of connections and meaning are needed.
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Affiliation(s)
- Anne P Wand
- Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Discipline of Psychiatry and Mental Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Older Persons Mental Health Service, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Aspasia Karageorge
- Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Roisin Browne
- Discipline of Psychiatry and Mental Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,ForeFront Motor Neuron Disease & Frontotemporal Dementia Clinic, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Capacity Australia, Sydney, New South Wales, Australia
| | - Tiffany Jessop
- Discipline of Psychiatry and Mental Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Capacity Australia, Sydney, New South Wales, Australia
| | - Carmelle Peisah
- Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Discipline of Psychiatry and Mental Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Capacity Australia, Sydney, New South Wales, Australia
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Cuperfain AB, Furqan Z, Sinyor M, Mulsant BH, Shulman K, Kurdyak P, Zaheer J. A Qualitative Analysis of Suicide Notes to Understand Suicidality in Older Adults. Am J Geriatr Psychiatry 2022; 30:1330-1338. [PMID: 36163122 DOI: 10.1016/j.jagp.2022.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/26/2022] [Accepted: 08/27/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Suicide is a complex multifactorial process influenced by a variety of biological, psychological, and social stressors. Many older adults face a characteristic set of challenges that predispose them to suicidal ideation, suicide-related behavior, and death by suicide. This study explored the subjective experience of suicidality through the analysis of suicide notes from older adults. DESIGN Qualitative study analyzing written suicide notes. SETTING Written notes for suicide deaths in Toronto, Canada, between 2003 and 2009 were obtained from the Office of the Chief Coroner for Ontario. PARTICIPANTS The analysis comprised 29 suicide notes (mean words per note: 221; range: 6-1095) written by individuals 65 years and older (mean ± SD age: 76.2 ± 8.3). MEASUREMENTS We employed a constructivist grounded theory framework for the analysis, conducted through line-by-line open coding, axial coding, and theorizing of data to establish themes. RESULTS Suicide notes elucidated the writers' conception of suicide and their emotional responses to stressors. Expressed narratives contributing to suicide centered on burdensomeness or guilt, experiences of mental illness, loneliness or isolation, and poor physical health or disability. Terms related to pain, poor sleep, apology, and inability to go on were recurrent. CONCLUSIONS Suicide notes enrich our understanding of the thoughts and emotions of those at highest risk of suicide, and they inform potential interventions for reducing suicide risk in older adults.
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Affiliation(s)
- Ari B Cuperfain
- Department of Psychiatry (ABC MS, BHM, KS, JZ), Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Zainab Furqan
- Centre for Mental Health (ZF), Department of Psychiatry, University Health Network, Toronto, ON, Canada
| | - Mark Sinyor
- Department of Psychiatry (ABC MS, BHM, KS, JZ), Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry (MS, KS), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Benoit H Mulsant
- Department of Psychiatry (ABC MS, BHM, KS, JZ), Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (BHM, PK, JZ), University of Toronto, Toronto, ON Canada
| | - Kenneth Shulman
- Department of Psychiatry (ABC MS, BHM, KS, JZ), Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry (MS, KS), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health (BHM, PK, JZ), University of Toronto, Toronto, ON Canada; Mental Health and Addictions Research Program at the Institute for Clinical Evaluative Science (PK), Toronto, ON, Canada
| | - Juveria Zaheer
- Department of Psychiatry (ABC MS, BHM, KS, JZ), Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (BHM, PK, JZ), University of Toronto, Toronto, ON Canada.
