Ethical Perspectives on Self-Neglect Among Older Adults

Abstract

Self-neglect is a serious and growing problem among older adults. A 2004 survey from Adult Protective Services (APS) showed that adults age 60 or older were named in 85,000 reports of self-neglect from 21 states (Naik, Lai, Kunik, & Dyer, 2008; Teaster, Dugar, Mendiondo, Abner, & Cecil, 2006). Although rehabilitation nurses are obligated to uphold the autonomy of older adults and strengthen their independence, dilemmas result when people's poor health behaviors put them or others at risk for negative consequences. When making decisions about nursing actions related to self-neglecting elderly people, the basic principles of autonomy, beneficence, nonmaleficence, and capacity must be considered. The purpose of this article is to discuss major ethical perspectives related to self-neglect among older adults.

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

“…Elder self‐neglect research is ethically complex because it is inherently related to autonomy, intentionality, and capacity, and may require taking action that limits independence (Mauk, ; Naik et al, , Naik, Teal et al, ; Torke & Sachs, ). Also, those who lack capacity for informed decision making may not be appropriate study subjects.…”

“…Understanding the possible origin of this phenomenon, as well as the impact of impairments, is likely to improve outcomes. Thoughtful consideration and review of the subject will ensure efficient ethical practice, which balances beneficence with autonomy (Mauk, ).…”

Prevalence and Risk Factors for Self-Neglect among Older Adults Living Alone in South Korea

“…Over the last few decades, extensive research of the topic of elder selfneglect has uncovered numerous risk factors, including living alone, advanced age (> 75 years old), poverty, psychiatric illness, physical function impairment, reduced cognitive capability, dementia, cerebrovascular disease, depression, chronic illness, nutritional deficiency, alcohol and substance misuse, lack of social network, or inadequate support services (Abrams, Lachs, McAvay, Keohane, & Bruce, 2002;Band-Winterstein et al, 2012;Day & Leahy-Warren, 2008;Dong, Simon, & Wilson, 2010;Levine, 2003;Mauk, 2011;Paveza, Vandeweerd, & Laumann, 2008;Pavlou & Lachs, 2006).…”

Etiology and Management of Elder Self-Neglect

“…Within the social domain, there are multiple factors that potentially contribute to ESN, ranging from social isolation to financial hardship. Mauk () cited social isolation as an important criterion for ESN, whereas Iris et al () asserted that living arrangement is the single most important predictor of ESN. When an older adult is living alone, he or she is at greater risk for limited access to needed support services because of the inability to complete the tasks needed to obtain them.…”

“…In essence, there is a higher value placed on individual and community welfare than individual autonomy. Additionally, there may be incidences where the ethical obligation to respect an older adult's autonomy conflicts with the ethical principle of “do no harm” (Mauk, ).…”