Elder self-neglect: The failure of coping because of cognitive and functional impairments

Abstract

Elder self-neglect is the most frequently reported form of elder abuse, and can increase risk of death by 16-fold. It is essential that providers understand overall risk factors for elder self-neglect, and how to best address the impact of factors that limit coping, such as cognitive and functional impairments. While research on elder self-neglect is still limited, this systematic review summarizes current data overall and the specific impact of cognitive and functional impairments. Searched Ovid-Medline, Scopus, and ISI Web of Science, with terms "self-neglect," elder*, cognitive, and function*. Two hundred and thirty-seven records were identified, which resulted in 37 articles after review for duplication, pertinence and specificity. Elder self-neglect is a multifactorial syndrome. Executive dysfunction appears to be the predominant factor which inhibits appropriate decision making and problem solving. This impaired frontal lobe functioning impedes elders' ability to cope with physical disabilities, resulting in, or exacerbating, functional impairments. Caring for elders who are failing to meet their own needs is clinically and ethically challenging. It requires a careful evaluation of all factors that limit coping and self-care ability, including a systematic examination of executive and functional impairments. Treatment should be interdisciplinary, and maximize safety while honoring elders' goals.