A new screening tool for self-neglect in community-dwelling older adults: IMSelf-neglect questionnaire

Prevalence and Factors Associated With Elder Self-Neglect Among Community-Dwelling Older Adults: A Cross-Sectional Study

PURPOSE

To report the prevalence and risk factors of elder self-neglect (ESN) among community-dwelling older adults (N = 604).

METHOD

The current cross-sectional study was conducted from July 2019 to October 2020 in Lanzhou City, China. ESN was determined by the Scale of Elderly Self-Neglect, which evaluates five dimensions: (a) medical health and care, (b) environmental sanitation and personal hygiene, (c) mental health, (d) safety, and (e) social engagement. Frailty was assessed using the Physical Frailty Phenotype scale. Participants were asked whether they had bothersome and activity-limiting pain over the past 1 month. Characteristics associated with ESN were identified through multiple linear regression analyses.

RESULTS

Mean age of participants was 71.34 years (SD = 7.15 years), and 255 (57.8%) were female. The prevalence of ESN among participants was 16.2%. Among the five dimensions of ESN, medical health and care accounted for the largest proportion (44%). Approximately 58% of participants were pre-frail and 11.4% were frail, and 45% reported experiencing bothersome pain. Older adults with a household monthly income per capita <2,000 RMB (β = -0.112, p < 0.05), larger waist circumference (β = 0.185, p < 0.001), pre-frailty (β = 0.176, p < 0.001), frailty (β = 0.420, p < 0.001), and pain (β = 0.102, p < 0.05) were more prone to ESN.

CONCLUSION

ESN is a prevalent issue among community-dwelling older adults. Frailty, pain, low economic status, and larger waist circumference are identified as independent risk factors for ESN. There is a need to improve the understanding of ESN among health care providers and policymakers. Personalized interventions aimed at preventing or addressing these risk factors may lead to improvements in ESN outcomes. [Journal of Gerontological Nursing, 51(3), 45-54.].

The prevalence of self-neglect among older adults: A systematic review and meta-analysis

PURPOSE

To quantitatively pool the overall prevalence of self-neglect in older adults and provide evidence-based information for healthcare professionals to develop preventive measures.

METHODS

Systematically and thoroughly searched ten databases from inception to September 1, 2024 and we pooled the prevalence of self-neglect in older adults using a random-effects model based on the Stata 15.0 software.

RESULTS

In our meta-analysis, 21 studies were included, and the estimated prevalence rate of self-neglect among older adults was 27% (95% CI: 23%-30%). We found that the incidence of self-neglect was higher in males, aged 80 years, developing countries, hospitals, and using the Elder Self-Neglect Questionnaire assessment tool.

CONCLUSION

Self-neglect is a common and underestimated phenomenon in older adults, and the prevalence rate of self-neglect is high. Several epidemiological characteristics such as gender, age, countries, settings, and definition criteria were associated with its prevalence. It deserves early screening and targeted intervention by using a globally accepted definition of self-neglect to prevent older adults from self-neglect.

IMPLICATIONS FOR NURSING PRACTICE

Our study can provide clinical evidence for nursing staff and healthcare professionals to identify high-risk groups of self-neglect in older adults.

Successful Aging and Self-Neglect Among Community-Dwelling Older People

OBJECTIVE

It was aimed to explore the relationship between successful aging and self-neglect and factors affecting successful aging among community-dwelling older people.

METHODS

This cross-sectional study was conducted with 316 participants aged 60 years and older in a Family Health Center (FHC). The data were collected by using the questionnaire form, Successful Aging Scale and Self-Neglect Scale. The questionnaire form includes sociodemographic characteristics, independence (Katz Daily Life Activities Scale) and well-being status (WHO-5 Well-Being Index), psychosocial support (Multidimensional Perceived Social Support Scale), and depressive symptoms (two questions-complaints such as feeling depressed or hopeless and loss of interest and inability to enjoy life).

