Sabrina Pickens - Academia.edu (original) (raw)
Papers by Sabrina Pickens
Self-neglect is an inability or refusal to meet one's own basic needs as accepted by societal... more Self-neglect is an inability or refusal to meet one's own basic needs as accepted by societal norms and is the most common report received by state agencies charged with investigating abuse, neglect and exploitation of vulnerable adults. Self-neglect is often seen in addition to one or multiple conditions of frailty, mild to severe dementia, poor sleep and depression. While awareness of elder self-neglect as a public health condition and intervention has significantly risen in the past decade as evidenced by the increasing amount of literature available, research on self-neglect still lacks comprehensiveness and clarity since its inception to the medical literature in the late 1960s. With the burgeoning of the older adult population, commonness of self-neglect will most likely increase as the current incidence rate represents only the “tip of the iceberg” theory given that most cases are unreported. The COVID-19 pandemic has exacerbated the incidence of self-neglect in aged popu...
Journal of Elder Abuse & Neglect
Journal of Applied Gerontology
Objectives: Pain assessment and treatment is challenging among persons with dementia (PWDs). To b... more Objectives: Pain assessment and treatment is challenging among persons with dementia (PWDs). To better understand reports of pain interference, we examined ratings made by PWDs, as well as corresponding ratings about PWDs, as reported by the caregiver. We aimed to assess alignment between and predictors of caregiver and PWD report of pain interference. Methods: The sample consisted of 203 veterans with pain and mild to moderately severe dementia and an informal caregiver. Results: Most PWDs and their caregivers reported at least some pain interference and similar levels of pain interference. PWDs with greater cognitive impairment reported less pain interference, whereas caregivers who perceived the PWD to have greater depression reported more pain interference. Conclusions: PWD and caregiver characteristics were differentially associated with PWD versus caregiver report of pain interference. Results suggest the importance of caregiver reports to inform assessment, as well as factors...
Dementia and Geriatric Cognitive Disorders Extra
Background: Although community-dwelling persons with dementia have an increased risk of hospital ... more Background: Although community-dwelling persons with dementia have an increased risk of hospital readmission, no systematic review has examined the contribution of dementia to readmissions. Summary: We examined articles in English, with no restrictions on publication dates, from Medline, PubMed, PsycINFO, CINAHL, and EMBASE. Keywords used were dementia, Alzheimer disease, frontotemporal lobar degeneration, elderly, frontotemporal dementia, executive function, brain atrophy, frontal lobe atrophy, cognitive impairment, readmission, readmit, rehospitalization, patient discharge, and return visit. Of 404 abstracts identified, 77 articles were retrieved; 12 were included. Four of 5 cohort studies showed significantly increased readmission rates in patients with dementia. On average the absolute increase above the comparison groups was from 3 to 13%. Dementia was not associated with readmission in 7 included case-control studies. Key Message: Findings suggest a small increased risk of hos...
Open Medicine Journal, 2016
Elder abuse is a serious social and public health issue with estimates of approximately five and ... more Elder abuse is a serious social and public health issue with estimates of approximately five and a half million annual reports in the U.S. Identifying and treating abused elders is difficult due to unstandardized protocols and identification guidelines as well as a lack of public awareness to the problem. An interdisciplinary approach in collaboration with Adult Protective Services investigation is paramount to the assessment and care for mistreated elders. Educating healthcare professionals, other professions, and the lay public through social media, local news, and community education can increase awareness to this often overlooked problem.
J Elder Abuse Negl, 2007
Pain is a worldwide health concern leading to cognitive impairments, depression, and decline in a... more Pain is a worldwide health concern leading to cognitive impairments, depression, and decline in activities of daily living when poorly controlled. Self-neglect is also a serious public health issue being the most common allegation reported to Adult Protective Services (APS). The purpose of this analysis is to determine whether self-reported pain is associated with validated cases of self-neglect compared with matched controls. This is a cross-sectional study of 80 (APS) validated cases of self-neglect aged 65 years and older and 80 control participants recruited from a geriatric clinic at Harris County Hospital District. Control participants were matched for age, race, gender, and zip code. Both groups were administered the Wong-Baker FACES rating scale and the Mini-Mental State Examination in their homes by a geriatric nurse practitioner and a research assistant. Self-reported pain was noted in 43% of the self-neglect group compared with only 28% in the control group (X2 = 3.85, df = 1, p = .05). This difference became non-significant after stratifying for MMSE scores of 19 or greater (X2 = 3.38, df = 1, p = .066). The self-neglecting elderly also reported significantly higher levels of pain compared with the matched controls (t = 2.5, df = 143, p = .014). This mean difference remained significant after stratifying by MMSE scores of 19 or greater (t = 2.6, df = 124, p = .009). The data provide preliminary support for the relationship between self-reported pain and elder self-neglect. Research is needed to determine whether pain is a causal or associated factor in self-neglect and whether therapeutic intervention can improve the syndrome of self-neglect.
