General Medical Conditions
The primary healthcare provider can diagnose, treat, and monitor, interventions. The home nurse can change a dressing of a wound or monitor the weight and treatment of someone with congestive failure. The home aid can help the person with activities of daily living. The companion can help with reducing isolation and loneliness.
To date, there are no clear specific medications used to treat self-neglect. Also, there are no guidelines to treating individuals with self-neglect (Amanullah, Oomman, & Datta, 2009). Antipsychotic medications, which are medications used to treat certain mental health diseases, have been tried to treat self-neglect with only minimal success (Herrán and Vázquez-Barquero, 1999). Instead, health care providers use medications to treat some of the symptoms that appear with self-neglect. For example, Zolpidem (Ambien) is used to treat sleep related problems, paroxetine (Paxil) can be used in cases of hoarding, and sodium valproate (Depakote) or quetiapine (Seroquel) for secondary bipolar disorders and depression. These medications can have positive outcomes in individuals with self-neglect (Saxena, Brody, Maidment, & Baxter, 2007).
Talking therapy is also known as cognitive behavior therapy. For example, a treatment plan may consist of treating depression with a medication and talk therapy for depression and hoarding. Treatments without medication are called non-pharmacological treatments. These treatments focus on changing behavior through talk therapy. It has shown to be the best treatment for hoarding (Kress, Stargell, Zoldan, & Paylo, 2016). Hoarding is commonly seen in the severe cases of self-neglect. Talk therapy may enable improved self-care once the personal goals of the person become known. The counselor or therapist may need to keep directing the person attention to those goals. The goals need take into account the person’s values and preferences. Throughout treatment, to increase motivation, misconceptions need to be clarified. The person may have more favorable treatment outcomes when counselors address the mental symptoms along with correcting any medical conditions that affect the mental state at the same time (Hall, Tolin, Frost, & Steketee, 2013). Talk therapy may give the person an opportunity to focus on the personal significance of well-being in the face of aging (MacLeod & Douthit, 2015).
Injury or disease to the part of the brain responsible for executive function like judgment and memory can compromise the capacity for self-care (Pavlou & Lachs, 2006). There are tests that can evaluate impaired cognition. These test broadly are called Neuropsychological testing. If your loved one has dementia, consider:
- Capacity determination. A health care provider can perform a Mini Mental State Examination to assess the mental capacity.
- Advance directives allow someone to express their wishes regarding the type of care they receive when they are unable to verbally consent for care. Advance directives become active when the person cannot verbally agree or disagree to care. because either they are unconscious or their heart and breathing ceased
- Dementia medications are available.
- Social support.
- Identify and wisely use resources like home care, adult day care.
Depression can cause functional impairments in a person (Pavlou & Lachs, 2006). If your elderly relative has depression , consider:
- Screening for depression. A health care provider can perform Geriatric Depression Scale to assess for depression.
- Many medications are available to treat depression.
- Safety evaluation like suicide evaluation.
- Referral. A health care provider can refer to specialist.
- Cognitive behavior therapy or talk therapy.
Psychosis is common among older adults. It is a risk factor for the elderly to lose their home and be sent to another place like a nursing home (Subramaniam et al., 2016). If you have a loved one has psychosis, consider:
- Neuropsychological testing and/or psychiatric evaluation by a qualified healthcare provider
- Medications to treat psychosis are available.
- Safety evaluation like suicide evaluation.
Delirium is temporary and often is reversible (it goes away) if the cause is removed. For example, Delirium can happen as an undesired effect of some medications. In a delirious state, the person becomes vulnerable. Delirium affects the executive function of the brain, which makes it difficult to negotiate self-care (Pavlou & Lachs, 2006). If your elderly relative has delirium consider contacting the healthcare provider. The provider may use a confusion assessment tool to look for underlying cause/s. For example, urinary tract infections (UTI) are common among older people with women being affected at higher rate than men (Alzheimer’s Association, n.d.). People with existing dementia (poor memory, poor judgment) who experience a UTI can become suddenly confused. This confusion is called delirium.References
Alzheimer’s Association. (n.d.). Urinary tract infections (UTIs) and dementia. Retrieved from https://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=1777
Amanullah, S., Oomman, S., & Datta, S. S. (2009). “Diogenes syndrome” revisited. The German Journal of Psychiatry, 12, 38-44.
Hall, B. J., Tolin, D. F., Frost, R. O., & Steketee, G. (2013). An exploration of comorbid symptoms and clinical correlates of clinically significant hoarding symptoms. Depression and Anxiety, 30(1), 67-76.
Herrán, A., & Vázquez-Barquero, J. L. (1999). Treatment of Diogenes syndrome with risperidone. Aging, Neuropsychology, and Cognition, 6(2), 96-98.
Kress, V. E., Stargell, N. A., Zoldan, C. A., & Paylo, M. J. (2016). Hoarding Disorder: Diagnosis, assessment, and treatment. Journal of Counseling & Development, 94(1), 83-90.
MacLeod, M. Z. K., & Douthit, K. Z. (2015). Etiology and management of elder self‐neglect. Adultspan Journal, 14(1), 11-23.
Pavlou, M. P., & Lachs, M. S. (2006). Could self‐neglect in older adults be a geriatric syndrome?. Journal of the American Geriatrics Society, 54(5), 831-842.
Saxena, S., Brody, A. L., Maidment, K. M., & Baxter, L. R. (2007). Paroxetine treatment of compulsive hoarding. Journal of Psychiatric Research, 41(6), 481-487.
Subramaniam, M., Abdin, E., Vaingankar, J., Picco, L., Shahwan, S., Jeyagurunathan, A., . . . & Chong, S. A. (2016). Prevalence of psychotic symptoms among older adults in an Asian population. International Psychogeriatrics / IPA, 28(7), 1211-1220.
Last updated: June 7, 2020 at 16:36 pm by
I. M. Abumaria, Doctor of Nursing Practice