RESULTS

Participants had a mean age of 67.5 (SD: 6.5) years, 55.4% were female. A strong positive correlation was determined between successful aging score and self-neglect score (r = 0.741, p < 0.001). Factors affecting successful aging were age, working status, education level, body mass index, physical activity, subjective health perception, health screening status, self-neglect level, depressive symptoms, independence in activities, well-being status, and psychosocial support. Gender, income status, chronic disease presence, cigarette and alcohol use, living alone, and family type did not affect it. According to multivariate linear regression, the factors affecting successful aging were age, psychosocial support presence, and self-neglect level (p < 0.05).

CONCLUSION

Older people have low successful aging and self-neglect scores. Successful aging is better at a young age, in the presence of psychosocial support and a low level of self-neglect. It is recommended to increase the existence of psychosocial support for them and to plan interventions to reduce self-neglect.

Development and validation of the self-neglect questionnaire for Chinese hospitalized older adults

This study developed the Self-neglect Questionnaire for Chinese Hospitalized Older Adults (SNQ-CHOA) and evaluated its psychometric properties. The questionnaire development followed two phases. Phase 1 included item pool construction, content validity examination and pilot study. In phase 2, the validation and reliability were evaluated among 435 hospitalized older adults. The final questionnaire yielded six dimensions with 24 items: environmental neglect (3 items), medical neglect (8 items), psychological neglect (2 items), security neglect (3 items), socialization neglect (4 items), and nutritional neglect (4 items). Significantly positive correlations with the Abrams geriatric self-neglect scale (r= 0.68) supported the concurrent validity of the scale. The internal consistency and test-retest reliability were acceptable (Cronbach's α = 0.86, intraclass correlation coefficient [ICC] = 0.99). The SNQ-CHOA is a valid and reliable tool for assessing self-neglect among Chinese hospitalized older adults.

Concept analysis of self-neglect in the elderly: a hybrid model

PURPOSE

Clarifying the concept of elder self-neglect.

METHODS

Researchers investigated the concept of elder self-neglect using a hybrid approach, including theoretical, fieldwork, and final analysis phases. After an extensive review of related literature to define the concept of self-neglect and describe its characteristics, the fieldwork phase was carried out to illustrate its empirical features. Accordingly, it led to the extraction of the elder self-neglect attributes from the first two phases.

FINDINGS

Elder self-neglect includes "subjective and objective high-risk behaviors pertinent to physical and spiritual health as well as restricted social interactions, disregarding the living environment, and a lack of compliance to personal hygiene routines that the elderly demonstrate deliberately or unintentionally. Various factors can contribute to such behaviors, including individual features, poor physical performance, elderly-oriented psychological disorders, financial challenges, detrimental stressors, unsuccessful social interactions, inaccessible supportive resources, inadequate educational resources, and inappropriate cultural norms. Consequently, such behaviors result in impaired physical and psychological health status, higher risk of misbehavior, poor quality of life, extra caregiving-treatment burden, and affected mental security in society."

CONCLUSION

Given that elder self-neglect is considered a relatively unknown concept in Iran, the study findings can pave the way for future extensive research in the Iranian context by clarifying the concept. It can play a significant role in developing related tools to design more efficient interventions and improve the quality of nursing care services.

IMPLICATIONS FOR NURSING PRACTICE

The elder self-neglect concept can lead to numerous health-related disorders among the elderly in society. Nurses cannot deal with an unknown phenomenon without exploring and identifying its exact meaning. It is, therefore, imperative to illustrate the different dimensions of this concept to help create a deep understanding among the nurses and perform timely diagnosis and interventional procedures.

