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June 7, 2007

NCEA

The Source of Information and Assistance on Elder Abuse


Clearinghouse on Abuse and Neglect of the Elderly (CANE)
Selected Annotated Bibliography:


Self-Neglect: An Update of the Literature
2000-2005



According to a recent survey of Adult Protective Services (APS) programs, self-neglect is the most commonly reported type of elder mistreatment in the U.S. (Teaster et al., 2003). There are state to state variations in defining self-neglect (as well as other types of elder mistreatment), and not all APS programs handle self-neglect cases. The National Adult Protective Services Association (NAPSA) endorses the definition that was adopted by the American Public Welfare Association in 1990: "Self-neglect is the result of an adult's inability, due to physical and/or mental impairments or diminished capacity, to perform essential self-care tasks including: providing essential food, clothing, shelter, and medical care; obtaining goods and services necessary to maintain physical health, mental health, emotional well-being and general safety; and/or managing financial affairs."

There is no one accepted theory that explains self-neglect among the elderly. Self-neglect may be secondary to prevailing medical conditions, such as dementia, schizophrenia, impaired mobility, sensory deficits, etc. However, self-neglect is not always due to medical conditions or formal psychiatric diagnoses. Financial limitations, inadequate social supports, and external events can trigger or exacerbate self-neglecting behaviors. Whatever the origin, self-neglect cases can be among the most difficult cases for adult protective services, aging, health and social services professionals, attorneys, law enforcement, and public health officials to address. It is not uncommon for self-neglectors to refuse services or resist interventions, and the need to balance autonomy with the individual's well-being presents an ongoing ethical challenge to those attempting to help.

This following annotated list of references is a supplement to the CANE bibliography, "Self-Neglect," published on the NCEA web site in 2001. While many studies include self-neglect as part of a wider examination of elder abuse, the references selected for inclusion in this bibliography focus primarily on self-neglect. Although compulsive hoarding is a distinct aspect of self-neglect, this bibliography does not address that subject as it is the topic of an upcoming CANE bibliography.

Most of these reference materials can be obtained through your local university and community libraries or interlibrary loan services. Some must be ordered directly through the publisher or production company. When available, contact and pricing information is included with the abstract. Increasingly, many resources are available online, and the web addresses are also included.* If you have difficulty obtaining any of these materials, please contact the CANE office for assistance by e-mailing [email protected] or telephoning (302) 831-3525.

Note: This is a selected annotated bibliography, which does not include all published references related to this topic. The included references have been selected to provide readers with a current and comprehensive collection of books and articles representing a variety of perspectives on the subject. International studies have also been included; country of origin is indicated at the end of the abstract. For additional references on self-neglect, including materials published prior to 2000, please visit the CANE online database at http://db.rdms.udel.edu:8080/CANE or the CANE bibliography, "Self-Neglect, September 2001" on the NCEA web site at: http://www.elderabusecenter.org/default.cfm?p=cane_neglect.cfm .)

To search the CANE Bibliography Series, go to www.elderabusecenter.org/default.cfm?p=cane.cfm

(*Web addresses may change without notice. If an address provided is no longer accurate, we recommend using a generic search engine, such as Google, to find a current link. If you cannot locate the online publication, contact the CANE offices for assistance by e-mailing [email protected] or telephoning (302) 831-3525).




The National Center on Elder Abuse (NCEA) serves as a national resource for elder rights advocates, law enforcement and legal professionals, public policy leaders, researchers, and citizens. It is the mission of NCEA to promote understanding, knowledge sharing, and action on elder abuse, neglect, and exploitation.

The NCEA is administered under the auspices of the National Association of State Units on Aging.

NCEA Partners
  • National Association of State Units on Aging (NASUA), Lead Partner
  • American Bar Association (ABA) Commission on Law and Aging
  • Clearinghouse on Abuse and Neglect of the Elderly (CANE) at the University of Delaware
  • National Adult Protective Services Association (NAPSA)
  • National Committee for the Prevention of Elder Abuse (NCPEA)


This publication was made possible through the support provided by the National Center on Elder Abuse. Major funding for the National Center on Elder Abuse comes from the U.S. Administration on Aging, Department of Health and Human Services.                    Grant No. 90-AM-2792.

Opinions or points of view expressed do not necessarily reflect the official position or policies of the U.S. Administration on Aging.