Http Dx Doi Org 10 1300 J084v18n04_02, Sep 7, 2008
Older adults with severe self-neglect have multiple deficits in various social, functional and ph... more Older adults with severe self-neglect have multiple deficits in various social, functional and physical domains, and often live insqualor. These individuals often present with poor personal hygiene, domestic squalor and hoarding which results in a threat to their own health as well as personal and public safety. Severe self-neglect occurs along a continuum with older adults often having cognitive and affective disorders compared with younger individuals presenting with psychiatric illnesses. In cases of severe self-neglect with hoarding, evidence has shown this behavior occurs in diverse social strata and not among the wealthy and professionals alone as believed earlier. Due to the multiple conditions associated with severe self-neglect, this population will require an interdisciplinary, multidimensional approach to reduce morbidity and mortality rates including nursing home placement. Research on this group has been limited and is rarely described in the medical and nursing literature. Future research is needed to provide practitioners with effective screening instruments and interventions on cases of severe self-neglect.
Encyclopedia of Family Health, 2011
Clinical Nursing Studies, 2013
Purpose: Self-neglect (SN) is the inability to maintain self-care needs. It is thought that older... more Purpose: Self-neglect (SN) is the inability to maintain self-care needs. It is thought that older adults who have impaired executive function (EF) develop the inability to self-care and to protect themselves. The specific aims were to determine the feasibility of using multiple EF measures and assess the different dimensions of EF with community-dwelling elders with SN. Methods: In this cross-sectional study, 50 adults aged 65 and older were recruited from Adult Protective Services with confirmed SN. A research nurse administered the following measures: Delis-Kaplan Card Sort Test (D-KEFS), Executive Interview (EXIT 25), CLOX Drawing Test (CLOX I, II), Trails Making Test A and B (TMT A & B) and the Mini-Mental State Examination (MMSE). Descriptive analyses and Pearson correlation coefficients were conducted on the different variables used in this study. Results: Older adults with SN were more likely to fail the CLOX1 and D-KEFS, while passing the other cognitive measures. The low D-KEFS scores indicate difficulties in generating new concepts, inhibiting previous conceptual thoughts, or initiating novel ideas. Conclusions: Results from this study provide support that individuals with SN will complete a battery of EF tests and that they exhibit the following impairments consistent with executive dysfunction: "concept generation", "planning, inhibition", and "spatial working memory". Utilizing only one EF measure in individuals with intact cognition may result in unidentification of individuals with executive dysfunction, thus delaying necessary treatment. Future studies should attempt to determine different etiologies of executive dysfunction and determine if early treatment can prevent or reverse SN.
Journal of the American Geriatrics Society, 2000
Journal of the American Geriatrics Society, 2000
To the Editor: We welcome the contribution by Drs. St. John and Montgomery. Their findings are co... more To the Editor: We welcome the contribution by Drs. St. John and Montgomery. Their findings are consistent with ours. 1 However, contrary to our findings, when they adjusted for physical function, the association lost significance. In our analyses, we adjusted for activity of daily living (ADL) limitations, which were found to be a significant predictor even while the effect of depressive symptoms remained highly significant. Drs. St. John and Montgomery also used ADLs and included an additional measurement for instrumental activities of daily living (IADLs). It appears that they added both variables into their model concurrently rather than determining the individual effect of each. It is possible that the IADL scale undermined the effect of physical impairment as measured using the ADLs. We adjusted for considerably more variables than Drs. St. John and Montgomery, which also may explain the different results. For example, we adjusted for arthritis and stroke, which may affect function. It may be that the physical function measured in their study was a confounder for these medical conditions Cognition did not significantly affect risk of nursing home admissions in Drs. St. John and Montgomery's model. This is inconsistent with some research. 2-4 We believe that this requires more research. As a measure of social support, we included home ownership. Although this is not a comprehensive measure of social support, other research has also shown that those who do not own their own home are far more likely to be admitted to a nursing home 4 and that home ownership can serve as a proxy for income. We also adjusted for economic level and marriage, which could possibly explain some differences. Drs. St. John and Montgomery acknowledge differences in the admitting practices for nursing homes in the United States and Canada. In Canada, entering a nursing home requires a panel review. Medicare requires a 3-day prior hospitalization and a physician's note that the individual can show some improvement before reimbursement is approved, which affects many admissions, although for direct admissions to long-term care in a nursing home, U.S. facilities accept anyone based on bed availability and insurance status (i.e., availability of private pay or Medicaid). Therefore, measures of physical function, cognitive status, depression, and physical health may play a different role in the risk of admissions in the United States than in Canada, where residents are only admitted for long-term care.
