Merck Manual

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Self–Neglect in Older Adults


Daniel B. Kaplan

, PhD, LICSW, Adelphi University School of Social Work;

Barbara J. Berkman

, DSW, PhD, Columbia University School of Social Work

Last review/revision Mar 2021 | Modified Sep 2022
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Self-neglect implies not caring for self. It can include ignoring personal hygiene, not paying bills, not maintaining the integrity or cleanliness of the home, not obtaining or preparing food (leading to undernutrition), not seeking medical care for potentially serious symptoms, not filling prescriptions, taking drugs (prescription or over-the-counter) incorrectly, and skipping follow-up visits.

Risk factors for self-neglect in older adults include

Warning signs of self-neglect include lack of a caregiver plus any of the following:

  • Rapid weight loss, malnutrition, dehydration

  • Unaddressed health conditions

  • Hypothermia or heat exhaustion

  • Unsanitary home or unkempt clothing

  • Lack of adequate food in the home

  • Disconnected utilities

  • Decubitus ulcers, poor hygiene, or poor body odor

  • Not taking medications

  • Delirium

Differentiating between self-neglect and simply choosing to live in a way that others find undesirable can be difficult. Social workers are often in the best position to make this determination.

In the US, 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.

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NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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