2005

1. P5923-18
Anetzberger, G.
Elder Abuse: Case Studies for Clinical Management
The Clinical Gerontologist; Vol. 28 (1/2), 43-53; 2005.
(Note: co-published simultaneously as The Clinical Management of Elder Abuse, Anetzberger, G., ed.; The Haworth Press, Inc., Binghamton, NY; 2005.)
Journal article (scholarship)
This article, part of an issue dedicated to elder abuse, describes three case studies used to analyze elder mistreatment through a multidisciplinary approach. In the first scenario, a woman lives reclusively and displays signs of self-neglect. In the second, the caregiver of an abusive spouse begins to neglect his needs. The third case study focuses on a verbally and emotionally abusive adult daughter who appears overburdened both at work as a nurses' aide and in taking care of her mother who is suffering from Alzheimer's disease. (Note: The book is not available through CANE; for further information, visit the Haworth Press, Inc. Web site at: www.haworthpress.com or telephone 1-800-429-6784 in the US/Canada or 607-722-5857 outside US/Canada.)


3. P6001-3
Campbell, H., Tadros, G., Hanna, G. & Bhalerao, M.
Diogenes Syndrome: Frontal Lobe Dysfunction or Multi-Factorial Disorder
Geriatric Medicine; Vol. 35 (3), 77-79; 2005.
Journal article (case study)
In this overview of Diogenes syndrome (DS), or severe self-neglect, the authors present information on co-existing medical and psychiatric conditions. Research indicates that many patients with DS also suffer from such conditions as cardiac failure, pneumonia, osteoarthritis, and gangrene. Little association has been found between DS and formal psychiatric diagnoses, and it is hypothesized that the condition is triggered by biological, psychological, or social stressors that exacerbate predisposing personality traits. A case study details the neurological assessment of a woman who had experienced significant personality and behavioral changes. The patient was found to have frontal lobe dysfunction, and the authors suggest that the presentation of DS may be indicative of other organic conditions.

4. P5908-7
Lauder, W. et al.
Self-Neglect: The Role of Judgements and Applied Ethics
Nursing Standard; Vol. 19 (18), 45-51; January 2005.
Journal article (scholarship)
Intended for continuing professional development of nurses, this overview discussion of self-
neglect presents a framework for management in an interdisciplinary context. Nurses view self-
neglect as a self-care deficit, "...the failure to engage in self-care activities that adequately regulate functioning, supply adequate levels of food, take actions to prevent, alleviate, cure or control conditions which affect life, health, and well-being..." The author points out that "the war against dirt and body fluids" is the cultural context in which self-neglect is measured, and suggests that decision making can be subjective, based upon the values and judgments of involved professionals. Evaluation of risk to self and others and the need to balance the individual's right to autonomy with the rights of others are discussed. (U.K.)        

5. P5910-7
Lauder, W., Anderson, I. & Barclay, A.
A Framework for Good Practice in Interagency Interventions with Cases of Self-Neglect
Journal of Psychiatric and Mental Health Nursing; Vol. 12 (2), 192-198; 2005.
Journal article (literature review)
Observing that there are very few evidence-based practice guidelines for addressing self-
neglect, this paper (written for nurses) briefly outlines the framework for developing an
interagency approach. The development of the framework involved a review of the literature, an empirical study of interdisciplinary responses to self-neglect; and the establishment of a structure that incorporated stakeholder input from professionals and volunteers in the health, housing, environmental health and social work fields and related research fields. The framework recommendations include the following: the development of public advocacy services which would encourage a coordinated, multidisciplinary response to client needs; the early identification of potential and actual self-neglect (which would require an accepted definition for the phenomenon as well as standard assessment strategies); an understanding of the self-neglecting client's perceptions and coping skills; established protocols for working across agencies, and a shared understanding of the possible roles and resources of various stakeholders. Interdisciplinary research is also warranted to develop a best practice model. While the authors emphasize the need for an accurate mental health diagnosis for each client in order to open potential resource avenues currently available, they emphasize that the absence of a formal psychiatric diagnosis should not prevent self-neglecting individuals from attaining services. (U.K.)

