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

Abstract

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.

Self-neglect: a review of opportunities and barriers to federal policy and research priorities

“…However, practitioners may find it challenging to engage individuals who self-neglect in treatment because many may be motivated to maintain a sense of control and autonomy in their lives and not be willing to work with providers who they feel threaten that control (Rathbone-McCuan, 2014). Additionally, the literature noted that medical decision-making capacity is often intact among persons who self-neglect, which makes it challenging for APS and community service providers to intervene when an individual is reluctant or refuses to accept services (Dahl et al , 2018). As pointed out in one UK-based study, part of the challenge to addressing self-neglect is the need to balance the individual’s autonomy with appropriate interventions (Braye et al , 2011).…”

Perspectives and experiences of living with self‐neglect among older adults: A systematic review and meta‐synthesis

“…This corresponds with Yu et al (2021) study on service providers' experiences and perspectives of ESN, where isolation and service refusal were reported to be cardinal features in older adults with self‐neglect. This reflects the dilemma that exists in balancing duty of care and obligation to intervene in cases of self‐neglect with respecting an individual's right to exercise self‐determination in living their lives (Dahl et al, 2020). Effectively addressing this dilemma requires a change in practice frameworks from approaches that solely follow medical models of care to acknowledging that self‐neglect describes a variety of medical conditions that are highly dependent on societal norms and cultural practices (Dahl et al, 2020).…”

“…This reflects the dilemma that exists in balancing duty of care and obligation to intervene in cases of self‐neglect with respecting an individual's right to exercise self‐determination in living their lives (Dahl et al, 2020). Effectively addressing this dilemma requires a change in practice frameworks from approaches that solely follow medical models of care to acknowledging that self‐neglect describes a variety of medical conditions that are highly dependent on societal norms and cultural practices (Dahl et al, 2020). Considering our finding that older self‐neglecters desire to be treated with normalcy and are actively interacting with their environment and reacting to threats to their identity (Band‐Winterstein et al, 2012; Kutame, 2007; Yu et al, 2022), there is a need to reframe conceptualizations of self‐neglect that integrate both medical and sociocultural approaches (Dahl et al, 2020; Lauder et al, 2009).…”

“…and professionals (i.e., social workers, caseworkers, elder abuse investigators, and general practitioners) (Pickens et al, 2021; Yu et al, 2022). This makes ESN a difficult syndrome for both lay and professional individuals to comprehend, and further complicates the effective management of this complex phenomenon (Dahl et al, 2020). A recent meta‐synthesis on professionals' perspectives and experiences of ESN illustrated that professionals experienced emotional and ethical dilemmas in caring for older adults with self‐neglect (Yu et al, 2022).…”

Mediating Role of Psychological Capital in the Relationship Between Social Support and Self-Neglect Among Chinese Community-Dwelling Older Adults

“…Furthermore, four key features of PsyCap—self-efficacy, optimism, hope, and resilience—have been shown to have a negative association with self-neglect. For example, self-efficacy is associated with self-neglect and mediates the relationship between self-neglect and related factors such as functional dependency and social networks ( Dahl et al, 2020 ). Optimism and hope are reported to be negative predictors of self-neglect, and resilience is considered an important factor for reducing the risk of self-neglect among older adults ( Gunstone, 2003 ; Genke, 2004 ; Minayo et al, 2019 ).…”