Study Offers New Look at "Self-Neglect" Among Older Persons

Newswise — Many older adults who cannot take care of the tasks of daily life such as eating and bathing are battling a multitude of health problems with little help from family or others in their community, according to a new study.

This portrait of "self-neglect," the most comprehensive to date, suggests these adults frequently suffer from heart problems and depression. They struggle with simple physical and mental tasks, and might even be oblivious to their problems.

"We believe elders who self-neglect are those with impairment in activities of daily living, who lack the needed support services, and who fail to recognize the danger," say Carmel Dyer, M.D., and colleagues in the September issue of the American Journal of Public Health.

Self-neglect is a common problem faced by Adult Protective Services agencies throughout the country, said Dyer, a researcher at the University of Texas Health Science Center in Houston.

Self-neglect happens most often when an older person lacks social support, the researchers found.

"Some elderly persons who self-neglect simply lack access to support services, whereas others either refuse help or who — when provided access to services — cannot complete the tasks necessary to obtain them," Dyer said.

The researchers examined the medical and testing records for 538 adults diagnosed with self-neglect whom Adult Protective Services in Houston referred to a geriatrics medical team.

Two-thirds of the adults had physical problems that kept them from functioning normally, and half scored poorly on mental health tests. Nearly 95 percent of those examined had inadequate social support, as determined by the researchers.

"Many patients were too impaired to complete even these basic tests; others were delirious and unable to answer, and some refused to be tested," Dyer said.

Maria Pavlou, M.D., of Weill Cornell Medical College, in Ithaca, N.Y., said self-neglect should be a "geriatric syndrome," which might help more primary care doctors recognize the problem.

"For instance, if an older adult visiting their primary care provider has long toenails, the diligent practitioner will typically refer them to podiatry. However if that practitioner has 'self-neglect' on their list of things to look out for, they might be more likely to investigate further why the patient has not come sooner to the office," Pavlou said.

Dyer CB, et al. Self-neglect among the elderly: a model based on more than 500 patients seen by a geriatric medicine team. Am J Public Health 97(9), 2007.