Understanding Self-Neglect: Ethical Issues and Assessment Tools

Exploring the complexities of self-neglect, this content delves into associated factors, ethical considerations, assessment tools, and measurement techniques. From environmental influences to personal health behaviors, the discussion covers a range of aspects related to self-neglect in vulnerable populations.

• Self-Neglect
• Ethical Issues
• Assessment Tools
• Elder Abuse

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1. Self-Neglect: Ethical Issues LAUNCH OF REGIONAL MULTI-AGENCY HIGH RISK BEHAVIOUR PROCEDURE POLICIES 19TH NOVEMBER 2021 MARY ROSE DAY

2. Self-Neglect: Associated Factors Environmental Physical/psycho-social Impaired physical function Pre-frailty (Lee et al., 2016) Pain, Nutrition Multiple chronic diseases (depression, dementia, mental health issues, suicidal ideation etc.) Autism Trauma Alcohol substance abuse Living alone, Isolation, Reduced social networks, Service refusal Self-Neglect is a risk factor for and a consequence of other types of elder abuse Poor self-esteem, coping (Gibbons 2009) Maladaptive attempts to maintain self-identity and continuity (Bozinovski, 2000) Financial issues Deprivation Lower neighbourhood cohesion, and neighbourhood disorder (trash, loud noise, strangers, unsafe traffic conditions, vandalism, and unsafety of walking around) (Hei & Dong, 2018; Mingming et al., 2020). DR. MARY ROSE DAY 05/12/2024

3. Assessment and Self-Neglect Assessment Ethical Issues Capacity Safeguarding Self-Neglect Measures

4. Assessment Tools Self-Neglect Assessment Measurement (SN-37) five factors and includes indicators of self-neglect. (Day & McCarthy, 2018) Short Form Elder Self-Neglect Assessment Tool (SF-ESNA) 25 items (12 physical and psycho-social and 13 environmental and personal living conditions. (Iris, 2017) Clutter image rating (CIR) scale. Nine photographs that depict a room in various states of clutter, beginning with a room that is as tidy as an empty hotel room. Free online. (Frost et al., 2008; Tolin et al., 2010) Multi-agency High Risk Panel Referral Form and Risk assessment

5. Self-Neglect Factors Self-Neglect Measurement Tool (SN-37 items) 31.5% Environment Variance 7.7% Social Networks Variance Emotional & Behavioural Liability 7.4% Self-Neglect Variance Health Avoidance 5% Variance 4% Self- Determinism Variance

6. Self-Neglect Measure (SN-37) Environment Subscale 1. Individual has no way to obtain and /or prepare meals 2. Individual lives in a house/apartment that does not have all the equipment/facilities to fit the individual s physical needs (i.e. wheelchair, bars in the bathroom or hallway or ramps, poor lighting, fuel poverty) 3. Individual has an accumulation of items that presents a safety hazard 4. Individual is hoarding animals 5. Individual is eating spoiled food 6. Individual has no access to bathing facilities 7. Individual lacks funds/money to pay bills (i.e. utilities, household repairs etc.) 8. Individual lives in a house/apartment where appliances are not working

7. Self-Determinism Subscale 1. Individual is not co-operative or willing to accept assistance 2. Individual has displayed self- neglectful behaviour at other times in his/her life 3. Individual is reluctant to receive help for daily care 4. Individual neglects personal hygiene (dirty clothing, bad odour, dishevelled appearance.

8. Self-Neglect is a Fine Balance .

9. Decision Making Tool (Campbell & McCarthy, 2016) Actions Responsibilities 1. Articulate the ethical problem(s) and identify relevant facts Be ethically sensitive and communicate clearly 2. Identify stakeholders interests, needs, values Be respectful and inclusive 3. Weigh the merits and demerits of available courses of action Be informed and fair 4. Select the action which can best be supported by ethical principles Be impartial and transparent 5. Review Check: have I been sensitive, clear, respectful, inclusive, informed, transparent? fair, impartial and

10. Perspectives -Lens Cultural & Social Artistic & Philosophical Futuristic Case/Person Ethical Environmental Political & Historical Economic Scientific Evidence

11. Effective Practice/ Conclusion Person centred and relationship centred practice; Values and ethics for my practice; Draw on knowledge from a wide range of sources; Multi-agency approach Organisational knowledge Best evidence to inform practice; Decision making and skills for practice Supervision that promotes reflection and critical analysis of approaches taken Legal literacy -ability to connect relevant policy, legislation, local national and international

12. Readings Braye, S., Orr, D. & Preston-Shoot, M. (2017): Autonomy and Protection in Self-neglect Work: The Ethical Complexity of Decision-making, Ethics and Social Welfare, DOI: 0.1080/17496535.2017.1290814 Day, M.R. (2019) Self-Neglect in Older Adults In: Amanda Phelan (Ed.)., Advances in Elder Abuse Research Springer International (Chapter 7 pp. 85-100. Springer Day, M.R. (2017). Self-Neglect In: Heather Herdman, T. & Kamitsuru, S. (Ed.), Nursing Diagnoses Definition and Classification 2018-2020 Eleventh edition(p.248) NANDA International, Thieme Publishers. Day, M. R. McCarthy G. & Fitzpatrick J. J. (Ed.), (2018). Self-Neglect in Older Adults a Global, Evidence-Based Resource for Nurses and Other Healthcare Providers New York: Springer. Day, M.R. & McCarthy, J. (2018). A Self-Neglecting Case Dilemma: Applying an Ethical Decision-Making Tool In: Day, M. R. McCarthy G. & Fitzpatrick, J. J. (Ed.), Self-Neglect in Older Adults a Global, Evidence-Based Resource for Nurses and Other Healthcare Providers (Chapter 24 p. 349-360) New York: Springer. Gibbon, S. & Day, M.R Day, M. R Day, M.R.

13. Readings Day, M.R. Day, M.R. Mulcahy, H. & Leahy-Warren, P. (2017) Self-Neglect Views and Experiences of Health & Social Care professionals Age and Ageing, 46, Issue Suppl_3, Pages iii13 iii59, https://doi.org/10.1093/ageing/afx144.186 Day, M. R Day, M. R. & McCarthy, G. (2016). Animal Hoarding: A Serious Public Health Issue Annuals of Nursing and Practice 3(4), 1054 . Martineau, S., Manthorpe, J., Woolham, J., Steils, N., Stevens, M., Owen, J., and Tinelli, M. (2021) Social care responses to self-neglect among older people: an evidence review of what works in practice, London: NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute, King s College London. https://doi.org/10.18742/pub01-047 Study webpage: www.kcl.ac.uk/research/self-neglect-and-hoarding-among-older-people Mingming Yu, Libin Gu, Yuexian Shi & Wenru Wang (2020) A systematic review of self-neglect and its risk factors among community-dwelling older adults, Aging & Mental Health, DOI: 10.1080/13607863.2020.1821168 Preston-Shoot, M. (2017) What Difference Does Legislation Make? Adult Safeguarding Through The Lens Of Serious Case Reviews And Safeguarding Adult Reviews. A Report For South West Region Safeguarding Adults Boards.