Impairment in instrumental activities of daily living and the geriatric syndrome of self-neglect

Psychometric Validation and Setting Cutoff Point for the Persian Version of Mindful Self-Care Scale (MSCS) Among Older Adults

Mindful self-care is a valuable activity that contributes to old people's independence and self-control and its development is in line with the duties of social workers. This study aimed to validate the mindful self-care scale (MSCS) for Iranian old people and was performed on old people living in the community of Shiraz, Iran. This cross-sectional study was conducted on old people living in the community who met the inclusion criteria in Shiraz, Iran. After linguistic validation of the Persian version of MSCS with 36 items, face, and content validity were determined. Then the first part of construct validity was conducted using a kurtosis test, and exploratory factor analysis with the first sample (n = 250). After selecting the appropriate items, confirmatory factor analysis was assessed with the second sample (n = 250). Scale reliability was also evaluated. The optimal cut-off points were obtained by calculating the area under the curve (AUC). SPSS version 23 was used for further data analysis, while confirmatory factor analysis was conducted using AMOS version 24. Exploratory factor analysis loaded only 24 items with four factors. The modified second-order confirmatory factor analysis model displayed a good fit (RMSEA = 0.04; CFI = 0.90; GFI = 0.90). Cronbach's alpha coefficient of MSCS with 24 items was .94. The cut-off points were 38, 11, 23, and 17 for factors of resilience, goal achievement, supportive relationship, and self-care respectively, and 90 for the whole instrument. The study found that the MSCS short form with 24 items is valid and reliable in the Iranian elderly population, making it an effective tool for mental self-care screening and a practical tool for social workers. However, the study recommends repeating the study in other cities of Iran to generalize the findings.

Meeting the challenges in conducting research in vulnerable older adults with self-neglect-notes from a field team

Gaining a systematic understanding of possible ways to increase the quality and lifespan of older adults experiencing self-neglect has unique challenges. These challenges include identifying self-neglect in the community and navigating levels of cognitive, physical, and/or psychological difficulties in this population that impact recruitment, consent, and accurate data collection. Conducting quality research under some of the environmental self-neglect conditions such as squalor, animal and insect infestations and no utilities can also challenge planned study protocols and study validity. This manuscript presents details of these overarching challenges and some of the workable solutions noted and implemented by research field-team members who have enrolled over 300 adults experiencing self-neglect for various studies. Usual research methodology must overcome these barriers to work to create consciousness about the self-neglect population. The classic series of cases is still a good alternative when describing self-neglect. Considerations for conducting future self-neglect research are presented.

Prevalence and predictors in self-neglect: A cross-sectional study of domestic migrant older adults in China

Insufficient information is available on the prevalence and predictors of self-neglect among Chinese domestic migrant older adults resulting from rapid aging and mass population migration. This cross-sectional study was conducted on 597 older adults in four districts of Wenzhou from May to November 2020. A self-neglect scale was used to assess the prevalence of self-neglect among such adults. Sixteen potential predictors were considered in the domains of sociodemographic, health condition, socioeconomic, social isolation, intergenerational relationship, and filial piety. The prevalence of self-neglect within this population was 72.7%. Social isolation (OR = 0.823; 95%CI 0.684-0.990), physical health (OR = 0.966; 95%CI 0.941-0.992), intergenerational ambivalence (OR = 1.240; 95%CI 1.013-1.519), and affective-cognitive solidarity (OR = 0.796; 95%CI 0.719-0.880) were found to be independent predictors of self-neglect in this population. We suggest that community health service organizations should prioritize migrant older adults with a poor health status and those with intergenerational ambivalence to reduce self-neglect in migrant older adults. Such older adults should also be encouraged to participate in community activities for more social integration.

A systematic review of self-neglect and its risk factors among community-dwelling older adults

OBJECTIVES

To systematically review published evidence on self-neglect (SN) and its risk factors among community-dwelling older adults.

METHOD

A comprehensive literature search was conducted in PubMed, Embase, CINAHL Plus, PsycINFO, and Scopus for studies that were published in English from inception to 8 April 2020. Grey database was also included to ensure a thorough search. The study quality was assessed by two reviewers independently using the Newcastle-Ottawa Scale or the checklist suggested by the Agency for Healthcare Research and Quality.

