@article{ref1,
title="Why do the very old self-harm? A qualitative study",
journal="American journal of geriatric psychiatry",
year="2018",
author="Wand, Anne P. F. and Peisah, Carmelle and Draper, Brian and Brodaty, Henry",
volume="26",
number="8",
pages="862-871",
abstract="OBJECTIVES: To examine the perspectives of people aged 80 years or older who self-harmed regarding their reasons for self-harm and its consequences, and their perceptions of care. <br><br>DESIGN: A qualitative study using in-depth interviews. SETTING: Participants were recruited from two teaching hospitals and associated community services. PARTICIPANTS: People aged 80 years or older who had self-harmed within the previous month. <br><br>METHODS: Structured psychiatric assessment including cognitive testing, DSM-5 diagnosis, and an in-depth qualitative interview focusing upon the reasons for and consequences of self-harm. Narrative enquiry was used to guide the discussion. All interviews were undertaken by a geriatric psychiatrist, audio recorded, transcribed verbatim, and subjected to thematic analysis using N-VIVO. <br><br>RESULTS: Themes that emerged for the reasons for self-harm included &quot;enough is enough&quot;; &quot;loneliness&quot;; &quot;disintegration of self&quot;; &quot;being a burden&quot;; &quot;cumulative adversity&quot;; &quot;hopelessness and endless suffering&quot;; &quot;helplessness with rejection&quot;; and &quot;the untenable situation&quot;. Themes for the consequences of self-harm were &quot;becoming engaged with or distanced from family&quot;; &quot;the problem was solved&quot;; &quot;gaining control&quot;; &quot;I&quot;m worse off now&quot;; &quot;rejection by health professionals&quot;; and &quot;tension in the role of the inpatient clinical environment&quot;. <br><br>CONCLUSIONS: Self-harm may communicate a need that cannot otherwise be expressed. An individualized person-centered approach is required to respond to self-harm, including a combination of practical, medical, and psychological approaches as indicated. Involvement of families in the process of understanding the meaning of and responding to self-harm through education and family therapy, as well as education of healthcare professionals beyond risk factor notation may be indicated.<br><br>Copyright © 2018 American Association for Geriatric Psychiatry. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="1064-7481",
doi="10.1016/j.jagp.2018.03.005",
url="http://dx.doi.org/10.1016/j.jagp.2018.03.005"
}