Self-Care (redundant)

In order to understand self-neglect, one must first understand its opposite: self-care. Self-care includes: adequate food and drink, exercise, rest, social interaction, and Activities of Daily Living (ADL) (Renpenning & Taylor, 2011; Hardy, 2011).

The living room of a person with self-neglect

More activities required for self-care include:

• Moving to and from bed, around the house, to the store, and other outside activities such as church
• Washing the body
• Dressing
• Eating
• Personal hygiene and grooming (including brushing teeth and combing hair)
• Toilet hygiene
• Transportation
• Prevention of hazards and maintenance of living environment:
  • General home maintenance, clean house
  • Pest control
  • Pet care

Brushing your teeth is an example of an Activity of Daily Living

Self-Neglect

Self-neglect occurs when self-care is not performed. However, the exact cause and definition of self-neglect have yet to be determined. Self-neglect is not included in any list of formally recognized medical or psychiatric diseases. It has no widely accepted definition. A commonly cited definition of self-neglect is by Gibbons, “the inability (intentional or non-intentional) to maintain a socially and culturally accepted standard of self-care with the potential for serious consequences to the health and well-being of the self-neglecters and perhaps even to their community” (Gibbons, Lauder, & Ludwick, 2006, p. 16).  According to NAPSA in January 2017, self-neglect involves seniors or adults with disabilities who fail to meet their own essential physical, psychological or social needs, which threatens their health, safety and well-being. This includes failure to provide adequate food, clothing, shelter and health care for one’s own needs (National Adult Protective Services Association, n.d.).

The National Committee for the Prevention of Elder Abuse (NCPEA) defines self-neglect as “the failure of caregivers to fulfill their responsibilities to provide needed care” (NCPEA, n.d.). Self-neglect is a form of abuse that has no perpetrator. Neglect results from the person refusing to accept care and services (NCPEA, n.d.).

Attributes and Criteria

Whichever definition is used, the following attributes are usually included or implied for the identification of self-neglect:

It is unknown how to prevent self-neglect

• Harmful or life threatening behaviors;
• No reason is given for engaging in the behaviors;
• The individual does not intend for the behaviors to end his or her life immediately;
• The effects of the behaviors can only be appreciated over a long period of time;
• The behaviors are repetitive and neglect several dimensions of self-care needs;
• The individual does not clean their body, clothes, possessions, and house, to the point of living in filth;
• The individual constantly refuses help/services that could improve their quality of life; and/or
• The individual makes bad decisions and chooses unsafe behaviors that place them at risk of harm. For example, he or she may refuse to take important medications (O’Brien, Thibault, Turner, & Laird-Fick, 2000).

In practical terms, a commonly used criterion for identifying self-neglect is when at least one of the following behaviors is observed. Please see Table 1 as cited by Pavlou & Lachs, (2008):

Table 1: A commonly used criterion  for identifying self-neglect

Prevention of Self-Neglect

It is not known whether self-neglect can be prevented. There is also no scientific evidence to support the benefits of early intervention in self-neglect. Controlled studies are needed, especially to show whether early diagnosis followed by increased social support and tailored health care services have an effect on the outcome (Papaioannou, Räihä, & Kivelä, 2012). See Prevention of Elder Abuse for tips on preventing elder abuse in general.

Last updated: June 7, 2020 at 16:28 pm by
I. M. Abumaria, AGPCNP-BC
Version 1.00