Perspectives and experiences of living with self-neglect among older adults: A systematic review and meta-synthesis.

PURPOSE: Given the global trajectory toward an aging population, renewed interest in the phenomena of self-neglect is needed if relevant stakeholders are to be adequately prepared for an expected increase in the number of elder self-neglect cases. This current study is designed to systematically review and synthesize the qualitative literature on the perspectives and experiences of older adults living with self-neglect. DESIGN: A narrative meta-synthesis was used. METHODS: Six English databases (PubMed, Web of Science, CINAHL Plus, Scopus, Embase, and PsycINFO) were comprehensively searched from inception to May 2022. The thematic synthesis method was applied to analyze and synthesize the findings of the included studies. The Critical Appraisal Skills Programme qualitative checklist was applied to evaluate the quality of the included studies. FINDINGS: A total of six qualitative studies were finally included with four studies conducted in the United States, one in Israel, and one in Ireland. Through meta-synthesis, five analytical themes were identified: attributes of self-neglect, life shaped by misery, insufficient social networks and resources, self-protection and preservation, and anchoring beliefs and practices. CONCLUSIONS: This qualitative synthesis provides profound insights into the self-neglect phenomenon from the standpoint of older adults with self-neglect and can provide guidance to relevant stakeholders on how to address elder self-neglect cases with respect to its assessment, reporting and management. Future research across geographical locations on the experiences of older adults with self-neglect are needed to provide a more global understanding of this significant and emerging public health issue. CLINICAL RELEVANCE: The development of future self-neglect management practices based on medical and sociocultural models of care can focus on supporting self-neglecters with positive coping mechanisms and supporting service providers with spiritual care competencies to ensure interventions achieve ethical principles of autonomy, beneficence, and nonmaleficence.

"Jolly fat" or "sad fat": a systematic review and meta-analysis of the association between obesity and depression among community-dwelling older adults.

OBJECTIVE: To review the evidence and explore the association between obesity and depression in community-dwelling older adults. METHODS: We searched 6 electronic databases from inception to November 28, 2019. Observational studies investigating the association between obesity and depression among community-dwelling older adults aged 60 years or older were included. Two reviewers independently screened the studies, extracted the data and assessed the quality of the studies. The eligible studies were meta-analysed using the Comprehensive Meta-analysis Version 3.0. RESULTS: Among the 16,059 studies identified from these databases, 19 studies meeting the inclusion criteria were included, of which 14 were meta-analysed. Meta-analyses showed that older adults who were overweight (pooled odds ratio: 0.847, 95% CI:0.789-0.908, p < 0.001) or obesity (pooled odds ratio: 0.795, 95% CI:0.658-0.960, p = 0.017) - assessed using the body mass index - were significantly less likely to be depressed than their counterparts with a normal weight. No significant association between obesity (as measured via waist circumference) and depression was detected (pooled odds ratio: 0.722, 95% CI:0.465-1.119, p = 0.145) in this group population. The subgroup analyses demonstrated that both female and male older adults with overweight/obesity were significantly less likely to have depression. CONCLUSIONS: The "jolly fat" hypothesis is deemed to be applicable among community-dwelling older adults. Older adults might, therefore, be encouraged to increase their body weight above the normal level to be mentally healthy. Monitoring intentional weight loss among older adults should be reinforced for public health strategies.

Understanding professionals' perspectives and experiences of elder self-neglect: A systematic review and meta-synthesis of qualitative studies.

PURPOSE: To systematically review and synthesize the findings on various professionals' perspectives of elder self-neglect (ESN) and/or their experiences with ESN. DESIGN: A systematic qualitative review was used. METHODS: Primary qualitative studies published either in English or Chinese until August 2020 were systematically searched in the following databases: PubMed, Web of Science, Embase, CINAHL Plus, PsycINFO, Wanfang Data, and China National Knowledge Infrastructure (CNKI). FINDINGS: Eleven studies were included. Five subthemes including retaining a sense of normalcy/identity, service refusal, isolation, contributing factors in ESN, and manifestations and consequences of ESN were included in the overarching theme of ESN features. Another two subthemes, emotional and ethical dilemmas in caring for self-neglecters and management strategies, were included under the second overarching theme of complicated experiences managing cases of ESN. CONCLUSIONS: This qualitative synthesis provides a deep and comprehensive insight into professionals' perspectives and experiences of self-neglect in older adults. Understanding professionals' perspectives of ESN can help with the knowledge and theory development pertinent to this particular phenomenon. CLINICAL RELEVANCE: Findings are valuable in informing the provision of funds and structural, informational, and emotional support systems development for professionals managing ESN cases. Establishing a strong link between ESN case management and improved outcomes in older self-neglecters is essential to establish a definite need for the provision of support, resource, and stardardized guidelines for these professionals.

A systematic review of self-neglect and its risk factors among community-dwelling older adults.

