Cross-sectional study of the characteristics of reported elder self-neglect in a community-dwelling population: findings from a population-based cohort

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.

Household factors and prevalence of squalor: meta-analysis and meta-regression

BACKGROUND

Severe domestic squalor occurs when a person lives in a dwelling that is significantly unclean, disorganised and unhygienic. The limited previous research has primarily focused on the characteristics of those who live in squalor and the associated risk factors. Robust and reliable studies of squalor prevalence have not been conducted. This study sought to produce a reliable estimate of the point prevalence of squalor.

METHODS

Using data from 13-years of the English Housing Survey, N = 85,681 households were included in a prevalence meta-analysis. Squalor prevalence over time, subgroup analysis and logistic regression investigated the role played by household and community characteristics.

RESULTS

The point prevalence of squalor was estimated to be 0.85% and squalor was seen to decrease significantly over time. More significant community deprivation, a rented dwelling, lower income and high numbers of people in the home was associated with a greater risk of squalor.

CONCLUSIONS

Squalor prevalence was higher than previous estimates and supports community care services in associated service planning. The results regarding household characteristics help to inform which households and individuals may be at a higher risk of living in squalid conditions.

Adult Maltreatment Risk Factors: Adding Community-Level Factors to an Individual-Level Field

Adult maltreatment is a pervasive problem in the United States and has serious individual and societal consequences. Adult protective services (APS) agencies are the social services programs responsible for serving older adults and adults with disabilities who may be experiencing adult maltreatment. The adult maltreatment literature differentiates elder maltreatment from the maltreatment of adults with disabilities, yet APS agencies serve both groups. Understanding the etiology of adult maltreatment as well as the associated risk and protective factors is crucial for APS workers, clinical practitioners, researchers, and policymakers. To advance the evidence in this area, we undertook a scoping review to examine recent evidence on risk and protective factors associated with adult maltreatment. Searches of nine electronic databases were conducted in 2020 to identify studies published in peer-reviewed journals since 2010. A total of 29 studies were included in the final review. The findings identified several categories of risk factors associated with the individual: demographic traits, socioeconomic characteristics, physical and mental health, interpersonal issues, and historical events. Several studies identified caregiver and alleged perpetrator risk factors. However, the current body of research lacks community and contextual risk and protective factors. Therefore, we present several potential data sources that may be leveraged to examine the links between social-contextual characteristics and adult maltreatment. These data may be combined with APS data to advance the field's understanding of risk and protective factors through advanced analytic techniques.

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.

The role of frailty, social networks, and depression in self-neglect in an older Chinese population: A cross-sectional descriptive study

OBJECTIVES

To identify the role of frailty, social networks, and depression in self-neglect in an older Chinese population.

METHODS

The study was conducted in 521 older adults recruited from four community healthcare centers in a district in Beijing, China. Participants were investigated by a set of questionnaires.

RESULTS

Frailty (β=0.150, p=0.759) was not associated with self-neglect of older adults. Social isolation (β=1.980, p<0.001) and depression (β=3.606, p<0.001) were both factors associated with self-neglect in older adults.

CONCLUSION

Management of depression and improvement of social networks of older adults should be incorporated into interventional strategies to effectively control self-neglect. Understanding self-neglect and its associated factors will ultimately contribute to the intervention development and well-being of older adults.

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.

Characteristics of Older People from a Poor Residential Environment in Okinawa, Japan: An Emergency Department-Based Cross-Sectional Study

BACKGROUND

Evidence for what diseases occur more commonly in older people from a poor residential environment (PRE) is limited.

OBJECTIVE

We investigated characteristics, especially the underlying reason (disease) for visiting an emergency department (ED), of older people from a PRE in ED settings.

METHODS

A cross-sectional study was conducted on people aged ≥65 years who presented to the EDs of 2 hospitals in Okinawa, Japan, between 2015 and 2019. PRE cases were identified by searching relevant words, such as a house overflowing with garbage from hoarding or housing squalor (gomi-yashiki in Japanese), in electric medical records. Controls (2 controls per case) were randomly selected from those without a PRE, with both living at home and matching each PRE case for age and sex. Characteristics of interest between cases and controls were compared using a χ2 test.

