Noah Syndrome: A Variant of Diogenes Syndrome Accompanied by Animal Hoarding Practices

Noah syndrome is a variant of Diogenes syndrome that presents as hoarding a large number of animals. Predisposing factors for developing this disorder are situations of psychosocial stress and loneliness. However, the medical conditions of the sufferer, which can represent the organic substrate for the development of this psychopathology, should be considered.     

Taking a Leap Forward: Adult Protective Services and the Elder Justice Act

ABSTRACT

The author outlines factors in the current environment for Adult Protective Services programs in the United States of America in the spring of 2003 and the significance of the Elder Justice Act to those programs. The commentary notes key strengths and challenges in the bill and warns against relying on legislation alone to address the root causes of elder abuse.     

The Devil is in the Details: Self-Neglect in Australia

ABSTRACT

Although elder self-neglect is of significant concern to adult protective service (APS) workers in the United States, minimal research has been conducted on this topic in Australia. Using qualitative research methods, this article examines how 24 Australian professionals understand situations of self-neglect. Unlike in the United States, where the term self-neglect is used in a broad and all-encompassing manner, participants in this research differentiated among self-neglect (the neglect of self), squalor (extreme neglect of environment), collecting (the accumulation of certain objects), and hoarding (the inability to throw objects away). It is argued that separating out the various behaviors that are classified under the broad umbrella of neglect can be useful in fostering reflective interventions in these situations.     

Cross-validation of the screening scale in an adult protective services sample

Adult Protective Services (APS) professionals are often called on to assess decision-making capacity when investigating financial exploitation. Previous research found that in consecutive APS cases, a decision-making screening scale (LFDSS) also detected financial exploitation. The purpose of this study was to apply the clinical cutoff scores derived from the previous study to a new sample of APS cases. Using a sample of 105 participants, from APS workers across 5 counties this study investigated the clinical utility of the LFDSS to detect financial exploitation based on ratings by APS professionals using the scale. Results demonstrate that the LFDSS has excellent internal consistency and clinical utility properties. This paper provides support for use of the LFDSS as a reliable and valid instrument. Instructions for use of the LFDSS are included in the article, along with information about online support tools.     

PERSPECTIVES:

No abstract available for this article.     

Correlates of depression in self-neglecting older adults: A cross-sectional study examining the role of alcohol abuse and pain in increasing vulnerability

ABSTRACT

Self-neglect among older adults results in increased morbidity and mortality rates. Depression is strongly linked to self-neglect and when untreated, severely complicates management of health and functional outcomes. The study aims to identify factors correlated with depression to inform approaches to service recruitment and retention that improve long-term outcomes. The sample included urban community-dwelling older adults (n = 96) 65 years of age and older with Adult Protective Services-substantiated self-neglect. All participants completed a range of validated cognitive, functional, and self-report demographic and clinical measures around health and mental health functioning. A secondary data analysis using multivariable logistic regression revealed that a positive screen for alcohol abuse, low self-rated health, and higher self-reported pain were associated with significantly higher odds of self-reported depression. Further research is needed to understand the temporality between these correlates and depression and to inform prevention and intervention practices for self-neglecting older adults.     

An Adult Protective Services' View of Collaboration With Mental Health Services

Mental Health Services (MHS) meet mental health needs of older adults through active, outpatient, community-based care. Adult Protective Services (APS) are involved with needs of older adults who have mental disability and mental illness. Adult Protective Services and MHS staff may to work together when they respond to the needs of victims and adults at risk for abuse, neglect, self-neglect, and exploitation. The purpose of this study was to understand effective APS–MHS collaborations (e.g., leadership, organizational culture, administration, and resources in predicting success). A survey that was sent to members of the National Adult Protective Services Association (NAPSA) revealed that both APS and MHS have strong commitments to protecting clients' rights and autonomy, but there appear to be differences between the two with regard to implementation, apparent in cases involving clients with diminished mental capacity who are at imminent risk, but who refuse help. Strengths of APS–MHS collaborations included improved communication and better service for at-risk clients.     

