Biopsychosocial profile of community-dwelling older adults at risk for direct and indirect self-harm

Objectives. A biopsychosocial model of self-harm risk factors in older adults was explored, distinguishing between direct and indirect self-harm. Methods. A cross-sectional, matched pair sample was drawn from a community-dwelling sample of 625 adults aged 60 years and over, including 44 participants with and 44 without self-harm. Mean age was 68.7 years (age range = 60–91). Data were gathered using a survey composed of validated instruments and additional self-developed items. Results. From our total sample, 8.2% had engaged in self-harm at age 60 and over. Indirect methods (e.g. substance misuse, not eating) were most common. The presence of a mental disorder, emotional loneliness, cognitive and physical frailty, and a lack of resilience were identified as potential risk factors. Those who have engaged in direct or both types of self-harm exhibit higher levels of these factors. A stepwise regression model showed that only emotional loneliness and mental disorder(s) were significantly associated with self-harm in old age. Conclusions. Investigating self-harm (subtypes) among community-dwelling older adults is vital, especially in those with a mental disorder and emotional loneliness.
Clinical Implications. Clinicians should be vigilant for self-harm in older adults, particularly for indirect methods and among those with a mental disorder and who experience emotional loneliness.