Self-neglect in older adults is a serious public health issue and a social problem that can have profound consequences for the health and well-being of older people. It is characterised by an inability to meet one’s own basic needs and is an increasingly common problem, which can be intentional or unintentional (Gibbons et al, 2006). Those who self-neglect often live in extreme conditions of squalor and evidence suggests they are at increased risk of death and institutionalisation (Lachs et al, 1998). Self-neglect can occur across the lifespan but is more common in older people (Pavlou and Lachs, 2006a). The complexity and multidimensional nature of self-neglect means it is difficult to detect and diagnose. Nurses and primary care staff are vital in its identification and management, and must be aware of its causes and risk factors (Lauder et al, 2006). Definition
Self-neglect is a common term used in medical, sociological and nursing research literature. There are no clear operational definitions of it nationally or internationally – Gunstone (2003) suggested a universal definition is not possible due to the dynamics and complexity of self-neglect. Gibbons (2006) defined it as: ‘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.’ This definition shows the negative impact of self-neglect for the person, their family and community. Self-neglect is a multidimensional complex phenomenon and researchers have used a variety of terminology to characterise it. Some historical categories include senile breakdown, Diogenes syndrome, senile squalor syndrome and gross self-neglect. Some researchers concur with Clarke et al’s (1975) concept of a distinct syndrome (Esposito et al, 2006; Pavlou and Lachs, 2006b), while others believe it to be a number of symptoms that can be linked to several mental and cognitive disorders (Halliday et al, 2000). Characteristics
The characteristics and behaviours used to describe self-neglect are: • Living in very unclean, sometimes verminous, circumstances; • Hoarding large numbers of pets;
• Neglecting household maintenance;
• Portraying eccentric behaviours/lifestyles;
• Poor self-care leading to a decline in personal hygiene (Halliday et al, 2000). Research on nurses’ views of gross self-neglect has identified other characteristics including poor personal hygiene and nutrition, poor healing/sores, shabby clothes, long toenails, isolation and failure to take medication (Adams and Johnson, 1998). However, the basis for some of these features can include cognitive impairment, poor eyesight, functional and financial constraints, or poor access to podiatry services. In addition, poor environmental and personal hygiene may be a matter of personal choice or lifestyle and not down to age or cognitive changes (Dyer et al, 2003). Incidence
Self-neglect can have physical, social, environmental and health consequences resulting in failure to engage in, or access, services. This can have grave consequences for people, families and communities. The estimated incidence of self-neglect in the UK is 0.5 per 1,000 in a population aged over 60 (Reyes-Ortiz, 2001). Self-neglect in older adults may not be evident on physical examination or identifiable outside of the home. It is difficult to detect and many cases go unreported or are unknown to services. Hurley et al (2000) surveyed 10 service agencies in Dublin. From their caseloads, 79 people from a variety of backgrounds were identified as having characteristics of self-neglect. According to unpublished data, self-neglect accounts for a large number of referrals to adult protective services and is more common than caregiver neglect and physical abuse (Pavlik et al, 2001). In the US...