RESULTS

PRE cases (n = 67), compared with controls (n = 134), were more often transported by ambulance (79.1% vs. 61.9%; p = 0.01). A family member or relative (43.4%) or professional supporter (20.8%) called an ambulance for most PRE cases. PRE cases were more likely to visit the ED due to injury/fracture (16.4% vs. 8.2%), rhabdomyolysis (11.9% vs. 1.5%), undernutrition/dehydration (10.4% vs. 1.5%), and cancer (9.0% vs. 5.2%) than controls (p < 0.001). PRE cases had a higher prevalence of being underweight (35.4% vs. 14.9%), dementia (41.8% vs. 16.4%), decubitus ulcer (29.9% vs. 8.2%), living alone (73.1% vs. 23.1%), and receiving public welfare assistance (35.8% vs. 9.0%) than controls (all p ≤ 0.001).

CONCLUSION

In EDs, older people from a PRE exhibited certain diseases and characteristics.

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.

Mediational Role of Self-efficacy between Selected Bio-psychosocial Factors and Elder Self-Neglect among Community-Dwelling Older Malaysian Adults

Elder abuse and neglect have been reported as significant public health and societal problem in many different societies across the world. In Malaysia, older adults recorded a high prevalence of neglect compared to other types of elder abuse. There is a dearth of empirical work on elder self-neglect (ESN) among the older population in Malaysia. This paper aims to explore the mediational role of self-efficacy on the relationship between selected biopsychosocial factors and ESN among community-living older adults in Selangor, Malaysia. This study utilized a cross-sectional survey to gather data from a representative sample of 202 older adults from Selangor. A newly developed scale of 16-items of elder self-neglect (ESN) was used in this study. The results showed that self-efficacy partially mediated the association between ADL, IADL, depression, and capacity of self-care on ESN. Self-efficacy also fully mediated the association between neuroticism, life satisfaction, social network, and education on ESN. These findings provided a deeper understanding of the phenomenon of self-neglect among older Malaysian adults. The results will also serve as a useful reference for professionals and policymakers to develop uniform guidelines, protocols, or programs to handle cases of elder self-neglect in the community.

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

OBJECTIVE

We aimed to develop a new screening tool for self-neglect in community-dwelling self-sufficient older adults.

METHODS

Istanbul Medical School Elder Self-Neglect questionnaire (IMSelf-neglect) was developed as a screening tool. Community-dwelling, self-sufficient older adults were recruited in a geriatric outpatient clinic (n = 226, 142 female, 84 male). Construct validity was based on social-worker's interview as a gold-standard method. The cut-off threshold for IMSelf-neglect questionnaire was calculated from ROC-analysis using cut-off values that predicted social-worker's opinion whether the older adult has self-neglect.

RESULTS

Mean age was 74 ± 6.5 years. The inter-rater and test-retest reliability were excellent (r = 0.887, p < .05; r = 0.942, p < .05, respectively). The internal consistency was good (Cronbach's alpha: 0.708). Cut-off threshold for IM Self-neglect questionnaire was calculated as 7 with 92.1% sensitivity and 70.7% specificity. Positive predictive value and negative predictive value of IMSelf-neglect questionnaire were 38.9% and 97.8%, respectively. There was significant moderate agreement between social worker's assessment and results of IMSelf-neglect questionnaire (κ = 0.407, p < .001). The social worker confirmed 16.8% of the participants have self-neglect by the gold-standard clinical interview. Participants with self-neglect had decreased functionality, worse quality of life and tended to have more depression compared with participants without self-neglect.

DISCUSSION/CONCLUSION

We developed the IMSelf-neglect questionnaire as a valid and reliable tool to screen self-neglect in outpatient clinics complementary to comprehensive geriatric assessment.

