Identifying Self-Neglect: The Ultimate Abuse

Identifying Self-Neglect: The Ultimate Abuse

Self-neglect is a serious problem that can affect your health and well-being. It’s important to know the signs so that you can get the help you need.

Self-neglect is a type of abuse that is often overlooked. In fact, self-neglect can be harder to identify than other types of abuse and may be easily mistaken for another disease or disorder

Notably, self-neglect is more prevalent in the elderly (persons older than 65 years) population and can have serious consequences for the individual’s health and safety. In some cases, self-neglect may even lead to death.

As such, it’s important to be aware of the signs of self-neglect so that you can get help if needed.

Research shows that the prevalence of self-neglect in the USA is about 9% in the population aged 65 and older. In some countries such as Madrid, self-neglect is the main type of elder abuse with rates as high as 27% (Touza & Prado, 2019).

What is self-neglect?

Self-neglect can be defined as a lack of self-care in which an individual fails to attend to their basic needs, such as food, shelter, and personal hygiene. It can also include hoarding and self-harm. 

Actually, self-neglect is a pattern of behavior of a person who persistently fails to attend to his/her personal needs for wellbeing and safety. Notably, self-neglect may be intentional or unintentional.

Although self-neglect is often seen as a sign of mental illness, it can also be the result of physical or cognitive impairments. 

Elderly adults are particularly vulnerable to self-neglect, as they may have difficulty caring for themselves due to declining health.

However, self-neglect can occur at any age and stage of life. If you are concerned that someone you know is self-neglecting, there are some signs to look out for, such as poor personal hygiene, not eating or drinking.

According to a study of 4,627 older adults in the USA, self-neglect including poor hygiene, environmental hazards and hoarding were more prevalent among black older adults and those with lower incomes and educational levels. In fact, rates for the black older population were 13.2% and 10.9% for men and women respectively, compared to 2.4% and 2.6% for white older men and women (Dong et al., 2011).

Read also: Ultimate guide to overcome limited health literacy

Signs of self-neglect
"Self-love, my liege, is not so vile a sin, as self-neglecting." - William Shakespeare

Common self-neglectful behaviors

The following list includes examples of some common self-neglectful behaviors: 

  • Failure to provide basic hygiene.
  • Failure to obtain necessary medical care.
  • Failure to maintain a clean or livable home environment.
  • Failure to maintain a proper diet.
  • Failure to attend to the safety of one’s living situation.
  • Failure to participate in important life activities.

Who is at risk of self-neglect?

People with a number of medical, psychological or social conditions are more likely to neglect themselves. These include:

  • Illnesses that affect the brain (e.g., dementia, mental illness).
  • Conditions that make it difficult to take care of oneself (e.g., paralysis, chronic pain).
  • Physical problems that interfere with activities of daily living (e.g., arthritis, loss of vision or hearing).
  • Chronic conditions that can be managed but not cured (e.g., diabetes, heart failure).
  • Drug or alcohol use disorders.

Other causes can include:

  • Financial problems.
  • Societal issues such as unemployment, underemployment, poverty and homelessness.
  • Medical problems such as pain, dizziness, nausea, and/or fatigue.
  • Limited access to a support network or social services.
  • Previous episodes of emotional abuse.

Read also: 10 Barriers to healthcare access + simple solutions

What are the signs someone might be neglecting themselves?

There are a number of signs that may indicate self-neglect. These can include poor personal hygiene, drastic weight loss, untreated medical conditions, and self-isolation. Specific signs of self-neglect include:

  • not taking medications as prescribed.
  • having cuts, fungal infections, sores, or ulcers that are not healing.
  • wearing dirty clothes or being unbathed.
  • having untreated medical problems that have serious consequences (e.g., uncontrolled diabetes leading to blindness).
  • living in a dangerous environment (e.g., home with no heat, infested by vermin, leaking roof).
  • living in a very cluttered environment that makes it hard to get around.
  • insufficient funds on inability to manage money.

Research suggests that self-neglect isn’t sudden, but often presents in persons who have already shown some signs of self-neglecting behavior, particularly during crisis (Touza & Prado, 2019).

How can I help someone suffering from self-neglect?

If you suspect that someone you know is neglecting their own needs, it is important to reach out and offer help.

However, it is also imperative to remember that self-neglect is often a symptom of a larger problem, such as social isolation or mental health issues.

Regardless, family members and friends are often in the best position to offer support and intervention.

Self-neglect is not a normal part of aging. It can be prevented. If you think of someone who may be self-neglecting, you should try to offer support and encourage the person to seek help.

You can also speak with an expert or their primary care doctor for more information or assistance.

For many people living alone, the first step is to find ways to fit services into their routine. For example:

  • Arrange times and days for housekeeping, laundry, and meals
  • Have transportation available if needed (e.g., taxi vouchers)
  • Identify a person or organization that can help (e.g., neighbor, religious group, social service agency)
  • Arrange for house calls by professional services where possible (e.g., Meals on Wheels)

For others, particularly those who are very frail, the first step is arranging for outside help to be in the home. This might include:

  • Help with cooking and cleaning, or having these tasks done for the person
  • Attending to urgent medical problems, even if they do not solve all health issues
  • Help to handle mail and bills
  • Meals on Wheels

Unfortunately, some persons experiencing self-neglect may have difficulty accepting help. 

If a person is suspected of self-neglect but does not want assistance from family or services, you may contact Adult Protective Services for support.

Read also: Causes and solutions for mistrust in healthcare

self neglect 1
"A wound gets worse when it's treated with neglect." - Stevie Nicks

If you suspect someone is neglecting themselves?

You should collect as much information and documentation about the situation as possible, including:

  • The person’s overall health status and medical history. What are they eating? How clean are they? What medications are they taking? Are there any mental or emotional problems?
  • Any financial problems the person is having. How are they managing their money? Do they have support from family, friends, or community organizations to manage life’s basic tasks?
  • The environment where the person lives. Is it safe and clean? Does it have enough space for the person to move around easily? Are there any hazards present?
  • Any other specific concerns, such as hoarding. This often indicates mental health issues.

Self-neglect is often caused or made worse by social isolation. As such, family members’ involvement is crucial. Self-neglect may not always be easy to spot, but if you look carefully it usually has a clear cause.

Final words on self-neglect

Self-neglect is a serious problem that can lead to health issues and even death. Unfortunately, the negative impacts of self-neglect are often underestimated or ignored by society.

However, there needs to be more awareness about this issue particularly for ethnic minorities and those with low incomes and educational levels; who are more vulnerable.

What are your thoughts on addressing the stigma behind self-neglect? Let me know in the comments below.

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Dong X, Simon MA, Evans DA. Prevalence of self-neglect across gender, race, and socioeconomic status: findings from the Chicago Health and Aging Project. Gerontology. 2012;58(3):258-68

Touza C, Prado C. Detecting Self-Neglect: A Comparative Study of Indicators and Risk Factors in a Spanish Population. Gerontol Geriatr Med. 2019 Jan 23;5:2333721418823605.

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