How to Recognize and Intervene (Gently!) in Elderly Self-Neglect

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Many family members understand how to recognize and report neglect or abuse of their loved ones. What might be less noticeable are the signs of self-neglect; some caregivers may not even know how to spot it at all. When they do, they may feel powerless to address it productively with their loved ones. Below are some of the common and more noticeable signs and symptoms of self-neglect in the elderly. There are also tips for addressing the issue.
Signs and Symptoms Of Self-Neglect
Self-neglect, like neglect caused by others, happens when seniors do not complete the activities of daily living on their own, or they deeply resist help in doing so. They may want to “skip” important medications, doctor’s appointments, baths, or meals. Some seniors even neglect themselves financially and avoid paying bills or signing important documents. It is important to keep in mind that seniors who behave this way are sometimes not in complete control of their actions, especially if they are experiencing cognitive difficulties and decline. In fact, self-neglect is how some caregivers realize that something may be wrong with their loved one’s cognitive health.
If an elderly loved one begins exhibiting behaviors that seem unusual and are potentially endangering the person’s health, some gentle ways to address it are listed below.

Risk Factors

If an elderly person is socially isolated, experiencing cognitive decline (such as dementia or another kind of memory or communication-impairing disease), is suffering from chronic pain, or is diagnosed with depression, the person is at risk for self-neglect. If an elderly person appears to be neglecting him- or herself, it may be due to the above conditions. Contact a doctor to see if there are medical avenues for getting the person the help he or she needs. Physicians are able to distinguish between a temporary change in behavior and a state of emergency requiring action. They are often excellent partners in getting appropriate help.

How to Bring Up the Subject

It is not easy to tell elderly loved ones that they are not taking proper care of themselves. Most seniors have spent their entire lives engaging in self-care. They can feel victimized or attacked by those who suggest they are not doing so now. The most important thing to do when bringing this up is to remember that the person is in a delicate state, and is likely battling emotions over his or her state of care.

Be A Friend

Rather than expressing shock, disgust, frustration, or anger, it is important to be sensitive to all possible responses and check in more generally. It is well to ask how the person is dealing with any chronic illness, such as diabetes or arthritis; to call and inquire about social activities, or to ask how happy the person is living in his or her current home. It is good to try to offer companionship that might lead to witnessing daily routines and being able to gently “remind” the person about important daily activities of self-care. Sometimes people just need to know that someone is making sure they are okay.
If small, extremely gentle prompts do not help, try addressing the concern in objective and non-judgmental language such as “I have noticed this behavior—is everything okay with you today/this week/month?” Make sure language is devoid of adjectives, as in“You are taking poor care of yourself—why?” or “Why aren’t you taking better care of yourself?” By removing negative language, the person may feel empowered to seek solutions.
If a loved one gets upset and refuses to make changes or discuss the situation, get a physician’s help immediately. The elderly person may need to be evaluated for mental and emotional health conditions. These could endanger life if left untreated. Balancing emotions with the obvious need to prioritize health can be difficult. Objective parties can help.
Caregivers need gather as many resources as possible before addressing the issue, and be ready for emotions to run high. Family members and caregivers do well to continue to advocate for the elderly ones they care for. This includes getting medical attention when necessary.

Sources

Boothroyd, Kaaren. (October 9, 2014). Elder Self-Neglect Is a Growing and Largely Hidden Problem. American Society on Aging. Available at http://www.asaging.org/blog/elder-self-neglect-growing-and-largely-hidden-problem. Retrieved September 5, 2016.
Graham, Judith. (July 10, 2013). Unable to Cope, Unwilling to Accept Aid. The New Old Age; Caring and Coping. The New York Times. Available at http://newoldage.blogs.nytimes.com/2013/07/10/unable-to-cope-unwilling-to-accept-aid/?_r=0. Retrieved September 5, 2016.
Kaplan, Daniel B., and Berkman, Barbara J. Self-Neglect in Older People. Merck Manual: Consumer Version. Merck & Co., Inc. Available at https://www.merckmanuals.com/home/older-people%E2%80%99s-health-issues/social-issues-affecting-older-people/self-neglect-in-older-people. Retrieved September 5, 2016.
National Committee for the Prevention of Elder Abuse (NCPEA). Neglect and Self-Neglect. Available at http://www.preventelderabuse.org/elderabuse/neglect.html. Retrieved September 5, 2016.

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