Chapter 13 - Prevention of Suicide and Self-Harm in Older People

Summary

This chapter takes public health, primary care, general adult psychiatry, and liaison perspectives to address the challenges of self-harm and suicide in older people. We focus on key differences – in epidemiology (social circumstances, methods, repetition of self-harm), outcomes, and antecedents (poor physical health, loss of autonomy, cognitive impairment) – between this group and the rest of the adult population. In the prevention of suicide, we recommend a life-course, transdiagnostic approach, and in particular a proactive treatment of depression. In emergency room settings, multiple sources of information over time improve assessment – then a holistic approach to interventions. We identify four higher-risk subgroups and set out mitigating interventions. Among the four, older psychiatric in-patients qualify for safer wards and safe discharge planning. An additional and related group is identified: carers of older people with combined physical and mental comorbidities, who have higher levels of suicidal ideation but do not disclose them. When the worst outcome – suicide – occurs, there are evidence-based interventions (now called ’postventions’).