İhmal Edilen Bir Sorun: Yaşlının Kendini İhmali ve Halk Sağlığı Hemşireliği

Öz

Tıbbi gelişmeler, doğumda beklenen yaşam süresini önemli ölçüde artırmış, nüfusun yaşlanması ise kendini ihmal gibi halk sağlığı konularını gündeme getirmiştir. Yaşlıya yönelik şiddetin en yaygın şekli olarak görülen kendini ihmal, bir yaşlının sağlığını ve güvenliğini tehdit eden, temel kişisel bakım görevlerini yerine getirememesi durumu olarak tanımlanmaktadır. Kendini ihmal olgularının en zorlayıcı yönü, erken dönemde tanımlanmasının güç olmasıdır. Kendini ihmal, erken dönemde tanımlanmadığında ise mortalite ve morbidite artış dahil olmak üzere çok ciddi sağlık sonuçlarıyla karşılaşılabilmektedir. Halk sağlığı hemşireleri toplumla iç içe oldukları ve yaşlıları kendi yaşadıkları ortamlarda görme fırsatına sahip oldukları için kendini ihmal riski taşıyan yaşlıları belirleme ve değerlendirme adına anahtar bir konumdadır. Hemşirelerin, yaşlılarda kendini ihmali öngören risk faktörlerini bilmeleri, kendini ihmalin neden olabileceği olumsuz sağlık sonuçlarının uygun şekilde tanımlanması ve önlemesi açısından önemlidir. Ulusal literatürde konu ile ilgili kaynaklar çok sınırlı olmakla birlikte, bu derlemenin amacı, ihmal edilen bir sorun olan yaşlının kendini ihmalinin, belirtileri, yaygınlığı, risk faktörleri ve sonuçlarıyla birlikte halk sağlığı hemşireliğinin tanılama ve değerlendirmedeki rollerinin ele alınmasıdır.
Anahtar Kelimeler: Yaşlı, Hemşire, Kendini İhmal, Halk sağlığı hemşireliği

Anahtar Kelimeler

• Kendini ihmal
• yaşlı
• hemşire
• halk sağlığı hemşireliği

Kaynakça

1. Abrams RC, Lachs M, McAvay G, Keohane DJ, Bruce ML. Predictors of self-neglect in community-dwelling elders. Am J Psychiatr. 2002; 159:1724-30
2. Akın B, Emiroğlu ON. [Mobility related disability and associated factors in the elderly livıng at home]. Turkish Journal of Geriatrics. 2003;6(2):59-67.
3. Band-Winterstein T, Doron I, Naim S. Elder self neglect: a geriatric syndrome or a life course story? Journal of Aging Studies. 2012; 26:109-118.
4. Beard JR, Officer A, De Carvalho IA, Sadana R, Pot AM, Michel JP et al. The World report on ageing and health: a policy framework for healthy ageing. The Lancet. 2016; 387(10033):2145-54.
5. Burnett J, Achenbaum WA, Hayes L, Flores DV, Hochschild AE, Kao D et al. Increasing surveillance and prevention efforts for elder self-neglect in clinical settings. Aging Health. 2012; 8(6):647-655.
6. Burnett J, Coverdale JH, Pickens S, Dyer BC. What is the association between self-neglect, depressive symptoms and untreated medical conditions? J Elder Abuse Negl. 2006; 18:25-34.
7. Choi N, Kim J, Assef J. Self neglect and neglect of vulnerable older adults: reexamination of etiology. Journal of Gerontological Social Work. 2009; 52(2):171-187.
8. Clark ANG, Mankikar GD, Gray I. Diogenes syndrome: a clinical study of gross neglect in old age. The Lancet. 1975;305(7903):366-368.