Journal of the American Academy of Nurse Practitioners, 2007
Purpose-Self-neglect is the most prevalent finding among cases reported to Adult Protective Servi... more Purpose-Self-neglect is the most prevalent finding among cases reported to Adult Protective Services and is characterized by an inability to meet one's own basic needs. The Kohlman Evaluation of Living Skills (KELS) has been validated in geriatric populations to assess performance with both instrumental (IADL) and basic activities of daily living (ADL), and as an assessment tool for the capacity to live independently, therefore, the purpose of this analysis was to compare the scores of the KELS between substantiated cases of self-neglect and matched community-dwelling elders. Methods-This is a cross-sectional pilot study of 50 adults aged 65 years and older who were recruited from Adult Protective Services (APS) as documented cases of self-neglect and 50 control participants recruited from Harris County Hospital District outpatient clinics. Control participants were matched for age, race, gender and zip code. A geriatric nurse practitioner-led team administered a comprehensive geriatric assessment in homes of all study participants. The assessment included the KELS and Mini-Mental State Examination (MMSE) tests. Chi-square analyses were used to determine if cases of self-neglect were significantly more likely to fail the KELS test than matched controls. Summary of Results-The analyses revealed that self-neglectors were significantly more likely to fail the KELS than non-self-neglectors (50% vs. 30%, p=0.025). When stratified by MMSE scores, self-neglectors with intact cognitive function remained significantly more likely to fail the KELS compared to matched, cognitively intact controls (45% vs. 17%, p=0.013). Conclusion-Abnormal results using an in-home KELS test was significantly associated with substantiated cases of self-neglect. These findings suggest that the KELS test has significant utility as part of a comprehensive geriatric assessment to aid clinicians in suspected cases of self-neglect. Implications for Practice-There is currently no gold standard measure for identifying capacity with self-care behaviors among cases of self-neglect. As a result, self-neglect may remain unidentified in many clinical settings. The KELS provides clinicians with an objective measure of an individual's capacity and performance with everyday life supporting tasks and thus, provides information that can help nurse practitioners identify elders at risk for self-neglect.
Journal of Elder Abuse & Neglect, 2006
Pain is a worldwide health concern leading to cognitive impairments, depression, and decline in a... more Pain is a worldwide health concern leading to cognitive impairments, depression, and decline in activities of daily living when poorly controlled. Self-neglect is also a serious public health issue being the most common allegation reported to Adult Protective Services (APS). The purpose of this analysis is to determine whether self-reported pain is associated with validated cases of self-neglect compared with matched controls. This is a cross-sectional study of 80 (APS) validated cases of self-neglect aged 65 years and older and 80 control participants recruited from a geriatric clinic at Harris County Hospital District. Control participants were matched for age, race, gender, and zip code. Both groups were administered the Wong-Baker FACES rating scale and the Mini-Mental State Examination in their homes by a geriatric nurse practitioner and a research assistant. Self-reported pain was noted in 43% of the self-neglect group compared with only 28% in the control group (X2 = 3.85, df = 1, p = .05). This difference became non-significant after stratifying for MMSE scores of 19 or greater (X2 = 3.38, df = 1, p = .066). The self-neglecting elderly also reported significantly higher levels of pain compared with the matched controls (t = 2.5, df = 143, p = .014). This mean difference remained significant after stratifying by MMSE scores of 19 or greater (t = 2.6, df = 124, p = .009). The data provide preliminary support for the relationship between self-reported pain and elder self-neglect. Research is needed to determine whether pain is a causal or associated factor in self-neglect and whether therapeutic intervention can improve the syndrome of self-neglect.
