Sociodemographic and socioeconomic characteristics of elder self-neglect in an US Chinese aging population

This study aimed to examine the socio-demographic and socioeconomic characteristics associated with prevalence and severity of elder self-neglect in an U.S. Chinese older population. The PINE study is a population-based epidemiological study in the greater Chicago area. In total, 3159 Chinese older adults were interviewed from 2011 to 2013. Elder self-neglect was assessed with systematic observations of a participant’s personal and home environment across five domains: hoarding, personal hygiene, house in need of repair, unsanitary conditions, and inadequate utility. Elder self-neglect was prevalent among older adults aged 80 years or over (mild self-neglect: 34.6% 95% CI 30.9–38.4; moderate/severe: 15.6% 95% CI 12.8–18.6), men (mild: 28.6% 95% CI 26.1–31.3; moderate/severe: 13.1% 95% CI 11.2–15.1), those with 0–6 years of education (mild: 32.2% 95% CI 29.7–34.9; moderate/severe: 12.6% 95% CI 10.8–14.5), and those with an annual personal income between $5000 and $10,000 (mild: 30.8% 95% CI 28.4–33.2; moderate/severe: 11.8% 95% CI 10.2–13.5). Older age (mild self-neglect: OR 1.02, 95% CI 1.01–1.03; moderate/severe self-neglect: OR 1.02, 95% CI 1.00–1.03) and lower education levels (mild self-neglect: OR 1.06, 95% CI 1.03–1.08; moderate/severe self-neglect: OR 1.07, 95% CI 1.04–1.09) were associated with significantly increased odds of elder self-neglect. Women (moderate/severe self-neglect: OR 0.73, 95% CI 0.58–0.93) had significantly decreased odds of moderate/severe elder self-neglect. No significant association was found between levels of income and overall elder-self-neglect of all severities. Future research is needed to examine risk/protective factors associated with elder self-neglect in U.S. Chinese older populations.     

Self-neglect of the elderly. An overview

Self-neglect is characterized by the inability to perform essential self-care tasks threatening a person's health and safety. The exact prevalence of self-neglect in a community-based aged population is not known. Cognitive impairment is the most important predisposing factor of self-neglect. There are also a number of other predisposing factors such as psychiatric diseases, pre-morbid personality, alcohol abuse, poor physical ability, lack of social support and a low socioeconomic situation. Self-neglect has a number of serious consequences. It is an independent risk factor for early mortality among the aged. It commonly causes malnutrition, frailty and the deterioration of physical ability, therefore, increasing the risk of falls and fractures. Untreated medical conditions result in emergency visits and acute hospitalization. The neglect of housekeeping and financial affairs seriously affects the domestic environment. Diagnosis and treatment of self-neglect should be based on the medical and psychosocial assessment of a patient. Patients require multidisciplinary support at home or in hospital, and sometimes long-term care is inevitable. There is no sufficient scientific evidence to support the benefits of early intervention in self-neglect. Controlled studies are needed, especially to show whether early diagnosis followed by increased social support and tailored health care services have an effect on the outcome.     

Editorial

Substantiated cases of elder self-neglect have been reported to be more common than either elder abuse or neglect. It is a problem that often requires the active involvement of a whole range of health, social, housing, police and voluntary agencies. The ways in which these various agencies respond to self-neglect and how they interact with one another is not known. This research explored the ways in which different health and social care organizations respond to the problems associated with self-neglect. Research methods involved qualitative in-depth interviews with housing, healthcare, environmental health and social workers and a sample of their clients who were described as living in self-neglecting circumstances. This study revealed a lack of joint working across the relevant professions in relation to self-neglect. Better co-ordinated intervention could improve effectiveness and help make available resources go further. The study also suggests a need for a preventative approach to self-neglect, although further work would be required to develop indicators for early intervention.     

农村慢性病老年人自我忽视与健康促进生活方式的相关性研究

目的 探讨农村慢性病老年人自我忽视（ESN）与健康促进生活方式(HPL)的现状及关系，为促进农村老年人的健康行为方式提供理论依据。方法 采用多阶段分层抽样的方法，在四川省德阳市、泸州市、广元市抽取719名农村慢性病老年人，采用一般资料调查表、农村老年人自我忽视量表、健康促进生活方式修订版调查量表进行问卷调查，运用多元线性回归分析探究ESN与HPL之间的关系。结果 共发放问卷785份，有效回收719份，有效回收率为91.6%。ESN得分为9(5,13)，筛查出28.9%的的老年人有ESN；HPL得分为91(80,105)，HPL水平差和一般的占比分别为7.5%、56.5%。分层多元线性回归分析结果显示在去除混杂因素（年龄段、文化程度、个人月收入、疼痛、自评健康状况、共患病）后，老年自我忽视可负相预测农村慢性病老年人的健康促进生活方式水平［β=-0.40,95%CI(-1.31,-0.94),P＜0.001］。结论 老年自我忽视可能是农村慢性病患者健康促进生活生活方式的独立危险因素，提示卫生服务人员重视农村慢性病老年人的ESN并加强对ESN的筛查。     

抑郁在空巢老年人日常活动能力与自我忽视间的中介效应

目的 探讨抑郁在空巢老年人日常活动能力与自我忽视间的中介作用。方法 运用2018年中国老年人健康影响因素跟踪调查（CLHLS）第四次全国追访数据,将3 680名60岁及以上的空巢老年人作为研究对象,采用SPSS 25.0进行描述性分析和偏相关分析,使用Process宏程序进行中介效应检验。结果 空巢老年人自我忽视与日常活动能力（r=-0.177, P<0.01）呈负相关,与抑郁（r=0.193, P<0.01）呈正相关。日常活动能力与抑郁呈负相关（r=-0.214, P<0.01）。日常活动能力可直接影响空巢老年人自我忽视（β=-0.118,t=-10.856, P<0.01）,还可通过抑郁的中介作用间接影响自我忽视,间接效应为总效应的19.68%。结论 抑郁是空巢老年人日常活动能力与自我忽视之间的中介变量,应采取有效的干预措施降低空巢老年人抑郁的发生,促进其社会活动参与,提升其日常活动能力,减少空巢老人自我忽视的发生。     

老年人自我忽视调查问卷的编制及信效度检验

目的编制适用于我国老年人的自我忽视调查问卷,并对其进行信效度检验,为鉴别老年人自我忽视提供一个有效的测评工具。方法基于前期质性研究的结果,通过文献回顾、德尔菲专家函询法形成初始问卷。2018年4—5月,采用便利抽样法选取武汉市某三级甲等医院71例住院老年人进行预调查,进行项目分析;2018年6—10月,采用便利抽样法选取武汉市某三甲医院的314例住院老年人进行正式调查,对问卷进行信效度评价。结果最终形成包含7个公因子、24个条目的老年人自我忽视调查问卷。问卷Cronbach'sα系数为0.875,折半信度系数为0.709。问卷的条目内容效度指数(I-CVI)为0.895~1,平均问卷效度指数(S-CVI/Ave)为0.987。探索性因子分析共提取7个公因子,累积方差贡献率为69.391%。结论老年人自我忽视调查问卷的信效度良好,可作为老年人自我忽视的评估工具。