Self-neglect predicts hospice use among elderly

By Sarah Guy

Both the presence and severity of self-neglect in the elderly independently predict hospice use, and are not mediated by the presence of health-related factors, show results published in the Archives of Gerontology and Geriatrics.

Use of such services has important implications for healthcare systems and policy, suggest the researchers, who note that medical expenditure is higher at the end of life than at any other time.

The findings also indicate that elderly individuals who self-neglect and end up in hospice care have shorter lengths of stay, and shorter lengths of time between hospice admission and death than their counterparts who enter hospice care without evidence of self-neglect.

"Clinical experience suggests that those who self-neglect often may not recognize or refuse to recognize the dangers of their self-neglectful behaviors and often only encounter the health care system after a catastrophic event has occurred," explain XinQi Dong (Rush University Medical Center, Chicago, Illinois, USA) and Melissa Simon (Northwestern University Medical Center, Chicago).

Among 1438 participants (aged above 65 years) of the Chicago Health and Aging Project (CHAP) who were reported to social services agencies for suspected elder self-neglect between 1993 and 2005, 290 (20%) were enrolled into hospice care. These individuals were compared with 1133 CHAP participants who were enrolled into hospice care without self-neglect.

Dong and Simon observed a 2.63-fold increased risk for hospice use among the self-neglect group compared with the no-neglect group, after adjustment for age, gender, and race. Further adjustment for potentially confounding medical conditions such as hypertension weakened the association slightly (hazard ratio=2.43), however, it remained significant, as it did after adjustment for psychologic and social factors.

Furthermore, each 1-point increase in self-neglect severity, as measured at a home assessment in domains such as personal hygiene and environmental hazards, increased the risk for hospice use by 4%.

"It is critical for professionals, social services agencies, and other relevant disciplines to identify older adults at risk for self-neglect and intervene before self-neglecting behaviors become more severe," write the authors, who believe early intervention is key.

They also suggest that their findings have implications for legal professionals, relating to guardianship proceedings for older adults with the most severe self-neglecting behaviors.

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