Association of personality traits with elder self-neglect in a community-dwelling population

The Development and Validation of Elder Self-Neglect Scale (ESNS) in Iranian Community-dwelling Older Population

The aim of this study was to develop a valid and reliable elder self-neglect scale (ESNS) for field research on Iranian community-dwelling older adults. This mixed-method exploratory study was conducted in three stages: (1) item generation using literature review, (2) item reduction by expert panels, and (3) assessing the psychometric properties. In the third stage, the face, content, and construct validity (exploratory factor analysis) were performed on the first sample (n = 450), and the final 26-item scale was developed. After that, confirmatory factor analysis and reliability were assessed on the second sample (n = 250). Data were analyzed using IBM-SPSS v.23 and AMOS v.24. Exploratory factor analysis identified six factors with a total variance of 77.53%. The goodness of fit was indicated by Structural Equation Modeling. The Cronbach's alpha was estimated at 0.85. The optimal cutoff point was 73. This scale with 26 items seems to be an effective tool in screening elder self-neglect.

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.

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.

A Vulnerability Risk Index of Self-Neglect in a Community-Dwelling Older Population

BACKGROUND

The only way to systematically screen for self-neglect among older adults is through in-home observations, which are often difficult and unfeasible for healthcare providers. To fill this gap, we need a robust and efficient prognostication tool to better treat and prevent self-neglect among older adults.

OBJECTIVES

To develop a predictive index that can be used to assess risk prognostication of the onset of self-neglect among community-dwelling older populations.

DESIGN

Two waves of longitudinal data from the Chicago Health and Aging Project (CHAP), collected during 2008 to 2012 with approximately 3-year follow-up intervals.

SETTING

Non-Hispanic black or non-Hispanic white community-dwelling older adults in three adjacent neighborhoods in Chicago, IL.

PARTICIPANTS

A total of 2885 individuals who were participants of the CHAP study.

MEASUREMENTS

The main outcomes are incident self-neglect cases. A total of 86 potential predictors were considered in the domains of sociodemographic and socioeconomic, general well-being, health behavior, medical health, medicine/healthcare, cognitive function, physical well-being, social well-being, and psychological well-being.

RESULTS

The 3-year self-neglect incidence rate is 241 (8.4%). A 10-item predictive model (with a c-statistic of 0.76) was developed using stepwise selection in multivariable logistical regression models. After corrections of overfitting by validating in 100 bootstrapping samples, the predictive accuracy of the model dropped to 0.71, suggesting at least moderate overfitting. A point-based risk index was developed based on parameter estimates of each predictive factor in the final logistic model. The index has an area under the receiver operating characteristic curve of 0.76.

CONCLUSION

The study developed an efficient index with good predictive ability of self-neglect. Further external validation and impact studies are necessary before practitioners can apply this index to determine risk of self-neglect among other community aging populations. J Am Geriatr Soc 68:809-816, 2020.

Relationship Tensions and Mood: Adult Children's Daily Experience of Aging Parents' Stubbornness

This study examined middle-aged individuals' reports of parents' behaviors commonly attributed to stubbornness. Middle-aged adults (N = 192) completed a 7-day diary reporting their mood and how often they felt their parents (N = 254) engaged in behaviors often described as 'stubbornness' (insistent or risky). Thirty-one percent of middle-aged children reported insistent behaviors and 17% reported risky behaviors by their parent(s). Daily reports of parent behaviors attributed to stubbornness were positively associated with parent-child relationship quality, parent functional limitations, and child neuroticism. Reports of perceived parent insistent behaviors were also associated with greater daily negative mood among adult children. Findings highlight the impact of adult children's daily perceptions of parent behaviors commonly attributed to stubbornness on the individual and relationship.

Nurses' Encounters With Older Adults Engaged in Self-Neglectful Behaviors in the Community: A Qualitative Study

OBJECTIVE

Alongside clinical tasks and decision making, there is a growing awareness of the emotions that arise during nurses' interaction with clients and its significance in relation to meeting the demands of one's role. This study aims to delve deeper into the experience of community care nurses' encounters with older adults engaged in self-neglectful behaviors.

