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Assessing risk
Published in Lorraine Bell, Helping People Overcome Suicidal Thoughts, Urges and Behaviour, 2021
All of these may be linked to increased risk of suicide or mortality. Domestic abuse or partner violence (especially when severe or persistent) is a strong risk factor for suicide and attempted suicide (Devries et al 2011; Munro & Aitken 2020). The distress, sense of entrapment and hopelessness arising from domestic abuse can cause victims to feel that suicide is “the only way out” (O’Connor & Knock 2014). As suggested in Part 1 with regard to substance abuse, clinicians or practitioners assessing anyone who is experiencing partner violence or suicidality should be alert for both (Salvatore 2018). Wu et al (2012) found levels of clinician-appraised risk of self-neglect, but not of suicide or violence, predicted mortality among people receiving a risk assessment in secondary mental health service. Self-neglect can occur across the lifespan but is more common in older people.
Mental health
Published in Gary Chan Kok Yew, Health Law and Medical Ethics in Singapore, 2020
The Vulnerable Adults Act55 protects vulnerable persons ie, any adult above 18 years of age who is by reason of mental or physical infirmity, disability or incapacity, incapable of protecting himself or herself from abuse,56 neglect57 or self-neglect.58 The words “neglect” and “self-neglect” encompass situations where the adult suffers from mental health problems or mental illnesses. The Director-General of Social Welfare and designated public officers have the power under the statute to enter into private premises to assess and, if necessary, remove a vulnerable adult in order to protect him or her from abuse, neglect and self-neglect.59 The penalties for offences against vulnerable persons have been enhanced under the Protection from Harassment Act60 (as amended by the 2019 Act) as well as under the Penal Code.61
Other uncommon psychiatric syndromes
Published in David Enoch, Basant K. Puri, Hadrian Ball, Uncommon Psychiatric Syndromes, 2020
David Enoch, Basant K. Puri, Hadrian Ball
Of the originally described aetiological factors, it has been found particularly to be associated with frontotemporal dementia (Cipriani et al., 2012), and recently an association has also been reported with autistic spectrum disorder (Sadlier et al., 2011) and Asperger syndrome (Padovan et al., 2018). In their large study (vide supra), Dyer et al. (2007) found strong evidence of impaired neuropsychological and physical performance and of low mood amongst sufferers with substantial overlap in impairments in physical performance, executive function and cognitive functions; based on these findings they put forward a model attempting to explain the self-neglect. Underlying medical/psychiatric conditions result in impaired executive functioning with consequent impairment in basic everyday activities and a reduced capacity for decision-making. The added presence of adverse extrinsic social factors along with inadequate support services then lead to the end result of extreme self-neglect.
Trauma from Physical and Emotional Sibling Violence as a Potential Risk Factor for Elder Abuse
Published in Journal of Gerontological Social Work, 2020
Marcia Spira, Nathan H. Perkins, Alicia H. Gilman
While no overarching definition of EA exists, EA can be defined as the intentional or unintentional maltreatment of persons over the age of 60. The Center for Disease Control and Prevention (2019) defines EA as “an intentional act, or failure to act, by a caregiver or another person in a relationship involving an expectation of trust that causes or creates a risk of harm to an older adult.” Physical, emotional, and neglect, including self-neglect, financial, and sexual exploitation are several of the forms of recognized EA (McAlpine, 2008). Some authors regard social abuse as a separate category, while others include it as a sub-type of psychological abuse (Johannesen & LoGiudice, 2013). Physical abuse includes pushing, shoving, or other forms of physical restraint. Emotional abuse includes language that is emotionally hurtful or diminishing to the older person. Financial exploitation is related to misappropriation of financial resources for the self-interest of the perpetrator rather than the care of the older person. Neglect manifests as ignoring the needs of the older person, such as ignoring medical concerns, avoiding contact and communication, or overlooking needs for nutrition or hygiene. The problem is magnified with the inclusion of self-neglect. Self-neglect is expressed through the inability to provide self-care, due to physical or mental impartment (Mosqueda & Dong, 2011). Sexual abuse is recognized as any non-consensual sexual contact. No matter what type of abuse an older person may experience EA is traumatic, and further trauma may result from acts that trigger previous trauma (Ramsey-Klawsnick & Miller, 2017).
