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Care of the Aging Patient: From Evidence to Action |

Elder Abuse and Self-neglect:  “I Don't Care Anything About Going to the Doctor, to Be Honest. . . . ”

Laura Mosqueda, MD; XinQi Dong, MD, MPH
JAMA. 2011;306(5):532-540. doi:10.1001/jama.2011.1085.
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Elder mistreatment encompasses a range of behaviors including emotional, financial, physical, and sexual abuse, neglect by other individuals, and self-neglect. This article discusses the range of elder mistreatment in community-living older adults, associated factors, and consequences. Although self-neglect is not considered a type of abuse in many research definitions, it is the most commonly reported form of elder mistreatment and is associated with increased morbidity and mortality. The case on which this article is based describes a 70-year-old woman who neglects herself and dies despite multiple contacts with the medical community. Despite significant gaps in research, enough is known to guide clinical practice. This article presents the practical approaches a health care professional can take when a reasonable suspicion of elder mistreatment arises. Public health and interdisciplinary team approaches are needed to manage what is becoming an increasing problem as the number of older adults around the world increases.

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Figure 1. Performance on CLOX-1 Test
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CLOX-1 test completed by Mrs O had a score of 8 out of 15, revealing substantial limitations in executive function.

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Figure 2. Clinician's Approach When Self-neglect Is Suspected
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Algorithm is based on the authors' clinical experience and review of the literature. APS indicates adult protective services.
aDepending on severity, imminent danger, or level of risk.

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