Development of a Conceptual Framework for Severe Self-Neglect (SN) by Modifying the CREST Model for Self-Neglect

Abstract

Self-neglect is an inability or refusal to meet one's own basic needs as accepted by societal norms and is the most common report received by state agencies charged with investigating abuse, neglect and exploitation of vulnerable adults. Self-neglect is often seen in addition to one or multiple conditions of frailty, mild to severe dementia, poor sleep and depression. While awareness of elder self-neglect as a public health condition and intervention has significantly risen in the past decade as evidenced by the increasing amount of literature available, research on self-neglect still lacks comprehensiveness and clarity since its inception to the medical literature in the late 1960s. With the burgeoning of the older adult population, commonness of self-neglect will most likely increase as the current incidence rate represents only the “tip of the iceberg” theory given that most cases are unreported. The COVID-19 pandemic has exacerbated the incidence of self-neglect in aged populations and the need for the use of intervention tools for aging adults and geriatric patients living alone, many of which may include in-home artificial intelligence systems. Despite this, little research has been conducted on aspects of self-neglect other than definition and identification. Substantial further study of this disorder's etiology, educating society on early detection, and conceivably preventing this syndrome altogether or at least halting progression and abating its severity is needed. The purpose of this research is to provide a definition of severe self-neglect, identify key concepts related to self-neglect, comprehensively describe this syndrome, present a conceptual framework and analyze the model for its usefulness, generalizability, parsimony, and testability.

Meeting the challenges in conducting research in vulnerable older adults with self-neglect-notes from a field team

“…To help broaden the definition, Pickens et al ( 21 ) recently published a definition for severe self-neglect as “an unawareness to the hazardous and progressive decline in personal, social, physical, mental and/or environmental domains leading to the inability to maintain culture and community standards of acceptable living that threatens one's own safety, health and quality of life”. From a research perspective, adding this definition to a study, helps understand the target population better and perhaps how to navigate associated challenges with recruitment and consent.…”

“…Cognitive impairments are common among older adults who experience self-neglect. Impairments can result from dementia, depression, psychiatric illnesses, substance abuse, or simply aging and may hinder informed consent procedures ( 21 ) as well as data collection. Short-term memory problems are the most common issues encountered with trying to study this population.…”

Postmenopausal giant ovarian tumor: a rare case report and literature review

“…Therefore, regular gynecological examinations and early diagnosis are particularly important for women. In addition, the patient was ashamed of or embarrassed about her image change caused by the abdominal mass, resulting in severe self-neglect 9 . Even though she could no longer maintain a normal life, and her family members repeatedly persuaded the patient to seek medical treatment as soon as possible, she still refused medical treatment and social help.…”

Prevalence and correlates of elder neglect in the community-dwelling Chinese population: New evidence from the CLHLS study

“…There is still no clear and unifying concept of EN; the definition may differ because of socioeconomic or medical factors in different regions and countries. We refer to the conceptual framework for the etiology of self-neglect presented in previous studies and combined it with the contents of the CHLHS questionnaire to screen for EN-related factors for inclusion in our analysis ( 6 , 7 ). In our study analysis, we divided elder neglect into three domains, namely, self-neglect, family neglect, and social neglect.…”

“…The primary outcomes of EN include the following three aspects: abnormal living status, impaired interpersonal relationships, and poor health outcomes. Self-neglect generally manifests itself as an older person who cannot perform daily living tasks, has poor personal hygiene and sanitation, and refuses to receive medical and social assistance ( 6 ). Poor living conditions and hygiene-related health problems are frequently encountered.…”