Understanding professionals’ perspectives and experiences of elder self‐neglect: A systematic review and meta‐synthesis of qualitative studies

Abstract

Purpose To systematically review and synthesize the findings on various professionals’ perspectives of elder self‐neglect (ESN) and/or their experiences with ESN. Design A systematic qualitative review was used. Methods Primary qualitative studies published either in English or Chinese until August 2020 were systematically searched in the following databases: PubMed, Web of Science, Embase, CINAHL Plus, PsycINFO, Wanfang Data, and China National Knowledge Infrastructure (CNKI). Findings Eleven studies were included. Five subthemes including retaining a sense of normalcy/identity, service refusal, isolation, contributing factors in ESN, and manifestations and consequences of ESN were included in the overarching theme of ESN features. Another two subthemes, emotional and ethical dilemmas in caring for self‐neglecters and management strategies, were included under the second overarching theme of complicated experiences managing cases of ESN. Conclusions This qualitative synthesis provides a deep and comprehensive insight into professionals’ perspectives and experiences of self‐neglect in older adults. Understanding professionals’ perspectives of ESN can help with the knowledge and theory development pertinent to this particular phenomenon. Clinical relevance Findings are valuable in informing the provision of funds and structural, informational, and emotional support systems development for professionals managing ESN cases. Establishing a strong link between ESN case management and improved outcomes in older self‐neglecters is essential to establish a definite need for the provision of support, resource, and stardardized guidelines for these professionals.

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

“…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). Holistic interventions that not only target the physical and psychological functioning and sociocultural environments of self‐neglecters, but also considers their innate capabilities and strengths are needed.…”

“…Another cardinal feature of self‐neglecters is their refusal to accept aid and intervention from informal caregivers (i.e., family, friends, etc.) 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).…”

“…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). Lack of clarity on the optimal balance between respecting the autonomy of self‐neglecters and the obligation to intervene makes it difficult for professionals and policy makers to arrive at acceptable practice solutions (Dong, 2017; Yu et al, 2022).…”

“…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). Lack of clarity on the optimal balance between respecting the autonomy of self‐neglecters and the obligation to intervene makes it difficult for professionals and policy makers to arrive at acceptable practice solutions (Dong, 2017; Yu et al, 2022). Additionally, this can further amplify the possibility of caregiver neglect, financial exploitation, and multiple forms of elder abuse in older adults (Dong et al, 2013).…”

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

“…Given that the risk of self‐neglect is directly related to the severity of health concerns (Yu et al, 2021), older people who are admitted to the hospital may be at a higher risk of self‐neglect than community‐dwelling older people. In addition, adherence to medicine or medical advice is more likely to occur among hospitalised older adults who engage in self‐neglect behaviours (Yu et al, 2022). If the self‐neglect behaviours of hospitalised older adults are not effectively addressed, this could result in longer hospital stays, a higher rate of readmissions and a heavier workload for healthcare workers (Dong, 2017).…”