RESULTS

A total of 19 studies was included in this review. Various tools were used to assess SN among the available studies. The prevalence rates of SN among community-dwelling older adults ranged from 18.4% to 29.1%. The risk factors of SN identified by these studies involved sociodemographic characteristics (male gender, older age, low economic status, ethnicity, lower educational level, marital status, and lower number of children), health-related characteristics (cognitive impairment, lower level of physical function, nutritional status, higher number of medical comorbidities, and pain), psychological characteristics (depression), and social context characteristics (living alone, lower social networks and social engagement, lower neighborhood cohesion, and neighborhood disorder).

CONCLUSION

SN is a common and under-recognized phenomenon among community-dwelling older adults. Our review provides healthcare professionals with an insight into SN and its risk factors. More studies are required to test the potency of each independent risk factor to deepen our understanding of this particular phenomenon.

Prevalence and associated factors of elder abuse in family caregivers of older people with dementia in central China cross-sectional study

OBJECTIVE

To explore the abuse risk and related important determinants among older people with dementia in central China.

METHODS

In this cross-sectional descriptive study, a sample of 158 family caregivers of older people with dementia was conveniently recruited from the Clinical Medicine Research Center of Dementia and Cognitive Impairment in Hubei Province, China. A social-demographic questionnaire, the Simplified Coping Style Questionnaire (SCSQ), the Social Support Rating Scale (SSRS), the Caregiver Burden Inventory (CBI), and the Caregiver Abuse Screen (CASE) were used for data collection. Descriptive statistics, Mann-Whitney U tests, Kruskal-Wallis tests, Spearman's rank correlation coefficient, and logistic regression analysis were used for the data analyses.

RESULTS

The results demonstrate that 77.8% reported a risk of the abuse of older people with dementia. Moreover, positive and negative reactions, subjective support, and emotional, social, and physical burden were associated with family caregivers' abusive behaviours.

CONCLUSION

This was a study conducted to examine the risk of the abuse of older people with dementia by family caregivers in central China. Elder abuse is prevalent among people with dementia. The present results confirmed the need to focus on family caregiver burden, coping styles, and social support in future interventions to prevent elder abuse.

Self-Neglect in Older Populations: A Description and Analysis of Current Approaches

Self-neglect in old age has severe effects on a person's health and quality of life and poses diverse challenges for primary caregivers and the community. The authors provide a narrative overview of the literature on self-neglect and summarize what is known to date about the main approaches for describing self-neglect, the factors that contribute to self-neglect, and the interventions that have been attempted. We found that answering the question about what factors led people into a state of self-neglect was extremely complex since many studies described a variety of interlinked factors, some of which are sociocultural and others medical. Our analysis suggested a need for a consolidated approach that focuses instead on the vulnerabilities affecting an older person and the factors that can improve resilience to adversity. Tackling vulnerability and resilience may hold the keys to successful multidisciplinary and person-centered management of self-neglect in older age.

Preliminary Outcomes From a Community-Based Elder Abuse Risk and Evaluation Tool

This research addresses the need to develop an assessment tool for case workers working in the aging services field outside of APS. As such, the research discusses the development, implementation, and preliminary outcomes of the Elder Abuse Risk Assessment and Evaluation© tool (EARAE). This instrument was developed and pilot tested by the Elder Abuse Prevention Program (EAPP), a program within Lifespan of Greater Rochester Inc. in Rochester, New York. A total of 189 suspected elder mistreatment cases were investigated using the EARAE instrument to track elements at the start and close of each case. Results indicate the tool represents an effective way to capture abuse indicators, track contributing risk factors, measure multiple case outcomes, and track types of interventions utilized. Opportunities and limitations of the tool are also discussed.

Screening for Functional Cognition in Postacute Care and the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014

Occupational therapists have a long history of assessing functional cognition, defined as the ability to use and integrate thinking and performance skills to accomplish complex everyday activities. In response to passage of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 (Pub. L. 113-185), the American Occupational Therapy Association has been advocating that the Centers for Medicare and Medicaid Services consider functional cognition for inclusion in routine patient assessment in postacute care settings, with important implications for occupational therapy. These efforts have the potential to increase referrals to occupational therapy, emphasize the importance of addressing functional cognition in occupational therapy practice, and support the value of occupational therapy in achieving optimal postacute care outcomes.