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Wand AP, Browne R, Jessop T, Peisah C. A systematic review of evidence-based aftercare for older adults following self-harm. Aust N Z J Psychiatry 2022; 56:1398-1420. [PMID: 35021912 DOI: 10.1177/00048674211067165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Self-harm is closely associated with suicide in older adults and may provide opportunity to intervene to prevent suicide. This study aimed to systematically review recent evidence for three components of aftercare for older adults: (1) referral pathways, (2) assessment tools and safety planning approaches and (3) engagement and intervention strategies. METHODS Databases PubMed, Medline, PsychINFO, Embase and CINAHL were searched from January 2010 to 10 July 2021 by two reviewers. Empirical studies reporting aftercare interventions for older adults (aged 60+) following self-harm (including with suicidal intent) were included. Full text of articles with abstracts meeting inclusion criteria were obtained and independently reviewed by three authors to determine final studies for review. Two reviewers extracted data and assessed level of evidence (Oxford) and quality ratings (Alberta Heritage Foundation for Medical Research Standard Quality Assessment Criteria for quantitative and Attree and Milton checklist for qualitative studies), working independently. RESULTS Twenty studies were reviewed (15 quantitative; 5 qualitative). Levels of evidence were low (3, 4), and quality ratings of quantitative studies variable, although qualitative studies rated highly. Most studies of referral pathways were observational and demonstrated marked variation with no clear guidelines or imperatives for community psychiatric follow-up. Of four screening tools evaluated, three were suicide-specific and one screened for depression. An evidence-informed approach to safety planning was described using cases. Strategies for aftercare engagement and intervention included two multifaceted approaches, psychotherapy and qualitative insights from older people who self-harmed, carers and clinicians. The qualitative studies identified targets for improved aftercare engagement, focused on individual context, experiences and needs. CONCLUSION Dedicated older-adult aftercare interventions with a multifaceted, assertive follow-up approach accompanied by systemic change show promise but require further evaluation. Research is needed to explore the utility of needs assessment compared to screening and evaluate efficacy of safety planning and psychotherapeutic approaches.
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Affiliation(s)
- Anne Pf Wand
- Specialty of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,Older Peoples Mental Health Service, Jara Ward, Concord Centre for Mental Health, Sydney Local Health District, Concord, Australia
| | - Roisin Browne
- School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,ForeFront Motor Neuron Disease & Frontotemporal Dementia Clinic, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Capacity Australia, Sydney, NSW, Australia
| | - Tiffany Jessop
- School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,Capacity Australia, Sydney, NSW, Australia
| | - Carmelle Peisah
- School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,Capacity Australia, Sydney, NSW, Australia
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McKay R, Pond D, Wand A. Towards Zero Suicide for older adults: implications of healthcare service use for implementation. Australas Psychiatry 2022; 30:294-297. [PMID: 34894758 DOI: 10.1177/10398562211054039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Implementing the Towards Zero Suicide (TZS) approach to suicide prevention in older adults requires evidence-based adaptation. This paper aims to highlight important differences and opportunities in healthcare service use by older adults relevant to implementation. CONCLUSION The TZS approach may prevent suicide in older adults, but only if implementation aligns with systemic differences in healthcare utilisation by older people. Of greatest importance in older adults are (1) most mental healthcare is delivered outside of specialist mental health services; (2) physical conditions and disability are major modifiable contributors to suicide that must be addressed within TZS; and (3) older people have very low use of Medicare-funded psychological services. Primary healthcare providers, who may be seeing older people at risk of suicide, are often neither equipped to provide expert assessment and care planning for often complex needs, nor may see this as their role. However, they are essential in providing pathways to care, which may prevent suicide. Leaders must recognise TZS for older people will usually involve multiple transitions. This requires engagement of key services with clear roles, targeted training, rapid access to specialist older persons mental health support and development of a new TZS element: the navigator.
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Affiliation(s)
- Roderick McKay
- NSW Health Education and Training Institute, North Parramatta, NSW, Australia
| | - Dimity Pond
- The University of Newcastle, Callaghan, NSW, Australia
| | - Anne Wand
- Faculty of Medicine and Health, University of Sydney, Australia; and Faculty of Medicine, University of New South Wales, Australia
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Wand APF, Peisah C. The Development of an Online Training Tool for Crisis Supporters on Late Life Suicide: Improving Knowledge While Promoting Empowerment. Arch Suicide Res 2022; 26:968-974. [PMID: 33076767 DOI: 10.1080/13811118.2020.1833798] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Telephone crisis services have an increasing role in suicide prevention yet existing interventions have not empowered crisis supporters with adequate education targeting the needs of older people in crisis. An existing educational intervention was adapted for crisis supporters through collaboration between a crisis support service, clinician researchers, and an eLearning technology company. Empowering crisis supporters, through improving knowledge and highlighting their strengths and expertise, was emphasized. The adaptive learning technology featured a pretest, middle learning module (educational content), and post-test individualized to the participant's incorrect pretest answers. The online training tool on suicidal behaviors in late-life combined clinician researcher expertise and evidence, insights from crisis supporters, and adaptive learning technology to create a purpose-built educational tool addressing an unmet need.
