Dr. Mary Rose Day presented on mental health and self-neglect in older people. Self-neglect is complex with multiple contributing factors including mental health issues, cognitive impairment, personality traits, life experiences, and physical health. Studies show prevalence of self-neglect increases with age and is associated with poorer quality of life, depression, alcohol abuse, and adverse health outcomes like increased mortality. Assessment of self-neglect requires evaluating domains like environment, social networks, emotional/behavioral traits, health avoidance, and self-determinism. Early identification and intervention are important to reduce negative consequences of self-neglect.

1. Mental Health and Wellbeing of
Older People: Self-Neglect
All Ireland Gerontological Nurses Association, (AIGNA) 8th
Annual Conference Mental Health & Wellbeing for Older People“
5th May 2016
Crown Plaza Hotel Dundalk
Dr. Mary Rose Day, DN, MA, HDip PHN, BSc ,
DipMang, RPHN, RM, RGN:

2. Objectives
Give some stories of cases
Discuss definitions of self-neglect
Mental Health Issues and Self-Neglect
Adverse outcomes and self-neglect
Assessment of Self-Neglect
Conclusion

3. Policy
• “Self-neglect: this
covers a wide range of
behaviour neglecting to
care for one’s personal
hygiene, health or
surroundings and
includes behaviour such
as hoarding” (DH 2014,
p234)
• the inability or
unwillingness to
provide for oneself the
goods and services
needed to live safely
and independently”
(HSE, 2014, p. 44).

4. • Diogenes of Synope Greek
Philosopher (323 – 412 BC)
• Scorned and rejected material
wealth & possessions
• life according to nature
• self-sufficiency
• lack of shame
• contempt for social organization
Diogenes Syndrome

5. Men
• 9.5% (65-74 years)
• 9.2% (75-84 years)
• and 10.1% (over 85 years).
Women
• 8.5% (65-74 years)
• 7.9% (75-84 years)
• and 7.5% (over 85 years).
Prevalence of Self-Neglect (Dong et al., 2012)
Assessed 5 domains: hoarding; poor basic personal hygiene; need of
repairs to the house; unsanitary conditions and inadequate utilities.
House needing repairs was the most common form, followed by hoarding,
while inadequate utilities were the least common.

6. Self-Neglect and Mental Health
• Chronic illness i.e. dementia and depression
• Cognitive impairment
• Impaired Executive Functioning (EF)
• EF is associated with frontal lobe dysfunction and
Alzheimer’s disease.
• Life long inequalities: poverty, violence and abuse
• Prevalence higher in older people with less
education on low income
(Abrams et al. 2002, Paveza et al. 2008, Dong et al. 2010, Dong, 2016)

7. Personality Traits and Self-Neglect
• A population based study Chicago Health Ageing Project
(CHAP) subset of suspected of self-neglect cases
(N=1802).
• NEO personality inventory (Cost & Crae, 1992)and the
Need for Cognition Scale (Cacioppo, Petty & Kao 1982).
• Personality traits were not associated with greater
self-neglect severity.
Dong, X., Simon, M., Wilson, R., Beck, T., McKinell, K., & Evans, D. (2011). Association of
Personality Traits with Elder Self-Neglect in a Community Dwelling Population. The American
Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric
Psychiatry, 19(8), 743–751

8. Quality of Life & Well Being
• Greater self-neglect severity associated with
lower health status, higher number of
unhealthy days, poorer physical health and
more days away from usual activities.
• Poorer Quality of Life was significantly
associated with greater risk for all self-neglect
(mild/moderate/severe).
Dong, X. (2014) Self-neglect in an elderly community-dwelling U.S. Chinese population: findings from the Population Study of Chinese
Elderly in Chicago study. Journal of the American Geriatric Society 62(12):2391-7.
Dong X., Simon M., Beck T. & Evans D. (2010b) A cross-sectional population based study of elder self-neglect and psychological, health, and social
factors in a biracial community. Aging and Mental Health 14(1), 74–84.

9. Depression
• Self-neglecting adults had a significantly higher prevalence
of depression when compared to older adults who were
referred for other forms of abuse (Dyer et al. 2000)
• Matched case-controls, elder self-neglecters (n= 91) higher
depression scores (GDS-short form) than those who were
non self-neglecters (Burnett et al. 2006)
• Alcohol abuse, lower self-rated health, and higher self-
reported pain intensity were associated with depression in
self-neglecting older adults (Hansen et al. 2016).