Analysis of the relationship between self-neglect and spiritual well-being in older adults

This study was conducted to examine the relationship between self-neglect and spiritual well-being in older adults. This descriptive, cross-sectional and correlational study was conducted with 232 older adults. Data were collected using the "Elder Self-Neglect Scale (ESNS)" and "Spiritual Well-Being Scale (FACIT Sp-12)." It was found that 54% of the participants were female, 86% were married, 35% were primary school graduates, 66% lived in the district, 27% had hypertension, 54% had income equal to expenses, and 76% were retired. Mean ESNS total score of older adults was 102.83 ± 24.82 and mean FACIT Sp-12 total score was 33.73 ± 9.70. FACIT Sp-12 total score was found to be a significant negative predictor of the dependent variable ESNS total score (p < .05). In this study, it was determined that the spiritual well-being levels of older adults were above average and their self-neglect levels were low. It was determined that as the spiritual well-being levels of older adults increased, their self-neglect levels decreased.

Adaptation and validation of the Abrams geriatric self-neglect assessment scale among older Chinese people admitted to the hospital

OBJECTIVES

Elder self-neglect is a global public health problem, and older people admitted to the hospital may have a higher risk of self-neglect due to their deteriorating health conditions. This study aimed to translate, adapt and validate the Abrams geriatric self-neglect assessment scale (AGSS) among older Chinese people admitted to the hospital.

METHODS

Data were derived from a cross-sectional survey of a convenience sample of 452 older people admitted to a general hospital. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to examine the structural validity of the AGSS. Content validity, criterion validity, internal consistency reliability, and test-retest reliability were also conducted to assess the psychometric properties of the scale.

RESULTS

EFA yielded a 6-item one-factor model, which was supported by CFA and explained 44.74% of the total variance. The internal consistency was acceptable (Cronbach α = 0.740), and the test-retest reliability with a 14-day interval was good (intraclass correlation coefficient, ICC = 0.966). Significantly positive correlations with the caregiver-rated elder self-neglect assessment scale (r = 0.648) supported the concurrent validity of the scale. Significant differences in scores between respondents with different ages, marital statuses, educational levels and numbers of chronic diseases demonstrated the discriminative validity.

CONCLUSION

The Chinese version of the AGSS is an easy-to-use, reliable and valid measure with satisfactory psychometric properties. Future studies should recruit a more representative sample of older people in China to verify the applicability of the scale.

IMPLICATIONS FOR PRACTICE

The Chinese version of the AGSS enables clinical staff to accurately screen for and assess elder self-neglect upon hospital admission, which can inform the development of specific interventions and assignment of additional guardianship to those at risk of elder self-neglect.

Self-neglect among older adults with disabilities in Liaoning Province during the COVID-19 outbreak: A cross-sectional study

Background

Self-neglect among older adults is a well-recognized public health issue. During the novel coronavirus disease 2019 (COVID-19), older adults with disabilities may be at increased risk for self-neglect. This study aimed to assess the prevalence of self-neglect and associated factors among older adults with disabilities in Liaoning Province during the COVID-19 outbreak.

Methods

A cross-sectional study was conducted from January 2021 to April 2021. A convenience sample of 230 older adults with disabilities filled out questionnaires that collected data on socioeconomic and demographic characteristics alongside data using the Barthel Index (BI), the Elder Self-Neglect Assessment (ESNA), the Geriatric Depression Scale-Short Form (GDS-SF), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Mini-Mental State Examination (MMSE).

Results

The overall self-neglect rate was 86%. The study revealed that self-neglect correlates positively with the degree of disability (p < 0.001) and depressive symptoms (p < 0.001). In contrast, monthly income (p = 0.002) and perceived social support (p = 0.001) were negatively associated with self-neglect.

Conclusion

During the COVID-19 outbreak, self-neglect has been a serious public health problem among older adults with disabilities. Lower monthly income, decreased physical function, depressive symptoms, and perceptions of poor social support contributed to self-neglect among older adults with disabilities.

