Characteristics of Older Adults With Domestic Squalor in Japan: A Cross-Sectional Study

Domestic squalor (DS) is related to physical problems, living alone, family and neighbourhood problems and mental illnesses, especially dementia. However, methods to detect and treat older adults with DS remain unclear. We aimed to clarify the methods of appropriate intervention for older adults with DS.

The Initial-phase Intensive Support Team for Dementia (IPIST) is a multidisciplinary outreach team in Japan that provides intensive support to people living at home with suspected dementia. We distributed a questionnaire to 50 IPISTs, specifically requesting the submission of 'two complex cases that were difficult to manage' regarding medical or long-term care. The questionnaire included sociodemographic characteristics, diagnosis, referral sources, and reasons for complexity. We compared cases with and without DS (DS+ vs. DS-), and DS cases living alone and those living with family (DS+ living alone vs. DS+ living with family).

We received responses from 33 IPISTs and collected data from 70 complex cases. DS was selected as the reason for complexity in 24 cases, 14 of which were people living alone. Significantly fewer DS+ cases were referred by family (8.3% vs. 54.3%), while significantly more were referred by others (87.5% vs. 41.3%). The most common referral sources were neighbours and social workers. DS+ cases had significantly higher rates of self-neglect (87.5% vs. 13.0%). Those living alone were significantly younger (median (interquartile range): 78.5 (76.8-82.8) years) than those living with family (85.0 (78.8-89.8) years). Family members living with DS+ cases also had issues, including mental illness or maltreatment.

In this study sample, many older adults with DS exhibited self-neglect and had limited family support. Our findings suggest that a comprehensive approach to both older adults with DS and their families is crucial for appropriate intervention. Therefore, IPISTs that have a multidisciplinary team with an outreach function may be effective.