9. Çuhadar D, Sertbaş G, Tutkun H. Relationship between level of cognitive functions and activities of daily life at elderly people who live in rest home. Anadolu Psikiyatri Dergisi. 2006; 7: 232-239.
10. Dahl N, Ross A, & Ong P. Self-neglect in older populations: A description and analysis of current approaches. Journal of Aging & Social Policy, 2018;1-22.
11. Day MR, Leahy-Warren P, McCarthy G. Perceptions and views of self-neglect: a client-centered perspective. Journal of Elder Abuse ve Neglect. 2013;25(1):76-94.
12. Day MR, Leahy-Warren P. Self-neglect 2: nursing assessment and management. Nursing Times. 2008; 104(25)28-29.
13. Day MR, Mulcahy H, Leahy-Warren P, Downey J. Self-neglect: a case study and implications for clinical practice. British Journal of Community Nursing. 2015; 20(3):110-115.
14. Dokuzcan I, Özyurda ZF, & Kızıl TEÖ. (2019). Bir yaşlı hizmet merkezine kayıtlı yaşlılarda depresif belirti, bilişsel bozukluk durumu ve etkili faktörler. Nobel Med. 2019; 15(3): 5-11.
15. Dong X, Simon M, Fulmer T, Mendes de Leon CF, Rajan B, Evans DA. Physical function decline and the risk of elder self-neglect in a community dwelling population. Gerontologist. 2010; 50(3):316-326.
16. Dong X, Simon M, Mendes de Leon C, et al. Elder self-neglect and abuse and mortality risk in a community-dwelling population. JAMA. 2009; 302(5):517-526
17. Dong X, Simon MA, Evans D. Elder self‐neglect and hospitalization: findings from the Chicago Health and Aging Project. Journal of the American Geriatrics Society. 2012; 60(2):202-209.
18. 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(3):258-268.
19. Dong X. Elder self-neglect: research and practice. Clinical Interventions in Aging. 2017; 12:949-954.
20. Dong X. Self‐neglect in an elderly community‐dwelling US Chinese population: findings from the population study of Chinese elderly in Chicago study. Journal of the American Geriatrics Society. 2014; 62(12):2391-2397.
21. Durmaz B, Soysal P, Ellidokuz H, Isik AT. Validity and reliability of geriatric depression scale-15 (short form) in Turkish older adults. Northern Clinics of Istanbul. 2018; 5(3):216-220
22. Dyer CB, Goodwin JS, Pickens‐Pace S, Burnett J, Kelly PA. Self‐neglect among the elderly: a model based on more than 500 patients seen by a geriatric medicine team. Am J Public Health. 2007; 97:1671-1676.
23. Elder Justice Act. (2010). Patient protection and affordable care act. Public Law 111-148. Washington, DC: United States Government.
24. Gomes JP, O’Brien JG. (2018). Medical perspectives of self-neglect: an issue for health and social care. In: Day MR, McCarty G, Fitzpatrick JJ, eds. Self-Neglect in Older Adults: A Global, Evidence-Based Resource for Nurses and Other Healthcare Providers. Springer Publishing Company; 2018. p:147-162.
25. Gunstone S. Risk assessment and management of patients whom self-neglect: a ‘grey area’ for mental healthworkers. Journal of Psychiatric and Mental Health Nursing. 2003; 10(3):287-296
26. Güngen C, Ertan T, Eker E, Yaşar R, Engin F. [Reliability and validity of the standardized mini mental state examination in the diagnosis of mild dementia in Turkish Population]. Turkish Journal of Psychiatry. 2002; 13(4):273-281.
27. Johnson Y. Home care nurses and self-neglect. An issue for health and social care in: Day MR,
28. Kurt G, Yücel Beyaztaş F, Erkol Z. The problems of aged people and the life satisfaction. Turkish Journal of Forensic Medicine. 2010;24(2):32-39.
