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Professional judgements of risk and capacity in situations of self-neglect among older people

Published online by Cambridge University Press:  17 March 2010

SHANNON MCDERMOTT*
Affiliation:
Social Policy Research Centre, University of New South Wales, Sydney, Australia.
*
Address for correspondence: Shannon McDermott, Social Policy Research Centre, University of New South Wales, Western Campus, Building G2, Sydney, NSW 2042, Australia E-mail: s.mcdermott@unsw.edu.au

Abstract

Over the past 50 years, self-neglect among older people has been conceptualised in both social policy and the academy as a social problem which is defined in relation to medical illness and requires professional intervention. Few authors, however, have analysed the concept of self-neglect in relation to critical sociological theory. This is problematic because professional judgements, which provide the impetus for intervention, are inherently influenced by the social and cultural context. The purpose of this article is to use critical theory as a framework for interpreting the findings from a qualitative study which explored judgements in relation to older people in situations of self-neglect made by professionals. Two types of data were collected. There were 125 hours of observations at meetings and home assessments conducted by professionals associated with the Community Options Programme in Sydney, Australia, and 18 professionals who worked with self-neglecting older people in the community gave in-depth qualitative interviews. The findings show that professional judgements of self-neglect focus on risk and capacity, and that these perceptions influence when and how interventions occur. The assumptions upon which professional judgements are based are then further analysed in relation to critical theory.

