All too often we hear about caregivers that have abused or neglected the seniors they are caring for. What is not widely known are the number of seniors whose health and wellbeing is compromised by self-neglect.
In the most basic terms, self-neglect occurs when an older person fails to meet their own physical, psychological, and/or social needs.
Self-neglect, if included statistically as a form of elder abuse, represents the highest percentage of cases of elder abuse. In fact, the Public Policy Institute of AARP estimates that self-neglect represents 40 to 50 percent of cases reported to states Adult Protective Services.
Unfortunately, these statistics fail to take into account the fact that self-abusers do not fit a uniform profile. There are many factors which may lead one to self-neglect and the subsequent intervention necessary for each is unique.
According to the National Center on Elder Abuse, there is no one accepted theory that explains self-neglect among the elderly. "Self-neglect may be secondary. Whatever the origin, self-neglect cases can be among the most difficult cases for adult protective services, aging, health and social services professionals, attorneys, law enforcement, and public health officials to address. It is not uncommon for self-neglectors to refuse services or resist interventions, and the need to balance autonomy with the individual's well-being presents an ongoing ethical challenge to those attempting to help."
"Self-neglect is often hard to recognize and cannot usually be attributed to a single cause. The root may be medical conditions, such as dementia, mental health issues, impaired mobility, prescription drug use or abuse, sensory deficits, or others. Yet often, there are underlying causes that include financial limitations, inadequate social supports, and external events. Families and friends really struggle with this issue. They want the senior to remain independent and living autonomously, but know that there are problems. No one wants to be the bad guy," according to Mardy Chizek, RN, FNP, BSN, MBA, AAS and president of Westmont's Charism Elder Care Services.
Some common indications of self-neglect are visually apparent on entering the senior's residence. Often family and friends find the senior in dirty clothes, find stacks of dirty dishes, unkempt premises, insufficient or spoiled food in the pantry or refrigerator, rodents in the home, prescription bottles unopened or unused and pets poorly cared for.
Clues for the clinician include unexplained weight loss, disheveled appearance, medication non-compliance, poor hygiene and change in ability to articulate needs and issues.
According to Chizek, interventions must be handled with extreme care and sensitivity. It is important to address medical, behavioral health, financial and psychosocial factors before selecting and executing solutions. The medical team should play an active role in determining why self-neglect is taking place and the possible remedies.
"Most seniors who experience self-neglect are living in the community. They will resent any intrusion into their lives, even if their living conditions place them at daily harm. It is important to attempt to maintain the senior's dignity and autonomy, but a senior who is experiencing self-neglect has needs that must be addressed for their safety and wellbeing. The balance between autonomy and safety is a tight rope that may require external resources for resolution," according to Chizek.
For more information on elder self-neglect visit Charism Elder Care Services at www.charism.net.