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Feature Article

Self-harm in late life. How can the GP help?

ANNE P.F. WAND, Brian Draper, Henry Brodaty, Carmelle Peisah

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Abstract

In late life, self-harm and suicide are closely associated. Thus, good assessment and management of self-harm may prevent suicide. GPs, with their knowledge of the medical, social and psychological issues of their patients, are well placed to intervene and co-ordinate care with relatives and with healthcare and community services. Moreover, GPs are often the first port of call for the older distressed person, and the next port of call after discharge from hospital.

Key Points

  • Self-harm is any act of self-injury or self-poisoning, regardless of motivation. This includes indirect self-harm, such as refusing to eat or drink or to take essential medications.
  • Self-harm in an older patient should be a red flag for GPs (and all clinicians) to consider suicide risk.
  • Understanding what is driving an individual to self-harm may direct intervention.
  • The acuity and intent of an individual’s self-harm thoughts or actions, access to means and the resources available to him or her will help determine the setting of care and an appropriate response.
  • Problems underlying self-harm may be broken down into areas for action by healthcare professionals and other service providers, with the GP in a co-ordinating role.
  • Carers are an integral part of effective patient care and are individuals who require support in their own right.
  • GPs of older patients who have self-harmed may experience feelings of helplessness. Peer support and resources that promote self-care for medical practitioners are important.

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