6. P5995-9
Lauder, W., Anderson, A. & Barclay, A.
Housing and Self-Neglect: The Responses of Health, Social Care and Environmental Health Agencies
Journal of Interprofessional Care; Vol. 19 (4), 317-325; August 2005.
Journal article (research)
This research, conducted in Scotland, considered the ways health, social services and housing professionals address cases of self-neglect. Various theories of self-neglect are described, ranging from underlying mental illness to self-care deficits. In -depth interviews were conducted with twelve housing officers, three environmental health officers, thirteen social workers, three healthcare workers, and six self-neglecting clients regarding their experiences and perceptions. Content analysis of the interviews revealed a wide range of behaviors related to self-neglect including hoarding, individuals who neglected property only, and individuals who neglected personal needs and hygiene as well as property. Most referrals came from neighbors concerned about safety risks, and most interventions were attempted when self-neglect had become extreme. A significant finding was that clients diagnosed with a mental illness were treated with more comprehensive and multidisciplinary services than self-neglectors who lacked a formal psychiatric diagnosis. The authors emphasize the need for an individualized approach in addressing self-neglect, incorporating multidisciplinary perspectives, and employing a therapeutic alliance with the client that values his or her perspective as the starting point for intervention. (U.K.)

7. P5924-23
McGreevey, J.
Elder Abuse: The Physician's Perspective
The Clinical Gerontologist; Vol. 28 (1/2), 83-103; 2005.
(Note: co-published simultaneously as The Clinical Management of Elder Abuse, Anetzberger, G., ed.; The Haworth Press, Inc., Binghamton, NY; 2005.)
Journal article (scholarship)
This article is part of an issue that focuses on three case studies in order to analyze elder mistreatment from the perspectives of various practitioners as they address clinical management using an interdisciplinary approach. The physician's role is highlighted in this entry. Issues addressed in the case study involving self-neglect include the need to evaluate substance abuse, depression, functional and decisional capacity, and cognitive impairment. Interventions are recommended in the context of Ohio state statutes.

8. P5925-28
Miller, C.
Elder Abuse: The Nurse's Perspective
The Clinical Gerontologist; Vol. 28 (1/2), 105-133; 2005.
(Note: co-published simultaneously as The Clinical Management of Elder Abuse, Anetzberger, G., ed.; The Haworth Press, Inc., Binghamton, NY; 2005.)
Journal article (scholarship)
This article is part of an issue that presents three case studies of elder mistreatment to illustrate an interdisciplinary approach. In particular, it focuses on the complexities encountered as nurses address elder abuse, neglect and self-neglect. Through the case analysis of the self-neglecting patient, the author explores the difficult task of balancing the patient's right to autonomy with the need for safety, and the importance of maintaining a therapeutic alliance.




2004

10. P6002-14
Nikolova, R., Carignan, M., Moscovitz, N. & Demers, L.
The Psychogeriatric and Risk Behavior Assessment Scale (PARBAS): A New Measure for Use with Older Adults Living in the Community
Archives of Gerontology and Geriatrics; Vol. 39 (2), 187-200; 2004.
This article describes the development and testing of the Psychogeriatric and Risk Behavior Assessment Scale (PARBAS), for use in assessing frail, older adults with severe mental illness living in the community. The PARBAS includes 34 items examining the following categories of risk: self-neglect, non-compliance, substance abuse, risk toward self and others, aggressive behavior, emotional distress, suicidal behavior, personal security, risk of victimization by others, and financial security. The tool was developed based upon the results of focus groups attended by mental health clinicians and researchers. Content validation was conducted by nine experts, and inter-rater reliability and item analyses were performed. While content validity appeared acceptable, inter-rater reliability was poor for several items. The authors recommend ongoing testing of the psychometric properties of the instrument, but suggest that it can provide valuable information to the community-based practitioner for prevention and intervention planning.

11. P5675-4
Nusbaum, N.
Safety versus Autonomy: Dilemmas and Strategies in Protection of Vulnerable Community-Dwelling Elderly
Annals of Long-Term Care; Vol. 12 (5), 50-53; May 2004.
Journal article (scholarship)
This author of this commentary suggests that the current laws addressing elder abuse are not
effective in addressing the ethical challenge of balancing autonomy with safety of vulnerable elders living in the community. Issues surrounding self-neglect and self-destructive behaviors (such as refusing Meals on Wheels or other supportive services) are considered along with issues that impact the safety of others as well as the elder (such as driving when marginally impaired, or possessing a firearm). He proposes that alternatives to moderate the risk to the individual, rather than "black or white" solutions (such as restricted licenses versus revoking licenses, enrollment in supportive community services, and placements in environments less restrictive than nursing homes) should be considered in an effort to preserve autonomy

