Self-Neglect

Challenges for Helping Professionals

James G O'Brien

• Publisher: Routledge
• Year: 2014
• Print ISBN: 9780789009937
• eBook ISBN: 9781317826095
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Understand the complex ethical, legal, medical, and psychological issues of the most common form of elder abuse!Self-Neglect examines the social, ethical, medical, and practical implications of the most prevalent form of elder abuse. It can be difficult to diagnose and treat, and it poses ethical questions that cannot be answered simply. Yet it is so common and so destructive that anyone who works with geriatric patients must come to terms with it. Everyone is familiar with the image of the wild-haired elderly recluse hoarding junk in a dilapidated house, but to their neighbors, friends, and family--as well as to the health care professionals, social workers, and clergy who deal with them--these recluses are a special burden. They often refuse care despite such obvious problems as open sores. They tend to be intelligent and independent. Do they have the right to choose to live in squalor, or are their choices dictated by depression or other diseases? Do health care professionals have a responsibility to treat them against their will or a duty to respect their stated preferences?Self-Neglect examines the topics of passive suicide and indirect life-threatening behavior to help medical practitioners working with the elderly understand why patients do not follow doctor's orders or take care of themselves. Through case studies, this informative book explores the ways in which patients practice self-neglect by ignoring their doctors'advice, extreme lack of self-care, refusal to eat, failure to take their prescribed medication, and alcohol abuse. Self-Neglect offers insight into many facets of this condition, including:

• choosing among the many definitions of self-neglect
• what kinds of people become self-neglecting
• managing self-neglecting patients
• when and how to intervene
• the patient's autonomy and personal rights versus the rights of the community
• self-neglect as a way to gain control of a negative life situation when other tactics have failedDiscussing the sometimes tragic outcome of misdiagnosing self-neglect or leaving it untreated, this intelligent book will help you identify and understand this dangerous behavior and offer your patients better care for this condition.

Index

Numbers followed by “f” indicate figures; “t” following page numbers indicate tables.

AA. See Alcoholics Anonymous

Abuse

alcohol. See Alcohol abuse

elder, 6

Adams, W. L., 58–59, 65

Adult Protective Services (APS), 2, 35

and patient advocacy, 42–45

Advance Directives, 51

Age, as factor in self-neglect, 6–7

Aging

as assault on dignity, 41–42

and erosion of health, 40–41

ethics and, confronting abuse and self-neglect in the elderly, 33–54. See also Self-neglect, in the elderly, ethical issues related to

Alcohol, physical dependence on, 60

Alcohol abuse

behavior reinforcement due to, 60

effect on thiamine absorption, 62

in the elderly

causes of, 59–60

pharmacology of, 60

prevalence of, 55, 57–59

and self-neglect, 7

and self-neglect in the elderly, 55–75

diagnosis of, 64–68, 66t

introduction to, 55–60

Korsakoff's psychosis due to, 66

neglect of basic needs, 61–62, 61t, 63t

neglect of psychosocial needs, 61t, 63–64

neglect of safety needs, 61t, 62–63

screening for, 64–68, 66t

treatment of, 68–71, 70f

AA in, 69

brief interventions in, 68–69, 70f

detoxification in, 69, 71

follow-up from, 71

structured interventions in, 69

Wernicke-Korsakoff syndrome due to, 62

Wernicke's encephalopathy due to, 62

systemic effects on, 62, 63t

tolerance resulting from, 60

“Alcohol use disorders,” defined, 57

Alcohol Use Disorders Identification Test (AUDIT), 65

Alcoholic Anonymous (AA), 69

Alcoholism

definitions of, 56–57

“milieu limited,” 59

types of, 59, 64

Allen, S. A., 46–47

Alternative suicide, 23

Autonomy

assessing decisional capacity and, 45–47

personal...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Preface-“Hector the Collector”
• Self-Neglect: An Overview
• Indirect Life-Threatening Behavior in Elderly Patients
• Ethics and Aging: Confronting Abuse and Self-Neglect
• Alcohol Abuse and Self-Neglect in the Elderly
• Community Dimensions of Elderly Self-Neglect
• Index