In this study, we found that self-neglect was not uncommon among disability elderly. Physical function impairment is the most significant and essential feature that distinguishes disability elderly from other groups. It is well-established that declines in physical function lead to declines in individual mobility and the ability of self-care. A number of prior studies have found elders whose physical function decline was associated with increased risk of self-neglect [3–5] .Therefore,disability elderly are avulnerable population prone to self-neglect.
We examined the prevalence of self-neglect among disability elderly in China. The prevalence of self-neglect in this study was 86%, which was higher than studies done in Korea(22.8%), Istanbul(16.8%)and American(19.2%) [3–5]. It might be due to a difference in our study population; that is all of the participants were elderly with disability because decline in physical function was prone to self-neglect in all of the findings. Besides, another reason might be due to self-neglect measurement tool variation, as in Istanbul, the study used Istanbul Medical School Elder Self-Neglect questionnaire (IMSelf-neglect) to screen self-neglect. The IMSelf-Neglect scale, which mainly investigates whether older adults neglect their personal hygiene, health habits,and social functioning, is different from the measurement tool used in our study.
As for sociodemographic characteristics, we found that marital status, or education level, was not associated with self-neglect, while monthly income had a strong negative association with self-neglect. The result of our study are similar to a cross-sectional study reported by Yu et al, which showed that elderly with lower monthly income predicting higher levels of self-neglect [7]. It might bedue to elderly with high levels of monthly income have greater opportunities to get healthcare service and take part in more social activities, which may reduce the risk of self-neglect [7].On the contrary, this outcome was in contrast with the findings of Dong et al, which reported that monthly income have no significant association with self-neglect [20].Our study did not show differences in the risk of self-neglect based on the participant's gender or age.In contrast, in a North American study,Abrams et al. [21] observed that male gender and older age reported suffering self-neglect more frequently.Further studies are needed to better examine the associations between sociodemographic variables and self-neglect.
The higher degree of disability was associated with higher levels of self-neglect. Among the different degree of disability, the self-neglect scores observed among severe disability elderly was higher compared to disability elderly in degree of mild and moderate. A previous study reported that decline in physical function was associated with increased risk of greater self-neglect severity [5].Our participants who needed assistance in daily living were at a higher risk than others, similar to that reported in another study, indicating that poor physical health appeared to be an independent predictor of self-neglect [8]. Additionally, the physical function impairment was one of the common elements that contribute to elder self-neglect, as illustrated in the model of self-neglect developed by Dyer [22]. According to Dyer et al, impairment with essential activities of daily living represent the central event associated with worsening vulnerability in the syndrome of elder self-neglect [22].
Depressive symptoms was found to be significantly correlated with self-neglect in disability elderly. Elderly with disabilities have a higher rate of depression than those without disabilities [23]. The results of the present study showed that the more depressive symptoms of disability elderly, the higher levels of self-neglect they have. Another study conducted with elderly living alone revealed a positive correlation between depressive symptoms and self-neglect [3]. Elderly with depressive symptoms tends to have lower life expectations, loss of interest or pleasure in activities and sense of hopelessness [24], all of which may increase their risk for self-neglect. Not surprisingly, higher levels of depression also significantly predict higher suicidal ideation among disability elderly [25]. In turn, suicidal ideation is associated with increased risk of self-neglect [26].
Another finding of the present study is that perceived social support was negatively correlated with self-neglect among the population with disability, higher levels of perceived social support was at significantly lower risk for self-neglect. Higher levels of social support lead to lower levels of psychological distress, social support could be used to maintain a stable psychological state [27]. On the other hand, social support perceived by the elderly significantly contributes to their experiences of life satisfaction and their self-esteem [28]. Our results suggest that higher perceived social support levels might play a protective role against self-neglect.Therefore, support from family, friends, and significant others helps to prevent self-neglect, which indicating the importance of promoting adequate social support of the disability elderly.
In our study, compared with normal cognition, cognitive impairment was associated with higher levels of self-neglect in the univariate analysis, though not statistically significant in the multiplelinear regression model. In previous studies, some reported that cognitive impairment tended to be a risk factor for elder self-neglect [6], while Lee et al.[3] observed a negative association between cognitive impairment and elder self-neglect. The inconsistency suggests the complex relationship between cognitive impairment and elder self-neglect. These findings suggest further studies are needed to explore the association between cognitive impairment and elder self-neglect.
This study further found that majority of the respondents do not see their behaviors as self-neglecting.This may be due to inadequate sensitization regarding the problem. Therefore, adequate education by TV shows or newspaper articles is vital to elderly suffering from self-neglect, which can contribute to deepen understanding [9].
Our study may have several potential limitations should be noted. First,only correlations rather than causal relationships can be established, as our results were based on a cross-sectional study. Further longitudinal studies is necessary to clarify the relationships between these risk factors and self-neglect. Second, all the participants are from two communities of a district in Shenyang, China, so the findings may not be generalized to other regions of the country. Third, variables like alcohol drink, educational status, and cigarette smoking are a sensitive issues and might cause social desirability bias. Finally, the use of questionnaires to collect data may have recall bias.