The relationships between frailty and depression, loneliness, and self-neglect in older adults: A cross-sectional study

Objectives: To clarify the latent profile of depressive symptoms in Chinese older adults living alone and to explore the relationship between this profile and self-neglect. Methods: Data from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS) were utilized to conduct a latent profile analysis for the identification of depressive symptoms. Logistic regression was employed to analyze the related factors. Generalized linear modeling was used to assess the impact of different profiles of depressive symptoms on self-neglect. Results: A total of 1822 older adults living alone, with a mean age of (83.60 ± 9.15) years, were included in the study. Three categories of depression were identified: the C1 mild depression-sleep disturbance group (29.36%), the C2 moderate depression-forcefulness group (55.22%), and the C3 major depression-loneliness loss group (15.42%). Logistic regression analysis indicated that gender, place of residence, annual household income, educational level, reason for living alone, self-rated health status, cognitive function, and emotional support were significant influencing factors (p < 0.05). The risk of experiencing higher levels of self-neglect in the C2 was 1.264 times greater than in the C1. Furthermore, the risk of higher levels of self-neglect in the C3 was 2.040 times greater than in the C1. Conclusions: Heterogeneity in depressive symptoms is evident among Chinese older adults living alone, with variations in self-neglect across different potential categories of these individuals. The focus should be on older adults in the C2 and C3 profiles. This study proposes targeted intervention strategies from family, community, and policy development perspectives to help improve self-neglect in older adults.

BackgroundSelf-neglect is common among older adults and may have devastating health consequences.ObjectiveThis study aims to examine the relationships between self-neglect and depression, social networks, and health literacy (HL) in older adults.MethodsThe cross-sectional study was conducted between March and May 2024 at four family health centres located in a district of Istanbul, Turkey. A total of 370 older adults, aged 65 years and above, were selected by simple random sampling from among those who visited the family health centres during the study period. A Sociodemographic Information Form, the Revised Turkish version of Mini Mental State Examination, the Istanbul Medical School Elder Self-Neglect Questionnaire, the Lubben Social Network Scale, the Geriatric Depression Scale-Short Form, and the Turkish Health Literacy Scale-32 were used for data collection. Data were analysed using descriptive statistics, Pearson’s correlation analysis, hierarchical linear regression analysis, and serial multiple mediation analysis.ResultsThe mean age of the participants was 71.42 ± 5.54 (65–90) years, and 55.7% were women. The prevalence of self-neglect among the participants was 34.9%, and the prevalence of depressive symptoms was 46.2%. The HL levels of 62.7% of the participants were inadequate, and those of 31.6% were problematic-limited. HL, depression, social networks, gender, education status, and income status were statistically significant predictors of self-neglect (R2 = 0.508, p < 0.001). Depression had a significant direct effect on self-neglect (effect = -0.148, p < 0.001), as did social networks (effect = 0.107, p < 0.001) and HL (effect = 0.107, p < 0.001). The mediating effect of social networks in the relationship between depression and self-neglect was significant (LLCI = -0.043, ULCI = -0.015), with an effect size of -0.028. The mediating effect of HL in the relationship between depression and self-neglect was also significant (LLCI = -0.121, ULCI = -0.063), with an effect size of -0.089.ConclusionOur findings showed that HL, depression, and social networks play a critical role in predicting self-neglect in older adults, and social networks and HL partially mediate the relationship between depression and self-neglect. Based on these results, efforts to improve HL and strengthen social support systems would be beneficial in mitigating the effects of depression and reducing self-neglect in older adults.

Factors associated with self-neglect from a salutogenic perspective among community-dwelling older adults: A cross-sectional correlational study

To quantitatively pool the overall prevalence of self-neglect in older adults and provide evidence-based information for healthcare professionals to develop preventive measures. Systematically and thoroughly searched ten databases from inception to September 1, 2024 and we pooled the prevalence of self-neglect in older adults using a random-effects model based on the Stata 15.0 software. In our meta-analysis, 21 studies were included, and the estimated prevalence rate of self-neglect among older adults was 27% (95% CI: 23%-30%). We found that the incidence of self-neglect was higher in males, aged 80 years, developing countries, hospitals, and using the Elder Self-Neglect Questionnaire assessment tool. Self-neglect is a common and underestimated phenomenon in older adults, and the prevalence rate of self-neglect is high. Several epidemiological characteristics such as gender, age, countries, settings, and definition criteria were associated with its prevalence. It deserves early screening and targeted intervention by using a globally accepted definition of self-neglect to prevent older adults from self-neglect. Our study can provide clinical evidence for nursing staff and healthcare professionals to identify high-risk groups of self-neglect in older adults.