METHOD

In-depth, semistructured interviews were conducted with 22 experienced nurses in Israel, who worked with older adults engaged in self-neglectful behaviors in the community.

RESULTS

Three main themes emerged: "Everything is amplified in old age": An age-related decline in functioning produces situations of self-neglect, Self-neglect as an experience imprinted on the nurse's work: The struggle for treatment, and "What is our role here?"-Nurses' obligations in cases of self-neglect.

CONCLUSION

The complexity of older adults engaged in self-neglectful behaviors results in feelings of confusion and ambiguity regarding the nurses' role.

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.

"My Parent is so Stubborn!"-Perceptions of Aging Parents' Persistence, Insistence, and Resistance

OBJECTIVE

Aging parents may respond to advice or help with daily problems from their grown children by insisting, resisting, or persisting in their ways or opinions, behaviors which are commonly viewed as stubbornness. Research has not examined how frequently such behaviors occur and what factors are associated with these behaviors.

METHODS

Middle-aged adults and parents (N = 189 dyads) reported the prevalence of parental behaviors attributed to stubbornness. Utilizing hierarchical linear regression and multilevel modeling this exploratory study examined the association of parent stubbornness with individual and relationship-based characteristics and concordance in reports within dyads.

RESULTS

Over 77% of children and 66% of parents reported parents acting in ways attributed to stubbornness at least sometimes. Children reported higher levels of parental stubbornness than parents self-reported. Children's perceptions of occurrence were related to parent disability and relationship characteristics, while parents' self-reports were associated with their own personalities. Discrepancies in reports between parents and children were associated with child and parent characteristics.

DISCUSSION

This novel exploration demonstrated that individual and relationship-based factors are linked to the perceived expression of stubbornness by parents and that there is discordance in perceptions within families. Findings suggest a need for intervention to increase understanding within families.

Elder self-neglect is associated with an increased rate of 30-day hospital readmission: findings from the Chicago Health and Aging Project

BACKGROUND/AIM

Elder self-neglect is associated with increased morbidity and mortality. The objective of this study is to examine the prospective relationship between reported elder self-neglect and the rate of 30-day hospital readmission in a community population.

METHODS

We conducted a prospective population-based study of community-dwelling older adults who participated in the Chicago Health and Aging Project. Of the 7,219 participants in the Chicago Health and Aging Project, a subset of 1,228 participants was reported to the social services agency for suspected elder self-neglect. The primary predictor was elder self-neglect reported to the social services agency. The outcome of interest was the annual rate of 30-day hospital readmission calculated from the Center for Medicare and Medicaid System hospitalization data from 1993 to 2009. Poisson regression models were used to assess these relationships.

RESULTS

The average annual rate of 30-day hospital readmission for those without elder self-neglect was 0.2 (SD 0.7) and for those with reported elder self-neglect 0.9 (SD 2.8). After adjusting for sociodemographic and socioeconomic characteristics, medical comorbidities, cognitive function, physical function, and psychosocial well-being, elders who self-neglect had a significantly higher rate of 30-day hospital readmission (rate ratio 2.50, 95% confidence interval 2.02-3.10). Greater self-neglect severity [mild: parameter estimate (PE) 1.09, standard error (SE) 0.19, p < 0.001; moderate: PE 0.84, SE 0.13, p < 0.001; severe: PE 1.24, SE 0.40, p = 0.002] was associated with increased annual rates of 30-day hospital readmission after considering the same confounders. Interaction term analyses suggest that the significant relationship between self-neglect and 30-day hospital readmission was not moderated by medical conditions, cognitive impairment, physical disability, or psychosocial well-being.

CONCLUSION

Reported elder self-neglect was associated with increased rates of 30-day hospital readmission in this community population. Greater self-neglect severity was associated with a greater increase in the rate of 30-day hospital readmission.

Personality disorders in older adults: findings from the National Epidemiologic Survey on Alcohol and Related Conditions

OBJECTIVES

To examine the prevalence, sociodemographic correlates, psychiatric and medical comorbidities, and the disability of personality disorders among adults age 65 years and older.

