Elder abuse sometimes comes from self-neglect
The man was living alone with his two dogs, in a remote area outside San Antonio, when someone called the Texas state hotline to report that a supposed friend was financially exploiting him. So the state adult protective services agency sent a caseworker to the man’s home.
She found an 86-year-old Vietnam veteran in a dirty, cluttered house full of empty liquor bottles. His legs swollen by chronic cellulitis, he could barely walk, so he used a scooter.
He missed doctor’s appointments. He had the medications he needed for cellulitis and diabetes, but didn’t take them. Though he had a functioning toilet, he preferred to urinate into plastic gallon jugs. He didn’t clean up after his dogs. He wasn’t eating well.
This behavior pointed to an underrecognized problem called self-neglect. It accounts for more calls to adult protective services agencies nationwide than any other form of elder abuse.
“If someone has decision-making capacity, do they have the right to live in squalor?” asked Dr. XinQi Dong, a researcher at the Rush Institute for Healthy Aging in Chicago. “As a society, we want to respect autonomy and independence.”
In the Texan’s case, “he wasn’t happy that APS was there, and he denied that he was being exploited,” said Raymond Kirsch, an agency investigator who became involved. “He also denied that he had a drinking problem.”
Grudgingly, he allowed the agency to set up a thorough housecleaning, to start sending a home care aide and to arrange for Meals on Wheels.
But on a follow-up visit a month later, the caseworker found her client markedly deteriorated. His swollen legs now oozed. He’d become personally filthy and was ranting incoherently. She returned with an ambulance and a doctor who determined that the client lacked the capacity to make medical decisions.
Off he went to a San Antonio hospital, under an emergency court order. The caseworker locked up the house and kenneled the dogs.
Self-neglect refers to someone whose behavior threatens her health and safety. In ongoing studies in Chicago, Dong and his colleagues look for factors like hoarding (of objects or animals), poor personal hygiene and unsanitary conditions.
In the Chicago studies, involving more than 4,600 South Side residents over age 65, researchers who conducted in-home interviews found self-neglect unnervingly common.
It occurred in 9 to 10 percent of men and 7.5 to 8.5 percent of women, depending on age. Because some residents refused access to their homes, “it wouldn’t surprise me if the prevalence were higher,” Dong said.
Neglect was more common among those with poor health and cognitive impairment. African-Americans and those with lower income and education had far higher rates of self-neglect.
Mental illness and social isolation are demonstrated risk factors, but among the many unanswered questions, Dong said, is cause and effect. Do depressed people neglect their care, or do people who selfneglect then become depressed?
Whatever the underlying causes, “it’s incredibly dangerous,” Dong said.