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Wand A, Verbeek H, Hanon C, de Mendonça Lima CA, Rabheru K, Peisah C. Is Suicide the End Point of Ageism and Human Rights Violations? Am J Geriatr Psychiatry 2021; 29:1047-1052. [PMID: 34272155 DOI: 10.1016/j.jagp.2021.05.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 11/19/2022]
Abstract
Ageism and human rights violations may pervade each of the potential factors underlying suicidal ideation or behavior in older persons, including physical and mental health, disability, relationships, and social factors. We outline how infringements of human rights and ageism may create or exacerbate risk factors associated with suicide in older persons. Strategies to address these issues are discussed, including tackling ageism, psychosocial interventions and education. A United Nations convention on the rights of older persons would create a uniform standard of accountability across health and social systems. Future studies are needed to evaluate the effects of alleviating ageism and human rights violations on suicide.
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Affiliation(s)
- Anne Wand
- Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney (AW), NSW, Australia; School of Psychiatry, Faculty of Medicine, University of New South Wales (AW, CP), Australia; Ageing Futures Institute, University of New South Wales (AW, CP), Australia.
| | - Hilde Verbeek
- Department of Health Services Research, CAPHRI, Faculty of Health, Medicine and Life Sciences (HV), Maastricht, The Netherlands
| | - Cecile Hanon
- Regional Resource Centre of old age Psychiatry - AP-HP Centre - Université de Paris (CH), France
| | | | | | - Carmelle Peisah
- School of Psychiatry, Faculty of Medicine, University of New South Wales (AW, CP), Australia; Ageing Futures Institute, University of New South Wales (AW, CP), Australia; Capacity Australia (CP), New South Wales, Australia
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Lascelles KM. Might Informal Carers of Adults With Enduring Suicidality Experience Anticipatory Loss? CRISIS 2021; 43:215-219. [PMID: 33860678 DOI: 10.1027/0227-5910/a000771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Carers of loved ones who repeatedly express suicidal intent and/or engage in suicidal behavior may experience a sense of anticipation of eventual suicide due to the potential of a fatal act of self-harm. An understanding of John Rolland's concept of anticipatory loss may help clinicians understand and attend to the experiences of carers of adults who engage in repeated suicidal behavior. Indeed, there appear to be some similarities between this model of anticipatory loss and experiences of informal carers, indicating that the phenomenon, which is hitherto under-explored in the suicidology field, may merit further consideration.
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Affiliation(s)
- Karen Moya Lascelles
- Mental Health Directorate, Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.,Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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Wand APF, Draper B, Brodaty H, Hunt GE, Peisah C. Evaluation of an Educational Intervention for Clinicians on Self-Harm in Older Adults. Arch Suicide Res 2021; 25:156-176. [PMID: 31941427 DOI: 10.1080/13811118.2019.1706678] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Clinicians may lack knowledge and confidence regarding self-harm in older adults and hold attitudes that interfere with delivering effective care. A 1-hour educational intervention for hospital-based clinicians and general practitioners (GPs) was developed, delivered, and evaluated. Of 119 multidisciplinary clinicians working in aged care and mental health at two hospitals, 100 completed pre/post-evaluation questions. There were significant improvements in knowledge, confidence in managing, and attitudes regarding self-harm in late life, and the education was rated as likely to change clinical practice. No GP education sessions could be conducted. A brief educational intervention had immediate positive impacts for hospital-based clinicians albeit with high baseline knowledge. The sustainability of these effects and effectiveness of the intervention for GPs warrant examination.
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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.
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