Predictors of Self-Neglect in Community-Dwelling Elders

TLDR

The study evaluated whether depressive symptoms and cognitive impairment predict self‑neglect among community‑dwelling elders. Using 2,812 participants from the New Haven EPIC cohort, the authors followed nine years of self‑neglect incidence confirmed by state investigations and built a stepwise risk model including depressive symptoms, cognitive impairment, male gender, older age, low income, living alone, hip fracture, and stroke. Among 2,161 participants, 92 cases of self‑neglect occurred; clinically significant depressive symptoms and cognitive impairment independently predicted self‑neglect, and the authors concluded that elders with these conditions are at higher risk and may benefit from intervention.

Abstract

OBJECTIVE: The study assessed the contribution of depressive symptoms and cognitive impairment to the prediction of self-neglect in elderly persons living in the community. METHOD: Data were drawn from the New Haven Established Populations for Epidemiologic Studies of the Elderly cohort, which included 2,812 community residents age 65 years and older in 1982. The principal outcome examined was the incidence of self-neglect, corroborated by the state’s investigation, during 9 years of follow-up (1982–1991). RESULTS: Among the 2,161 subjects included in the analysis, 92 corroborated cases of self-neglect occurred from 1982 to 1991. The prevalence of clinically significant depressive symptoms at baseline (score ≥16 on the Center for Epidemiologic Studies Depression Scale [CES-D]) was 15.4%, and the prevalence of clinically significant cognitive impairment (four or more errors on the Pfeiffer Short Portable Mental Status Questionnaire) was 7.5%. Subjects with clinically significant depressive symptoms and/or cognitive impairment were more likely than others to experience self-neglect. Clinically significant depressive symptoms and cognitive impairment remained significant predictors of self-neglect in a multivariate model that included age, gender, race, and income. A final model for self-neglect constructed with stepwise selection of risk factors included depressive symptoms and cognitive impairment, as well as male gender, older age, income less than $5,000 per year, living alone, history of hip fracture, and history of stroke. CONCLUSIONS: Elderly individuals living in the community who experience clinically significant depressive symptoms and/or cognitive impairment may be at risk for the development of self-neglect and may become candidates for intervention.