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Self-Neglect in Older People

by Daniel B. Kaplan, PhD, MSW, Barbara J. Berkman, DSW, PhD

Sometimes older people do not take care of themselves. They may not provide food, drugs, or other necessities for themselves, and they may ignore personal hygiene. This problem is called self-neglect.

Self-neglect is most likely when older people

  • Live alone and isolate themselves

  • Have a disorder that impairs memory or judgment (such as Alzheimer disease)

  • Have several chronic disorders

  • Have substance abuse

  • Have severe depression

However, some people have no particular medical problems. Why such people neglect themselves is unclear.

People can neglect themselves by not keeping themselves or their clothing clean, by not paying bills, or by eating too little and becoming dehydrated and malnourished. People may not see a doctor when they have possibly life-threatening health problems. Or if they do see a doctor, they may refuse treatment, not fill their prescriptions, or skip follow-up visits. Their home may be filthy, in hazardous disrepair, or infested by animal or insect pests. Sometimes self-neglect endangers public health—for example, when people's behavior increases the risk of fire.

Distinguishing between self-neglect and the right to autonomy and privacy can be very difficult for family members, friends, and health care practitioners. Older people may be making informed choices. They may simply have decided to live in a way that others find undesirable. Often, a social worker is in the best position to make such a determination and can intervene if alerted by family members or friends. If intervention is thought to be needed, help can be just a phone call away. Contacting the person’s primary care doctor is a good way to start. Also, Adult Protective Services or the state unit on aging (whose numbers are available through the Eldercare Locator at 800-677-1116) can help by coordinating in-home safety assessments and helping older people obtain counseling services, emergency response systems, referrals to additional support services, and, if necessary, hospitalization.