12. P5732-7
Tierney, M. et al.
Risk Factors for Harm in Cognitively Impaired Seniors Who Live Alone: A Prospective Study
Journal of the American Geriatrics Society/JAGS; Vol. 52 (9), 1435-1441; 2004.
Journal article (research)
This study was designed to identify risk factors for harm caused by self-neglect or behaviors
related to disorientation due to cognitive impairment. The sample included 139 participants, aged 65 and over, who were identified as cognitively impaired and were referred by health care and/or community service agency representatives. At baseline, participants were assessed for dementia, social resources, medical diagnosis, and medication use. The sample was monitored for 18 months for incidence of harm. Incident of harm was described as a physical injury to self or other (or property loss or damage) related to issues of self-neglect due to disorientation, that resulted in emergency intervention. The three factors that appeared to most significantly predict incidence of harm were fewer social resources, poor performance on the Mini-Mental Status Exam (MMSE), and the presence of chronic obstructive pulmonary disease (COPD). Such predictors can be identified in the primary care setting, and therefore could be used by physicians to identify patients at greatest risk.




2003

15. M105-156
The Humane Society of the United States, and the Wisconsin Department of Health and Family Services
Creating Safer Communities for Older Adults and Companion Animals
The Department of Health and Family Services; Madison, WI and the Humane Society of the United States; Washington, D.C.; September 2003.
Manual
As quoted from the Foreword, this manual is intended to assist "...professionals in the adult protective services, elder abuse and animal protection fields to expand their working knowledge of the role of companion animals in patterns of abuse, exploitation and self-neglect..." While the manual highlights Wisconsin statutes and systems, much of the material can be adapted for use in other regions to foster multidisciplinary approaches in addressing such topics as animal hoarding and self-neglect, and animal cruelty as an indicator of family violence. The section devoted to animal hoarding addresses factors that contribute to the behavior, effective interventions, issues surrounding prosecution, rescue operations, case resolution, multidisciplinary collaboration, and recommendations for friends and family members. (Note: This manual is not available through CANE. To obtain an order form, contact Susan Veleke at
DHFS/DDES/Bureau of Aging & Long Term Care Resources, P.O. Box 7851,
Madison WI 53707-7851, email: [email protected] or phone: (608) 267-7285
Price: $5.00.)




2002

16. P5825-7
Abrams, R., Lachs, M., McAvay, G., Keohane, D. & Bruce, M.
Predictors of Self-Neglect in Community Dwelling Elders
American Journal of Psychiatry; Vol. 159 (10), 1724-1730; 2002.
Journal article (research)
In this study, researchers investigated the impact of depression and cognitive impairment upon self-neglect among community-dwelling elders. Data regarding 2,161 participants of the New Haven Established Populations for Epidemiological Studies of the Elderly was analyzed for incidence of self-neglect. Ninety-two corroborated cases of self-neglect were identified occurring over a nine year period, suggesting a crude incidence of seven cases of self-neglect per 1,000 person-years. Results indicate that clinically significant depressive symptoms and cognitive impairment were independent predictors of self-neglect. Cognitive impairment was a greater predictor of self-neglect, and the presence of both cognitive impairment and depressive symptoms enhanced the risk.

17. P5262-6
Lachs, M., Williams, C., O'Brien, S. & Pillemer, K.
Adult Protective Service Use and Nursing Home Placement
The Gerontologist; Vol. 42 (6), 734-739; 2002.
Journal article (research)
This article considers whether Adult Protective Service (APS) use for elder abuse and self-neglect is an independent predictor of nursing home placement after the adjustment of other predictive factors. Data was drawn from the New Haven Established Population for Epidemiologic Studies (EPESE) cohort, a community-based cohort that was established in 1982. Of the sample of 2,087 community residents, 202 had been referred to APS between 1982 and 1990. Eight-one percent of th allegations were verified. Fifty-two percent of those mistreated and 69.2 percent of the self-neglectors were placed in nursing homes, significantly higher rates than for those who had no APS contact. Although the researchers recognize that APS professionals encourage autonomy more now than in recent decades, the results raise the possibility that nursing home placement is still considered a solution for difficult situations.