The Caregiver Thoughts Scale: An Instrument to Assess Functional and Dysfunctional Thoughts about Caregiving
Published in Clinical Gerontologist, 2023
Anne Katrin Risch, Marcus Mund, Gabriele Wilz
Nearly every caregiver experiences feeling overburdened over the course of the caregiving process. Accepting thoughts about one’s own limits (e.g.” I can’t control everything all the time”) and of the caregiver’s life situation (e.g., “I don’t have it easy, but I try to make the best of the situation”), may help caregivers to cope better with demands and daily hassles. Caregivers also experience losses and (pre-death) grief, defined as the “emotional and physical response to the perceived losses in a valued care recipient” (Lindauer & Harvath, 2014, p. 2203). Thoughts related to higher acceptance of pre-death losses during the course of illness may help to prepare better for the final loss of the care recipient, than thoughts related to low acceptance (e.g., “We still had so much to experience together, now my life is ruined”) would do. The lack of preparedness to the final loss was associated with more depression, anxiety, and complicated grief after bereavement (Hebert et al., 2006). Moreover, lower acceptance of perceived losses in the care recipient was associated to higher depression, anxiety, and heart troubles, as well as to lower quality of life in the domains of psychological health and social relationships (Meichsner et al., 2016). Besides the experience of grief, many caregivers also experience negative emotions and thoughts related to caring or the care recipient, and even thoughts like, “It would be better for everyone that my relative dies” (Losada et al., 2006b, p. 120) are relatively frequent. The acceptance of negative thoughts and emotions is seen to be helpful in a way, as it prevents the caregiver from “self- neglect” (see, Losada et al., 2006b). Accordingly, hiding negative thoughts and emotions was found to be associated with higher burden (Muela et al., 2001) and higher mean arterial pressure in caregivers (Losada et al., 2014). Spira et al. (2007) found robust correlations between higher acceptance of negative emotions and lower depression in family caregivers. Moreover, acceptance and commitment therapy for caregivers with high depressive symptoms resulted in lower experiential avoidance (i.e. opposite of acceptance) and lower depression and anxiety at post intervention, although inferences about mediational effects could not be made due to the study design (Losada et al., 2015).
A new screening tool for self-neglect in community-dwelling older adults: IMSelf-neglect questionnaire
Published in The Aging Male, 2020
Birkan İlhan, Gülistan Bahat, Filiz Saka, Cihan Kılıç, Meryem Merve Oren, Mehmet Akif Karan
Self-neglect has been defined in different ways in the literature. It commonly refers to the inability or reluctance or refusal to provide himself/herself with adequate food, water, clothing, shelter, personal hygiene, medication, and safety precautions, that threatens his/her own health or safety [1]. Self-neglect has been reported as the primary type (41.9%) of older adult’s abuse cases reported to adult protective service agencies across the United States [2]. These reported cases are on the rise [3]. In addition, the National Center on Elder Abuse reports that elder self-neglect is more common than all other forms of elder abuse, neglect and exploitations combined [3]. Recent cohort studies have shown various self-neglect prevalences between 5.3–29.1% due to different study populations and methodological inconsistency, such as inconsistent definitions and measurements [4–7]. There is a variety of methodological issues regarding detection and assessment of self-neglect in older adults. Although there is growing body of research which examines self-neglect, there is a lack of information on how to systematically estimate its prevalence [8]. A recent comprehensive review on older adults’ self-neglect stated that diversity in conceptual and operational definitions and tools have greatly complicated the comparison and limited the impact of the current researches [8]. Detection of self-neglect is generally based on combination of home interview and examining multiple scales such as functional assessment scales, social functioning scales, quality of life, mental status questionnaires, and other psychometric tests [9]. Social workers assess various phenotypes such as hoarding, personal hygiene, the house needs repair, unsanitary conditions, and inadequate utility in home interview details. Limited number of specific self-neglect screening and detection tools exist which can be used during home interview, and most of them have not been tested for the reliability and validity [8,10,11]. However, in geriatric practice, most of older adults are generally assessed in outpatient clinics by geriatrics teams rather than by home assessment. Only a very limited number of older adults are assessed at home by the clinicians. To the best of our knowledge, there is no self-neglect screening questionnaire designed for community-dwelling older adults admitted to outpatient clinics.