Recognizing Self-Neglect

Self-neglect is most often reported because of unusual or dangerous behaviors are recognized in a loved-one. Because these features take months-to-years to develop, friends and family may not notice the change as being significant. Eventually, there is an event that makes clear that there is self-neglect.

Research and observation indicates that self-neglect does not have one set of features (Burnett et al., 2014). There appears to be different types of self-neglect that can have been categorized in different ways (see Types of Self-Neglect).

Common characteristics of self-neglect include (also see Picture List on How to Recognize Self-Neglect):

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Ignoring hygiene is common in self-neglect

Physical Appearance

  • Poor personal hygiene
  • Not wearing suitable clothing for the weather
  • Messy hair, nails, or clothes
  • Unexplained weight loss
  • Unusual odors

Nutrition

  • Poor diet and nutrition
  • Dehydration

Living Conditions

  • Filthy home
  • Not doing household maintenance
  • Odd behavior and lifestyles
  • Hoarding animals and/or invaluable items
  • Dangerous living conditions
  • Home infestations (e.g., mice, insects)
  • Non-functioning utilities
  • Rotten food
  • Bad smells
  • Threatened eviction

Health

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See the Picture List on How to Recognize Self-Neglect

  • Not refilling medications
  • Missing provider’s appointment
  • Refusal to seek medical treatment for serious illness
  • Decreased ability to perform routine daily activities

Behaviors

  • Social isolation
  • Refusing to to let people that provide services into the house (e.g., utility workers, home health care providers, APS)
  • Antisocial behavior / not getting along with others
  • Dangerous forgetful behavior (e.g., leaving a burning stove and going to sleep)
  • Not paying the bills because they either forget or the bills are lost in the clutter

Mental

  • Decreased ability to reason
  • Confusion
  • Depression
  • Psychosis; such as hallucinations
  • Refuse to consider health care provider’s recommendations

Geriatric Care Manager Perspective

Two hundred and eighty eight geriatric care managers from the National Association of Professional Geriatric Care Managers (NAPGCM) completed a survey in September of 2014 (Boothroyd, 2014). The results of the survey are as follow:

  • 92% say that elderly self-neglect was a significant problem in their community,
  • 52% believe that self-neglect is significant and growing problem,
  • 94% agree that elderly self-neglect is a largely hidden problem with cases frequently or mostly going unreported, and
  • 76%  report that self-neglect is the most common non-financial form of elder abuse/neglect that they deal with in practice.

According to the NAPGCMs, there are 6 warning signs of self-neglect that they see in practice often. Each sign is followed by the percentage of NAPGCMs who agreed:

  1. Signs of poor personal hygiene/not bathing or taking care of hair and nails (92 %)
  2. Poor medication management or refusing to take medications (89%)
  3. Evidence of dehydration, malnutrition or other unattended health conditions (75%)
  4. Unsanitary/very unclean living quarters (72%)
  5. Signs of unpaid bills, bounced checks or utility shut-offs (64%)
  6. Evidence of missing adequate food in house or signs of weight loss (63%)

Culture

Different cultures and beliefs may not agree on what is a normal level of comfort, material goods, necessities, health, and hygiene. This makes assessing and treating self-neglect very difficult. It requires specialized knowledge in healthcare, sociology, and ethics (Day & Leahy-Warren, 2008; Gibbons et al., 2006).

References

Burnett, J., Dyer, C. B., Halphen, J. M., Achenbaum, W. A., Green, C. E., Booker, J. G., & Diamond, P. M. (2014). Four subtypes of self‐neglect in older adults: Results of a latent class analysis. Journal of the American Geriatrics Society62(6), 1127-1132.

Day, M. R., & Leahy-Warren, P. (2008). Self-neglect 1: Recognizing features and risk factors. Nursing Times, 104(24), 26-27.

Gibbons, S. W. (2009). Theory synthesis for self-neglect: A health and social phenomenon. Nursing Research58(3), 194-200.


Last updated: March 13, 2017 at 20:39 pm by
I. M. Abumaria, AGPCNP-BC
Version 1.00