| Personal and environmental decline, described by outsiders as poor hygiene and squalid living conditions, as well as non-adherence to health care regimens, occur in competent and incompetent self-neglecting older adults. Research has repeatedly validated the links between self-neglect in incompetent community-dwelling adults and functional and/or mental impairment resulting from cognitive decline, depression, or alcohol abuse. Extensive socio-demographic data, available from these and earlier studies, reveal a wide range of self-neglect characteristics. Variables identified in the literature, essential to a framework for self-neglect include: control, culture, agency, action, age-related changes requiring new coping skills and social support.; This research identified adults early in the trajectory of self-neglect, prior to the involvement of Adult Protective Services (APS). The primary purposes of this qualitative study were to describe characteristics and behaviors of (intentional and non-intentional) self-neglect in community-dwelling older adults who were identified by their primary health care provider and to propose a theoretical framework of self-neglect for nursing practice and research. The secondary purposes were to demonstrate the use of a diagnostic tool for early identification of older adult self-neglect in the primary care setting and to describe characteristics and behaviors of self-neglect identified by physicians who refer self-neglecting patients for participation in this research. The conceptual orientation for this research was based on Orem's (1995) Self-Care Deficit Theory of Nursing.; A descriptive exploratory study design, with post hoc comparison of intentional and non-intentional self-neglecters, was undertaken. Descriptive statistics were used to illustrate the study population characteristics, obtained from the personal data sheet and the geriatric screening tools. Content analysis as described by Neuendorf (2002) was used to analyze the health care provider diagnostic decision-making and the patient participant interview data.; Research results indicate a need to consider coping abilities of self-neglecting patients. Self-neglect is not as much related to aging as it is to complex health and social circumstances and an individual's ability and willingness to address these. In addition to factors identified in prior studies, research findings indicate the need to include medical culture in a theoretical framework for self-neglect. |