To examine the prevalence of self-neglect and its specific behaviors in a community-dwelling population of older adults. A population-based cohort study conducted between 2007 and 2010 rated participant's personal and home environment, particularly with regard to hoarding, personal hygiene, house in need of repair, unsanitary conditions, and inadequate utility. Prevalence estimates were presented across health-related variables of health status, physical function, and cognitive function. There were 4,627 older adults (1,645 men and 2,982 women). Prevalence of self-neglect in older adults increased with lower health status in both men (4.7% in very good/excellent health, 7.9% in good health, and 14.9% in fair/poor health) and women (4.5% in very good/excellent health, 7.9% in good health, and 10.6% in fair/poor health). For those with ≥3 Katz impairments, the prevalence of self-neglect in older adults was 12.8% in men and 13.8% in women. For those with MMSE (Mini-Mental State Examination) ≤20, the prevalence of self-neglect in older adults was 18.8% in men and 13.6% in women. Self-neglect was clearly prevalent among older adults, especially among those with lower health status and physical and cognitive function.

Prevalence and influencing factors of self-neglect in older adults: a systematic review and meta-analysis.

We aimed to screen self-neglect in older adults before and after the COVID-19 pandemic, to evaluate the effect of the pandemic on self-neglect, and to evaluate the relationship between self-neglect and geriatric syndromes in this study. Older adults ≥65 years old and without dementia who applied to a single-centre geriatric outpatient clinic between December 2023 and May 2024 were included in the study. We performed self-neglect screening for the pre- and post-pandemic era with the Istanbul Medical School Elder Self-Neglect questionnaire. Additionally, comprehensive geriatric assessment data and quality of life data with the Euro-Quality of Life 5D-3L scales were evaluated. A total of 104 patients, with a mean age of 76.8 ± 5.9 years and 70% female, were included in the study. Self-neglect was detected in 19 patients (18.3%) at the post-pandemic period. The older adults with self-neglect were more frail, more dependent, more depressed, had higher risk of sarcopenia, also had more common polypharmacy and urinary incontinence (all P < 0.05). Also, quality of life was found to be more impaired in the self-neglect group (P < 0.001). In multivariate Cox regression analysis, being dependent and having a high risk of sarcopenia were associated with self-neglect in the post-COVID-19 period (odds ratio (OR): 0.15; CI: 0.03-0.83; P = 0.030 and OR: 1.45; CI: 1.01-2.09; P = 0.048, respectively.). Self-neglect in older adults is an important part of comprehensive geriatric assessment and should be screened with validated methods. As it is significantly related with other geriatric syndromes, it suggests that interventions in geriatric syndromes may prevent self-neglect.

Self-neglect in older adults is a complex phenomenon characterized by inattention to health and hygiene, typically stemming from an inability or unwillingness to access potentially remediating services. Some aspects of self-neglect clinically resemble geriatric syndromes (e.g., falling, incontinence). The literature on self-neglect was comprehensively reviewed and its quality evaluated in the context of considering its candidacy for a geriatric syndrome. MEDLINE (1966-2004) was searched using self-neglect as a keyword. Using a "snowball" sampling strategy, associated terms (e.g., Diogenes' syndrome) were combined, selecting relevant papers and frequently cited references, assessing each one using specific criteria. Its candidacy for consideration for a geriatric syndrome was assessed based on the quality of data in four domains: multifactorial etiology, shared risk factors with other geriatric syndromes, association with functional decline, and association with increased mortality. The 54 articles reviewed included 24 case series, 13 theoretical articles, 11 observational studies, and six reviews; these were of highly variable methodological quality. The strongest evidence that self-neglect may be a geriatric syndrome includes its often multifactorial etiology, its clear independent association with increased mortality, and the fact that two other geriatric syndromes (cognitive impairment and depression) are risk factors for self-neglect. Self-neglect in older adults is a prevalent problem that appears to have at least some features of a geriatric syndrome. Insofar as the concept of geriatric syndrome has been a useful clinical and research paradigm to create interventions for vulnerable older adults, and no such strategies are available for this vexing and understudied clinical problem, future research is warranted in this area.

ObjectivesSelf-neglect in older adults has become an important public health issue and is associated with negative health outcomes and increased morbidity and mortality. Social support has been recognized as a prominent predictor of self-neglect, but the underlying mechanism is unclear. This study aims to investigate and illustrate the associations among social support, psychological capital, and self-neglect.MethodsThis study used a cross-sectional convenience sampling design. A total of 511 older adults were recruited in Chinese communities. Spearman’s correlation coefficient and hierarchical multiple regression analysis were performed to assess the influencing factors of self-neglect. A structural equation model was applied to test the hypothesized mediation model.ResultsSocial support and psychological capital were found to be negatively related to self-neglect. Social support and psychological capital explained 5.1 and 11.9% of the incremental variances of older adults’ self-neglect, respectively. Psychological capital acts as a mediator between social support and self-neglect.ConclusionSelf-neglect among older adults is a rising problem in China. Social support and higher psychological capital could decrease the risk of self-neglect in older adults. It is crucial to improve social networks and facilitate psychological interventions to reduce such self-neglect.

