A THORNY ISSUE

Self-neglect is its own phenomenon. Although some experts do not consider self-neglect to be a form of elder maltreatment/abuse (but a related issue), it is the most common type of abuse reported to Adult Protective Services agencies nationally.

Self-neglect is when someone fails to care for themselves, either intentionally or unintentionally. It becomes an issue when the person’s health and safety are impacted or when community health and safety are affected.

Self-neglect is ongoing, not a one-time event. Common examples are when a person doesn’t take their medications consistently or stops bathing.

“Even when it is identified, an individual may refuse help from family and loved ones. This can be very challenging for people who care and want to intervene to help the situation. However, in our society, we value the right of self-determination. This means a person has the right to make decisions — even bad ones — as long as they don’t legally impact someone else,” Reynolds explains.

The only way this changes is if a judge takes those rights away. “As you can imagine, there are various degrees of severity of self-neglect, making this a complicated issue for families, practitioners and policymakers,” she says.

Reynolds and other researchers at Cleveland’s Benjamin Rose Institute on Aging, a nonprofit organization that supports older adults and caregivers, are taking the lead locally on the subject; they’ve studied self-neglect for more than a decade.

The team led by Dr. Farida Ejaz has received two grants from the U.S. Administration for Community Living (ACL), to study interventions to prevent self-neglect among at-risk adult primary care patients in Texas and people reported to Adult Protective Services for self-neglect in Oklahoma.

They are creating profiles of people who self-neglect, analyzing the data to help better understand the problem.

expected to worsen. By 2030, more than 25 percent of Ohio’s population will be 60 and older.

Abusers are usually family members. According to national Adult Protective Services data from 31 states, only 23 percent of perpetrators had no familial relationship to the older adult they abused. “This tells us that the vast majority of people abusing older adults are known individuals who are also related in some way,” Reynolds points out.

“Although this may seem counterintuitive at first — Why would you abuse your own family? — it also makes sense. Our family members are the ones who have the most access to us, have the most complex relationships with us, and are most likely to be dependent on us financially, emotionally or physically in a way that can lead to conflict.”

Every state has laws to prevent elder abuse (any intentional or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult).

Ohio recognizes seven forms of abuse: physical abuse, sexual abuse, emotional or psychological abuse, self-neglect, neglect by others, abandonment and exploitation. Those found guilty of elder abuse can be charged with misdemeanors and felonies punishable by prison time, depending on the severity of the crime; convicted financial abusers must pay full restitution. Reynolds is part of a team developing and testing interventions for elder abuse and self-neglect, and is developing training for Ohio’s mandated reporters, including caregivers, physicians and attorneys. While it’s difficult to acknowledge elder abuse, pretending it doesn’t exist only allows the problem to perpetuate. We must face it in order to stop its spread.