Cultural and Ethical Issues in Korea's Recent Elder Abuse Reporting System

The primary purpose of this article is to examine the relevance of cultural values, such as familism and individualism, that influence public policy implementation processes for protecting older adults in Korea and the United States. The secondary purpose is to identify ethical dilemmas and policy implications for effectively implementing the recently developed public law designed to protect vulnerable older adults in Korea. This article discusses both similarities and differences found in the two countries' elder abuse reporting systems and the service delivery systems for protecting older adults at risk of abuse and neglect.     

Competing Values in Serving Older and Vulnerable Adults: Adult Protective Services,Mandated Reporting,and Domestic Violence Programs

State mandatory reporting statutes may directly or indirectly list domestic violence programs as among those that are mandated reporters of cases of suspected abuse, neglect, or exploitation of older individuals and those with disabilities. Domestic violence programs, however, may not consider themselves to be mandated reporters, because the responsibility of reporting abuse may be contrary to their programmatic philosophy. In the Commonwealth of Virginia, the potential conflict between domestic violence programs and Adult Protective Services about the issue of mandated reporting has created tension between these organizations as each entity continues interpreting the issues and policies of mandated reporting through its own lens. The authors draw out some of the reasons for the conflict as well as make recommendations for improving relationships between the two organizations, which will ultimately benefit vulnerable adults who are experiencing abuse.     

Animal Rights Talk: Moral Debate over the Internet

Messages sent over Animal Rights-Talk, an electronic mail network devoted to the discussion of issues related to the animal rights movement, were analyzed. Messages typically fell into the following categories: questions and information, discussions of philosophical issues, ethical problems associated with the treatment of particular species, the politics of the animal rights movement, problems of moral consistency, the ethics of particular uses of non-human species (e.g., meat consumption, biomedical research with animal subjects), and matters pertaining to the internal life of the network (e.g., efforts at control of perceived norm violations). Debates between animal activists and animal researchers over the network often reflected the conflicting cosmologies of scientists and animal protectionists. We argue that computer bulletin boards offer a potentially important avenue for qualitative research.     

When practice and policy collide: Child welfare workers' perceptions of investigation processes

This qualitative study examines variability in practices surrounding Child Protective Services (CPS) investigations regarding the allegations of child maltreatment. Working under the auspices of a community-research collaboration with Department of Human Services officials, university researchers conducted a series of focus groups with CPS caseworkers in a state that was under court-ordered consent decree to improve child welfare investigations. Focus groups with caseworkers sought to better understand caseworkers' common investigative practices and their perceptions of best practices in conducting child welfare investigations. Two main areas were noted for improvement: (1) the need for ongoing training of CPS workers, particularly at the stage of initial intake of the allegations of maltreatment, and cross-training of police and hospital staff who regularly work with CPS, and (2) implementation of an improved risk assessment tool. These recommendations are discussed in detail.     

Managing Guardianships of the Elderly:

Guardianships and conservatorships are currently used to carry out public policy concerning protection of and advocacy for elderly people who cannot care for themselves. This article analyzes this public policy with the idea in mind that the legal aspects of guardianships and conservatorships must be linked with clinical assessment in order for public agencies to provide high quality, need-based services for individual clients. The article also explores the notion that case management for such clients involves coordination of services between the court system and human services providers.     

The feasibility of goal attainment scaling to measure case resolution in elder abuse and neglect adult protective services intervention

Objectives: This pilot study describes implementation procedures of goal attainment scaling (GAS) and examines the feasibility of using GAS to measure the multifarious intervention outcome of case resolution in elder mistreatment (EM) adult protective services (APS).

Methods: Substantiated EM victims (n = 27) were recruited prospectively from the State of Maine APS. An adapted GAS approach was implemented involving development of a pre-populated goal scale menu and web-based GAS application.

Results: The GAS menu comprised 18 goals and corresponding scales spanning several domains of case resolution: social support, service access, health/functioning, enhancing independence, and protective measures. The overall GAS process had mean length 33.8 min per case. The mean GAS summary t-score (54.3) aligned with theoretical expectations.

