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

Abstract

Objective: Self-neglect is an imprecisely defined entity with multiple clinical expressions and adverse health consequences, especially in the elderly. However, research has been limited by the absence of a measurement instrument that is both inclusive and specific. Our goal was to establish the psychometric properties of a quantitative instrument, the Abrams Geriatric Self-Neglect Scale (AGSS). Methods: We analyzed data from a 2007 case-control study of 71 cognitively intact community-dwelling older self-neglectors that had used the AGSS. The AGSS was validated against two "gold standards": a categorical definition of self-neglect developed by expert consensus; and the clinical judgment of a geriatric psychiatrist using chart review. Frequencies were examined for the six scale domains by source (Subject, Observer, and Overall Impression). Internal consistency was estimated for each source, and associations among the sources were evaluated. Results: Internal consistency estimates for the AGSS were rated as "good," with the Subject responses having the lowest alpha and omega (0.681 and 0.692) and the Observer responses the highest (0.758 and 0.765). Subject and Observer scores had the lowest association (0.578, p < 0.001). Using expert consensus criteria as the primary "gold standard," the Observer and Overall Impression subscales were "good" at classifying self-neglect, while the Subject subscale was "fair."Conclusions: The AGSS correctly classified and quantified self-neglect against two "gold standards." Sufficient correlations among multiple sources of information allow investigators and clinicians to choose flexibly from Subject, Observer, or Overall Impression. The lower internal consistency estimates for Subject responses are consistent with self-neglectors' propensity to disavow symptoms.

Self-neglect: a review of opportunities and barriers to federal policy and research priorities

“…Identifying self-neglect is challenging for several reasons, including the lack of research on self-neglect risk factors, the subtlety of signs of self-neglect and the absence of a convenient, reliable tool for assessment (Dong et al , 2011b; Mosqueda and Dong, 2011). Although tools to assess self-neglect exist (Abrams et al , 2018; Dong, 2017; Iris et al , 2014), a lack of consensus on the best approach and variation across states and agencies in how self-neglect cases are handled were reported (Abrams et al , 2018; Burnett et al , 2014). Furthermore, instruments to assess self-neglect focus on different issues, so agencies that use them have information on different aspects of self-neglect.…”

“…Although tools to assess self-neglect exist (Abrams et al, 2018;Dong, 2017;Iris et al, 2014), a lack of consensus on the best approach and variation across states and agencies in how self-neglect cases are handled were reported (Abrams et al, 2018;Burnett et al, 2014). Furthermore, instruments to assess self-neglect focus on different issues, so agencies that use them have information on different aspects of self-neglect.…”

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

“…Of note are the SN-37, the Elder Self-Neglect Assessment, the Abrams Geriatric Self-Neglect Scale, the IMSelf-Neglect questionnaire, and the Chicago Health and Aging Self-Neglect Scale. Many of these scales expand upon the foundation laid by the SSS (6,(74)(75)(76)(77). The SN-37 is an instrument comprised of 37 items separated into 5 factors that contribute to self-neglect: environment, social networks, emotional and behavioral liability, health avoidance, and self-determinism.…”

“…The items are prescription medications, personal care, nutrition, environment/housing, financial stewardship, and socialization. The supporting questions help determine a score for each item of 0-4 for a total score range of 0-24, 0 meaning a complete absence of self-neglect and 24 meaning the most severe selfneglect (76). Given that the AGSS also does not classify which range of scores indicate mild, moderate, or severe self-neglect, the same limitation applies as it relates to this conceptual framework.…”

Adaptation and validation of the Abrams geriatric self‐neglect assessment scale among older Chinese people admitted to the hospital

“…There are multiple tools available for assessing elder self‐neglect, such as the Elder Self‐Neglect Assessment (ESNA) (Iris et al, 2014), Self‐Neglect‐37 (SN‐37) (Day & McCarthy, 2016), Abrams geriatric self‐neglect scale (AGSS) (Abrams et al, 2018) and Self‐Neglect Questionnaire (IMSelf‐neglect) (İlhan et al, 2020). However, most self‐neglect assessment instruments are other‐rated scales (Xu et al, 2021), which require estimators (including caregivers, family members and professionals) to have a thorough understanding of the older person or to conduct an on‐site investigation of the person's living environment or habits.…”