Self-Neglect Associated with Depressive Symptoms and Untreated Medical Disease
Self-neglect associated with Depressive Symptoms and Untreated Medical Disease
Jason Burnett, MS,1 John Coverdale, MD,1,2 Sabrina Pickens, MSN,1 Carmel Bitondo Dyer, MD1,2
Abstract
Purpose: Self-neglect and depression are both risk factors for increased mortality in the elderly population. Two studies assessing the psychosocial and medical characteristics of self-neglect have shown that depression is an independent risk factor. There have been no studies however, describing the psychosocial and medical profile of elders with depressive symptoms and who self-neglect. Therefore this study compares the prevalence of depressive symptoms as measured by an abnormal Geriatric Depression Score in self-neglectors to a matched sample of non-self-neglecting community dwelling elders and describes the medical profile of self-neglectors with depressive symptoms.
Methods: Fifty self-neglect cases ages 65 and older (mean age 76.3+ 7.22; Female 64%; African-Americans 58%) referred by Adult Protective Services were matched for gender, age, ethnicity, and socioeconomic status with 50 non self-neglecting participants recruited from the Harris County Hospital District. All were home-based participants in an urban setting. Comprehensive geriatric assessment included a history and physical exam, a nutritional assessment battery, and the administration of formal assessment tools including the Geriatric Depression Scale (GDS), the Mini-Mental State Exam (MMSE), Self-rated Health and Mortality Scale, and the Physical Performance Test (PPT). Untreated medical disease was determined during the assessment by a geriatric nurse practitioner and included findings such as accelerated hypertension or diabetes out of control.
Summary of Results: There was a statistically higher prevalence of depressive symptoms in the self-neglect (n=25, 51%) versus the control group (n=14, 28%; c2 =5.49, df=1, p = .019). Self-neglectors with depressive symptoms were also significantly more likely (56% vs. 21%) to have untreated medical disease compared to self-neglectors without depressive symptoms (OR=4.84, 95% CI=1.37-17.09). A variety of untreated medical diseases were discovered with hypertension being the most common followed by arthritic pain and cardiac problems.
The data provided in this preliminary report are the first to show a higher prevalence of depressive symptoms between self-neglectors and non-self-neglecting community dwelling elders employing a matched case control design. Clinicians should anticipate untreated medical disease in patients who both exhibit depressive symptoms and self-neglect.
Keywords: Self-neglect; Depression; Untreated Disease;
From: 1Baylor College of Medicine, and 2Harris County Hospital District, Houston, Texas.
Address correspondence and reprint requests to Carmel Bitondo Dyer, MD, Quentin Mease Hospital, 3601 N. MacGregor Way, Houston, TX 77004.