Journal of General Internal Medicine

, Volume 23, Issue 11, pp 1841–1846 | Cite as

Self-neglect in Older Adults: a Primer for Clinicians

  • Maria P. PavlouEmail author
  • Mark S. Lachs
Populations at Risk


Self-neglect in older adults is an increasingly prevalent, poorly understood problem, crossing both the medical and social arenas, with public health implications. Although lacking a standardized definition, self-neglect is characterized by profound inattention to health and hygiene. In light of the aging demographic, physicians of all specialties will increasingly encounter self-neglectors. We outline here practical strategies for the clinician, and suggestions for the researcher. Clinical evaluation should include attention to medical history, cognition, function, social networks, psychiatric screen and environment. The individual’s capacity is often questioned, and interventions are case-based. More research is needed in basic epidemiology and risk factors of the problem, so that targeted interventions may be designed and tested. The debate of whether self-neglect is a medical versus societal problem remains unresolved, yet as health sequelae are part of the syndrome, physicians should be part of the solution.


self-neglect older adults clinical guidelines 



Dr. Pavlou is supported by The John A. Hartford Foundation, Inc., and The Gruss Lipper Family Foundation. She is also the recipient of a Brookdale Leadership in Aging Fellowship.

Dr. Lachs is the recipient of a Mid Career Mentoring Award in Patient Oriented Research from the National Institute on Aging 5 K24 AG022399–04–05.

Supported in Part by a Donald W. Reynolds Foundation Grant to Improve Geriatric Medical Education at the Weill Cornell Medical College.

Conflict of Interest

None disclosed.


  1. 1.
    Clark AN, Mankikar GD, Gray I. Diogenes syndrome. A clinical study of gross neglect in old age. Lancet. 1975;1(7903):366–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Pavlou MP, Lachs MS. Could self-neglect in older adults be a geriatric syndrome? J Am Geriatr Soc. 2006;54(5):831–42.PubMedCrossRefGoogle Scholar
  3. 3.
    Statutory Provisions: Types of Abuse Defined in Adult Protective Services Statutes. American Bar Association Commission on Law and Aging (2005). Prepared for the National Center of Elder Abuse. Available at: Accessed on June 4, 2008.
  4. 4.
    Cybulska E, Rucinski J. Gross self-neglect in old age. Br J Hosp Med. 1986;36(1):21–5.PubMedGoogle Scholar
  5. 5.
    Rathbone-McCuan E, Fabian, DR., ed. Self-Neglecting Elders: A Clinical Dilemma. Westport: Greenwood Publishing Group: 1992.Google Scholar
  6. 6.
    The National Center on Elder Abuse. The 2004 National Survey of State Adult Protective Services. Available at:–14–06%20FINAL%2060+REPORT.pdf. Accessed on June 4, 2008.
  7. 7.
    Lachs MS, Williams C, O’Brien S, Hurst L, Horwitz R. Older adults. An 11-year longitudinal study of adult protective service use. Arch Intern Med. 1996;156(4):449–53.PubMedCrossRefGoogle Scholar
  8. 8.
    Abrams RC, Lachs M, McAvay G, Keohane DJ, Bruce ML. Predictors of self-neglect in community-dwelling elders. Am J Psychiatry. 2002;159(10):1724–30.PubMedCrossRefGoogle Scholar
  9. 9.
    DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000;160(14):2101–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Alexopoulos GS. Role of executive function in late-life depression. J Clin Psychiatry. 2003;64(Suppl 14):18–23.PubMedGoogle Scholar
  11. 11.
    Kapp MMB. Ethical aspects of guardianship. Clin Geriatr Med. 1994;10(3):501–12.PubMedGoogle Scholar
  12. 12.
    Lachs MS, Williams CS, O’Brien S, Pillemer KA. Adult protective service use and nursing home placement. Gerontologist. 2002;42(6):734–9.PubMedGoogle Scholar
  13. 13.
    Lachs MS, Williams CS, O’Brien S, Pillemer KA, Charlson ME. The mortality of elder mistreatment. JAMA. 1998;280(5):428–32.PubMedCrossRefGoogle Scholar
  14. 14.
    Mendes de Leon CF, Glass TA, Beckett LA, Seeman TE, Evans DA, Berkman LF. Social networks and disability transitions across eight intervals of yearly data in the New Haven EPESE. J Gerontol B Psychol Sci Soc Sci. 1999;54(3):S162–72.PubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  1. 1.Division of Geriatric Medicine and Gerontology, Department of MedicineWeill Cornell Medical CollegeNew YorkUSA

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