Type
Research Article
Copyright
Copyright © Cambridge University Press 2010

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References

Åberg, A. C., Sidenvall, B., Hepworth, M., O'Reilly, K. and Lithell, H. 2004. Continuity of the self in later life: perceptions of informal caregivers. Qualitative Health Research, 14, 6, 792815.CrossRefGoogle ScholarPubMed
Adam, B. and Van Loon, J. 2000. Repositioning risk: the challenge for social theory. In Adam, B., Beck, U. and Van Loon, J. (eds), The Risk Society and Beyond: Critical Issues for Social Theory. Sage, London, 132.CrossRefGoogle Scholar
American Bar Commission on Law and Aging 2005. Information About Laws Related to Elder Abuse. National Center on Elder Abuse, Washington DC.Google Scholar
Angus, J., Kontos, P., Dyck, I., McKeever, P. and Poland, B. 2005. The personal significance of home habitus and the experience of receiving long-term home care. Sociology of Health and Illness, 27, 2, 161–87.CrossRefGoogle ScholarPubMed
Banks, S. 2004. Ethics, Accountability and the Social Professions. Palgrave Macmillan, Basingstoke, UK.CrossRefGoogle Scholar
Barnes, M. 1997. Care, Communities and Citizens. Longman, London.Google Scholar
Beck-Gernsheim, E. 2000. Health and responsibility: from social change to technological change and vice versa. In Adam, B., Beck, U. and Van Loon, J. (eds), The Risk Society and Beyond: Critical Issues for Social Theory. Sage, London, 122–35.CrossRefGoogle Scholar
Bergeron, L. R. and Gray, B. 2003. Ethical dilemmas of reporting suspected elder abuse. Social Work, 48, 1, 96–106.CrossRefGoogle ScholarPubMed
Biggs, S., Manthorpe, J., Tinker, A., Doyle, M. and Erens, B. 2009. Mistreatment of older people in the United Kingdom: findings from the first national prevalence study. Journal of Elder Abuse and Neglect, 21, 1, 114.CrossRefGoogle ScholarPubMed
Biggs, S. and Powell, J. L. 2001. A Foucauldian analysis of old age and the power of social welfare. Journal of Aging and Social Policy, 12, 2, 93–112.CrossRefGoogle ScholarPubMed
Breaux, J. and Hatch, O. 2002. The Elder Justice Act, S. 333. Journal of Elder Abuse and Neglect, 14, 2/3, 16.CrossRefGoogle Scholar
Browne, A., Dickson, B. and van der Wal, R. 2003. The ethical management of the noncompliant patient. Cambridge Quarterly of Healthcare Ethics, 12, 3, 289–99.CrossRefGoogle ScholarPubMed
Bryman, A. 2001. Social Research Methods. Oxford University Press, Oxford.Google Scholar
Bushman, R. L. and Bushman, C. L. 1988. The early history of cleanliness in America. Journal of American History, 74, 4, 1213–38.CrossRefGoogle Scholar
Byers, B. 1993. Qualitative and quantitative profiles of elder self-neglect. Free Inquiry in Creative Sociology, 21, 2, 149–59.Google Scholar
Byers, B. and Zeller, R. 1995. Social judgements of responsibility in elder self-neglect cases. Journal of Psychiatry, 129, 3, 331–42.Google Scholar
Clark, A. N. G., Mankikar, G. D. and Gray, I. 1975. Diogenes syndrome: a clinical study of gross neglect in old age. The Lancet, 305, 7903, 366–8.CrossRefGoogle Scholar
Clarke, L. and Short, J. F. 1993. Social organization and risk: some current controversies. Annual Review of Sociology, 19, 375–99.CrossRefGoogle Scholar
Cole, A., Gillett, T. and Fairburn, A. 1992. A case of senile self-neglect in a married couple: Diogenes a deux. International Journal of Geriatric Psychiatry, 7, 11, 839–41.CrossRefGoogle Scholar
Cyphers, G. 1999. Out of the shadows: elder abuse and neglect. Policy and Practice of Public Human Services, 57, 3, 2530.Google Scholar
Dolon, R. and Blakely, B. 1989. Elder abuse and neglect: a study of Adult Protective Service workers in the United States. Journal of Elder Abuse and Neglect, 1, 3, 3149.CrossRefGoogle Scholar
Douglas, M. 1966. Purity and Danger: An Analysis of the Concepts of Pollution and Taboo. Routledge and Kegan Paul, London.Google Scholar
Douglas, M. 1992. Risk and Blame: Essays in Cultural Theory. Routledge, London.CrossRefGoogle Scholar