18. P5998-8
Lauder, W., Anderson, A. & Barclay, A.
Sociological and Psychological Theories of Self-Neglect
Journal of Advanced Nursing; Vol. 40 (3), 331-338; 2002.
Journal article (scholarship)
In this article, the authors consider various sociological and psychological theories of self-neglect. As opposed to the medical model, such theories suggest that "...the self-neglector is not a passive diseased individual but an active actor in the creation of this identity..." Various theories are analyzed and applied to the phenomenon of self-neglect. The authors suggest that such theories broaden the perspectives of those working with self-neglectors and will enhance the designing of effective interventions based upon the needs and perceptions of the individual client. (U.K.)

19. P5049-7
Linzer, N.
An Ethical Dilemma in Home Care
Journal of Gerontological Social Work; Vol. 37 (2), 23-34; 2002.
Journal article (scholarship)
In this discussion, the author uses a case scenario to explore the intricacies of ethical dilemmas in
home care. The principles of autonomy, beneficence, dignity and paternalism are considered as
they impact upon the social worker's decision to intervene when clients, who appear self-neglecting due to dementia or physical incapacity, refuse services. The client's decision-making capacity is at the heart of this dilemma.




2001

22. P5997-7
Lauder, W.
The Utility of Self-Care Theory as a Theoretical Basis for Self-Neglect
Journal of Advanced Nursing; Vol. 34 (4), 545-551; 2001.
Journal article (scholarship)
This article examines self-care theory as a framework for understanding self-neglect. Key concepts are defined, such as self-care agency (SCA), or the ability to engage in self-care, and self-care requisites, or factors necessary for health and wellbeing. While research suggests that self-neglectors as a group have lower levels of SCA than non-neglectors, the fact that some self-neglectors have higher levels of SCA than non-neglectors highlights the complexities of understanding and addressing these behaviors. Factors which may have an impact upon self-neglect include lifestyle choice, family dynamics, culture and class. Nursing implications are also discussed. (U.K.)

23. P5999-8
Lauder, W., Scott, P. & Whyte, A.
Nurses' Judgements of Self-Neglect: A Factorial Survey
International Journal of Nursing Studies; Vol. 38 (5), 601-608; 2001.
Journal article (research)
This factorial survey was designed to analyze the subjective nature of judgments regarding self-neglect among three nursing groups: psychiatric nurses, general nurses, and student nurses. Sixty-four students, 67 psychiatric nurses and 59 general nurses reviewed and rated a randomly selected sample of 10 vignettes which depicted various aspects and levels of self-neglect. Participants were asked to rate the degree of self-neglect depicted as well as the level of lifestyle choice that they believed that the self-neglector had exercised. Results indicate that similar perceptions of self-neglect were held among nursing groups. While all nursing groups were inclined to judge that self-neglectors exercised an active degree of lifestyle choice, general nurses were more likely than either psychiatric nurses or student nurses to believe this. Six variables incorporated into the vignettes (gender, socio-economic status, psychiatric status, self-care status, stated preference for lifestyle, and functional ability) accounted for only 21 percent of the total variance in neglect judgments. This suggests that other factors are operant and that subjective judgmental processes are involved in addressing self-neglect. (U.K.)
        
25. P6000-5
Reyes-Ortiz, C.
Diogenes Syndrome: The Self-Neglect Elderly
Comprehensive Therapy; Vol. 27 (2), 117-121; 2001.
Journal article (scholarship)
This article presents an overview of severe elder self-neglect, also known as Diogenes Syndrome (DS). Historically, the condition received more attention through public media than medical literature. Primary DS, which is not related to an acute mental illness, is estimated to account for 50 to 70 percent of community-based cases. Secondary DS is related to such disorders as schizophrenia, depression, dementia, and alcoholism. An underlying personality disorder may exist, and may be characterized by unfriendliness, stubbornness, suspiciousness, independence, or eccentricity. DS may signify a hostile attitude toward the world, or possibly a death wish. Hospitalization and institutionalization usually leads to deterioration and increased mortality rates. Day health care facilities and home care services are potentially effective interventions. Several recommendations for the physician and/or health care professional are provided.

26. P5993-4
Reyes-Ortiz, C.
Neglect and Self-Neglect of the Elderly in Long-Term Care
Annals of Long-Term Care; Vol. 9 (2), 21-24; 2001.
Journal article (scholarship)
In this overview, the author begins by describing distinctions between neglect by others and self-neglect among the elderly. Diogenes Syndrome (DS), as severe self-neglect is sometimes termed, can be classified as either primary or secondary. Primary DS is not related to acute mental illness, although long-term conditions such as personality disorders may exist. Secondary DS is associated with dementia, depression, substance abuse, schizophrenia and other mental health problems. Viable long-term care treatment approaches include day health care and home health care services. Alternatives in dealing with uncooperative patients, which may include hospitalization or nursing home placement, are also considered. The prognosis of DS is poor and the mortality rate for this condition is high.