OBJECTIVES: To systematically review published evidence on self-neglect (SN) and its risk factors among community-dwelling older adults. METHOD: A comprehensive literature search was conducted in PubMed, Embase, CINAHL Plus, PsycINFO, and Scopus for studies that were published in English from inception to 8 April 2020. Grey database was also included to ensure a thorough search. The study quality was assessed by two reviewers independently using the Newcastle-Ottawa Scale or the checklist suggested by the Agency for Healthcare Research and Quality. RESULTS: A total of 19 studies was included in this review. Various tools were used to assess SN among the available studies. The prevalence rates of SN among community-dwelling older adults ranged from 18.4% to 29.1%. The risk factors of SN identified by these studies involved sociodemographic characteristics (male gender, older age, low economic status, ethnicity, lower educational level, marital status, and lower number of children), health-related characteristics (cognitive impairment, lower level of physical function, nutritional status, higher number of medical comorbidities, and pain), psychological characteristics (depression), and social context characteristics (living alone, lower social networks and social engagement, lower neighborhood cohesion, and neighborhood disorder). CONCLUSION: SN is a common and under-recognized phenomenon among community-dwelling older adults. Our review provides healthcare professionals with an insight into SN and its risk factors. More studies are required to test the potency of each independent risk factor to deepen our understanding of this particular phenomenon.

Predictors of self-neglect among community-dwelling older adults living alone in China.

Little is known about the prevalence of self-neglect and its predictors among community-dwelling older adults living alone in China. The present study was conducted among 181 older adults living alone in Nanjing, China. Self-neglect was assessed using a self-neglect screening scale. Participants' sociodemographic data, social network, functional ability, cognitive function, and depression level were also collected through a set of questionnaires. The prevalence of self-neglect among this group of older adults was 23.2%, which is comparative to their counterparts in Korea and in the United States. Only depression (ß = 0.361, p < 0.001) and monthly income (ß = -0.159, p = 0.025) were identified as significant predictors of self-neglect, accounting for 27.1% of the variance. Understanding self-neglect and its predictive factors is essential to provide culturally relevant and tailored interventions to enhance the confidence and self-care abilities of older adults to maintain their health and well-being.

Mediating effects of stigma on the relationship between contact and willingness to care for people with mental illness among nursing students.

BACKGROUND: Previous studies have demonstrated that contact positively impacts nursing students' willingness to care for people with mental illness. However, studies that have explored the mechanism of such a relationship between contact and willingness remain few. OBJECTIVES: To examine the direct relationship between contact and nursing students' willingness to care for people with mental illness and to explore the potential mediating roles of stigma. DESIGN: This was a cross-sectional study design. SETTINGS: The study was conducted in a nursing school in Nanjing city, China. PARTICIPANTS: A total of 839 nursing students were recruited in the study through convenience sampling. METHODS: Nursing students' stigma, contact, and willingness to care for people with mental illness were measured online through the Stigma toward People with Mental Illness Scale (SPMI), the Level of Contact Report, and one item of "which degree indicates your willingness to provide care for people with mental illness," respectively. The structural equation model was applied to explore the potential mediating roles of stigma. RESULTS: Contact with people suffering from mental illness directly affected nursing students' willingness to care for them (ß = 0.076, p < 0.05). Meanwhile, stigma partly mediated the effect of students' contact on willingness to care for people with mental illness (ß = 0.048, p < 0.05). CONCLUSIONS: High level of contact can improve nursing students' willingness to care and the relationship is partly mediated by stigma. Measures to improve the level of contact and reduce stigmatizing attitudes of nursing students are accordingly essential in influencing them to have more willingness to care for people with mental illness.

Psychiatric-mental health education with integrated role-play and real-world contact can reduce the stigma of nursing students towards people with mental illness.

Stigma and negative attitudes towards people with mental illness are frequently found among nursing students. Interventions targeting mental illness stigma are the critical elements in altering the status. The aim of the present study was to examine the effects of the psychiatric-mental health education with role-play and real-world contact on stigma of nursing students towards people with mental illness in China. A single group pretest and posttest study design was adopted and total 373 students were recruited whilst 343 completed the course. We integrated the role-play and contact with patients in the routine psychiatric-mental health education. After the education was completed, the students' stigma towards people with mental illness were positively changed (pretest mean score of stigma: 53.77, posttest mean score of stigma: 49.01, 95% CI: 2.63-6.87) and their willingness to care for the people with mental illness was also significantly increased (pretest mean score of willingness: 5.45, posttest mean score of willingness: 7.38, 95% CI: -2.22--1.65). The psychiatric-mental health education especially with integrated role-play and real-world contact is an effective way to reduce nursing students' stigma and negative attitudes towards people with mental illness and increases their willingness to care for people with mental illness.

Depression in Community-Dwelling Older Adults Living Alone in China: Association of Social Support Network and Functional Ability.

Older adults who live alone are more likely to experience depressive symptoms compared to those who live with others. The current study aimed to investigate the prevalence of depression and identify its associated factors among community-dwelling older adults living alone in China. A cross-sectional questionnaire survey was conducted with a total of 172 older adults living alone in Nanjing city, Jiangsu province of mainland China. The prevalence of depression among this group of Chinese older adults was 18.6%. The possibility of depression among older adults who had social isolation risk was 2.59 times higher than those who had no such risk. Compared with older adults who had normal functional abilities, the possibility of depression was 3.31 times higher in older adults with mild functional impairments and 4.72 times higher in those with severe functional impairments. The results suggest that health care providers should develop effective interventions to help older adults living alone maintain their mental health by enhancing their functional abilities and increasing their social support networks and social engagement. [Research in Gerontological Nursing, 13(2), 82-90.].