Elder Self-Neglect: Medical Emergency or Marker of Extreme Vulnerability?
Abstract
To address the vulnerability that often accompanies aging, a social contract was established with older Americans in the 1960s through legislation leading to the creation of the Social Security and Medicare programs. This contract was augmented in 1975 through passage of Title XX of the Social Security Act, which required states to develop and maintain protective service agencies for senior citizens. In most states, these agencies are the first responders to reports of elder abuse, including physical abuse, neglect and financial exploitation. The most common reason for referral to adult protective services, however, is self-neglect, an ill-defined syndrome characterized by the inability to meet one’s basic needs to an extend that it poses a threat to personal health and safety (1,2). The absence of a caregiver distinguishes self-neglect from neglect, which is the most common subtype of elder abuse (3).
In this issue of JAMA, Dong and colleagues (4) evaluate the mortality related to self-neglect and abuse in a large biracial cohort of community-living persons aged 65 years or older who were followed for a median of 6.9 years. Confirming prior work (5), the number of reported cases of self-neglect dwarfed that of abuse by a ratio of nearly 14 to 1. While both self-neglect and abuse were independently associated with mortality, the short-term affect of self-neglect was particularly pronounced, with a nearly 6-fold elevation in the risk of death within 1 year. Such elevations in…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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