Deliberate Self-Harm and the Elderly: A Volatile Combination—An Overview from the Plastic Surgery Perspective

Aims. To study the factors associated with the DSH in the elderly group of 60 years and above and to recommend changes to be implemented in order to improve the management in this specific group. Materials and Methods. Five-year retrospective study was undertaken from July 2005 to July 2010 in the Plastic Surgery Department of the Royal Preston Hospital, NHS Trust. A Performa was designed to collect data about the inpatient admission and included certain areas of key information. The case notes for all patients were extensively analysed in order to gather adequate information for the devised Performa. Results. DSH is getting more common in the elderly group, and males are more affected than females. 60% of the patients had a previous history of DSH. A large number (80%) of patients had a previous history of mental illness. 60% of those DSH patients were living with family. Almost all patients (90%) were reviewed by the Psychiatry Liaison Team. The timing of patients being assessed was highly variable. Conclusions. Marriage is not a protective factor in the prevention of the DSH in the elderly group. A mental health team referral in the early phases of the management would be of huge benefit and a likely step to prevent possible future admissions. The Department would benefit from the creation of a protocol for the management of these patients. There should be a joint effort of the professionals in the management of DSH in the elderly, and GPs play a very important role in the prevention of DSH in the later life. 1. Introduction Deliberate self-harm (DSH) is defined as the direct, intentional injuring of the body without suicidal intent [1], and the resulting wounds can range from superficial cuts to a “full house,” involving tendons, nerves, and important blood vessels [2]. These self-inflicted injuries are a common source of referrals to hand trauma units and thought to account for approximately 150,000 cases per year in the UK [2]. DSH is commonest in the younger population, often first appearing between the ages of 14 and 24 [3]. While the number of elderly patients presenting with DSH is much lower than in the comparative younger age group, recent observations suggested a rise in DSH, particularly in elderly men. Also, it is thought that DSH in the elderly comes with an increased risk of serious injury and suicide [4]. It appears that, amongst this older age group, deliberate self-harm is in fact a strong predictor of subsequent suicide. According to a new case control study comparing 76 adults, the majority of elderly people who had deliberately