Journal of Elder Abuse & Neglect, 2006
Objective. There have been no studies describing the occurrence of untreated medical condition(s)... more Objective. There have been no studies describing the occurrence of untreated medical condition(s) in elders with depression who self-neglect. This study compares the prevalence of depression as indicated by an abnormal score (Ն 5) on the Geriatric Depression Scale-Short Form (GDS-SF) between self-neglecters and matched non self-neglecting community-dwelling elders. It also describes the relationship between untreated medical condition(s) associated with self-neglect and abnormal scores on the GDS-SF.
Journal of Elder Abuse & Neglect, 2006
Compared to older adults with disabilities and those who autonomously choose to live in squalor; ... more Compared to older adults with disabilities and those who autonomously choose to live in squalor; self-neglect syndrome arises from a predicate state of vulnerability in frail older adults. This state of vulnerability is characteristically associated with a decline in decision-making capacity regarding the ability to care for and protect oneself. We developed the COMP Screen to evaluate vulnerable older adults to identify potential gaps in decision-making capacity using a screening tool. A total of 182 older adults were evaluated and consistent declines in cognitive ability and decision-making processes were present in this population. However, there were no significant differences between elders referred for self-neglect and matched older adults. These findings suggest that declines in decision-making processes are not uncommon in vulnerable older adults but traditional conceptualizations of decision-making capacity may be inadequate for differentiating the capacity for self care and protection in elders who self-neglect.
Journal of Elder Abuse & Neglect, 2006
Self-neglect is an independent risk factor for early mortality in older people and has been linke... more Self-neglect is an independent risk factor for early mortality in older people and has been linked to depression and the occurrence of mental and physical decline. Sound social networks have been shown to slow the process of decline in the elderly, and currently little is known about the social networks associated with elder self-neglect. The aim of this study was to explore the social networks associated with elder self-neglect compared with a matched-control group. Ninety-one Adult Protective Services-validated cases of elder self-neglect were compared on formal and informal social network factors with 91controls matched for age, race, gender, and socio-economic status. Elders in the self-neglect group were significantly less likely to (1) Live with a spouse, (2) Live with others, (3) Have weekly contact with children or siblings, (4) Visit with neighbors and friends and (5) Participate in religious activities. Less adequate social resources related to family, friends, and religious affiliations are significantly associated with elder self-neglect.
Journal of Elder Abuse & Neglect, 2006
Background: Research in elder self-neglect has lagged behind that of other forms of mistreatment,... more Background: Research in elder self-neglect has lagged behind that of other forms of mistreatment, despite the fact that self-neglect is the most common allegation reported to Adult Protective Service agencies throughout the US. The lack of a gold-standard to measure selfneglect has hampered efforts to study this phenomenon. Methods: Researchers designed the Self-neglect Severity Scale (SSS) based on interviews with Adult Protective Service workers and a national expert panel. The SSS is based on observation and interview and is administered in the home to include an environmental assessment. It was piloted, extensively field tested and then revised. Results: The CREST SSS was developed using survey data and consultation with experts in the field. This instrument utilizes observer ratings, interview responses, and assesses subjects' physical and environmental domains. It also assesses functional status as it relates to health and safety issues. After field and pilot testing the SSS was finalized and is currently undergoing reliability and validity testing. Conclusions: The CREST SSS was developed as a state scale to provide a common language for describing cases of self-neglect. It is the first self-neglect severity scale available to researchers. If found to be both reliable and valid it can be used in future intervention studies.
Journal of Elder Abuse & Neglect, 2006
Older adults with severe self-neglect have multiple deficits in various social, functional and ph... more Older adults with severe self-neglect have multiple deficits in various social, functional and physical domains, and often live insqualor. These individuals often present with poor personal hygiene, domestic squalor and hoarding which results in a threat to their own health as well as personal and public safety. Severe self-neglect occurs along a continuum with older adults often having cognitive and affective disorders compared with younger individuals presenting with psychiatric illnesses. In cases of severe self-neglect with hoarding, evidence has shown this behavior occurs in diverse social strata and not among the wealthy and professionals alone as believed earlier. Due to the multiple conditions associated with severe self-neglect, this population will require an interdisciplinary, multidimensional approach to reduce morbidity and mortality rates including nursing home placement. Research on this group has been limited and is rarely described in the medical and nursing literature. Future research is needed to provide practitioners with effective screening instruments and interventions on cases of severe self-neglect.