Demographic-based risk of reporting psychopathology and poor health among mistreated older adults in the national elder mistreatment study wave II

Objectives: Past year elder mistreatment rate is about 11% of community residing older adults, with significant demographic-based variations in prevalence. However, very little research on demographic variable-based differences in correlates of elder abuse, such as mental health, exist. The National Elder Mistreatment Study 8-year follow-up (NEMS II) specifically investigated the relation between demographic factors and the presence of these correlates (i.e. diagnoses of depression, post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and self-ratings of physical health).Methods: The NEMS II used random digit dial telephone survey methodology to assess demographic variables and reports of depression PTSD, GAD, and poor health, in 774 older adults. RESULTS: a consistent association was observed between demographic factors related to financial status and poor mental and general health ratings.Discussion: A subset of demographic factors associated with increased risk of reporting elder abuse, low income and financial distress, were also associated with increased risk of reporting correlates of elder abuse that included depression, PTSD GAD and poor health.

Elder abuse and its sociocultural factors from the perspectives of Kurdish rural older people: Does gender matter?

We aimed to explore the meaning of elder abuse and its sociocultural factors from the perspectives of Kurdish older people. We purposively selected the participants, 38 female and 17 male, from a rural area in Boukan country, Iran. Data were collected using semi-structured interviews and focus group discussions and were analyzed applying conventional content analysis. Researchers finally characterized viewpoints of the participants into two themes including structural changes in family interactions and changes in sociocultural values. Public education about moral norms and enactment of supportive laws for elderly people may help minimize elder abuse.

Elder Abuse in American Indian Communities: An Integrative Review

BACKGROUND

American Indian elders have one of the lowest life expectancies in the United States. Disproportionate disease burden, socioeconomic disparities, and higher rates of violence across the lifespan are thought to contribute to higher rates of elder abuse. Elder abuse and higher rates of trauma exposure are linked with adverse outcomes.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines informed the methodology and assessment of the literature on elder abuse among American Indians.

RESULTS

Of the nine studies published in the last 30 years, rates of elder abuse varied by study, location, and tribal affiliation from 4.3% to 45.9%. Large studies with comparison populations found higher rates for American Indians. There was a consensus for three risk factors: substance abuse, mental health problems, and caregiving issues. Importance of tribal norms, the notion of respect conferred to elders, and the concept of acculturation were major culturally relevant themes. Perceived tribal norms and strengths, for example, respect for elders, were at odds with abuse experiences, particularly financial exploitation and neglect. Historical trauma, shame, and fear impacted reporting. There was little consistency in study designs, most were qualitative or mixed methods, samples were small, there was no common measurement tool or time frame for abuse, and there was only one intervention study.

IMPLICATIONS

High rates of abuse suggest healthcare providers should be encouraged to screen and intervene despite the lack of empirical evidence. Providers should not assume that traditional culturally ascribed strengths, such as honor and respect for elders, provide any degree of protection against elder abuse.

Factors associated with elder abuse: a systematic review of the literature

Elder abuse is a complex public health problem. It is of fundamental importance to ascertain which factors are associated with each specific type of abuse, as a way of enabling the creation of evidence-based public policies. The aim of the present study was to systematically review the literature regarding analytical epidemiological studies of factors associated with elder abuse. Four databases were used for the bibliographic search: Pubmed, Scopus, Web of Science and Lilacs, with no limitations regarding year of publication. Articles were selected by pairs of researchers in two stages: reading of abstracts (3.121) and reading of complete articles (64). The total number of articles selected was 27. The risk of bias was evaluated. The factors associated with general violence were age, sex, marital status, educational level, income, family arrangement, social support, solitude, mental disorder, depression, suicide attempt, dependence on others in daily activities, cognitive function, chronic diseases, alcohol or drug abuse, among others. Elder abuse was found to be a multifactorial and complex phenomenon that should not therefore be viewed in a partial one-dimensional manner, but in such a way as to take into account all dimensions and the interdependence of these.

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.

Elder Mistreatment Among Older Chinese Americans: The Role of Family Cohesion

Cultural values are believed to influence perceptions of and solutions to elder mistreatment (EM) perpetrated by family members. This study aimed to understand the influence of family cohesion on EM reported by community-dwelling older Chinese Americans. A mixed-method approach consisting of a quantitative survey built on focus group interviews was utilized. Focus group interviews were conducted to ensure subsequent survey questions about EM were culturally and linguistically appropriate. The revised survey questionnaires were then administered to 266 Chinese American older adults to assess estimated EM prevalence and the effects of family cohesion. Survey findings indicate that 1 in 10 reported at least one occurrence of EM in the past year. Depressed Chinese older adults (OR= 1.14) and those reporting low levels of family cohesion (OR = .82) were more likely to experience EM. Multigenerational family interventions can be designed to reduce older adults’ depression levels and promote family cohesion.

