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. 2007 Sep;97(9):1671-6.
doi: 10.2105/AJPH.2006.097113. Epub 2007 Jul 31.

Self-neglect among the elderly: a model based on more than 500 patients seen by a geriatric medicine team

Carmel Bitondo Dyer  1 , James S Goodwin, Sabrina Pickens-Pace, Jason Burnett, P Adam Kelly
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Self-neglect among the elderly: a model based on more than 500 patients seen by a geriatric medicine team

Carmel Bitondo Dyer et al. Am J Public Health. 2007 Sep.

Abstract

Objectives: We sought to identify the functional, cognitive, and social factors associated with self-neglect among the elderly to aid the development of etiologic models to guide future research.

Methods: A cross-sectional chart review was conducted at Baylor College of Medicine Geriatrics Clinic in Houston, Tex. Patients were assessed using standardized comprehensive geriatric assessment tools.

Results: Data analysis was performed using the charts of 538 patients; the average patient age was 75.6 years, and 70% were women. Further analysis in 460 persons aged 65 years and older showed that 50% had abnormal Mini Mental State Examination scores, 15% had abnormal Geriatric Depression Scale scores, 76.3% had abnormal physical performance test scores, and 95% had moderate-to-poor social support per the Duke Social Support Index. Patients had a range of illnesses; 46.4% were taking no medications.

Conclusions: A model of self-neglect was developed wherein executive dyscontrol leads to functional impairment in the setting of inadequate medical and social support. Future studies should aim to provide empirical evidence that validates this model as a framework for self-neglect. If validated, this model will impart a better understanding of the pathways to self-neglect and provide clinicians and public service workers with more effective prevention and intervention strategies.

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Figures

FIGURE 1—
FIGURE 1—
A Venn diagram of percentages of abnormal scores among elderly self-neglect patients: Houston, Tex, 1999–2004. Note. A battery of geriatric assessment measures was administered to each patient and included the Mini Mental State Examination (cognition), the Geriatric Depression Scale (depression), the physical performance test (activities of daily living),, the clock drawing test (executive function), and other test. See “Methods” section for more details.The Venn diagram illustrates the relationship among neuropsychiatric and functional impairments in persons who self-neglect.The diagram shows substantial overlap of the scores of 3 of the tests, except for the Geriatric Depression Scale.The Duke Social Support Index was abnormal in almost all of the patients (n = 250) who completed the assessment (N = 293) and is not shown in the Venn diagram.
FIGURE 2—
FIGURE 2—
Model of self-neglect among the elderly.
See this image and copyright information in PMC

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