The Utility of the KELS Test is Associated with Substantiated Cases of Elder Self-neglect
Abstract
Purpose: Self-neglect is the most prevalent form of elder mistreatment and can be defined as the inability to meet one's own basic needs. The Kohlman Evaluation of Living Skills (KELS) has been validated in geriatric populations to assess performance in both instrumental (IADL) and basic activities of daily living (ADL), and as an assessment tool for the ability to live independently, therefore the purpose of this analysis was to compare the scores of the KELS between known self-neglectors and healthy, community-dwelling elders.
Methods: This is a cross-sectional 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. Control participants were matched for age, race, gender and zip code as closely as possible. Both groups were administered a comprehensive geriatric assessment in their homes by a geriatric nurse practitioner and a research assistant. An occupational therapist provided training on KELS administration. The assessment included the KELS and Mini-Mental State Examination (MMSE) tests.
Summary of Results: Chi-square analyses were used to determine if self-neglectors were significantly more likely to fail the KELS than non-self-neglectors. The analyses revealed that self-neglectors were significantly more likely to fail the KELS than non-self-neglectors (c2 = 5.0, df=1, p=0.025). When controlling for the possible confound associated with MMSE scores, self-neglectors scoring 24 or greater remained significantly more likely to fail the KELS compared to non-self-neglectors also scoring normal on the MMSE (c2 = 6.15, df=1, p=0.013). No significant difference in the pass or fail rate of the KELS was detected between self-neglectors and non-self-neglectors who scored abnormally on the MMSE.
Conclusion: Scoring abnormally on the KELS is significantly associated with self-neglect. These findings provide strong support for implementing the KELS 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 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 ability to complete everyday life supporting tasks and thus, provides information that can help identify cases of self-neglect.
Key Words: Self-neglect; Activities of Daily Living; Kohlman Evaluation of Living Skills; Elder Mistreatment