2000

27. L4386-20
Bozinovski, S.D.
Older Self Neglecters: Interpersonal Problems and the Maintenance of Self Continuity
Journal of Elder Abuse and Neglect; Vol. 12 (1), 37-56; 2000.
Journal article (research)
Using the Grounded Theory Method, this study examines self-neglect among elders involved with Adult Protective Services. Two social psychological processes were identified, which seem to explain self-neglecting behavior. These processes are "preserving and protecting self" and "maintaining customary control". Of those elders that neglect themselves, it is found that interpersonal problems are the main threat to their identity and self control. This search for continuity seems to be the motivating force and the life goal of these elders.

28. P5275-21
Choi, N. & Mayer, J.
Elder Abuse, Neglect, and Exploitation: Risk Factors and Prevention Strategies
Journal of Gerontological Social Work; Vol. 33 (2), 5-25; 2000.
Journal article (research)
As quoted from the abstract: "Along with health care professionals, social workers are the
professionals most likely to be responsible for detecting signs of elder maltreatment and providing interventions and preventive services. In this study, using data from a county adult protective services unit…we compare self-neglecting elders and those abused and/or neglected by others…" It was found that elders who abused substances were more likely to be self-neglecting.

29. N4552-5
Dyer, C. & Goins, A.
The Role of the Interdisciplinary Geriatric Assessment in Addressing Self-Neglect of the Elderly
Generations; p23-p27; Summer 2000.
Journal article (scholarship)
In order to address the apparent relationship between medical conditions and risk factors for elder mistreatment, particularly self-neglect, Baylor College of Medicine Geriatrics Program collaborated with the Texas Department of Protective and Regulatory Services in 1997 to form the Texas Elder Abuse Mistreatment Institute (TEAM). This article describes the role of the interdisciplinary geriatrics assessment team, comprised of physicians, nurses, social workers and other health professionals who provide an integrated approach to prevention, identification and intervention in elder abuse and neglect. (This article is part of a special edition of Generations dedicated to the recognition of the problem of elder abuse.)

30. K4262-4
Dyer, C., Pavlik, V., Murphy, K., and Hyman, D.
The High Prevalence of Depression and Dementia in Elder Abuse or Neglect
Journal of the American Geriatrics Society/JAGS; Vol. 48 (2), 205-208; 2000.
Journal article (scholarship)
This study examines the clinical characteristics of patients referred to an urban geriatric assessment and treatment center that had been experiencing elder abuse, neglect and/or self-neglect. Researchers compared the rates of depression and dementia among these patients with the rates of depression and dementia among patients referred to the program for reasons other than elder mistreatment. Results indicate that among patients referred for self-neglect, there were significantly higher rates of both depression (62 percent versus 12 percent) and dementia (51 percent versus 30 percent) than among other patients.
        
31. P5868-4
Phillipson, C.
National Elder Abuse Incidence Study
Journal of Elder Abuse & Neglect; Vol. 12 (1), 29-32; 2000.
Journal article (scholarship)
This commentary highlights some of the findings of the National Elder Abuse Incidence Study
(NEAIS) regarding neglect and self-neglect. Nearly half of the 71,000 substantiated adult protective services (APS) reports were attributed to neglect, and over 44,000 additional cases involved self-neglect. Societal challenges related to dealing with poverty, confusion and self-care deficits, characteristics associated with neglect and self-neglect, are raised.




To review the literature on elder self-neglect published prior to 2000, please visit the CANE Bibliography, "Self-Neglect," 2001 on the NCEA web site at:
http://www.elderabusecenter.org/default.cfm?p=cane_neglect.cfm .

To access the CANE bibliography series, visit:
http://www.elderabusecenter.org/default.cfm?p=cane.cfm .

To search for additional elder abuse references on this and other topics, visit the CANE online database at:
http://db.rdms.udel.edu:8080/CANE


National Center on Elder Abuse
1201 15th Street, N.W., Suite 350 · Washington, DC 20005-2842
(202) 898-2586 · Fax: (202) 898-2583 · Email: [email protected]
http://www.elderabusecenter.org/