10. Alcohol Abuse and Self-Neglect
• More common in self-neglecting older adults
(Blanco et al., 2012; Merrick et al., 2008)
• Associated with people who self-neglect (Bozinovski
1995, Payne & Gainey 2005, Kutame 2007, Gregory et al. 2011, Day et al. 2013).
• Predictive of higher recidivism rates to APS
(Blondell, 2000; Choi & Mayer, 2000; Spensley, 2008)
• Problematic alcohol abuse (19.3% n=311) (Dyer
et al. 2007)
• Alcohol misuse that led to self-neglect more
challenging (Sullivan et al. 2014).

11. Cognition
• A study of Chinese older people reported a
correlation between lower MMSE score and greater
self-neglect severity, and found an increased
prevalence of mild self-neglect (34.1%) and
moderate/severe self-neglect (14.1%) in those who
had lower cognitive function based on MMSE scores
less than 22 when compared to those who had
MMSE scores greater than 26 (17.4% and 5.4%
respectively) (Dong, 2014).

12. Cognitive Function
• Global cognition as measured by MMSE was normal in
80% of participants and did not identify impairments in
executive functioning (poor EXIT 25 performance: 53%
poor CL0X1 performance) (Schillerstrom et al. 2009)
• Results found that a decline in EF scores were
independently associated with greater risk of reported
ESN and self-neglect severity (Dong et al. 2010)
• EF may be an important factor in older adults who self-
neglect (Pickens et al. 2014)

13. Characteristics of Executive
Dysfunction
• Inability to complete complex cognitive
tasks (i.e. managing finances, identifying
dangerous situations)
• Inability to maintain adequate hygiene
or self-administer medications
(Royall et al., 2005, Dyer et al., 2007)

14. Risk Factors: Executive Functioning
• Cognitive impairment (e.g., depression, dementia, executive
dysfunction)
• Multiple morbidities (cardiovascular disease, hypertension,
diabetes, malnutrition, etc.)
• Poor/reduced social networks, living alone
• Poverty, poor economic circumstances & deprivation
• Traumatic life history (e.g., abuse in early years, bereavement,
divorce, chaotic lifestyles due to mental health issues, and drug
or alcohol abuse)
• Poor coping
• Older age and mental status problems strongly associated with
global neglect behaviours
(Bozinovski 2000, Burnett et al. 2006, 2014, Choi et al. 2009, Gibbons 2009, Lauder et al., 2009).

15. Adverse Outcomes
Vulnerable self-neglecting adults are characterized by
profound and chronic negative sequelae, including:
• significantly greater mortality (Dong et al., 2009)
• hospitalization (Dong, Simon, & Evans, 2012b, Dong et al., 2012c; Dong & Simon, 2015)
• hospice use (Dong & Simon, 2013)
• nursing home placement (Lachs et al., 2002)
• elder abuse (Dong et al., 2013)
• and risk for homelessness (Snowdon, 2011).

16. Policy, Legislation & Research
Evidence

17. Self-Neglect Assessment Measure (Day &
McCarthy, 2016)
Self-Neglect
Environment 12 items
Social
Networks
7 items
Emotional &
Behavioural
Liability
8 items
Health
Avoidance 6 items
Self-
Determinisim
4 items

18. Conclusion
• Self-neglect is a growing serious, and complex public
health issue
• Characterized by a complex interplay of mental health
and biopsychosocial risk factors and predictors.
• Mental health issues are associated with and significant
risk for self-neglect
• Self-neglecting older adults at risk for serious adverse
outcomes
• An objective assessment measurement tool has potential
to reduce or prevent negative health outcomes.

19. References
• Day, M.R. McCarthy, G. (2016) Self-Neglect: Development and Evaluation
of a Self-Neglect (SN-37) Measurement Instrument Archives of Psychiatric
Nursing manuscript Available at:
http://www.sciencedirect.com/science/article/pii/S0883941716000492
• Day, MR. (2016) Elder Self-Neglect Chapter 2 In Nursing Concept Analysis:
Applications to Research and Practice Joyce J. Fitzpatrick, & Geraldine
McCarthy (Eds) Springer: New York
• Day, M.R. McCarthy, G. (2015) A national cross sectional study of
community nurses and social workers knowledge of Self-Neglect. Age and
Ageing, 44(4), 717-720. doi: 0.1093/ageing/afv025
• Svanberg, I., & Arluke, A. (2016). The Swedish Swan Lady. Society &
Animals, 24(1), 63-77. doi:10.1163/15685306-12341388