Disorderly Households, Self-Presentation, and Mortality: Evidence From a National Study of Older Adults

This article examines whether disorderly household conditions and bodily self-presentation predict mortality, above and beyond four sets of variables conceptually linked to both death and disorder. Data come from 2005/2006 and 2010/2011 waves of the National Social Life, Health, and Aging Project. We used naturalistic observation of respondents' homes and bodies, along with a diverse range of additional covariates, to predict probability of death. Older adults living in disorderly households were at highest risk of death over 5 years, primarily because they confronted high levels of frailty. Disorderly bodily self-presentation was also related to mortality risk, but this association could be only partially explained by demographic factors, health conditions, frailty, and low social connectedness. Findings suggest that disorder in the residential context-dress and hygiene in particular-is a strong predictor of mortality. Support providers should be mindful of changes in bodily presentation among community-dwelling older adults.

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.

Associations of self-neglect with quality of life in older people in rural China: a cross-sectional study

BACKGROUND

Elder self-neglect (ESN) has become a public health issue globally. Limited studies have focused on ESN, as well as the relationship between ESN and quality of life (QoL) in developing countries. The study's objective is to explore the association between ESN and QoL among rural elderly in China.

METHODS

A cross-sectional study was conducted among 3,182 elder adults aged 60 years or older, using a cluster-sampling technique in one township in Dangtu, a county in Anhui province. All participants completed face-to-face interview in their household. QoL was assessed using a brief form of the World Health Organization's quality of life questionnaire (WHOQOL-BREF), and ESN was assessed using the Scale of the Elderly Self-neglect (SESN). Hierarchical linear regression models were used to analyze the associations between the ESN scores and QoL scores after adjusting for sociodemographic, social support, and physical and psychological variables.

RESULTS

The scores of overall ESN and five domains were significantly correlated with the scores of four QoL domains (p < 0.001). After adjusting for sociodemographic characteristics, social support, and physical and psychological health characteristics, elders who reported higher overall self-neglect scores had significantly lower scores in the four QoL domains (p < 0.001). Education, economic level, physical health, ADL, depression, and cognitive function are consistent predictors across all QoL domains.

CONCLUSIONS

ESN is an independent risk factor for poor QoL in elderly people in rural China. Understanding the role of ESN and its influence on QoL is important for the management of and intervention in ESN.

Sociodemographic and socioeconomic characteristics of elder self-neglect in an US Chinese aging population

This study aimed to examine the socio-demographic and socioeconomic characteristics associated with prevalence and severity of elder self-neglect in an U.S. Chinese older population. The PINE study is a population-based epidemiological study in the greater Chicago area. In total, 3159 Chinese older adults were interviewed from 2011 to 2013. Elder self-neglect was assessed with systematic observations of a participant's personal and home environment across five domains: hoarding, personal hygiene, house in need of repair, unsanitary conditions, and inadequate utility. Elder self-neglect was prevalent among older adults aged 80 years or over (mild self-neglect: 34.6% 95% CI 30.9-38.4; moderate/severe: 15.6% 95% CI 12.8-18.6), men (mild: 28.6% 95% CI 26.1-31.3; moderate/severe: 13.1% 95% CI 11.2-15.1), those with 0-6 years of education (mild: 32.2% 95% CI 29.7-34.9; moderate/severe: 12.6% 95% CI 10.8-14.5), and those with an annual personal income between $5000 and $10,000 (mild: 30.8% 95% CI 28.4-33.2; moderate/severe: 11.8% 95% CI 10.2-13.5). Older age (mild self-neglect: OR 1.02, 95% CI 1.01-1.03; moderate/severe self-neglect: OR 1.02, 95% CI 1.00-1.03) and lower education levels (mild self-neglect: OR 1.06, 95% CI 1.03-1.08; moderate/severe self-neglect: OR 1.07, 95% CI 1.04-1.09) were associated with significantly increased odds of elder self-neglect. Women (moderate/severe self-neglect: OR 0.73, 95% CI 0.58-0.93) had significantly decreased odds of moderate/severe elder self-neglect. No significant association was found between levels of income and overall elder-self-neglect of all severities. Future research is needed to examine risk/protective factors associated with elder self-neglect in U.S. Chinese older populations.