Self-neglect in older adults is a complex phenomenon characterized by inattention to health and hygiene, typically stemming from an inability or unwillingness to access potentially remediating services. Some aspects of self-neglect clinically resemble geriatric syndromes (e.g., falling, incontinence). The literature on self-neglect was comprehensively reviewed and its quality evaluated in the context of considering its candidacy for a geriatric syndrome. MEDLINE (1966-2004) was searched using self-neglect as a keyword. Using a "snowball" sampling strategy, associated terms (e.g., Diogenes' syndrome) were combined, selecting relevant papers and frequently cited references, assessing each one using specific criteria. Its candidacy for consideration for a geriatric syndrome was assessed based on the quality of data in four domains: multifactorial etiology, shared risk factors with other geriatric syndromes, association with functional decline, and association with increased mortality. The 54 articles reviewed included 24 case series, 13 theoretical articles, 11 observational studies, and six reviews; these were of highly variable methodological quality. The strongest evidence that self-neglect may be a geriatric syndrome includes its often multifactorial etiology, its clear independent association with increased mortality, and the fact that two other geriatric syndromes (cognitive impairment and depression) are risk factors for self-neglect. Self-neglect in older adults is a prevalent problem that appears to have at least some features of a geriatric syndrome. Insofar as the concept of geriatric syndrome has been a useful clinical and research paradigm to create interventions for vulnerable older adults, and no such strategies are available for this vexing and understudied clinical problem, future research is warranted in this area.

Self-neglect in older adults is an increasingly prevalent, poorly understood problem, crossing both the medical and social arenas, with public health implications. Although lacking a standardized definition, self-neglect is characterized by profound inattention to health and hygiene. In light of the aging demographic, physicians of all specialties will increasingly encounter self-neglectors. We outline here practical strategies for the clinician, and suggestions for the researcher. Clinical evaluation should include attention to medical history, cognition, function, social networks, psychiatric screen and environment. The individual's capacity is often questioned, and interventions are case-based. More research is needed in basic epidemiology and risk factors of the problem, so that targeted interventions may be designed and tested. The debate of whether self-neglect is a medical versus societal problem remains unresolved, yet as health sequelae are part of the syndrome, physicians should be part of the solution.

Cel badania: W analizach nierówności społecznych coraz większą uwagę poświęca się wykluczeniu społecznemu. Celem prezentowanej pracy było określenie związku między wykluczeniem społecznym a ryzykiem zaniedbania/samozaniedbania w starszym wieku. Za Giddensem (2009) wyróżniono cztery wymiary wykluczenia społecznego.Metodologia badania: Do analizy ilościowej wykorzystano dane pochodzące z próby losowo wybranych osób w wieku 65+ (1634 obserwacji), mieszkańców województwa małopolskiego. Zaprezentowane w tekście modele regresji logistycznej skupiały się na związku pomiędzy różnymi aspektami wykluczenia społecznego a zaniedbaniem/samozaniedbaniem osób starszych.Wyniki: Spośród wszystkich analizowanych wymiarów wykluczenia społecznego jedynie subiektywne ubóstwo i słaba sieć społeczna były istotnie powiązane z prawdopodobieństwem zaniedbania. Brak wystarczającej ilości pieniędzy na zaspokojenie własnych potrzeb i posiadanie mniejszej sieci społecznościowej zwiększały ryzyko bycia zaniedbanym. To ostatnie wiązało się również z samozaniedbaniem. Obiektywne ubóstwo także zwiększało ryzyko samozaniedbania.Dyskusja/wnioski: Wykluczenia w starszym wieku ma wpływ na stan zdrowia, jakość życia i wzorce umieralności. Dyskutowane jest także w kontekście wykrywania i zapobiegania krzywdzeniu i zaniedbywaniu osób starszych. Zaniedbanie/samozaniedbanie w starszym wieku są nadal trudne do rozpoznania. Przedstawione wyniki mogą być pomocne w identyfikacji grup szczególnie wrażliwych i dostosowaniu interwencji, aby pomóc osobom starszym pozbawionym opieki, szczególnie narażonym na zaniedbanie i samozaniedbanie.

Self-neglect in older adults: an evolutionary concept analysis

The role of frailty, social networks, and depression in self-neglect in an older Chinese population: A cross-sectional descriptive study

Self-neglect is a pernicious problem and represents the most common type of report investigated by adult protective services (APS). Calls for culturally competent approaches to addressing self-neglect in older adults have been undermined by the lack of research on racial/ethnic group differences and how they may vary across communities. Analyses of 101,015 reports of self-neglect among people 65+ years old validated by the Texas APS system from 2021 through 2023 found the incidence was nearly twice as high for (non-Hispanic) African Americans as for other older adults (IRR=1.91, 95%CI: 1.88, 1.94), whereas the difference for Hispanics was modest (IRR=0.95, 95%CI: 0.93, 0.96). Stratified analyses, however, found marked variation across the state’s 11 regions. In rural regions of West Texas, the higher reporting rates for African Americans were especially pronounced: three to four times the rates for other older adults. And in rural regions of East Texas, reporting rates for Hispanics were only one half to one third those of other older adults. Less variation was observed across major metropolitan regions. Further analyses assessed how regional population demographics and the racial/ethnic composition of APS staff may explain these divergent results. Efforts to understand and address racial/ethnic group differences in self-neglect should reconsider the propriety of describing groups as “underserved” when they may be disproportionately more likely to be investigated by APS. When addressing self-neglect in a diverse client population, agencies should consider the background of staff and whether distinct approaches for are needed in rural areas.