The New Old Age - Caring and Coping July 10, 2013,
Unable to Cope, Unwilling to Accept Aid By JUDITH GRAHAM
The 72-year-old man hadn’t bathed in more than six months. His hair was long and matted. Instead of using the bathroom, he would urinate in a bucket and throw it out the window.
From his standpoint, nothing was wrong: he was living the way he liked. But his neighbors in Houston thought his neglectful habits and filthy house were a health hazard.
They called the local adult protective services agency, which investigated and brought in a geriatric team from the University of Texas Health Science Center at Houston for a consultation. Sabrina Pickens, a nurse, went to the man’s home, located in a fairly wealthy neighborhood.
It reeked of human waste, Ms. Pickens recalled, one of the worst examples of self-neglect she had seen — and she has examined hundreds of people with this condition.
It is a surprisingly common problem in older adults; self-neglect is believed to account for nearly 40 percent of all cases of abuse and neglect in the elderly. You’ve read about extreme examples: the elderly Arizona woman with 104 cats at her house, or the aunt and cousin of Jacqueline Kennedy Onassis who resided at Grey Gardens, a once-grand East Hampton mansion, with no running water and piles of garbage.
Once, elderly adults of this sort were considered eccentric or alarmingly idiosyncratic. Today, researchers believe they have underlying medical or mental health issues — depression, dementia and delirium top the list — that compromise their ability to function and care for themselves, according to a recent panel sponsored by the Institute of Medicine.
It isn’t easy to help this hidden, difficult-to-reach population. But recent research, not yet published, suggests that connecting elderly people who cannot care for themselves with a team of multidisciplinary specialists and with physical therapy can have an impact, said Jason Burnett, associate director of clinical and behavioral research at the Texas Elder Abuse and Mistreatment Institute.
Mostly, these older adults live alone, shunning contact with family or friends. Relatives become frustrated when their efforts to offer assistance are rejected; they frequently drop out of the picture. Authorities become aware of these cases mostly when temporary caregivers, neighbors or others report them to adult protective services agencies.
Six years ago, Texas researchers studied 538 elderly people suffering from self-neglect and published results in the American Journal of Public Health. Sixty percent had abnormal results on a test evaluating their cognition and executive functioning. More than three-quarters showed deficits in their ability to perform instrumental daily activities, like paying bills, shopping for groceries, cooking meals. Sixteen percent had depressive symptoms; 95 percent reported moderate to poor social support.
How do experts recognize self-neglect? People stop bathing, eating, cleaning their homes, taking their medications, managing their financial affairs, disposing of garbage, going to the doctor and more.
“You’ll see an older man with physical disabilities who hoards and who persistently falls at home because of the environmental hazards,” said Dr. XinQi Dong, associate director of Rush University Medical Center’s Institute for Healthy Aging in Chicago. “Or a patient with diabetes and congestive heart disease, reliant on an oxygen tank, who smokes two packs a day, refuses to take her insulin and is unclean to a degree that endangers her health.”
He and other experts consider self-neglect a geriatric syndrome like frailty, delirium or falls associated with the deterioration of multiple physical functions as people age.
In Houston, the unkempt older man Ms. Pickens visited had lost more than 50 pounds since his mother, who had lived with him, died the year before. Depressed and stubborn, he had declined help from a concerned stepdaughter, the only family member with whom he had any contact.