Neglect and Self-Neglect
Neglect is the failure of caregivers to fulfill their responsibilities to provide needed care.
"Active" neglect refers to behavior that is willful - that is, the caregiver intentionally withholds care or necessities. The neglect may be motivated by financial gain (e.g. the caregiver stands to inherit) or reflect interpersonal conflicts
"Passive" neglect refers to situations in which the caregiver is unable to fulfill his or her care giving responsibilities as a result of illness, disability, stress, ignorance, lack of maturity,
or lack of resources
Self neglect refers to situations in which there is no perpetrator and neglect is the result of the older person refusing care.
Who are the perpetrators?
Perpetrators may be paid attendants, family members, employees of long term care facilities, or others
Caregivers who lack adequate skills, training, time, or energy
Caregivers who are mentally ill, or who have alcohol, substance abuse or other mental health problems
In self-neglect cases, there are no perpetrators
Who is at risk?
Persons with physical or mental disabilities who depend on others for care
Persons with high care needs. The literature on care giving suggests that certain conditions are particularly stressful to caregivers. These include fluctuations in the older person's need for care, disturbed sleep, incontinence, and lack of support from other family members.
Self-neglect is often associated with mental health problems, including substance abuse, dementia, and depression.
What are the indicators?
Indicators are signs or clues that neglect has occurred. Indicators of neglect include the condition of the older person's home (environmental indicators), physical signs of poor care, and behavioral characteristics of the caregiver and/or older person. Some of the indicators listed below may not signal neglect but rather reflect lifestyle choices, lack of resources, or mental health problems, etc. One should look for patterns or clusters of indicators that suggest a problem.
Signs of neglect observed in the home
Absence of necessities including food, water, heat
Inadequate living environment evidenced by lack of utilities, sufficient space, and ventilation
Animal or insect infestations
Signs of medication mismanagement, including empty or unmarked bottles or outdated prescriptions
Housing is unsafe as a result of disrepair, faulty wiring, inadequate sanitation, substandard cleanliness, or architectural barriers
Physical indicators
Poor personal hygiene including soiled clothing, dirty nails and skin, matted or lice infested hair, odors, and the presence of feces or urine
Unclothed, or improperly clothed for weather
Decubiti (bedsores)
Skin rashes
Dehydration, evidenced by low urinary output, dry fragile skin, dry sore mouth, apathy, lack of energy, and mental confusion
Untreated medical or mental conditions including infections, soiled bandages, and unattended fractures
Absence of needed dentures, eyeglasses, hearing aids, walkers, wheelchairs, braces, or commodes
Exacerbation of chronic diseases despite a care plan
Worsening dementia
Behavioral indicators
Observed in the caregiver/abuser
Expresses anger, frustration, or exhaustion
Isolates the elder from the outside world, friends, or relatives
Obviously lacks care giving skills
Is unreasonably critical and/or dissatisfied with social and health care providers and changes providers frequently
Refuses to apply for economic aid or services for the elder and resists outside help
Observed in the victim
Exhibits emotional distress such as crying, depression, or despair
Has nightmares or difficulty sleeping
Has had a sudden loss of appetite that is unrelated to a medical condition
Is confused and disoriented (this may be the result of malnutrition)
Is emotionally numb, withdrawn, or detached
Exhibits regressive behavior
Exhibits self-destructive behavior
Exhibits fear toward the caregiver
Expresses unrealistic expectations about their care (e.g. claiming that their care is adequate when it is not or insisting that the situation will improve)
How can I learn more?
Volume 11, Number 2 (1999) of the Journal of Elder Abuse & Neglect is devoted to the issue of self-neglect. For more information about JEAN, and a listing of articles in the issue, click here.
Duke, J. (1991). A national study of self-neglecting adult protective services clients.Richmond, VA: Virginia Department of Social Services.
Fulmer, T. & Paveza, G. Neglect in the elderly patient. (1998). Nursing Clinics of North America. 33(3), 457-467.
Rathborn-McCuan, E., & Fabian, D.R. (Eds.). (1992). Self-neglecting elders: A clinical dilemma. Westport, CT: Auburn House
