What does 'self-neglect' in older adults really cost?

摘要

In this edition of the Journal of the American Geriatrics Society, Franzini and Dyer report on the healthcare utilization of self-neglecting adult protective service (APS) clients who were referred to their hospital-based geriatric assessment program. Predictably, in the year preceding the APS and geriatric assessment referral, self-neglecters had substantially lower rates of healthcare utilization than their non-self-neglecting counterparts, who were demographically matched controls from the same geriatric practice. This should surprise no one. By definition, self-neglecters (particularly those who really excel at it, thereby attracting the attention of the local APS office), represent the most extreme examples of medical nonadherence. We're not talking about dietary indiscretion, missing a dose of your diuretic, or failing to check your blood sugar a few times here. Self-neglecters who join the ranks of protective services are the most recalcitrant patients physicians will ever encounter, if indeed they ever encounter them at all. More typically, they will arrive at the local emergency department in extremus, when skin ulcers, edema from heart failure, or other medical problems that have been untreated (and often undiagnosed) for years worsen to the extent that they cannot function and the healthcare system can no longer be avoided. Quite simply, this is the ultimate "low self-care state." It would not seem shocking that such patients would not run up big medical bills.