29. Lachs MS, Williams CS, O’ Brien S, Pillemer KA, Charlson ME. The mortality of elder mistreatment. J Am Med Assoc. 1998; 280:428- 32.
30. Lauder W, Roxburgh M, Harris J, Law J. Developing self-neglect theory: analysis ofrelated and atypical cases of people identified as self-neglecting. Journal of Psychiatric and Mental Health Nursing. 2009;16(5), 447-454.
31. Lee M, Kim K. Prevalence and risk factors for self-neglect among older adults living alone in South Korea. International Journal of Aging ve Human Development. 2014;78, 115-131.
32. Leff EW, Sonstegard-Gamm J. The home care team approach to self-neglecting elders. Home Healthcare Now. 2006; 24(4):249-257.
33. Mardan H, Hamid T, Redzuan MR, Ibrahim R. Correlate of self-care and self-neglect among community-dwelling older adults. Iranian Journal of Nursing and Midwifery Research. 2014; 19(7 Suppl1):71.
34. Miller C. Elder abuse: the nurse’s perspective. The Clinical Gerontologist. 2005; 28 (1-2):105-133.
35. Mohseni M, Rashedi V, Iranpour A, Tahami AN ve Borhaninejad V. Prevalence of elder abuse and associated factors among community-dwelling older adults in Iran. Journal of Elder Abuse ve Neglect. 2019; 31(4-5):363-372.
36. Mosqueda L, Dong X. Elder abuse and self-neglect: “I don't care anything about going to the doctor, to be honest”. JAMA. 2011;306(5):532-540.
37. Naik AD, Lai JM, Kunik ME, Dyer CB. Assessing capacity in suspected cases of self-neglect. Geriatrics. 2008; 63(2):24-31.
38. National Research Council. Elder mistreatment: abuse, neglect and exploitation in an aging America. Washington, DC: National Academies Press; 2003.
39. Noblett K. Clinical implications of self-neglect among patients in community settings. British Journal of Community Nursing. 2019; 24(11):524-526.
40. Özkan Pehlivanoğlu EF, Özkan MU, Balcıoğlu H, Bilge U, Ünlüoğlu İ. Adjustment and reliability of katz daily life activity measures for elderly in Turkish. Ankara Medical Journal. 2018;18(2):219-223.
41. Özmete E, Duru S, & Yildirim H. Yaşlılarda Kendini İhmal Ölçeği: Türkçeye uyarlama çalışması. Psychiatry. 2018;19(2):87-95.
42. Papaioannou ESC, Räihä I, Kivelä SL. Self-neglect of the elderly. An overview. The European Journal of General Practice. 2012;18(3):187-190.
43. Sarikaya D, Halil M, Kuyumcu ME, Kilic MK, Yesil Y, Kara O et al. Mini nutritional assessment test long and short form are valid screening tools in Turkish older adults. Archives of Gerontology and Geriatrics. 2015; 61(1):56-60.
44. Shah A. Squalor syndrome: a viewpoint. Australian Journal on Ageing. 1995;14(4): 160-162.
45. Spensley C. The role of social isolation of elders in recidivism of self-neglect cases at San Francisco Adult Protective Services. J Elder Abuse Negl. 2008; 20:43-61
46. Şahin EM, Özer C, Ölüç F, Tunç Z. Dementia and depression among nursing home residents, Turk Geriatri Derg 2005; 8: 22-24. http://geriatri.dergisi.org/pdf/pdf_TJG_248.pdf
47. Thomson MJ, Lietzau LK, Doty MM, Cieslik L, Williams R, Meurer LN. An analysis of elder abuse rates in Milwaukee County. WMJ: Official publication of the State Medical Society of Wisconsin. 2011;110(6), 271.
48. 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(9):741-749.
49. TÜİK. İstatistiklerle Yaşlılar, 2018. Erişim adresi: https://hsgm.saglik.gov.tr/depo/birimler/kronik-hastaliklar-engelli-db/hastaliklar/Yasli_Sagligi/raporlar_istatistikler/TUIK_Yasli_Istatistik_2018.pdf
50. UN. World Population Ageing 2019. United Nations New York, 2019. Erişim adresi: https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2019-Highlights.pdf