Elder self-neglect: research and practice

Elder self-neglect is a global public health and human rights issue that threatens older people's health and safety. It commonly refers to refusal or failure to provide oneself with care and protection in areas of food, water, clothing, hygiene, medication, living environments, and safety precautions. While prevalent, the status of self-neglecting individuals remains largely unclear, in particular within community-dwelling populations. By reviewing the epidemiology of elder self-neglect (definition, prevalence, risk factors, and consequences) to date, the present paper identifies key research gaps such as methodological inconsistency in case identification and measurement, and study designs that are inadequate to determine risk factors of self-neglect. More importantly, in light of the rapidly growing older population, relevant stakeholders (researchers, healthcare providers, social service providers, legal professionals, community organizations, and policymakers) must be prepared for an expected increasing number of self-neglect cases and enlarging scope of the problem. Hence, in this article, I present an overview regarding the management issues of elderly self-neglect related to the detection, assessment, reporting and referral, and decision-making capacity. Based on the current literature, the paper is aimed to explore the present knowledge and challenges, and how they can pave the way for solutions to self-neglect research, practice, and policy.

Correlates of depression in self-neglecting older adults: A cross-sectional study examining the role of alcohol abuse and pain in increasing vulnerability

Self-neglect among older adults results in increased morbidity and mortality rates. Depression is strongly linked to self-neglect and when untreated, severely complicates management of health and functional outcomes. The study aims to identify factors correlated with depression to inform approaches to service recruitment and retention that improve long-term outcomes. The sample included urban community-dwelling older adults (n = 96) 65 years of age and older with Adult Protective Services-substantiated self-neglect. All participants completed a range of validated cognitive, functional, and self-report demographic and clinical measures around health and mental health functioning. A secondary data analysis using multivariable logistic regression revealed that a positive screen for alcohol abuse, low self-rated health, and higher self-reported pain were associated with significantly higher odds of self-reported depression. Further research is needed to understand the temporality between these correlates and depression and to inform prevention and intervention practices for self-neglecting older adults.

Informing evidence-based practice: a review of research analyzing adult protective services data

The mission of Adult Protective Services (APS) is to protect older and vulnerable adults from abuse, neglect, and exploitation. The complexity of APS cases and the potential for life-changing interventions point to the need for research that examines and evaluates APS practices. A literature review identified 50 studies published during a 16-year period that used APS agencies, clients, data, or resources to test hypotheses regarding elder abuse. The analysis revealed promising efforts toward knowledge development about elder mistreatment and self-neglect. This article provides an overview of salient findings, notes the scarcity of studies that analyze the effectiveness of APS, and highlights the need for additional research. Lessons learned are described, and APS practitioners and researchers are urged to work collaboratively to develop key practice-related questions about APS processes and outcomes that can be tested with appropriate research methodologies.

The challenge to health professionals when carers resist truth telling at the end of life: a qualitative secondary analysis

AIMS AND OBJECTIVES

To draw out the similar complexities faced by staff around truth-telling in a children's and adult population and to interrogate the dilemmas faced by staff when informal carers act to block truth-telling.

BACKGROUND

Policy encourages normalisation of death, but carers may act to protect or prevent the patient from being told the truth. Little is known about the impact on staff.

DESIGN

Secondary analysis of data using a supra-analysis design to identify commonality of experiences.

METHODS

Secondary 'supra-analysis' was used to transcend the focus of two primary studies in the UK, which examined staff perspectives in a palliative children's and a palliative adult setting, respectively. The analysis examined new theoretical questions relating to the commonality of issues independently derived in each primary study. Both primary studies used focus groups. Existing empirical data were analysed thematically and compared across the studies.

RESULTS

Staff reported a hiding of the truth by carers and sustained use of activities aimed at prolonging life. Carers frequently ignored the advance of end of life, and divergence between staff and carer approaches to truth-telling challenged professionals. Not being truthful with patients had a deleterious effect on staff, causing anger and feelings of incompetence.

CONCLUSIONS

Both children's and adult specialist palliative care staff found themselves caught in a dilemma, subject to policies that promoted openness in planning for death and informal carers who often prevented them from being truthful with patients about terminal prognosis. This dilemma had adverse psychological effects upon many staff.

RELEVANCE TO CLINICAL PRACTICE

There remains a powerful death-denying culture in many societies, and carers of dying patients may prevent staff from being truthful with their patients. The current situation is not ideal, and open discussion of this problem is the essential first step in finding a solution.

Correlate of self-care and self-neglect among community-dwelling older adults

BACKGROUND

The prevalence of self-neglect among the elderly is expected to rise with a rapid increase in the growth of the older population. However, self-neglect in the elderly and the factors related to it are not fully understood due to the limited research in the area, lack of consensus in the definition of the concept, and limited instrumentation. The purpose of this study was to investigate the relationship between selected socio-demographic factors on self-care and self-neglect among older persons living in the community.

