History of deliberate self harm may predict methods of fatal self harm in the elderly

In this study we examined the association between methods of Deliberate Sel f Harm (DSH) by the elderly and their subsequent methods of Fatal Self Harm (FSH). Data was collected from the files of inquests into suicide by the e lderly in Birmingham and Cheshire Coroner's Courts. All the subjects were a bove the age of 60, had history of deliberate self harm before the final ac t of fatal self harm and attracted either suicide or open verdict returned by the Coroners over a period of four years 1995-1998. We compared the meth ods of Deliberate Self Harm (DSH) to the methods of Fatal Self Harm (FSH) u sed by all the included elderly. 18 per cent of elderly victims of FSH had a previous history of DSH and in 35 per cent of the sample, the last known attempt of DSH occurred more than one year prior to the FSH. The majority of the methods that had been used in elderly DSH were used again in their final act of FSH. Nearly two thirds of all the elderly who died of an overdose had attempted suicide earlier b y an overdose and one in five of those who died by hanging or drowning used the same method in an unsuccessful attempt of FSH within 12 months. A detailed history of DSH can improve the quality of risk assessment of sel f harm in the elderly. As more than one in three elderly victims of FSH att empted DSH more than a year prior to the final act, it is important when as sessing an elderly DSH attempt that we obtain any previous case notes and q uestion informants about the distant as well as the recent past.