Self-neglect is an inability or refusal to meet one's own basic needs as accepted by societal... more Self-neglect is an inability or refusal to meet one's own basic needs as accepted by societal norms and is the most common report received by state agencies charged with investigating abuse, neglect and exploitation of vulnerable adults. Self-neglect is often seen in addition to one or multiple conditions of frailty, mild to severe dementia, poor sleep and depression. While awareness of elder self-neglect as a public health condition and intervention has significantly risen in the past decade as evidenced by the increasing amount of literature available, research on self-neglect still lacks comprehensiveness and clarity since its inception to the medical literature in the late 1960s. With the burgeoning of the older adult population, commonness of self-neglect will most likely increase as the current incidence rate represents only the “tip of the iceberg” theory given that most cases are unreported. The COVID-19 pandemic has exacerbated the incidence of self-neglect in aged popu...
Journal of Elder Abuse & Neglect
Journal of Applied Gerontology
Objectives: Pain assessment and treatment is challenging among persons with dementia (PWDs). To b... more Objectives: Pain assessment and treatment is challenging among persons with dementia (PWDs). To better understand reports of pain interference, we examined ratings made by PWDs, as well as corresponding ratings about PWDs, as reported by the caregiver. We aimed to assess alignment between and predictors of caregiver and PWD report of pain interference. Methods: The sample consisted of 203 veterans with pain and mild to moderately severe dementia and an informal caregiver. Results: Most PWDs and their caregivers reported at least some pain interference and similar levels of pain interference. PWDs with greater cognitive impairment reported less pain interference, whereas caregivers who perceived the PWD to have greater depression reported more pain interference. Conclusions: PWD and caregiver characteristics were differentially associated with PWD versus caregiver report of pain interference. Results suggest the importance of caregiver reports to inform assessment, as well as factors...
Dementia and Geriatric Cognitive Disorders Extra
Background: Although community-dwelling persons with dementia have an increased risk of hospital ... more Background: Although community-dwelling persons with dementia have an increased risk of hospital readmission, no systematic review has examined the contribution of dementia to readmissions. Summary: We examined articles in English, with no restrictions on publication dates, from Medline, PubMed, PsycINFO, CINAHL, and EMBASE. Keywords used were dementia, Alzheimer disease, frontotemporal lobar degeneration, elderly, frontotemporal dementia, executive function, brain atrophy, frontal lobe atrophy, cognitive impairment, readmission, readmit, rehospitalization, patient discharge, and return visit. Of 404 abstracts identified, 77 articles were retrieved; 12 were included. Four of 5 cohort studies showed significantly increased readmission rates in patients with dementia. On average the absolute increase above the comparison groups was from 3 to 13%. Dementia was not associated with readmission in 7 included case-control studies. Key Message: Findings suggest a small increased risk of hos...
Open Medicine Journal, 2016
Elder abuse is a serious social and public health issue with estimates of approximately five and ... more Elder abuse is a serious social and public health issue with estimates of approximately five and a half million annual reports in the U.S. Identifying and treating abused elders is difficult due to unstandardized protocols and identification guidelines as well as a lack of public awareness to the problem. An interdisciplinary approach in collaboration with Adult Protective Services investigation is paramount to the assessment and care for mistreated elders. Educating healthcare professionals, other professions, and the lay public through social media, local news, and community education can increase awareness to this often overlooked problem.
J Elder Abuse Negl, 2007
Pain is a worldwide health concern leading to cognitive impairments, depression, and decline in a... more Pain is a worldwide health concern leading to cognitive impairments, depression, and decline in activities of daily living when poorly controlled. Self-neglect is also a serious public health issue being the most common allegation reported to Adult Protective Services (APS). The purpose of this analysis is to determine whether self-reported pain is associated with validated cases of self-neglect compared with matched controls. This is a cross-sectional study of 80 (APS) validated cases of self-neglect aged 65 years and older and 80 control participants recruited from a geriatric clinic at Harris County Hospital District. Control participants were matched for age, race, gender, and zip code. Both groups were administered the Wong-Baker FACES rating scale and the Mini-Mental State Examination in their homes by a geriatric nurse practitioner and a research assistant. Self-reported pain was noted in 43% of the self-neglect group compared with only 28% in the control group (X2 = 3.85, df = 1, p = .05). This difference became non-significant after stratifying for MMSE scores of 19 or greater (X2 = 3.38, df = 1, p = .066). The self-neglecting elderly also reported significantly higher levels of pain compared with the matched controls (t = 2.5, df = 143, p = .014). This mean difference remained significant after stratifying by MMSE scores of 19 or greater (t = 2.6, df = 124, p = .009). The data provide preliminary support for the relationship between self-reported pain and elder self-neglect. Research is needed to determine whether pain is a causal or associated factor in self-neglect and whether therapeutic intervention can improve the syndrome of self-neglect.
