What’s Self-Neglect in Older Adults? 9 Signs

Updated

Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

Self-neglect is a serious problem that may start off unnoticed until it gets out of hand. As a family member of someone who shows signs of self-neglect, it can be challenging to know when to intervene. Your standards might be different than those of your parent or another older adult, and you may not want to intrude.

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In many cases, the best prevention is planning for the unexpected. Long-term care planning should begin as soon as possible including healthcare and financial powers of attorney. If you wait too long, problems can mount, making it very difficult to intervene with someone who is resistant and defiant. Without some legal authority, you won’t be able to get healthcare or financial information.

Start to look for the signs of self-neglect to assess the situation early and help your family member regain control.  

What’s Self-Neglect in Aging Adults?

Self-neglect is the inability of an individual to attend to their basic needs. The causes of self-neglect can be dementia, mental illness, general decline, alcohol or drug use, depression, and delirium. Aging adults are at greater risk for self-neglect due to functional decline, cognitive impairment, and isolation.

Some degree of self-neglect is not uncommon with older adults as they become more frail and are unable to attend to their activities of daily living. Self-neglect turns into an issue when an older adult has persistent and growing problems with taking care of themselves.

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How Can Self-Neglect Impact Aging Adults and Their Loved Ones?

Self-neglect can have devastating emotional and physical impacts on aging adults and their loved ones. No one starts out wanting to self-neglect to the point of pain, suffering, and physical deterioration. If no one intervenes, an older adult who self-neglects can experience many problems. For example, increasingly poor health can result in hospitalization due to dehydration and malnutrition, or other medical problems.

Other problems include the following:

  • Pressure ulcers from the inability to get out of bed
  • Worsening of pre-existing medical and cognitive conditions
  • Exacerbation of mental health problems like depression and anxiety
  • Excessive alcohol and drug abuse or misuse of prescription medications
  • Inability to manage day-to-day activities and self-care due to irrational thinking and poor judgment
  • Poor balance, increasing the risk of falls.
  • Vulnerability to scams and other forms of financial exploitation
  • Unpaid bills and poor financial management
  • Dangerous conditions in the home due to neglect of maintenance issues

For loved ones who encounter an aging adult self-neglecting, the anguish and confusion about what to do can be overwhelming and ultimately frustrating. It is common to feel guilty and shame for not intervening at an earlier point, in addition to communicating with an aging adult who may refuse your help and clean-up efforts.

Unfortunately, unless things have deteriorated to the point of needing to intervene legally, the existing medical and social systems in place may not be able to help you if your parent or family member is resistant to intervention. 

Keep in mind as well that as a responsible family member, you may be held accountable for their actions. A neighbor or other concerned person could report you to Adult Protective Services if they feel you haven’t taken steps to help. Document your efforts just in case.

What Are the Signs of Self Neglect?

There are several generally accepted signs of self-neglect. One sign alone may or may not be cause for concern. It will depend on how bad it is and if a particular sign causes health problems or compromises safety.

The signs of self-neglect are only evident if you actually know what is going on with your loved one. If you haven’t visited in a while, watch out for these red flags so you can take stock of the situation and intervene if necessary.  

1. Hoarding

You may have a family member who has always been a bit of a hoarder, but things have worsened as they have aged. Hoarding is a serious problem because it contributes to an unsafe and unsanitary environment. It contributes to falling risk, encourages vermin and insects, and increases fire potential.

People hoard everything from animals to mail and magazines and newspapers. It is not unheard of for a hoarder’s home to be so bad that there is a very narrow walkway to get around the house. Stacks of papers and garbage can reach the ceiling.

The challenge of hoarding disorders is that hoarders experience extreme distress at the thought of someone throwing anything away. Hoarding can be a very complicated problem to manage.

2. Poor hygiene

As adults age, they often don’t take as many showers as they used to. Poor hygiene is not the same as reducing bathing to three times a week. It is much more severe than that. Poor hygiene refers to not bathing at all, or very infrequently. Clothes aren’t washed, and someone with poor hygiene can have a very powerful body odor and soiled clothes. 

Poor hygiene can lead to other medical problems like urinary tract infections, head lice, ringworm, diarrhea, and other serious problems.