MATERIALS AND METHODS

A cross-sectional survey design with cluster sampling was adopted for the study. Data were gathered from 201 older persons aged 60 years and over in the state of Selangor, Malaysia, through face-to-face interviews in their homes with a team of trained enumerators. A new instrument was developed to measure self-neglect.

RESULTS

The internal consistency of the new instrument showed a reliability of 0.90. A significant bivariate relationship was noted between self-care and self-neglect. The socio-demographic factors were also reported between self-care and self-neglect.

CONCLUSIONS

The new instrument of elder self-neglect (ESN) could be used to measure self-neglect in a community dwelling. The need to increase the self-care skills and the capacity of self-care among older adults is crucial in order to reduce self-neglect and enhance their well-being.

Perceptions and views of self-neglect: a client-centered perspective

Aging populations and chronic illness increase vulnerability of older people for self-neglect, which is a serious public health issue. Many referrals received by Elder Abuse Services (EAS) in Ireland are categorized as self-neglect. The aim of the research was to observe and describe the living circumstances of a purposive sample of eight older people who were deemed self-neglectful by senior case workers. An exploratory descriptive research design was used. The themes that emerged were early life experiences and lifestyle, disconnectivity, vulnerability, frugality, and service refusal. The majority of participants were content so decisions to live in this way must be respected.

Increasing surveillance and prevention efforts for elder self-neglect in clinical settings

Elder self-neglect is a growing public health problem characterized by a complex network of biopsychosocial risk factors and predictors. The lack of reliable and valid assessment criteria for identifying elder self-neglect during brief clinical visits often results in missed opportunities for reducing or preventing the negative health outcomes commonly associated with this geriatric syndrome. Knowing the most salient risk factors and predictors of self-neglect in older patients may help clinicians and other healthcare providers appropriately identify and prevent self-neglect and the associated negative health outcomes. This article discusses the salient factors that contribute to elder self-neglect and how they can be used to improve clinical surveillance and guide intervention and prevention efforts.

Self-neglect of the elderly. An overview

Self-neglect is characterized by the inability to perform essential self-care tasks threatening a person's health and safety. The exact prevalence of self-neglect in a community-based aged population is not known. Cognitive impairment is the most important predisposing factor of self-neglect. There are also a number of other predisposing factors such as psychiatric diseases, pre-morbid personality, alcohol abuse, poor physical ability, lack of social support and a low socioeconomic situation. Self-neglect has a number of serious consequences. It is an independent risk factor for early mortality among the aged. It commonly causes malnutrition, frailty and the deterioration of physical ability, therefore, increasing the risk of falls and fractures. Untreated medical conditions result in emergency visits and acute hospitalization. The neglect of housekeeping and financial affairs seriously affects the domestic environment. Diagnosis and treatment of self-neglect should be based on the medical and psychosocial assessment of a patient. Patients require multidisciplinary support at home or in hospital, and sometimes long-term care is inevitable. There is no sufficient 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.

The prevalence of elder self-neglect in a community-dwelling population: hoarding, hygiene, and environmental hazards

OBJECTIVE

To examine the prevalence of self-neglect and its specific behaviors in a community-dwelling population of older adults.

METHOD

A population-based cohort study conducted between 2007 and 2010 rated participant's personal and home environment, particularly with regard to hoarding, personal hygiene, house in need of repair, unsanitary conditions, and inadequate utility. Prevalence estimates were presented across health-related variables of health status, physical function, and cognitive function.

RESULTS

There were 4,627 older adults (1,645 men and 2,982 women). Prevalence of self-neglect in older adults increased with lower health status in both men (4.7% in very good/excellent health, 7.9% in good health, and 14.9% in fair/poor health) and women (4.5% in very good/excellent health, 7.9% in good health, and 10.6% in fair/poor health). For those with ≥3 Katz impairments, the prevalence of self-neglect in older adults was 12.8% in men and 13.8% in women. For those with MMSE (Mini-Mental State Examination) ≤20, the prevalence of self-neglect in older adults was 18.8% in men and 13.6% in women.

DISCUSSION

Self-neglect was clearly prevalent among older adults, especially among those with lower health status and physical and cognitive function.

Elder abuse and self-neglect: "I don't care anything about going to the doctor, to be honest..."