Self-neglect among older adults admitted to a Chinese comprehensive hospital in the COVID-19 pandemic era: a cross-sectional study

This study aims to explore the prevalence of self-neglect and associated factors among older adults admitted to the hospital in the COVID-19 pandemic context. The cross-sectional study conducted at a Chinese comprehensive hospital between January and April 2021, 452 older adults were recruited to complete the Abrams Geriatric Self-Neglect Scale, Social Support Rate Scale, FRAIL scale, Barthel index, Patient Health Questionnaire-9, and 10-item Connor-Davidson Resilience Scale. Multivariate logistic regression was used to explore the factors associated with elder self-neglect. The results showed that the prevalence of self-neglect among our sample was 30.3%. Factors that were associated with the risk of elder self-neglect included male, having multiple children (≥4), receiving infrequent visits from children, frailty, and depression. There is a need to screen for self-neglect among older adults admitted to the hospital in the COVID-19 pandemic context. Tailored interventions are warranted to improve the quality of life of older adults.

Development of a Conceptual Framework for Severe Self-Neglect (SN) by Modifying the CREST Model for Self-Neglect

Self-neglect is an inability or refusal to meet one's own basic needs as accepted by societal norms and is the most common report received by state agencies charged with investigating abuse, neglect and exploitation of vulnerable adults. Self-neglect is often seen in addition to one or multiple conditions of frailty, mild to severe dementia, poor sleep and depression. While awareness of elder self-neglect as a public health condition and intervention has significantly risen in the past decade as evidenced by the increasing amount of literature available, research on self-neglect still lacks comprehensiveness and clarity since its inception to the medical literature in the late 1960s. With the burgeoning of the older adult population, commonness of self-neglect will most likely increase as the current incidence rate represents only the "tip of the iceberg" theory given that most cases are unreported. The COVID-19 pandemic has exacerbated the incidence of self-neglect in aged populations and the need for the use of intervention tools for aging adults and geriatric patients living alone, many of which may include in-home artificial intelligence systems. Despite this, little research has been conducted on aspects of self-neglect other than definition and identification. Substantial further study of this disorder's etiology, educating society on early detection, and conceivably preventing this syndrome altogether or at least halting progression and abating its severity is needed. The purpose of this research is to provide a definition of severe self-neglect, identify key concepts related to self-neglect, comprehensively describe this syndrome, present a conceptual framework and analyze the model for its usefulness, generalizability, parsimony, and testability.

Gerontechnological factors affecting successful aging of elderly

In this article, the gerontological factors affecting the successful aging of the elderly have been uncovered, the quality of life and successful aging issues have been related to gerontology and investigated on a different dimension. It has been emphasized that the importance of gerontechnology on the successful aging, creation of awareness through formal and non-formal education, qualitative and quantitative researches should be increased. Qualitative and quantitative researches on the subject were evaluated together, gerontology and gerontechnology were considered together with successful aging, and gerontology functions and ergonomics should be taken into consideration in increasing quality of life. In addition, the concept of geronsafety, a new concept in gerontology, has been put forward, emphasizing the effects of safety on gerontology and successful aging.

Nurses' Perceptions of Factors Influencing Elder Self-neglect: A Qualitative Study

PURPOSE

Elder self-neglect is a global public health issue and should be taken seriously at large. Nurses, usually working directly with elderly patients, have a better understanding of what factors may cause elder self-neglect. In this qualitative study, we explored the influencing factors of elder self-neglect from the perception of nurses in the context of Chinese culture.

METHODS

Face-to-face, in-depth interviews were conducted from November 2018 to December 2018. Purposive sampling was used. Twenty one participants recruited from eight geriatric wards of a general hospital located in Wuhan were interviewed. A content analysis of qualitative nature was performed to analyze the data.

RESULTS

Our conceptual model illustrated the findings based on the three themes of the conflict between personal recognition and social judgment, the choice between current needs and individual beliefs, as well as the compromise between insufficient abilities and limited resources.

CONCLUSION

Nurses together with family members and social workers can help older adults improve their awareness of self-neglect to bridge the gap with social judgment, learn to focus on their own needs, as well as seek as much support as possible. Nurses should also respect the autonomy and self-determination of elder self-neglecters because self-neglect is related to older adults' values. Furthermore, larger studies are needed to quantitatively test and refine the model.