Neglect
is the failure of caregivers to fulfill their responsibilities
to provide needed care.
"Active"
neglect refers to behavior that is willful - that is,
the caregiver intentionally withholds care or necessities.
The neglect may be motivated by financial gain (e.g. the
caregiver stands to inherit) or reflect interpersonal
conflicts
"Passive"
neglect refers to situations in which the caregiver is
unable to fulfill his or her care giving responsibilities
as a result of illness, disability, stress, ignorance,
lack of maturity, or lack of resources
Self
neglect refers to situations in which there is no perpetrator
and neglect is the result of the older person refusing care.
Who
are the perpetrators?
Perpetrators
may be paid attendants, family members, employees of long
term care facilities, or others
Caregivers
who lack adequate skills, training, time, or energy
Caregivers
who are mentally ill, or who have alcohol, substance abuse
or other mental health problems
In
self-neglect cases, there are no perpetrators
Who
is at risk?
Persons with physical or mental disabilities who depend
on others for care
Persons
with high care needs. The literature on care giving suggests
that certain conditions are particularly stressful to
caregivers. These include fluctuations in the older person's
need for care, disturbed sleep, incontinence, and lack
of support from other family members.
Self-neglect
is often associated with mental health problems, including
substance abuse, dementia, and depression.
What
are the indicators?
Indicators
are signs or clues that neglect has occurred. Indicators
of neglect include the condition of the older person's home
(environmental indicators), physical signs of poor care,
and behavioral characteristics of the caregiver and/or older
person. Some of the indicators listed below may not signal
neglect but rather reflect lifestyle choices, lack of resources,
or mental health problems, etc. One should look for patterns
or clusters of indicators that suggest a problem.
Signs
of neglect observed in the home
- Absence
of necessities including food, water, heat
- Inadequate
living environment evidenced by lack of utilities, sufficient
space, and ventilation
- Animal
or insect infestations
- Signs
of medication mismanagement, including empty or unmarked
bottles or outdated prescriptions
- Housing
is unsafe as a result of disrepair, faulty wiring, inadequate
sanitation, substandard cleanliness, or architectural
barriers
Physical
indicators
- Poor
personal hygiene including soiled clothing, dirty nails
and skin, matted or lice infested hair, odors, and the
presence of feces or urine
- Unclothed,
or improperly clothed for weather
-
Decubiti (bedsores)
- Skin
rashes
- Dehydration,
evidenced by low urinary output, dry fragile skin, dry
sore mouth, apathy, lack of energy, and mental confusion
- Untreated
medical or mental conditions including infections, soiled
bandages, and unattended fractures
-
Absence of needed dentures, eyeglasses, hearing aids,
walkers, wheelchairs, braces, or commodes
- Exacerbation
of chronic diseases despite a care plan
- Worsening
dementia
Behavioral
indicators
Observed
in the caregiver/abuser
-
Expresses anger, frustration, or exhaustion
- Isolates
the elder from the outside world, friends, or relatives
- Obviously
lacks care giving skills
- Is
unreasonably critical and/or dissatisfied with social
and health care providers and changes providers frequently
- Refuses
to apply for economic aid or services for the elder and
resists outside help
Observed
in the victim
-
Exhibits emotional distress such as crying, depression,
or despair
- Has
nightmares or difficulty sleeping
- Has
had a sudden loss of appetite that is unrelated to a medical
condition
- Is
confused and disoriented (this may be the result of malnutrition)
- Is
emotionally numb, withdrawn, or detached
- Exhibits
regressive behavior
- Exhibits
self-destructive behavior
- Exhibits
fear toward the caregiver
- Expresses
unrealistic expectations about their care (e.g. claiming
that their care is adequate when it is not or insisting
that the situation will improve)
How
can I learn more?
Volume
11, Number 2 (1999) of the Journal of Elder Abuse & Neglect
is devoted to the issue of self-neglect. For more information
about JEAN, and a listing of articles in the issue,
click here.
Duke,
J. (1991). A national study of self-neglecting adult protective
services clients.Richmond, VA: Virginia Department of Social
Services. For more information and contact information,
click here.
Fulmer,
T. & Paveza, G. Neglect in the elderly patient. (1998).
Nursing Clinics of North America. 33(3), 457-467.
Rathborn-McCuan, E., & Fabian, D.R. (Eds.). (1992). Self-neglecting
elders: A clinical dilemma. Westport, CT: Auburn House
Last
Updated March 2003
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