Elder mistreatment encompasses a range of behaviors including emotional, financial, physical, and sexual abuse, neglect by other individuals, and self-neglect. This article discusses the range of elder mistreatment in community-living older adults, associated factors, and consequences. Although self-neglect is not considered a type of abuse in many research definitions, it is the most commonly reported form of elder mistreatment and is associated with increased morbidity and mortality. The case on which this article is based describes a 70-year-old woman who neglects herself and dies despite multiple contacts with the medical community. Despite significant gaps in research, enough is known to guide clinical practice. This article presents the practical approaches a health care professional can take when a reasonable suspicion of elder mistreatment arises. Public health and interdisciplinary team approaches are needed to manage what is becoming an increasing problem as the number of older adults around the world increases.

A prospective population-based study of differences in elder self-neglect and mortality between black and white older adults

BACKGROUND

Self-neglect is the behavior of an elderly person that threatens his or her own health and safety, and it is associated with increased morbidity and mortality. Although report of self-neglect is more common among black older adults, the racial/ethnic differences in mortality remain unclear.

METHODS

The Chicago Healthy Aging Project is a population-based cohort study conducted from 1993 to 2005. A subset of these participants were suspected to self-neglect and were reported to a social services agency. Mortality was ascertained during follow-up and from the National Death Index. Cox proportional hazards models were used to assess the mortality risk.

RESULTS

In the total cohort, there were 5,963 black and 3,475 white older adults, and of these, 1,479 were reported for self-neglect (21.7% in black and 5.3% in white older adults). In multivariable analyses with extensive adjustments, the interaction term indicated that impact of self-neglect on mortality was significantly stronger in black than in white older adults (parameter estimate, 0.54, SE, 0.14, p < .001). This difference persisted over time. In race/ethnicity-stratified analyses, at 6 months after report of self-neglect, the hazard ratio for black older adults was 5.00 (95% confidence interval, 4.47-5.59) and for white older adults was 2.75 (95% confidence interval, 2.19-3.44). At 3 years after report, the hazard ratios were 2.61 (95% confidence interval, 2.25-3.04) and 1.47 (95% confidence interval, 1.10-1.96) for black older adults and white older adults, respectively.

CONCLUSIONS

Future studies are needed to qualify the casual mechanisms between self-neglect and mortality in black and white older adults in order to devise targeted prevention and intervention strategies.

Decline in cognitive function and risk of elder self-neglect: finding from the Chicago Health Aging Project

OBJECTIVES

To examine the longitudinal association between decline in cognitive function and risk of elder self-neglect in a community-dwelling population.

DESIGN

Prospective population-based study.

SETTING

Geographically defined community in Chicago.

PARTICIPANTS

Community-dwelling subjects reported to the social services agency from 1993 to 2005 for self-neglect who also participated in the Chicago Health Aging Project (CHAP). Of the 5,519 participants in CHAP, 1,017 were reported to social services agency for suspected elder self-neglect from 1993 to 2005.

MEASUREMENTS

Social services agency identified reported elder self-neglect. The primary predictor was decline in cognitive function assessed using the Mini-Mental State Examination (MMSE), the Symbol Digit Modalities Test (Executive Function), and immediate and delayed recall of the East Boston Memory Test (Episodic Memory). An index of global cognitive function scores was derived by averaging z-scores of all tests. Outcome of interest was elder self-neglect. Logistic and linear regression models were used to assess these longitudinal associations.

RESULTS

After adjusting for potential confounding factors, decline in global cognitive function, MMSE score, and episodic memory were not independently associated with greater risk of reported and confirmed elder self-neglect. Decline in executive function was associated with greater risk of reported and confirmed elder self-neglect. Decline in global cognitive function was associated with greater risk of greater self-neglect severity (parameter estimate=0.76, standard error=0.31, P=.01).

CONCLUSION

Decline in executive function was associated with risk of reported and confirmed elder self-neglect. Decline in global cognitive function was associated with risk of greater self-neglect severity.

Physical function decline and the risk of elder self-neglect in a community-dwelling population

PURPOSE

This longitudinal study examines the association between physical function decline and the risk of elder self-neglect in a community-dwelling population.

DESIGN AND METHODS

Of the 5,570 participants in the Chicago Health Aging Project, 1,068 were reported to social services agency for suspected elder self-neglect from 1993 to 2005. The primary predictor was objectively assessed physical function using decline in physical performance testing. Secondary predictors were assessed using the decline in self-reported Katz, Nagi, and Rosow-Breslau scales. Outcome of interest was elder self-neglect. Logistic and linear regression models were used to assess these associations.