Prevalence of self-neglect in the caseloads of public health nurses

BACKGROUND

The extent of self-neglect on public health nurses' (PHNs) caseloads in Ireland is unknown. People who self-neglect may be vulnerable or hidden and, as a consequence, difficult to profile. PHNs in Ireland profile their areas to identify the nursing needs of their population.

AIM

This paper aims to: collate caseloads on self-neglect on the basis of a review of community profile and health need assessments (CPHNA) and identify the geographical and demographic factors within which self-neglect cases were found.

METHOD

A retrospective review of the CPHNA of student PHNs (n=88) was undertaken from 2010 to 2014 in a university in Ireland. In all, 88 community profiles were manually reviewed.

RESULTS

A total of 374 self-neglect cases were identified-79 cases were aged between 18-64 years and 295 were over 65 years. The range of self-neglect cases per profiled area was between 0 to 25. The geographic and demographic factors linked to self-neglect across profiles were higher rates of older people, deprivation, disadvantage, and cultural factors.

CONCLUSION

This retrospective review illustrates that self-neglect is a prominent feature in PHN caseloads, which has not been identified previously. Early identification is important to promote the mental health and wellbeing of self-neglecting clients.

Association Between Depressive Symptoms, Multiple Dimensions of Depression, and Elder Abuse: A Cross-Sectional, Population-Based Analysis of Older Adults in Urban Chicago

OBJECTIVE

Depression is conceptualized as both a risk factor for and a consequence of elder abuse; however, current research is equivocal. This study examined associations between elder abuse and dimensions of depressive symptoms in older adults.

METHOD

Participants were 10,419 older adults enrolled in theChicago Health and Aging Project (CHAP), a population-based study of older adults. Regression was used to determine the relationships between depressive symptoms, depression dimensions, and abuse variables.

RESULTS

Depressive symptoms were consistently associated with elder abuse. Participants in the highest tertile of depressive symptoms were twice as likely to have confirmed abuse with a perpetrator (odds ratio = 2.07, 95% confidence interval = [1.21, 3.52], p = .008). Elder abuse subtypes and depression dimensions were differentially associated.

DISCUSSION

These findings highlight the importance of routine depression screening in older adults as a component of abuse prevention and intervention. They also provide profiles of depressive symptoms that may more accurately characterize risk for specific types of abuse.

Elder Abuse: Systematic Review and Implications for Practice

This article is based on the lecture for the 2014 American Geriatrics Society Outstanding Scientific Achievement for Clinical Investigation Award. Elder abuse is a global public health and human rights problem. Evidence suggests that elder abuse is prevalent, predictable, costly, and sometimes fatal. This review will highlight the global epidemiology of elder abuse in terms of its prevalence, risk factors, and consequences in community populations. The global literature in PubMed, MEDLINE, PsycINFO, BIOSIS, Science Direct, and Cochrane Central was searched. Search terms included elder abuse, elder mistreatment, elder maltreatment, prevalence, incidence, risk factors, protective factors, outcomes, and consequences. Studies that existed only as abstracts, case series, or case reports or recruited individuals younger than 60; qualitative studies; and non-English publications were excluded. Tables and figures were created to highlight the findings: the most-detailed analyses to date of the prevalence of elder abuse according to continent, risk and protective factors, graphic presentation of odds ratios and confidence intervals for major risk factors, consequences, and practical suggestions for health professionals in addressing elder abuse. Elder abuse is common in community-dwelling older adults, especially minority older adults. This review identifies important knowledge gaps, such as a lack of consistency in definitions of elder abuse; insufficient research with regard to screening; and etiological, intervention, and prevention research. Concerted efforts from researchers, community organizations, healthcare and legal professionals, social service providers, and policy-makers should be promoted to address the global problem of elder abuse.

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.