Duke, J. 1991. A National Study of Self-neglecting Adult Protective Services Clients. Virginia Department of Social Services and the National Association of Adult Protective Services Administrators, Washington DC.Google Scholar
Estes, C. L., Biggs, S. and Phillipson, C. 2003. Social Theory, Social Policy and Ageing: A Critical Introduction. Open University Press, Maidenhead, UK.Google Scholar
Ezzy, D. 2002. Qualitative Analysis. Allen and Unwin, Crows Nest, Australia.Google Scholar
Fine, G. A. and Hallett, T. 2003. Dust: a study in sociological miniaturism. Sociological Quarterly, 44, 1, 115.CrossRefGoogle Scholar
Gruman, C. A., Stern, A. S. and Caro, F. G. 1997. Self-neglect among the elderly: a distinct phenomenon. Journal of Mental Health and Aging, 3, 3, 309–23.Google Scholar
Haimes, E. 2002. What can the social sciences contribute to the study of ethics? Theoretical, empirical and substantive considerations. Bioethics, 16, 2, 89–113.CrossRefGoogle Scholar
Halliday, G., Benerjee, S., Philpot, M. and MacDonald, A. 2000. Community study of people who live in squalor. The Lancet, 355, 9207, 882–6.CrossRefGoogle ScholarPubMed
Herskovits, E. J. and Mitteness, L. S. 1994. Transgressions and sickness in old age. Journal of Aging Studies, 8, 3, 327–40.CrossRefGoogle Scholar
Hewett-Taylor, J. 2001. Use of constant comparative analysis in qualitative research. Nursing Standard, 15, 42, 3942.CrossRefGoogle Scholar
Holstein, M. B. and Minkler, M. 2003. Self, society and the ‘new gerontology’. The Gerontologist, 43, 6, 787–96.CrossRefGoogle ScholarPubMed
Katz, S. 1996. Disciplining Old Age: The Formation of Gerontological Knowledge. University of Virginia Press, Charlottesville, Virginia.Google Scholar
Kurrle, S. 1994. Australian society for geriatric medicine position statement on elder abuse. Australian Journal on Ageing, 13, 4, 172–75.Google Scholar
Lauder, W. 1999. The medical model and other constructions of self-neglect. International Journal of Nursing Practice, 5, 5863.CrossRefGoogle ScholarPubMed
Lauder, W. 2005. Self-neglect: the role of judgements and applied ethics. Nursing Standard, 19, 18, 4551.Google ScholarPubMed
Lauder, W., Ludwick, R., Zeller, R. and Winchell, J. 2006. Factors influencing nurses' judgements about self-neglect cases. Journal of Psychiatric and Mental Health Nursing, 13, 3, 279–87.CrossRefGoogle ScholarPubMed
Lauder, W., Roxburgh, M., Harris, J. and Law, J. 2009. Developing self-neglect theory: analysis of related and atypical cases of people identified as self-neglecting. Journal of Psychiatric and Mental Health Nursing, 16, 5, 447–54.CrossRefGoogle ScholarPubMed
Lawton, J. 1998. Contemporary hospice care: the sequestration of the unbounded body and ‘dirty dying’. Sociology of Health and Illness, 20, 2, 121–43.CrossRefGoogle Scholar
Longres, J. F. 1994. Self-neglect and social control: a modest test of an issue. Journal of Gerontological Social Work, 22, 3/4, 3–20.CrossRefGoogle Scholar
Lupton, D. 2003. Medicine as Culture. Sage, London.Google Scholar
MacMillan, D. and Shaw, P. 1966. Senile breakdown in standards of personal and environmental cleanliness. British Medical Journal, 2, 5521, 1032–7.CrossRefGoogle ScholarPubMed
Minichiello, V., Browne, J. and Kendig, H. 2000. Perceptions and consequences of ageism: views of older people. Ageing & Society, 20, 3, 253–78.CrossRefGoogle Scholar
Nair, P. and Mayberry, J. 1995. The compulsory removal of elderly people in England and Wales under Section 47 of the National Assistance Act and its 1951 amendment: a survey of its implementation in England and Wales in 1988 and 1989. Age and Ageing, 24, 3, 180–4.CrossRefGoogle Scholar
Nerenberg, L. 2000. Developing a service response to elder abuse. Generations, 24, 2, 8692.Google Scholar
Nettleton, S. and Gustafsson, U. 2002. The Sociology of Health and Illness Reader. Polity, Cambridge.Google Scholar
O'Shea, B. and Falvey, J. 1997. Diogenes' syndrome: review and case history. Irish Journal of Psychiatric Medicine, 14, 3, 115–6.CrossRefGoogle Scholar