Http Dx Doi Org 10 1300 J084v18n04_02, Sep 7, 2008
Older adults with severe self-neglect have multiple deficits in various social, functional and ph... more Older adults with severe self-neglect have multiple deficits in various social, functional and physical domains, and often live insqualor. These individuals often present with poor personal hygiene, domestic squalor and hoarding which results in a threat to their own health as well as personal and public safety. Severe self-neglect occurs along a continuum with older adults often having cognitive and affective disorders compared with younger individuals presenting with psychiatric illnesses. In cases of severe self-neglect with hoarding, evidence has shown this behavior occurs in diverse social strata and not among the wealthy and professionals alone as believed earlier. Due to the multiple conditions associated with severe self-neglect, this population will require an interdisciplinary, multidimensional approach to reduce morbidity and mortality rates including nursing home placement. Research on this group has been limited and is rarely described in the medical and nursing literature. Future research is needed to provide practitioners with effective screening instruments and interventions on cases of severe self-neglect.
Encyclopedia of Family Health, 2011
Clinical Nursing Studies, 2013
Purpose: Self-neglect (SN) is the inability to maintain self-care needs. It is thought that older... more Purpose: Self-neglect (SN) is the inability to maintain self-care needs. It is thought that older adults who have impaired executive function (EF) develop the inability to self-care and to protect themselves. The specific aims were to determine the feasibility of using multiple EF measures and assess the different dimensions of EF with community-dwelling elders with SN. Methods: In this cross-sectional study, 50 adults aged 65 and older were recruited from Adult Protective Services with confirmed SN. A research nurse administered the following measures: Delis-Kaplan Card Sort Test (D-KEFS), Executive Interview (EXIT 25), CLOX Drawing Test (CLOX I, II), Trails Making Test A and B (TMT A & B) and the Mini-Mental State Examination (MMSE). Descriptive analyses and Pearson correlation coefficients were conducted on the different variables used in this study. Results: Older adults with SN were more likely to fail the CLOX1 and D-KEFS, while passing the other cognitive measures. The low D-KEFS scores indicate difficulties in generating new concepts, inhibiting previous conceptual thoughts, or initiating novel ideas. Conclusions: Results from this study provide support that individuals with SN will complete a battery of EF tests and that they exhibit the following impairments consistent with executive dysfunction: "concept generation", "planning, inhibition", and "spatial working memory". Utilizing only one EF measure in individuals with intact cognition may result in unidentification of individuals with executive dysfunction, thus delaying necessary treatment. Future studies should attempt to determine different etiologies of executive dysfunction and determine if early treatment can prevent or reverse SN.
Journal of the American Geriatrics Society, 2000
Journal of the American Geriatrics Society, 2000
To the Editor: We welcome the contribution by Drs. St. John and Montgomery. Their findings are co... more To the Editor: We welcome the contribution by Drs. St. John and Montgomery. Their findings are consistent with ours. 1 However, contrary to our findings, when they adjusted for physical function, the association lost significance. In our analyses, we adjusted for activity of daily living (ADL) limitations, which were found to be a significant predictor even while the effect of depressive symptoms remained highly significant. Drs. St. John and Montgomery also used ADLs and included an additional measurement for instrumental activities of daily living (IADLs). It appears that they added both variables into their model concurrently rather than determining the individual effect of each. It is possible that the IADL scale undermined the effect of physical impairment as measured using the ADLs. We adjusted for considerably more variables than Drs. St. John and Montgomery, which also may explain the different results. For example, we adjusted for arthritis and stroke, which may affect function. It may be that the physical function measured in their study was a confounder for these medical conditions Cognition did not significantly affect risk of nursing home admissions in Drs. St. John and Montgomery's model. This is inconsistent with some research. 2-4 We believe that this requires more research. As a measure of social support, we included home ownership. Although this is not a comprehensive measure of social support, other research has also shown that those who do not own their own home are far more likely to be admitted to a nursing home 4 and that home ownership can serve as a proxy for income. We also adjusted for economic level and marriage, which could possibly explain some differences. Drs. St. John and Montgomery acknowledge differences in the admitting practices for nursing homes in the United States and Canada. In Canada, entering a nursing home requires a panel review. Medicare requires a 3-day prior hospitalization and a physician's note that the individual can show some improvement before reimbursement is approved, which affects many admissions, although for direct admissions to long-term care in a nursing home, U.S. facilities accept anyone based on bed availability and insurance status (i.e., availability of private pay or Medicaid). Therefore, measures of physical function, cognitive status, depression, and physical health may play a different role in the risk of admissions in the United States than in Canada, where residents are only admitted for long-term care.
