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标题：Self-Neglect Among the Elderly: A Model Based on More Than 500 Patients Seen by a Geriatric Medicine Team
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作者：Carmel Bitondo Dyer ; James S. Goodwin ; Sabrina Pickens-Pace 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2007
卷号：97
期号：9
页码：1671-1676
DOI：10.2105/AJPH.2006.097113
语种：English
出版社：American Public Health Association
摘要：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. Self-neglect is the inability to provide for oneself the goods or services to meet basic needs. In almost every US jurisdiction, it is the most common problem faced by Adult Protective Service agencies. 1 ^– 3 Two national studies reported the prevalence of self-neglect to be 50.3% and 39.1% 4 ^, 5 among Adult Protective Service clients. These numbers may represent a low estimate because 15 states do not mandate the reporting of this form of mistreatment. In a client-matched study of the Established Populations for Epidemiological Studies in the Elderly database and the records of the Connecticut Ombudsman’s Office, 72.7% of the Adult Protective Service clients were reported as having issues of self-neglect. 2 In a population-based study of Texas adult protective services division of the state protective services program, 62.5% of the clients were referred for self-neglect, with 90% of the self-neglect cases occurring in persons aged 65 years and older. 1 Not only is self-neglect common, but it also has been shown to be an independent risk factor for death. 6 Individuals who neglect themselves are typically older persons with multiple deficits in social, functional, and physical domains and who in extreme instances live in squalor. First described in the 1960s in the United States 7 and Great Britain, 8 self-neglect was called the “Social Breakdown Syndrome” or “Senile Breakdown.” Others have used the term “Diogenes Syndrome” 9 for those who hoard as well as live in squalor, although the term also describes younger patients with mental illness, patients with personality disorders, and persons without identifiable diagnoses. In the late 1970s, the term “self-neglect” came into use in the medical and social service literature. A number of studies have been published on self-neglect; those studies with descriptive information on persons who self-neglect included 30 to 233 persons for a total of 548 persons. 8 ^– 14 Despite these studies, there is still no clear case definition for self-neglect. We aimed to describe the characteristics of 538 instances of self-neglect reported to an urban protective service agency, which were subsequently referred to an interdisciplinary geriatrics medicine team. We report the demographics, medical diagnoses, medication use, and the results of geriatric assessment measures in this large sample to clarify the case definition for self-neglect and to present a model for future studies.