One thing that Nadia always loved about her mom was how low-maintenance she was. She always heard her friends complain about their parents and their demands, from childhood into adulthood. But Lana, her mother, who raised the three girls alone after their father died in a car accident, never made a fuss over herself, and her kids were the same way. They didn’t ask much from anyone, and never needed it. As Lana got older, that self-reliance maintained itself, but lately, Nadia thought it was changing into something worse.
As the only child still living nearby, she would frequently go over to her mom’s place and ask if she could help: cook some food, clean up, maybe go buy groceries. Lana would always refuse, which was predictable, but increasingly troubling. Nadia would do these chores regardless, but her mom would stop her, and even get angry. Nadia didn’t want her mother to feel belittled, and wasn’t sure what to do. As the place got dirtier, and her mom got sicker, Nadia began to truly get worried. She felt her mom was incapable of helping herself, but still entirely reliant upon it, and unwilling or unable to say differently.
What was happening to her mom was a form of elder abuse known as self-neglect. Self-neglect is unlike physical, financial, emotional, or sexual abuse. It doesn’t really have a perpetrator. But since The 1987 Amendment to the Older Americans Act, self-neglect has been categorized as one of the major forms of abuse, defined as “behavior of an older adult that threatens his or her own health or safety.” There are many reasons for this, and they are all devastating. Understanding the signs of self-neglect is a must for any family member who hopes to prevent the misery of an aging loved one.
Understanding and Recognizing Self-Neglect
A recent survey by the National Association of Professional Geriatric Care Managers (NAPGCM) revealed some startling statistics about self-neglect. Out of nearly 300 professional caregivers surveyed, 92% believe that self-neglect is a growing problem, with 76% reporting that, after financial abuse, this was the most common example of elder abuse.
It’s important to note that self-neglect can usually be seen as different than suicidal tendencies, which involve an active will to die, generally. This is more of a passive phenomenon, and most often an unwitting one, where the older adult simply can no longer take care of themselves, but won’t admit or acknowledge it. The most prominent signs of self-neglect are:
- Unpaid bills or overdue accounts. A person who has paid their bills on time their whole life suddenly lets things slip. Unpaid bills can be a sign of financial abuse: someone taking advantage of an older person and robbing them, taking away their ability to pay. But if that is not the case, it might be that they are slipping on their own, forgetting bills, unable to manage the paperwork and tasks.
- Inadequate medication management. This can be, quite literally, a killer. Medication management is vitally important, and if an older adult stops taking their medicine, or takes the wrong kind, or doesn’t understand how certain medicines need to be of guaranteed quality, they are putting their health on the line. Failure to do this, even if you have gotten them technology to help them keep track, is an indication that they are not taking care of themselves, and are possibly unable to do so.
- Unsanitary conditions. This is almost always a sure sign of self-neglect. If normally-clean living quarters start to get messy: dishes in the sink, grime in the bathroom, clutter everywhere—it can be a tell that the older adult is slipping into self-neglect and unable to complete cleaning.
- Malnutrition or dehydration. Forgetting to drink water, forgetting to eat, or being unable to do either of these is dangerous self-neglect. Families and loved ones need to monitor this and do what they can to keep their loved ones fed and safe. This also includes making sure that there is proper food in the house: not shopping can be a sign of scary forgetfulness or physical inabilities.
- Poor personal hygiene. If an older loved one stops showering, brushing their teeth, washing their hands, or dressing well (relatively), they may have lost the ability to do these tasks, or the ability to remember to do so.
Why Self-Neglect Occurs
In reading this, you might be wondering why this happens, and why it can get like this. After all, if they can’t cook, wouldn’t it be easy to ask someone to help? The example of Nadia and Lana is instructive in this.
Lana was beginning to be unable to take care of herself, but her independence led her to keep trying, even when it was difficult. Even people who aren’t as headstrong as Lana have difficulty admitting that they are unable to do things like shower easily, go to the store, or make food for themselves. They make little excuses, and try to cover it up. It’s basic human psychology, the will to lie to yourself and others about limitations. It is understandable, but in this case, it can easily turn tragic.
As a loved one, and as a possible caregiver, you have to be able to recognize these signs, and understand when they are getting dangerous. You may need to step up and provide more direct help as a caregiver, and get your family more involved. We know it can be difficult and time-consuming, which is why it is important to turn toward home care and support services if needed, to provide care management, medical management, financial management, and more. Getting the help you need for when you aren’t there can prevent self-neglect from taking the life of your loved one.
Remember, self-neglect is different from a willful, conscious choice to do oneself harm or to commit suicide. That is very serious, and needs to be addressed immediately. Self-neglect is when the inability to help yourself is combined with the inability to communicate it, whether through embarrassment, mental health disorder, or fear. Self-neglect is a lack of agency. By recognizing the signs, and working to provide more care, you can give agency, and life, back to your aging loved one.
At Institute on Aging, we provide services and programs for older adults, caregivers, and families in order to help people live independently and with dignity. Connect with us today to learn more about our work.