Journal of the American Academy of Nurse Practitioners, 2007
Purpose-Self-neglect is the most prevalent finding among cases reported to Adult Protective Servi... more Purpose-Self-neglect is the most prevalent finding among cases reported to Adult Protective Services and is characterized by an inability to meet one's own basic needs. The Kohlman Evaluation of Living Skills (KELS) has been validated in geriatric populations to assess performance with both instrumental (IADL) and basic activities of daily living (ADL), and as an assessment tool for the capacity to live independently, therefore, the purpose of this analysis was to compare the scores of the KELS between substantiated cases of self-neglect and matched community-dwelling elders. Methods-This is a cross-sectional pilot study of 50 adults aged 65 years and older who were recruited from Adult Protective Services (APS) as documented cases of self-neglect and 50 control participants recruited from Harris County Hospital District outpatient clinics. Control participants were matched for age, race, gender and zip code. A geriatric nurse practitioner-led team administered a comprehensive geriatric assessment in homes of all study participants. The assessment included the KELS and Mini-Mental State Examination (MMSE) tests. Chi-square analyses were used to determine if cases of self-neglect were significantly more likely to fail the KELS test than matched controls. Summary of Results-The analyses revealed that self-neglectors were significantly more likely to fail the KELS than non-self-neglectors (50% vs. 30%, p=0.025). When stratified by MMSE scores, self-neglectors with intact cognitive function remained significantly more likely to fail the KELS compared to matched, cognitively intact controls (45% vs. 17%, p=0.013). Conclusion-Abnormal results using an in-home KELS test was significantly associated with substantiated cases of self-neglect. These findings suggest that the KELS test has significant utility as part of a comprehensive geriatric assessment to aid clinicians in suspected cases of self-neglect. Implications for Practice-There is currently no gold standard measure for identifying capacity with self-care behaviors among cases of self-neglect. As a result, self-neglect may remain unidentified in many clinical settings. The KELS provides clinicians with an objective measure of an individual's capacity and performance with everyday life supporting tasks and thus, provides information that can help nurse practitioners identify elders at risk for self-neglect.
Journal of Elder Abuse & Neglect, 2006
Pain is a worldwide health concern leading to cognitive impairments, depression, and decline in a... more Pain is a worldwide health concern leading to cognitive impairments, depression, and decline in activities of daily living when poorly controlled. Self-neglect is also a serious public health issue being the most common allegation reported to Adult Protective Services (APS). The purpose of this analysis is to determine whether self-reported pain is associated with validated cases of self-neglect compared with matched controls. This is a cross-sectional study of 80 (APS) validated cases of self-neglect aged 65 years and older and 80 control participants recruited from a geriatric clinic at Harris County Hospital District. Control participants were matched for age, race, gender, and zip code. Both groups were administered the Wong-Baker FACES rating scale and the Mini-Mental State Examination in their homes by a geriatric nurse practitioner and a research assistant. Self-reported pain was noted in 43% of the self-neglect group compared with only 28% in the control group (X2 = 3.85, df = 1, p = .05). This difference became non-significant after stratifying for MMSE scores of 19 or greater (X2 = 3.38, df = 1, p = .066). The self-neglecting elderly also reported significantly higher levels of pain compared with the matched controls (t = 2.5, df = 143, p = .014). This mean difference remained significant after stratifying by MMSE scores of 19 or greater (t = 2.6, df = 124, p = .009). The data provide preliminary support for the relationship between self-reported pain and elder self-neglect. Research is needed to determine whether pain is a causal or associated factor in self-neglect and whether therapeutic intervention can improve the syndrome of self-neglect.