Orrell, M., Sahakian, B. and Bergmann, K. 1989. Self-neglect and frontal lobe dysfunction. British Journal of Psychiatry, 155, January, 101–5.CrossRefGoogle ScholarPubMed
Pavlou, M. P. and Lachs, M. S. 2006. Could self-neglect in older adults be a geriatric syndrome? Journal of the American Geriatrics Society, 54, 5, 831–42.CrossRefGoogle ScholarPubMed
Phillipson, C. and Baars, J. 2007. Social theory and social ageing. In Bond, J., Peace, S., Dittmann-Kohli, F. and Westerhof, G. (eds), Ageing in Society: European Perspectives on Gerontology. Sage, London, 6884.CrossRefGoogle Scholar
Pickens, S., Naik, A. D. and Dyer, C. B. 2006. Self-neglect in older adults is a geriatric syndrome. Journal of the American Geriatrics Society, 54, 11, 1796–7.CrossRefGoogle ScholarPubMed
Pope, C., Ziebland, S. and Mays, N. 2000. Analysing qualitative data. British Medical Journal, 320, 7227, 114–6.CrossRefGoogle ScholarPubMed
Post, F. 1983. Functional disorders I: description, incidence and recognition. In Levy, R. and Post, F. (eds), The Psychiatry of Late Life. Blackwell, Oxford, 176–96.Google Scholar
Powell, J. and Biggs, S. 2000. Managing old age: the disciplinary web of power, surveillance and normalization. Journal of Aging and Identity, 5, 1, 3–13.CrossRefGoogle Scholar
Radebaugh, T. S., Hooper, F. J. and Gruenberg, E. M. 1987. The social breakdown syndrome in the elderly population living in the community: the helping study. British Journal of Psychiatry, 151, September, 341–6.CrossRefGoogle ScholarPubMed
Rathbone-McCuan, E. and Bricker-Jenkins, M. 1992. A general framework for elder self-neglect. In Rathbone-McCuan, E. and Fabian, D. R. (eds), Self-neglecting Elders: A Clinical Dilemma. Auburn House, New York, 1324.Google Scholar
Reyes-Ortiz, C. A. 2001. Diogenes syndrome: the self-neglect elderly. Comprehensive Theory, 27, 2, 117–21.CrossRefGoogle ScholarPubMed
Rubin, A. 2000. Standards for rigor in qualitative inquiry. Research on Social Work Practice, 10, 2, 173–8.CrossRefGoogle Scholar
Scallan, E., De La Harpe, D., Johnson, H. and Hurley, M. 2000. Adult service refusers in the greater Dublin area. Irish Medical Journal, 93, 7, 208–11.Google Scholar
Seale, C. 1996. Living alone toward the end of life. Ageing & Society, 16, 1, 7591.CrossRefGoogle Scholar
Seale, C. and Silverman, D. 1997. Ensuring rigour in qualitative research. European Journal of Public Health, 7, 4, 379–84.CrossRefGoogle Scholar
Shah, A. K. 1995 a. Squalor syndrome: a viewpoint. Australian Journal on Ageing, 14, 4, 160–2.CrossRefGoogle Scholar
Shah, A. K. 1995 b. The use of legislation in cases of squalor. Medical Science Law, 35, 1, 4344.CrossRefGoogle ScholarPubMed
Silverman, D. 2000. Doing Qualitative Research: A Practical Handbook, Sage, London.Google Scholar
Snowdon, J. 1987. Uncleanliness among persons seen by community health workers. Hospital and Community Psychiatry, 38, 5, 491–4.Google ScholarPubMed
Snowdon, J., Shah, A. and Halliday, G. 2007. Severe domestic squalor: a review. International Psychogeriatrics, 19, 1, 3751.CrossRefGoogle ScholarPubMed
Teaster, P. B. 2003. A Response to the Abuse of Vulnerable Adults: The 2000 Survey of State Adult Protective Services. National Center on Elder Abuse, Washington DC.Google Scholar
Tierney, M. C., Charles, J., Naglie, G., Jaglal, S., Kiss, A. and Fisher, R. H. 2004. Risk factors for harm in cognitively impaired seniors who live alone. Journal of the American Geriatrics Society, 52, 9, 1435–41.CrossRefGoogle ScholarPubMed
Twigg, J. 2004. The body, gender, and age: feminist insights in social gerontology. Journal of Aging Studies, 18, 1, 5973.CrossRefGoogle Scholar
Vinton, L. 1992. An exploratory study of self-neglectful elderly. Journal of Gerontological Social Work, 18, 1/2, 5567.CrossRefGoogle ScholarPubMed
Vostanis, P. and Dean, C. 1992. Self-neglect in later life. British Journal of Psychiatry, 161, August, 265–7.CrossRefGoogle Scholar
Wrigley, M. and Cooney, C. 1992. Diogenes syndrome: an Irish series. Irish Journal of Psychological Medicine, 9, 1, 3741.CrossRefGoogle Scholar