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):

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

• 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

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Last updated: June 6, 2020 at 15:22 pm by
I. M. Abumaria, Doctor of Nursing Practice
Version 2.00