Box 1 – Elder self-neglect

Self-neglect is a worrisome public health problem [14–19]. Like violence and neglect by others, it is often encountered in cases dealt with by Adult Protective Services in the United States. Self-neglect has not been widely documented in Québec and is not included in either AP-1 or AP-2. Below is a definition of this phenomenon that has been proposed in Québec on the basis of an international literature review and work by Neesham-Grenon [20]:

Self-neglect includes a wide range of behaviours, distributed along a continuum of severity, that are socially and culturally framed, intentional or unintentional, that result from failure to meet one’s own needs or to obtain care, and that can potentially have negative repercussions on the well-being, health and safety of the self-neglected person or others [21]. 

The lack of an operational definition of self-neglect [15,22], together with conceptual differences, limit the comparison of studies, the development of knowledge, and the determination of prevalence and incidence rates [15]. In addition, several factors create barriers to the detection of self-neglect, namely, inadequate knowledge and awareness of the problem; limited supporting resources and systems; lack of training and intervention protocols; inadequate evidence determining risk factors and adjuncts that can predict the onset of self-neglect; and a lack of reliable, valid and culturally-appropriate assessment tools [15].


As with mistreatment or bullying of older adults, the consequences of self-neglect are numerous. Moreover, they vary according to the severity of the self-neglect and individual reactions. Older adults may have difficulty looking after themselves, paying their bills, and following prescribed treatments. In self-neglect situations, they may refuse all types of services, which can lead to the deterioration of their home and living environment, electrical defects, excessive accumulation of garbage, and unsanitary living conditions, sometimes involving the presence of several animals [23]. Self-neglect can also affect a person’s physical and psychological health and raise the risk of mortality from heart, lung, neuropsychiatric and other problems [15].


A Québec study of social workers who have worked with older adults in situations of self-neglect has defined the challenges involved and identified possible interventions focused on risk assessment, biopsychosocial assessment, harm reduction, values and ethics, organizational support, and the acquisition of up-to-date knowledge [20]. The social workers said that they had difficulty intervening in certain self-neglect situations and were not properly equipped. These findings led to a proposal for the preparation of a practice guide entitled L’intervention en contexte d’autonégligence [24]. The guide defines the concept of self-neglect and describes the main characteristics of the problem. It also suggests possible interventions, such as contacting or visiting the self-neglected senior, doing an assessment of the person and his or her needs, analyzing urgency and danger levels, doing a critical appraisal of the person’s support network and other available resources, and conducting an assessment of his or her ability to make informed decisions and give consent, etc. The guide encourages professionals to provide older adults with assistance and support that meet their needs, while ensuring the safety of the adults and others. Lastly, it presents possible solutions for the various challenges that social workers may encounter, as well as practical advice.