RESULTS

After adjusting for confounding factors, every 1-point decline in physical performance testing was associated with increased risk of reported elder self-neglect (odds ratio [OR], 1.05, confidence interval [CI], 1.03-1.07, p < .001). Decline in Katz (OR, 1.05, CI, 1.00-1.10, p < .05) and decline in Rosow-Breslau (OR, 1.19, CI, 1.11-1.27, p < .001) were associated with increased risk of reported elder self-neglect. Decline in physical performance testing (standardized parameter estimate [PE]: 0.19, SE: 0.06, p = .002), Katz (PE: 0.65, SE: 0.14, p < .001), Nagi (PE: 0.48, SE: 0.14, p < .001), and Rosow-Breslau (PE: 0.57, SE: 0.21, p = .006) scales were associated with increased risk of greater self-neglect severity.

IMPLICATIONS

Decline in physical function was associated with increased risk of reported elder self-neglect and greater self-neglect severity in this community-dwelling population.

Convergent validation of the Kohlman Evaluation of Living Skills as a screening tool of older adults' ability to live safely and independently in the community

OBJECTIVE

To evaluate the convergent validity of the Kohlman Evaluation of Living Skills (KELS) to screen older adults' ability to live safely and independently.

DESIGN

Cross-sectional study correlating KELS with components of a Comprehensive Geriatric Assessment.

SETTING

Participants' homes.

PARTICIPANTS

Community-dwelling older adults (N=200) 65 years and older including 100 persons referred by Adult Protective Services (APS) and 100 ambulatory patients matched on age, race, sex, and socioeconomic status.

INTERVENTIONS

In-home comprehensive assessment.

MAIN OUTCOME MEASURES

KELS, Geriatric Depression Scale (GDS), modified Physical Performance Test (mPPT), Mini-Mental State Examination (MMSE), Knee Extensor Break Test, Executive Cognitive Test (EXIT25), executive clock-drawing test (CLOX) 1 and 2, and an 8-foot walk test.

RESULTS

Older adults with abnormal KELS scores performed significantly worse on all tests except for the Knee Extensor Break Test. Accordingly, among the entire group, the KELS correlated with measures of executive function (EXIT25, r=.705, P<.001; CLOX 1, r=-.629, P<.001), cognitive function (MMSE, r=-.508, P<.001), affect (GDS, r=.318, P<.001), and physical function (mPPT, r=-.472, P<.001) but did not correlate with the Knee Extensor Break Test (r=-.068, P=.456). Among those referred by APS, the KELS failed to correlate with only the 8-foot walk test (r=.175, P=.153) and GDS (r=.080, P=.450).

CONCLUSIONS

This study demonstrated the convergent validity of KELS with a battery of cognitive, affective, executive, and functional measures often used to determine older adults' ability to live safely and independently in the community. KELS may be a valid and pragmatic alternative to screen for the capacity to live safely and independently among older adults.

Is greater self-neglect severity associated with lower levels of physical function?

OBJECTIVE

This study examined the association between severity of self-neglect and physical function in a population of community-dwelling older adults.

METHOD

Participants were older adults (N = 1,094) reported to the Chicago Department on Aging for suspected self-neglect from 1993 to 2005, who also participated in the Chicago Health Aging Project. The primary outcome of physical function was assessed using physical performance tests. Secondary outcomes were assessed using the Katz, Nagi, and Rosow-Breslau scales. Multiple regression models were used to assess these associations.

RESULTS

After adjusting for confounders, higher self-neglect severity scores were associated with lower physical performance testing (coefficient = -.062, p = .001). Greater self-neglect severity was also correlated with the reported number of impairments on the Katz, Nagi, and Rosow-Breslau scales (coefficients = .024, .024, and .016, respectively, p = .001).

DISCUSSION

Higher self-neglect severity is associated with lower levels of physical function among older adults.

Elder self-neglect: a discussion of a social typology

This article presents a theoretical framework for the study of social and behavioral factors associated with elder self-neglect. The model presented reflects the authors' beliefs that a risk-vulnerability model offers a useful framework from which to study all forms of elder mistreatment, as well as elder self-neglect. This model has particular utility, because it can begin to define the elements of risk and vulnerability that may be addressed using preventative measures as opposed to solely addressing intervention, which is often the case when addressing elder mistreatment and self-neglect. The authors then address a method for using the Consortium for Research in Elder Self-neglect of Texas data as currently constructed and adding to that database to effectively study risks and vulnerabilities in the elder self-neglect population. These additional data would greatly expand the scope of the study. The discussant adds his perspective to the ideas proposed by the authors.