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Self-injurious behavior in the elderly.

OBJECTIVE
To review the literature for self-injurious behavior (SIB) in the elderly and compare it with SIB in other populations.


DATA SOURCES
Literature searches were conducted using MEDLINE/PubMed, Merck-Medicus, clinicaltrials.gov, OVID, and an Internet search for "self-injurious behavior, SIB, and self-mutilation."


STUDY SELECTION
Sixteen studies were reviewed. Studies used provided data relative to SIB in general or treatment for the geriatric population.


DATA SYNTHESIS
The data suggest that young children, adolescents, young adults, and developmentally disabled patients most commonly exhibit self-injurious behaviors. The elderly population, in particular those with certain psychiatric and neurodegenerative illnesses, also can exhibit these behaviors. There has been little published for this cohort in comparison with other populations. The authors reviewed the literature for papers on SIB and its management in the elderly. A general overview of SIB is provided, including specific factors for the elderly. Management strategies including pharmacological and behavioral interventions are also discussed.


CONCLUSION
Although the prevalence of SIB appears to be relatively small, patients who do exhibit this behavior are of great concern to their families and caregivers. Risk factors such as dementia, depressive disorders, physical illness, and loss of a spouse, which are commonplace in the elderly, all may contribute to those who do exhibit SIB. The literature is devoid of specific drug therapies or treatments that demonstrate significant efficacy in patients with SIB, particularly the elderly. Additionally, while there is some understanding of why younger people engage in SIB, it is hypothesized that elderly SIB is different and is related to frustration, as well as to deficits in the ability to communicate effectively with others. Recognition of behavioral triggers, behavioral-care planning, and safety management are key.