Journal of Elder Abuse & Neglect, 2006
Objective. There have been no studies describing the occurrence of untreated medical condition(s)... more Objective. There have been no studies describing the occurrence of untreated medical condition(s) in elders with depression who self-neglect. This study compares the prevalence of depression as indicated by an abnormal score (Ն 5) on the Geriatric Depression Scale-Short Form (GDS-SF) between self-neglecters and matched non self-neglecting community-dwelling elders. It also describes the relationship between untreated medical condition(s) associated with self-neglect and abnormal scores on the GDS-SF.
Journal of Elder Abuse & Neglect, 2006
Compared to older adults with disabilities and those who autonomously choose to live in squalor; ... more Compared to older adults with disabilities and those who autonomously choose to live in squalor; self-neglect syndrome arises from a predicate state of vulnerability in frail older adults. This state of vulnerability is characteristically associated with a decline in decision-making capacity regarding the ability to care for and protect oneself. We developed the COMP Screen to evaluate vulnerable older adults to identify potential gaps in decision-making capacity using a screening tool. A total of 182 older adults were evaluated and consistent declines in cognitive ability and decision-making processes were present in this population. However, there were no significant differences between elders referred for self-neglect and matched older adults. These findings suggest that declines in decision-making processes are not uncommon in vulnerable older adults but traditional conceptualizations of decision-making capacity may be inadequate for differentiating the capacity for self care and protection in elders who self-neglect.
Journal of Elder Abuse & Neglect, 2006
Self-neglect is an independent risk factor for early mortality in older people and has been linke... more Self-neglect is an independent risk factor for early mortality in older people and has been linked to depression and the occurrence of mental and physical decline. Sound social networks have been shown to slow the process of decline in the elderly, and currently little is known about the social networks associated with elder self-neglect. The aim of this study was to explore the social networks associated with elder self-neglect compared with a matched-control group. Ninety-one Adult Protective Services-validated cases of elder self-neglect were compared on formal and informal social network factors with 91controls matched for age, race, gender, and socio-economic status. Elders in the self-neglect group were significantly less likely to (1) Live with a spouse, (2) Live with others, (3) Have weekly contact with children or siblings, (4) Visit with neighbors and friends and (5) Participate in religious activities. Less adequate social resources related to family, friends, and religious affiliations are significantly associated with elder self-neglect.
Journal of Elder Abuse & Neglect, 2006
Background: Research in elder self-neglect has lagged behind that of other forms of mistreatment,... more Background: Research in elder self-neglect has lagged behind that of other forms of mistreatment, despite the fact that self-neglect is the most common allegation reported to Adult Protective Service agencies throughout the US. The lack of a gold-standard to measure selfneglect has hampered efforts to study this phenomenon. Methods: Researchers designed the Self-neglect Severity Scale (SSS) based on interviews with Adult Protective Service workers and a national expert panel. The SSS is based on observation and interview and is administered in the home to include an environmental assessment. It was piloted, extensively field tested and then revised. Results: The CREST SSS was developed using survey data and consultation with experts in the field. This instrument utilizes observer ratings, interview responses, and assesses subjects' physical and environmental domains. It also assesses functional status as it relates to health and safety issues. After field and pilot testing the SSS was finalized and is currently undergoing reliability and validity testing. Conclusions: The CREST SSS was developed as a state scale to provide a common language for describing cases of self-neglect. It is the first self-neglect severity scale available to researchers. If found to be both reliable and valid it can be used in future intervention studies.
Journal of Elder Abuse & Neglect, 2006
Older adults with severe self-neglect have multiple deficits in various social, functional and ph... more Older adults with severe self-neglect have multiple deficits in various social, functional and physical domains, and often live insqualor. These individuals often present with poor personal hygiene, domestic squalor and hoarding which results in a threat to their own health as well as personal and public safety. Severe self-neglect occurs along a continuum with older adults often having cognitive and affective disorders compared with younger individuals presenting with psychiatric illnesses. In cases of severe self-neglect with hoarding, evidence has shown this behavior occurs in diverse social strata and not among the wealthy and professionals alone as believed earlier. Due to the multiple conditions associated with severe self-neglect, this population will require an interdisciplinary, multidimensional approach to reduce morbidity and mortality rates including nursing home placement. Research on this group has been limited and is rarely described in the medical and nursing literature. Future research is needed to provide practitioners with effective screening instruments and interventions on cases of severe self-neglect.