Elder Self-Neglect a Growing Concern, UT-Houston Experts Say
HOUSTON – (Sept. 25, 2007) – Elder self-neglect, an independent risk factor for early death, is on the rise and researchers need to develop screening tools to identify those who can no longer take care of themselves, according to an article published in the Sept. 26 issue of Journal of the American Medical Association.
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Carmel Bitondo Dyer, M.D.
Authors of the article, titled “Vulnerable Elders: When It Is No Longer Safe to Live Alone,” are Carmel Bitondo Dyer, M.D., professor and director of the Division of Geriatrics and Palliative Medicine; Sabrina Pickens, instructor; and Jason Burnett, research associate, all of The University of Texas Medical School at Houston.
“Our clinical team at the Harris County Hospital District has cared for vulnerable elders in conjunction with Texas Adult Protective Services for years,” said Dyer, who is chief of geriatrics at Lyndon B. Johnson General Hospital. “Together we have seen the loss of dignity that engulfs vulnerable elders who are no longer able to care for themselves and lapse into a state of self-neglect. Research is ongoing at The University of Texas Health Science Center at Houston to study the causes, interventions and prevention strategies to help the most vulnerable adults in our society."
Elder self-neglect can lead to piling garbage in the home, allowing food to spoil, failing to maintain utilities, ignoring serious medical issues and even lying in their own excrement, according to the article. When a crisis does occur and the patient seeks medical treatment, hospital staff or outpatient clinics may not recognize clues to elder self-neglect and discharge the patient back home to an unsafe environment, the article says.
In a population-based study of the Texas Adult Protective Services, published in 2001, 62.5 percent of cases were referred for self neglect. Data from 2001 and 2004 adult protective services nationwide, collected by the National Center on Elder Abuse, showed that self-neglect remained the single most common category of substantiated elder abuse reports. That data also showed a 34 percent increase in self-neglect investigations in just four years.
The article comes on the heels of Dyer’s study on elder self-neglect published in the September issue of the American Journal of Public Health. The study, the most comprehensive to date, found that many vulnerable elders who neglected themselves were suffering from common geriatric syndromes such as depression and dementia, as well as undiagnosed illnesses such as hypothyroidism, hypertension and diabetes. Lack of family or social support was common.
“We actually believe that in some cases by diagnosing and treating undiagnosed medical problems we may be able to restore mental function, as in the case of hypothyroidism or depression,” Dyer said.
But in cases where the disease is not reversible and the individual lacks the capacity to make decisions, others must intervene, she said.
“This intervention can be by the state through guardianship and nursing home placement or through family, neighbors or non-profit or faith-based organizations, where for instance, homemakers might be provided to the senior,” Dyer said.
Dyer calls for interdisciplinary research by the medical, nursing, social work, legal and public health communities to provide tools to determine when the safety of elders is in jeopardy.
Early intervention, she reports, could reduce the case loads of adult protective service workers, costs of hospitalization and nursing home placement while increasing quality of life for the elderly.