Self-injurious behavior in the nursing home setting

Background: Self-injurious behavior (SIB) in older adults is defined as harm inflicted on oneself without conscious suicidal intent. SIB as a separate entity distinct from suicidal intent is poorly understood. However, it is of great concern to the patients' families and caregivers and it poses serious clinical challenges for clinicians. Methods: We searched the database of PubMed, Ovid Medline, and ScienceDirect for reports published between 1970 and 2009 using combination of the following keywords: "self-injurious behavior'', "self-destructive behavior'', "self-mutilating behavior'', "older adults'', "geriatric population'', and "nursing homes''. The term "self-harm behavior'' which also appears in the literature is broader in scope than "self-injurious behavior''. It encompasses high suicide intent and failed suicide attempts; therefore, we excluded this term in order to focus purely on "self-injurious behavior''. Our search yielded 10 publications concerning SIB in older adults, four of which included studies investigating SIB in nursing homes. Results: Clinical studies of SIB in older adult nursing home residents are sparse. This limited literature suggests that SIB is a prevalent phenomenon and is reported to be as high as 14% in one study of nursing home subjects aged 65 and older. It is reported to be strongly associated with dementia and a risk of accidental death. It has been suggested that SIB among demented patients occurs in the context of poor impulse control and physical isolation. Conclusion: SIB is likely a common phenomenon in older adult nursing home residents. There is little evidence-based treatment guidance for SIB in older population. Copyright (C) 2010 John Wiley & Sons, Ltd.