Vulnerable Elders

Abstract

IN 2004, STATE-LEVEL ADULT PROTECTIVE SERVICE AGENcies across the United States received more than 600 000 reports of elders who were in need of protection. The New York City Department of Aging estimates 50 000 cases of elder mistreatment in the boroughs, even though only 1600 instances are reported. Some elders experience physical abuse, caregiver neglect, and financial exploitation, but the most common report to adult protective service agencies in the United States is self-neglect, a syndrome that afflicts vulnerable older adults who are not able to meet basic needs. Self-neglect, often discounted as a harmless peculiarity of old age, is actually an independent risk factor for early death. Elders neglecting themselves usually live alone. They display behaviors such as piling garbage inside the home, allowing food to spoil, failing to maintain utilities in the home, ignoring serious medical issues, and even lying in their own excrement. In most jurisdictions, elder self-neglect is a reportable form of elder mistreatment, as are physical abuse, caregiver neglect, and financial exploitation. Americans are fiercely independent, a highly valued personal trait respected by most health care professionals. In some instances, however, when older persons no longer can care for themselves, their personal health, well-being, and even their lives are at risk. Research is needed to develop evidence-based screening tools so that clinicians and their caregiving teams know when and how to intervene. Title XX of the Social Security Act, passed in 1974, mandates states to develop and maintain protective service agencies for senior citizens. Since 1981, each state has established its own agency dedicated to protecting vulnerable older persons. By law, these agencies are charged with receiving reports of suspected abuse from family members and persons known by elderly individuals, conducting investigations, and delivering services to elderly individuals whose cases are substantiated. However, the characteristics underlying causes and effects of self-neglecting behavior are poorly defined and not well understood. Unsafe Environments