Assessing self-neglect in older patients

Scenario: Do physicians have a responsibility to report suspected self-neglect?

Older patients with chronic conditions can, over time, lose the
ability to care for their own basic needs and safety. But how can
physicians maintain respect for a patient's autonomy while assessing
self-neglect?

Response:

Self-neglect is the inability to care for one's own basic needs,
including health, welfare and safety. In two national studies,
self-neglect was cited most often for referrals to adult protective
services, more common than any category of elder mistreatment,
including neglect by others. Older people who do not care for their own
health and well-being adequately typically have functional impairments
and lack necessary support networks; ultimately, they lack the
cognitive capacity for self-protection.

A landmark 1998 study in the Journal of the American Medical Association
revealed that self-neglect is medically significant and is associated
with an increased risk for death. Those who refuse medical care may
suffer higher morbidity from untreated medical conditions. Usually the
person who is neglecting his or her own care is not aware of the need
for assistance, or agrees to get help but then refuses services. The
factors that contribute to self-neglect are still incompletely
understood. But a geriatric medical team at the Baylor University
College of Medicine, Houston, recently developed and published a model
of self-neglect in the American Journal of Public Health, and
researchers are seeking to understand it as a geriatric syndrome rather
than a distinct medical condition. In geriatric medicine, the concept
of a syndrome assumes multiple etiologies and resultant functional
decline.