Community-based system, reports, and substantiated cases of elder abuse: disparities between municipalities and relating factors in Japan

This study examines (1) the staffing and financial characteristics of systems for elder abuse detection and intervention in the municipal governments of Japan and (2) the relationship among the development of detection and intervention systems, the reporting rates of suspected elder abuse cases, and substantiated abuse rates in 927 municipalities across Japan. Progressive systems for the detection and intervention of elder abuse were significantly associated with a larger number of public officers than in non-progressive systems. Furthermore, greater rates of both suspected and substantiated cases of abuse were associated with progressive systems for elder abuse detection and intervention. Per capita annual expenditures on the comprehensive support project and the community general support center's catchment under the Long-Term Care Insurance (LTCI) program showed no significant association with the development of systems, the rate of suspected cases, or the number of substantiated cases. National social policy makers should examine strategies that would help municipalities assign sufficient staff to elder abuse detection and intervention programs.

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.

A review on the prevalence and measurement of elder abuse in the community

OBJECTIVES

Aging is a rising phenomenon globally and elder abuse is becoming increasingly recognized as a health and social problem. This review aimed to identify the prevalence of elder abuse in community settings, and discuss issues regarding measurement tools and strategies to measure elderly abuse by systematically reviewing all community-based studies conducted worldwide.

METHOD

Articles on elder abuse from 1990 to 2011 were reviewed. A total of 1,832 articles referring to elders residing at home either in their own or at relatives' houses were searched via CINAHL and MEDLINE electronic databases, in addition to a hand search of the latest articles in geriatric textbooks and screening references, choosing a total of 26 articles for review.

RESULTS

Highest prevalence was reported in developed countries, with Spain having 44.6% overall prevalence of suspicion of abuse and developing countries exhibiting lower estimates, from 13.5% to 28.8%. Physical abuse was among the least encountered, with psychological abuse and financial exploitation being the most common types of maltreatment reported. To date, there is no single gold standard test to ascertain abuse, with numerous tools and different methods employed in various studies, coupled with varying definitions of thresholds for age.

CONCLUSION

Current evidences show that elder abuse is a common problem in both developed and developing countries. It is important that social, health care, and legal systems take these findings into consideration in screening for abuse or reforming existing services to protect the health and welfare of the elderly.

Association between reported elder abuse and rates of admission to skilled nursing facilities: findings from a longitudinal population-based cohort study

BACKGROUND

Elder abuse is common and is a frank violation of an older adult's fundamental rights to be safe and free of violence. Our prior study indicates elder abuse is independently associated with mortality. This study aims to quantify the relationship between overall elder abuse and specific subtypes of elder abuse and rate of admission to skilled nursing facilities (SNF).

METHODS

A prospective population-based study conducted in Chicago of community-dwelling older adults who participated in the Chicago Health and Aging Project (CHAP). Of the 6,674 participants in the CHAP study, 106 participants were reported to the social services agency for elder abuse. The primary predictor was elder abuse reported to the social services agency. The outcome of interest was the annual rate of admission to SNF 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 SNF for those without elder abuse was 0.14 (0.58) and for those with elder abuse was 0.66 (1.63). After adjusting for sociodemographic and socioeconomic variables, medical comorbidities, cognitive and physical function, and psychosocial wellbeing, older adults who have been abused had higher rates of SNF admission (RR 4.60 (2.85-7.42)). Psychological abuse (RR 2.31 (1.17-4.56)), physical abuse (RR 2.36 (1.19-4.66)), financial exploitation (RR 2.81 (1.53-5.17)) and caregiver neglect (RR 4.73 (3.03-7.40)) were associated with increased rates of admission to SNF, after considering the same confounders. Elder abuse is associated with a higher rate of SNF stay longer than 30 days (RR 6.27 (3.68-10.69)).

CONCLUSION

Elder abuse was associated with increased rates of admission to SNF in this community population. Specific subtypes of elder abuse had a differential association with an increased rate of admission to SNF.

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.

