Elder neglect in patients with frequent emergency department admissions: a cross-sectional study

Background: Abuse and neglect, including self-neglect, are frequent among geriatric patients and can lead to serious medical consequences. Unfortunately, these issues are often overlooked. The aim of our study was to assess the impact of elder neglect on emergency department admissions among elderly individuals who frequently present to the emergency department. Methods: Elderly patients aged 65 and above who visited the emergency department at least twice within one year were included in this study. We used the Elderly Self-Neglect Scale for assessment of elder neglect, a valid and reliable tool in Turkish. Physicians recorded each patient’s sociodemographic characteristics, including gender, age, marital status, number of children, cohabitation status, chronic disease and living arrangements, to evaluate their association with neglect. Results: Self-neglect was associated with marital status (F = 9.04; p < 0.05), number of children (F = 5.78; p < 0.05) and cohabitation status (F = 7.86; p < 0.05) but not with living arrangements. Conclusions: Given the increasing geriatric population, emergency physicians have an ethical duty to diagnose, treat, appropriately refer and report suspected cases of neglect. It is important to consider neglect in elderly patients who frequently present to the emergency department. Among geriatric patients, factors such as abuse, neglect, affective disorders, caregiver stress and cognitive disorders should be evaluated. Physicians involved in geriatric rehabilitation must be aware of the signs and implications of elder self-neglect.

Geriatrics; Elder self-neglect; Recurrent visits; Emergency department

[1] Sultanoğlu H, Erdem Sultanoğlu T. Evaluation of elderly patients in adult suicide cases admitted to the emergency department. Journal of Forensic and Legal Medicine. 2021; 77: 102103.

[2] Turner A, Hochschild A, Burnett J, Zulfiqar A, Dyer CB. High prevalence of medication non-adherence in a sample of community-dwelling older adults with adult protective services-validated self-neglect. Drugs Aging. 2012; 29: 741–749.

[3] Mazzotti MC, Fais P, Amadasi A, Pelletti G, Giovannini E, Giorgetti A, et al. When the hidden issue of elder abuse leads to death: do not neglect elder neglect. The American Journal of Forensic Medicine and Pathology. 2022; 43: 60–65.

[4] Alimohammadi GF, Mohammadi SF, Tabrizi KN, Fallahi KM, Rassouli M. Concept analysis of self-neglect in the elderly: a hybrid model. International Journal of Nursing Knowledge. 2025; 36: 90–105.

[5] Dong X, Simon MA, Evans DA. Prevalence of self-neglect across gender, race, and socioeconomic status: findings from the Chicago Health and Aging Project. Gerontology. 2012; 58: 258–268.

[6] Rosen T, Hargarten S, Flomenbaum NE, Platts-Mills TF. Identifying elder abuse in the emergency department: toward a multidisciplinary team-based approach. Annals of Emergency Medicine. 2016; 68: 378–382.

[7] Bond MC, Butler KH. Elder abuse and neglect: definitions, epidemiology, and approaches to emergency department screening. Clinics in Geriatric Medicine. 2013; 29: 257–273.

[8] Chen M, Chan KL. Elder abuse and neglect in china: prevalence, co-occurrence, and intergenerational risk factors. Journal of Interpersonal Violence. 2022; 37: NP9839–NP9862.

[9] Yip SH, O’Connor D, Shakeri SF, Brown A, Hyman J. Emergency assistance in situations of abuse, neglect, and self-neglect: exploring the complexity and challenges. Journal of Elder Abuse & Neglect. 2022; 34: 124–151.

[10] Slankamenac K, Zehnder M, Langner TO, Krähenmann K, Keller DI. Recurrent emergency department users: two categories with different risk profiles. Journal of Clinical Medicine. 2019; 8: 333.

[11] Cimino FN. Elder abuse and neglect: making the diagnosis and devising a treatment plan in the emergency department. Emergency Medicine Practice. 2024; 26: 1–20.

[12] Iris M, Conrad KJ, Ridings J. Observational measure of elder self-neglect. Journal of Elder Abuse & Neglect. 2014; 26: 365–397.

[13] Özmete E, Duru S, Yildirim H. Elder self-neglect scale: the adaptation study into Turkish. Anatolian Journal of Psychiatry. 2018; 19: 87–95.

[14] Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behavior Research Methods. 2009; 41: 1149–1160.

[15] Cheng X, Yang Y, Schwebel DC, Liu Z, Li L, Cheng P, et al. Population ageing and mortality during 1990-2017: a global decomposition analysis. PLOS Medicine. 2020; 17: e1003138.

[16] World Health Organization (WHO). WHO clinical consortium on healthy ageing 2021: report of consortium meeting held virtually. 2022. Available at: https://www.who.int/health-topics/ageing (Accessed: 16 January 2025).

[17] Lewis SD, Connolly MT, Kimball PF, Rogers G, Salvo E, Burnes D. Self-neglect co-occurs with and is a risk factor for elder mistreatment: an analysis of Maine adult protective services administrative data. Journal of the American Geriatrics Society. 2024; 72: 1913–1915.

[18] Lee H, Lee E. Subgroups of self-neglect and effects on suicidal ideation among the older adults. Development and Psychopathology. 2023; 12: 1–9.

[19] Yu M, Gu L, Shi Y, Wang W. A systematic review of self-neglect and its risk factors among community-dwelling older adults. Aging and Mental Health. 2021; 25: 2179–2190.

[20] Can Oz Y, Duran S, Dogan K. The meaning and role of spirituality for older adults: a qualitative study. Journal of Religion and Health. 2022; 61: 1490–1504.

[21] Öztürk Z, Bahçecioğlu Turan G, Donmez O. Analysis of the relationship between self-neglect and spiritual well-being in older adults. Journal of Elder Abuse & Neglect. 2024; 14: 1–15.

[22] İlhan B, Bahat G, Saka F, Kılıç C, Merve Oren M, Karan MA. A new screening tool for self-neglect in community-dwelling older adults: IMSelf-neglect questionnaire. Aging Male. 2020; 23: 388–395.

[23] Özer N, Tanriverdi D. Determining depression, abuse, and neglect in elderly individuals. Psychogeriatrics. 2023; 23: 690–700.

[24] Day MR, Leahy-Warren P, McCarthy G. Self-neglect: ethical considerations. Annual Review of Nursing Research. 2016; 34: 89–107.

[25] Bastholm RP, Bergqvist M, Modig K, Gustafsson LL, Schmidt MK. Homecare workers—an untapped resource in preventing emergency department visits among older individuals? A qualitative interview study from Sweden. BMC Geriatrics. 2024; 24: 350.

[26] Yan E, To L, Wan D, Xie X, Wong F, Shum D. Strategies to build more effective interventions for elder abuse: a focus group study of nursing and social work professionals in Hong Kong. BMC Geriatrics. 2022; 22: 978.

[27] Folorunsho S, Okyere M. The impact of neglect, physical, and financial abuse on mental health among older adults: a systematic review. Aging and Mental Health. 2024; 10: 1–11.