Discussion: Without a measure of case resolution, research cannot compare the effectiveness of different EM intervention models. Findings suggest that GAS is a feasible, client-centered strategy to measure the multifarious EM intervention case resolution outcome.     

The medicalization of Nonhuman Animal rights: frame contestation and the exploitation of disability

Nonhuman Animal rights activists are sometimes dismissed as ‘crazy’ or irrational by countermovements seeking to protect status quo social structures. Social movements themselves often utilize disability narratives in their claims-making as well. In this article, we argue that Nonhuman Animal exploitation and Nonhuman Animal rights activism are sometimes medicalized in frame disputes. The contestation over mental ability ultimately exploits humans with disabilities. The medicalization of Nonhuman Animal rights activism diminishes activists’ social justice claims, but the movement’s medicalization of Nonhuman Animal use unfairly otherizes its target population and treats disability identity as a pejorative. Utilizing a content analysis of major newspapers and anti-speciesist activist blogs published between 2009 and 2013, it is argued that disability has been incorporated into the tactical repertoires of the Nonhuman Animal rights movement and countermovements, becoming a site of frame contestation. The findings could have implications for a number of other social movements that also negatively utilize disability narratives.     

Feasibility of intervention in elder self-neglecters: Setting the stage for future research

Objectives: Interventions are critical to improving clinical outcomes in elder self-neglecters. This study assessed feasibility of a randomized controlled trial of oral vitamin D in Adult Protective Services-substantiated self-neglect clients ≥65 years.

Methods: Participants were directly observed to consume ergocalciferol 50,000 IU (treatment) or ergocalciferol 400 IU (control), once a month, for 10 months. For months 6–10, half the control group randomly crossed into the treatment group (crossover). Intervention feasibility was measured by number of potential participants who agreed to participate and by retention rates during the study.

Results: Ninety-four referrals were received and 59 (63%) agreed to participate. Forty-nine participants were enrolled after prescreening and 35 completed the two-phase trial for a 72% retention rate. The participants’ average age was 75.2 ± 6.8 years, mainly female (59%), African-American (47%), and living alone (41%).

Discussion: Despite assumptions that self-neglecters are resistant to care, we have successfully conducted the first clinical intervention in this vulnerable population.     

Shifting Symbolic Boundaries: Cultural Strategies of the Animal Rights Movement1

How do activists create cultural change? Scholars have investigated the development and maintenance of collective identities as one avenue for cultural change, but to understand how activists foster change beyond their own movements, we need to look at activists’ strategies for changing their targets’ mindsets and actions. Sociologists need to look at activists’ boundary work to understand both the wide‐sweeping goals and strategies that activists enact to generate broad‐based cultural changes. Using data from participant observation and interviews with animal rights activists in France and the United States, and drawing on research on ethnic boundary shifting, I show how activists used two main strategies to shift symbolic boundaries between humans and animals, as well as between companion and farm animals—(1) they blur boundaries through focusing and universalizing strategies and (2) they cross boundaries physically, discursively, and iconographically. This study contributes a new theoretical and empirical example to the cultural changes studied by scholars of social movements, and it also provides a useful counterpoint to studies of symbolic boundary construction and maintenance in the sociology of culture.     

Assessing Capacity in the Setting of Self-Neglect: Development of a Novel Screening Tool for Decision-Making Capacity

ABSTRACT

Compared with older adults with disabilities and those who autonomously choose to live in squalor, self-neglect syndrome arises from a predicate state of vulnerability in frail older adults. This state of vulnerability is characteristically associated with a decline in decision-making capacity regarding the ability to care for and protect oneself. We developed the COMP Screen to evaluate vulnerable older adults to identify potential gaps in decision-making capacity using a screening tool. A total of 182 older adults were evaluated and consistent declines in cognitive ability and decision-making processes were present in this population. However, there were no significant differences between elders referred for self-neglect and matched older adults. These findings suggest that declines in decision-making processes are not uncommon in vulnerable older adults but traditional conceptualizations of decision-making capacity may be inadequate for differentiating the capacity for self-care and protection in elders who self-neglect.