Q&A: What is the Best Way to Discuss Elder Self Neglect?

A: Elder self neglect is not an easy topic to discuss, but there are times when it’s necessary—especially if there’s concern about the safety of a loved one.
Elder self neglect is defined as the failure or refusal of an independent older adult to provide one or more of the necessities essential to their physical and mental well-being.
In many cases, it stems from long-term behavior that’s no longer safe or healthy as a person’s circumstances change.

Lisa Waxman is a community social worker at Somerville-Cambridge Elder Services (SCES),
Lisa Waxman is a community social worker at Somerville-Cambridge Elder Services (SCES)

In any event, it is vital to remember that, when you’re dealing with an adult who is competent to make his/her own decisions, you need to respect his/her wishes, because that is how we all want to be treated. There are programs that can help, but the elder needs to be onboard with accepting the help.
We find that being very respectful is the best way proceed. You need to approach the situation from the elder’s point of view. Listen carefully to the elder’s perspective and work with him/her to acknowledge whatever the issue is. Sometimes that can take time but patience is a must. You want to work alongside the elder at a pace with which they feel comfortable.
I think it’s very important to state that most adults engage in some sort of self-neglect at times—be it not going to the doctor when we’re sick or not eating well if you have diabetes. We all self-neglect to a certain degree. But unfortunately as we get older the stakes get higher and the consequences can be more dire.
What we try to do with older adults is validate that change is very hard, and for many older adults change means the loss of something. They have fears about losing independence and changing routines can be quite disorienting. Acknowledging and validating specific concerns while being on the elder’s side is the way to get in the door and develop a strong rapport.
Accepting help often means change, and for most adults that doesn’t happen overnight. It really requires a feeling of being understood and trusting that accepting help will to be to their benefit.

Lisa Waxman, LICSW is a community social worker at SCES. For more information, check out the Self-Neglect episode of Aging Well at the SCES Youtube Channel, or contact the SCES Aging Information Center at 617-628-2601 for free advice and guidance.