Self-neglect increases risk of death in elderly

Elders who neglect themselves show an "alarming" increase in one-year death rates, five times higher than those getting adequate care, a Chicago study found.

The self-neglect often occurs in over-65 adults who are mentally competent and physically able. The research, in a recent Journal of the American Medical Association, also showed that people older than 65 who suffer confirmed mental or physical abuse from caregivers are more than twice as likely to die during the first year after the behavior is identified.

The study is the first to demonstrate death rates increase for elders showing self-neglect even among those who have little impairment to their mental and physical ability, according to the authors. As the number of older adults in the U.S. increases, resources are needed to improve the well-being of this population, said the lead author, XinQi Dong.

"Elder abuse and self-neglect is under recognized," said Dong, an associate professor of medicine at Rush University Medical Center in Chicago, in a telephone interview. "It is associated with premature death, especially premature death due to heart disease."

The mortality risk is "especially alarming during the first year after the report of elder self-neglect," he wrote in the journal article.

About 2 million cases of elder abuse and self-neglect occur in the U.S. each year, according to Dong and his co-authors. Self-neglect includes refusing or failing to obtain adequate food, water, clothing, shelter, medicine or other basic needs. Abuse can include emotional abuse, physical abuse, caregiver neglect or financial exploitation.

The researchers looked at the records of 9,318 people 65 and older who were enrolled in the Chicago Health and Aging Project between 1993 and 2005. Of those, 1,657 came to the attention of social agencies because of reports of self-neglect or abuse.

In the study, those reported to social workers for self- neglect showed 270 deaths per 100 person years in the first year after their behavior was reported, a risk calculated to be five times higher than those not neglecting themselves, Dong said. Factoring in a person's physical and cognitive function, medical conditions, health habits and depression didn't significantly alter the findings, the researchers said.

The results challenge conventional assumptions about elder neglect or abuse, which "have traditionally been thought to be more common among the most vulnerable individuals, especially those with the most impaired cognitive and physical function," the authors wrote.

Those exposed to abuse showed 18.3 deaths per 100 person years, a rate calculated to be about twice higher than those not abused, the study said.

The study was funded by the National Institute on Aging and several foundations.