3. Malnutrition and dehydration

If an older adult shows signs of malnutrition, they aren’t eating and it may be because of cognitive decline. Malnutrition is most common in people with dementia who aren’t able to organize shopping for food or cook a meal. A malnourished person will have weight loss, weakness, and fatigue. 

However, dehydration can also occur in older adults who do not have self-neglect. As people age, they lose their thirst mechanism. Dehydration occurs along with one or more of the other signs mentioned for a person who self-neglects. Severe dehydration can result in hospitalization.

4. Medical neglect

If you have a loved one who refuses to go to the doctor, you are not alone. But does this problem suggest self-neglect? It depends. An occasional refusal to go to the doctor is probably not that serious. Repeated rejection of medical treatment that is considered urgent or life-sustaining is a more serious matter.

Here are some examples of medical neglect:

  • Refusing to take medications or mismanaging medications
  • Refusing surgery or other medical interventions 
  • Neglecting oral and eye care to the point that it interferes with functioning

5. Neglected home maintenance

Some neglected home maintenance is within normal limits, but self-neglect is when things reach a point where safety is an issue. Examples of this include the utilities being turned off because bills aren’t paid. Or unattended structural problems that make the home a safety hazard. Leaving the stove on, or the doors unlocked are other red flags that someone is unable to care for themselves. 

If bills aren’t paid, look into your loved one’s finances. They may not be able to manage bill paying any longer. Or perhaps they are being exploited by criminals through scams and fraud.

6. Lack of food and other essentials

Not having enough food to eat, clothes to wear, and other daily essentials is self-neglect that can lead to medical complications.

For people who wander outside in the cold and are unaware of the weather, not dressing properly can have life-threatening consequences. 

7. Living in squalid and unsafe conditions 

Living in squalid conditions is a combination of lack of home maintenance, hoarding, and other problems connected with neglecting to keep a home safe.

Dirt, debris, clutter, spoiling food are all signs of squalid conditions.

8. Too many animals

Having too many animals to care for and continuing to get new ones could be a sign of hoarding.

The inability to care for lots of animals can also contribute to unsanitary conditions and health risks for the individual. Animals under these circumstances may starve or have untreated diseases.

9. Increasing isolation

As people self-neglect, they often start to isolate. It is a vicious cycle where someone is ashamed of their appearance and household so they cut off contact with others.

Isolation can exacerbate cognitive decline and lead to depression, which leads to further isolation.

How Can You Prevent Self-Neglect in an Aging Loved One?

It is far easier to try and prevent self-neglect than deal with it once it is out of control. You are busy and have your own life and issues to deal with, but rationalizing some of the signs of self-neglect is kicking the can down the road. Let’s take a look at the steps you can take and questions to keep in mind to prevent the self-neglect of an older adult.

Recognize the signs

Recognizing the insidious and gradual signs of self-neglect can make it far easier to intervene. Some of the symptoms of self-neglect may seem like normal aging. Pay attention to problems with keeping the house clean and clutter-free. Is your loved one setting up and taking medications correctly? Are they having difficulty with driving and accessing medical appointments, or getting food? Do you notice unusual weight loss or increasing confusion?

Visit often

If you live close by, visit as often as you can. Calling your loved one and asking how they are doing is likely to bring a response of, “I’m doing just fine.” When you are there, look in the fridge and cupboards to see if there is adequate food. Check on the medications by seeing if there are expired medications and if there is a well organized medication box. Does your loved one appear to have clean clothes and good hygiene?

Hire a care manager

If you don’t live near your loved one, hiring a care manager who can make regular visits can be very beneficial. A care manager can give reports on your loved one’s condition, make recommendations for interventions, and arrange for assistance in the home. A care manager can be your eyes and ears.

Hire in-home caregivers

Starting early on by hiring in-home caregivers can help your loved one stay on top of things. An in-home caregiver can buy groceries, cook, do light housekeeping, provide transportation, do laundry, and many other tasks as assigned. An in-home caregiver can keep things under control and report back to the family any concerns or problems. In-home caregivers can also provide companionship, which combats social isolation and loneliness. 

Advance directives

If your loved one doesn’t have advance directives, then start that process immediately if possible. Especially in cases where an aging adult has dementia where conditions can and do worsen, it will be much more difficult to get advance directives in place. You will want to make sure you have healthcare and financial power of attorney so that you can advocate for your loved one.

