Narratives of Self‐Neglect: Patterns of Traumatic Personal Experiences and Maladaptive Behaviors in Cognitively Intact Older Adults

Abstract

Background/Objectives Self-neglect is a complex, poorly understood public health problem associated with high morbidity and mortality. Previous qualitative research is limited to small samples and second-hand accounts, with a dearth of self-reported, comprehensive narratives in the geriatric population. Our goal was to identify patterns of personal experience or behavior in self-neglect by exploring narratives of cognitively intact older adults. Design/Setting/Participants We used qualitative data from a larger parent study of self-neglect characteristics. For our analysis, we evaluated interviews with 69 cognitively intact, self-neglecting older adults referred from 11 community-based senior services agencies. Measurements Interviews included a comprehensive psychiatric assessment using the Structured Clinical Interview for DSM-IV Axis-I and II Disorders (SCID-I and II), and an unstructured interview that allowed subjects to describe important elements of their life stories. We used content analysis to identify key personal experiences and behavior patterns within each subject's narrative. Results We identified 4 traumatic personal experiences and 5 behavior patterns in the life stories. Traumatic personal experiences included: psychologically traumatic loss, separation or abandonment (29%), violent victimization, physical trauma or sexual abuse (19%), exposure to war or political violence (9%) and prolonged mourning (7%). Maladaptive behavior patterns included: significant financial instability (23%), severe lifelong mental illness (16%), mistrust of people or paranoia (13%), distrust and avoidance of the medical establishment (13%), and substance abuse or dependence (13%). Conclusion Patterns of traumatic personal experiences and maladaptive behaviors frequently reported among self-neglecters were identified. Experiences, perceptions, and behaviors developed over a lifetime may contribute to elder self-neglect. Further exploration and improved understanding of these patterns may identify potential risk factors and areas for future targeted screening, intervention, and prevention.

The Abrams geriatric self‐neglect scale: introduction, validation and psychometric properties

“…Eighty‐five percent ( N = 60) had a primary care physician. Additional clinical information derived from the original interviews is published elsewhere (Pavlou et al, ; Lien et al, ).…”

“…A growing and probably under-reported syndrome (Dong et al, 2012a;Boothroyd, 2014), self-neglect is especially consequential in the elderly, in whom it has been associated with adverse health outcomes, among them higher rates of hospitalization (Dong et al, 2012b), mortality (Dong et al, 2009), depression (Abrams et al, 2002), and misuse of prescription medicines (Culberson et al, 2011). Etiologically, self-neglect in later life has been linked to childhood or adolescent traumas (Lien et al, 2016). Older self-neglectors are often unable or unwilling to accept responsibility for their circumstances, a deficit in insight that may exacerbate their distress (Rathborn-McCuan and Fabian, 1992).…”

Associação Entre Maus-Tratos Na Infância E Declínio Cognitivo No Idoso: Uma Revisão Integrativa

“…Foram identificados padrões de experiências pessoais traumáticas e comportamentos desadaptativos, relacionados à autonegligência. 19 Dessa forma, experiências, percepções e comportamentos desenvolvidos ao longo da vida podem contribuir para a autonegligência dos idosos. Nesse contexto, foi evidenciada a associação entre a violência sexual, negligência e autonegligência e mudanças na função cognitiva de idosos.…”

Análisis de la autonegligencia en las personas mayores [Analysis of elder self-neglect]

“…Aunque no existe un acuerdo unánime en los resultados, las investigaciones sobre factores de riesgo han relacionado la autonegligencia con la fragilidad, la hipertensión, las deficiencias nutricionales, la depresión, la demencia, los déficits en la función ejecutiva, Carmen Touza INTERVENCIÓN PROFESIONAL las dificultades para el desarrollo de actividades de la vida diaria, las dificultades para el desarrollo de actividades instrumentales, el consumo de alcohol u otras drogas, haber mostrado comportamientos autonegligentes en otros momentos anteriores a la vejez, haber vivido experiencias traumáticas (malos tratos, ser veterano de guerra, etc. ), vivir solo, la falta de apoyo social, la pobreza y otras variables sociodemográficas como la edad (ser mayor de 80 años) y el nivel educativo (nivel educativo bajo) (Day et al, 2015;Dong, 2016;Dyer et al, 2007;Hildebrand et al, 2014;Lee et al, 2016;Lien et al, 2016;Wilkins et al, 2014).…”