Exploring self-neglect in older adults: preliminary findings of the self-neglect severity scale and next steps

Despite the public health implications of self-neglect, no tool exists for characterizing this condition. Self-neglecters often have no caregivers or surrogates to interview regarding the neglect and are often too cognitively impaired to provide valid self-reports. In response to this need, researchers from the Consortium for Research in Elder Self-neglect of Texas (CREST) collaborated with other experts in the field of elder self-neglect to design the Self-neglect Severity Scale (SSS). The SSS assesses three domains of self-neglect (hygiene, functioning, and environment) and relies on observational ratings assigned by trained observers. After pilot testing and revision, the SSS was field tested in the homes of subjects who had been reported to and substantiated by Texas Adult Protective Services (APS) as self-neglecting and compared with results of subjects recruited from a local geriatric clinic who were reported to APS but had no history of self-neglect. The first field test demonstrated that the SSS could distinguish elderly self-neglecters from community dwellers who do not self-neglect. The SSS exhibited adequate scale reliability (Cronbach alpha) and correlation with case status. Interrater reliability also appeared adequate, although sensitivity and specificity fell below the conventional acceptable range. Future methods are proposed for refining the SSS to improve its use as the benchmark for identifying elder self-neglect.