A systematic review of evidence-based aftercare for older adults following self-harm

Understanding aggression displayed by patients and families towards intensive care staff: A systematic review

Objectives

The objective of this systematic review was to synthesise literature pertaining to patient and family violence (PFV) directed at Intensive Care Unit (ICU) staff.

Design

Study design was a systematic review. The data was not amenable to meta-analysis.

Data Sources and Review Methods

Electronic searches of databases were conducted to identify studies between 1 January 2000 and 6 March 2023, limited to literature in English only. Published empirical peer-reviewed literature of any design (qualitative or quantitative) were included. Studies which only described workplace violence outside of ICU, systematic reviews, commentaries, editorials, letters, non-English literature and grey literature were excluded. All studies were appraised for quality and risk of bias using validated tools.

Results

Eighteen studies were identified: 13 quantitative; 2 qualitative and 3 mixed methodology. Themes included: (i) what is abuse and what do I do about it? (ii) who is at risk? (iii) it is common, but how common? (iv) workplace factors; (v) impact on patient care; (vi) effect on staff; (vii)the importance of the institutional response; and (viii) current or suggested solutions.

Conclusions

This systematic review demonstrated that PFV in the ICU is neither well-understood nor well-managed due to multiple factors including non-standardised definition of abuse, normalisation, inadequate organisational support and general lack of education of staff and public. This will guide in future research and policy decision making.

Healthcare practitioners' views of self-harm management practices in older adults in Ireland: A qualitative study

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.

The characteristics, life problems and clinical management of older adults who self-harm: Findings from the multicentre study of self-harm in England

BACKGROUND

Older adults have a high risk of suicide following self-harm. Contemporary information on self-harm in this population is needed to inform care provision.

OBJECTIVES

To examine subgroup differences in the incidence of self-harm, sociodemographic and clinical characteristics, preceding life problems and outcomes in individuals aged 60 years and over presenting to hospital following self-harm.

METHOD

Data on Emergency Department (ED) presentations for self-harm from 2003 to 2016 from three centres in the Multicentre Study of Self-Harm in England were analysed. Changes in self-harm rates were examined using Poisson regression. Univariable logistic regression was used to investigate factors associated with 12-month self-harm repetition.

RESULTS

There were 3850 presentations for self-harm by 2684 individuals aged 60 years and over. Self-harm rates increased over time for 60-74-year-old men (Incident Rate Ratio = 1.04, 95% Confidence Interval 1.02-1.06, p < 0.0001). Problems most frequently reported to have preceded self-harm were mental health (40.5%) and physical health (38.3%) concerns. Problems with alcohol, finances, employment and relationship with partner were found more frequently in 60-74-year-olds compared with those aged over 74 years. Physical health problems were common with increasing age, as were problems with alcohol for men. One in ten (10.8%) individuals presented to hospital with self-harm within 12 months of their index presentation.

CONCLUSIONS

Self-harm-related ED attendances in older men have increased, particularly for men aged 60-74 years. Prevention and clinical management should involve a comprehensive psychosocial assessment to target common precipitants for the wide range of problems preceding self-harm and may include support with physical and mental wellbeing and advice on safer alcohol use.

A qualitative study of multiple voices to inform aftercare services for older persons following self-harm

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.