Self-neglect and Resistance to Intervention: Ethical Challenges for Clinicians

Excerpt

The recent IOM report Retooling the Aging Workforce 1 draws attention to the urgent need for all health care providers to develop greater expertise in geriatric medicine in order to care for the nation’s growing population of older adults. General internists will play an essential role in that care, and therefore must gain competence in the recognition and treatment of geriatric syndromes. In addition to syndromes that have been well characterized, such as falls and incontinence, there may be additional conditions that have been less well described but that are equally important. In this issue of the Journal, Pavlou and Lachs describe such a clinical entity: self-neglect.2 The authors point out that self-neglect is an important problem for medical professionals because it has medical causes and leads to negative health consequences. Although the prevalence may be high in older adults and the causes may be treatable in an important number of cases (for example when caused by depression), self-neglect has been studied very little. There is a need for empirical data to guide medical practice. The authors have made an important contribution by drawing our attention to the issue of self-neglect. They also provide a useful clinical approach to such patients, based on the limited evidence base that is currently available on this topic. Finally, they outline a research agenda to better define self-neglect, augment the evidence base for this condition, and identify effective treatments. …