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Defined as "actions that cause harm or create a serious risk of harm to an older adult by a caregiver or other person who stands in a trust relationship to the older adult, or failure by a caregiver to satisfy the elder's basic needs or to protect the elder from harm"
Self-neglect is the most common form of elder mistreatment and occurs among all demographic strata of the aging population
In the United States, according to the best available estimates,
About 14% of adults over age 70 experience some sort of mistreatment annually
Each year, 5% of elders may be victims of financial abuse or scams
Laws in most states require health care providers to report suspected mistreatment or neglect to Adult Protective Services
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It is helpful to observe and talk with every older person alone for at least part of a visit to ask questions directly about possible mistreatment and neglect, such as
When self-neglect is suspected, it is critical to establish whether the patient has decision- making capacity in order to determine what course of action needs to be taken
A patient who has full decision-making capacity should be provided with help and support but can choose to live in conditions of self-neglect, providing that the public is not endangered by the actions of the person
In contrast, a patient with self-neglect who lacks decision-making capacity requires more aggressive intervention, which may include guardianship, in-home help, or placement in a supervised setting
Montreal Cognitive Assessment (https://www.mocatest.org/) score may provide some insight into the patient's cognitive status but is not designed to assess decision-making capacity
A standardized tool for determining decision-making capacity, such as the "Aid to Capacity Evaluation," is easy to administer, has good performance characteristics, and is available free online at http://www.jcb.utoronto.ca/tools/documents/ace.pdf
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