Stay involved in your loved one’s healthcare

With a healthcare power of attorney, you can access your loved one’s medical records, talk with their physicians, and give reports. Try to stay on top of preventative care appointments and if you can’t attend yourself, ask an in-home caregiver or care manager to assist. If your loved one starts to decline and needs more medical attention, consider home health care covered by insurance.

Early intervention in healthcare issues will go a long way to keeping your loved one healthy. Also it is important to remember hearing and eye tests. Hearing loss is associated with increased cognitive impairment, and eyesight problems can contribute to falls. 

Get to know the neighbors

Getting to know the neighbors can be a good way of keeping an eye on things at the house. Ask them to call you if they notice any suspicious activity like a door-to-door salesman that might take advantage of your loved one. They can also help by reporting to you about any unmowed grass or snow that isn’t shoveled in the winter. 

Consider hiring a home inspector

If you suspect there might be home maintenance issues, hiring a home inspector can be a valuable way to precisely determine the problems. With a home inspector’s report, you can hire contractors to take care of issues before they get out of hand. 

How Can You Help an Older Adult Who Self-Neglects?

There are several steps you can take to help an older adult who self-neglects.

Start with the least intrusive, and then if necessary, move to more stringent methods. Document your efforts so you avoid becoming accused of elder neglect, and because you will want evidence to present to Adult Protective Services if necessary.

Talk about your concerns and problem solve

The first step to dealing with signs of self-neglect is to talk about it. Expect resistance, but do what you can to let an older adult know your concerns. Circle back to the impact self-neglect has on your loved one’s health. 

Be specific about what you have observed and offer to help. If necessary, hire a handyman to make home repairs that are safety issues. If you think the home might have other problems, have it inspected, so you know how to prioritize.

Get other family members involved in talking with a loved one. Ask for their support and involvement. If your family member will agree, hire private caregivers to take over shopping, cooking, and housekeeping. They may be resistant to this idea but try anyway. If necessary, take charge yourself and do what you can to clean and organize. 

Rule out dementia

If your loved one has a diagnosis of dementia, self-neglect problems are unlikely to improve and you may have to seek guardianship.

If you suspect cognitive impairment, try to get an evaluation. Although there is no cure for dementia, having a diagnosis will help you with planning. In the process, you might discover other medical problems that are interfering with functioning. 

Call Adult Protective Services (APS)

If all of your efforts fail, call Adult Protective Services. From a legal perspective, without guardianship, your family member has a right to make bad decisions. APS may or may not intervene, but calling them is your responsibility and lays the groundwork for guardianship later. Reports to APS are anonymous, and some states require reporting of abuse, neglect, or exploitation. 

The tricky question in situations like this is if your family member has the capacity to make poor decisions. If they do, then they have the legal right to live how they want. However, if their health and well-being are in serious danger, and there is a confirmed diagnosis or dementia or some other mental illness, they might be incapacitated. Incapacity is typically only determined by the courts.

Consider guardianship

As a last resort, consider guardianship. Guardianship is a serious step to take, but one that might be necessary to protect your loved one from harm. Since guardianship is a legal proceeding you will need evidence of incapacity: from a doctor, Adult Protective Services, or some other source. Make sure you provide a graphic description of the conditions of self-neglect that warrant guardianship.

As an appointed guardian, you have the legal right to remove your loved one from their home. This might not be easy. If the situation is life-threatening, removal might be your only option. Possible placements include assisted living, memory care, or a nursing home if there are serious medical issues.

Self-Neglect in Older Adults

Self-neglect can be very heartbreaking to witness. Someone who was once a vibrant and independent individual loses their ability to function, leaving them at risk for health and safety complications.

Have compassion, work with your loved one, and take whatever steps necessary to keep your loved one safe. If you are able to catch it early, it can make all the difference.


Sources:
  1. “About National Adult Protective Services Association.” National Adult Protective Services Association, 2021. napsa-now.org.
  2. “A Closer Look at Animal Hoarding.” The American Society for the Prevention of Cruelty to Animals, 2021. aspca.org.
  3. “Hygiene Related Diseases.” Centers for Disease Control and Prevention, 2021. cdc.gov.
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