Association between elder self-neglect and hospice utilization in a community population

Elder self-neglect is associated with substantial 1-year mortality. However, hospice utilization among those with self-neglect remain unclear. The objective of this study is to quantify the prospective relation between self-neglect and risk for hospice utilization in a community population of older adults. Prospective population-based study in a geographically defined community in Chicago of older adults who participated in the Chicago Health and Aging Project. Of the 8669 participants in the Chicago Health and Aging Project, a subset of 1438 participants was reported to social services agency for suspected elder self-neglect. Outcome of interest was the hospice utilization obtained from the Center for Medicare and Medicaid System. Cox proportional hazard models were used to assess independent association of self-neglect with risk of hospice utilization using time-varying covariate analyses. After adjusting for potential confounding factors, elders who self-neglect was associated with increased risk for hospice utilization (HR, 2.43, 95% CI, 2.10-2.81). Greater self-neglect severity (mild: (HR, 2.12 (1.61-2.79); moderate: (HR, 2.36 (1.95-2.84); severe: (HR, 4.66 (2.98-7.30)) were associated with increased risk for hospice utilization. Interaction term analyses suggest that the significant relationship between self-neglect and hospice utilization was not mediated through medical conditions, cognitive impairment and physical disability. Moreover, self-neglect was associated with shorter length of stay in hospice (PE, -0.27, SE, 0.12, p<0.02) and shorter time from hospice admission to death (PE, -0.32, SE, 0.13, p<0.01). Elder self-neglect was associated with increased risk of hospice use in this community population. Elder self-neglect is associated with shorter length of stay in hospice care and shorter time from hospice admission to death.

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.

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.

Prevalence of self-neglect across gender, race, and socioeconomic status: findings from the Chicago Health and Aging Project

BACKGROUND

Self-neglect is the behavior of an elderly person that threatens his/her own health and safety, and it is associated with increased morbidity and mortality. However, the scope of the self-neglect in the community population remains unclear. We examined the prevalence of self-neglect and its specific behaviors of hoarding, hygiene and other environmental hazards in a community-dwelling elderly population.

METHODS

A population-based cohort study conducted from 2007 to 2010 in a single cycle in a geographically defined community of 4 adjacent neighborhoods in Chicago, Ill., USA. Participant's personal and home environment was rated on hoarding, personal hygiene, house in need of repair, unsanitary conditions, and inadequate utility. Prevalence estimates were presented across gender, race/ethnicity, education and income levels.

RESULTS

There were 4,627 older adults in the cohort. The prevalence of self-neglect and specific personal and environmental hazards varied significantly by race/ethnicity and by levels of education and income. For race/ethnicity, black older adults (men 13.2%; women 10.9%) had a significantly higher prevalence of self-neglect than white older adults (men 2.4%; women 2.6%). For those with less than high school education, the prevalence of the self-neglect was 14.7% in men and 10.9% in women. For those with an annual income of less than USD 15,000, the prevalence of self-neglect was 21.7% in men and 15.3% in women.

CONCLUSION

The prevalence of self-neglect and specific behaviors of hoarding, poor hygiene, and other environmental hazards are higher among black older adults and among those with lower levels of education and income.

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.

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

OBJECTIVE

Elder self-neglect is an important public health issue. However, little is known about the association between personality traits and risk of elder self-neglect among community-dwelling populations. The objectives of this study are as follows: 1) to examine the association of personality traits with elder self-neglect and 2) to examine the association of personality traits with elder self-neglect severity.

METHODS

Population-based study conducted from 1993 to 2005 of community-dwelling older adults (N = 9,056) participating in the Chicago Health Aging Project (CHAP). Subsets of the CHAP participants (N = 1,820) were identified for suspected self-neglect by social services agency, which assessed the severity. Personality traits assessed included neuroticism, extraversion, rigidity, and information processing. Logistic and linear regressions were used to assess these associations.

RESULTS

In the bivariate analyses, personality traits (neuroticism, extraversion, information processing, and rigidity) were significantly associated with increased risk of elder self-neglect. However, after adjusting for potential confounders, the above associations were no longer statistically significant. In addition, personality traits were not associated with increased risk of greater self-neglect severity. Furthermore, interaction term analyses of personality traits with health and psychosocial factors were not statistically significant with elder self-neglect outcomes.

CONCLUSION

Neuroticism, extraversion, rigidity, and information processing were not associated with significantly increased risk of elder self-neglect after consideration of potential confounders.

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.

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.