METHODS

Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions, focusing on a subsample of 8,205 adults age 65 years and older.

RESULTS

A total of 8.07% (SE: 0.37) of American adults age 65 years and older presented at least one personality disorder. The most prevalent personality disorder was the obsessive-compulsive personality disorder. The overall pattern of associations between each personality disorder and lifetime psychiatric comorbidity correlates was statistically significant. Participants with a personality disorder show a lower quality of life than their counterparts.

CONCLUSIONS

Personality disorders in older adults are highly associated with disability, medical, and psychiatric disorders. These findings highlight the need to develop more effective prevention and intervention programs in this specific population.

Elder self-neglect and hospitalization: findings from the Chicago Health and Aging Project

OBJECTIVES

To quantify the relation between reported elder self-neglect and rate of hospitalization in a community population of older adults.

DESIGN

Prospective population-based study.

SETTING

Geographically defined community in Chicago.

PARTICIPANTS

Community dwelling older adults who participated in the Chicago Health and Aging Project. One thousand one hundred sixty-five of the 6,864 participants in the Chicago Health and Aging Project was reported to social services agency for suspected elder self-neglect.

MEASUREMENTS

The primary predictor was elder self-neglect reported to social services agency. The outcome of interest was the annual rate of hospitalization, obtained from the Centers for Medicare and Medicaid Services. Poisson regression models were used to assess these longitudinal relationships.

RESULTS

The average annual rate of hospitalization was 0.6 ± 1.3 for participants without elder self-neglect and 1.8 ± 3.2 for those with reported elder self-neglect. After adjusting for sociodemographic and socioeconomic characteristics, medical commorbidities, and cognitive and physical function, older adults who neglected themselves had significantly higher rate of hospitalization (rate ratio = 1.47, 95% confidence interval = 1.39-1.55). Greater severity of self-neglect (mild: standardized parameter estimate (PE) = 0.24, standard error (0.05); moderate: PE = 0.45 (0.03); severe: PE = 0.54, (0.11), all P < .001) was associated with higher annual rates of hospitalization after adjusting for the same confounders. Interaction term analyses suggest that medical conditions, cognitive impairment, and physical disability did not mediate the significant relationship between self-neglect and hospitalization.

CONCLUSION

Reported elder self-neglect was associated with higher rates of hospitalization in this community population. Greater severity of self-neglect was associated with a greater rate of hospitalization.

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.

Prospective study of the elder self-neglect and ED use in a community population

PURPOSE

This study aims to quantify the relation between elder self-neglect and rate of emergency department utilization in a community-dwelling population.

METHODS

A prospective population-based study is conducted in a geographically defined community in Chicago of community-dwelling older adults who participated in the Chicago Health and Aging Project. Of the 6864 participants in the Chicago Health and Aging Project, 1165 participants were reported to social services agency for suspected elder self-neglect. The primary predictor was elder self-neglect reported to social services agency. The outcome of interest was the annual rate of emergency department utilization obtained from the Center for Medicare and Medicaid Services. Poisson regression models were used to assess these longitudinal relationships.

RESULTS

The average annual rate of emergency department visits for those without elder self-neglect was 0.6 (1.3), and for those with reported elder self-neglect, it was 1.9 (3.4). After adjusting for sociodemographics, socioeconomic variables, medical conditions, and cognitive and physical function, older people who self-neglect had significantly higher rates of emergency department utilization (rate ratio, 1.42; 95% confidence interval, 1.29-1.58). Greater self-neglect severity (mild: standardized parameter estimate [PE], 0.27; standard error [SE], 0.04; P < .001; moderate: PE, 0.41; SE, 0.03; P < .001; severe: PE, 0.55; SE, 0.09; P < .001) was associated with increased rates of emergency department utilization, after considering the same confounders.

CONCLUSION

Elder self-neglect was associated with increased rates of emergency department utilization in this community population. Greater self-neglect severity was associated with a greater increase in the rate of emergency department utilization.