There has been an increase in the number of older people and this has been a public health concern around the world. Elder self-neglect is a complex issue that cannot be easily distinguished from other forms of elder abuse, neglect and exploitation(Connolly, 2008). It has several effects on elder health, quality of life and public health consequences(Dahl et al., 2020). However, due to the lack of a standard definition, professionals may not be able to identify this syndrome, there are a large number of unreported cases of self-neglect and it is impossible to determine its prevalence. Self-neglect appears to be a growing epidemic that can affect large numbers of people around the world and can occur in a variety of socio-economic or cultural contexts. Despite differences in the legal definition of self-neglect in many countries, self-neglect poses a variety of complex medical, legal and ethical challenges for health and social workers(E. S. Papaioannou et al., 2012).
Concept analysis is an effective way of clarifying concepts that are widely used but vaguely defined. This concept analysis attempts to provide a clearer definition of self-neglect in older people based on the identification of terms and surrogate expressions used to describe and explain the concept of elder self-neglect. A comprehensive literature review and analysis was carried out using Rodgers' evolutionary method(Rodgers et al., 2018). The characteristics and antecedents of self-neglect, as well as its negative consequences, need to be understood before professionals can provide health services to older people. In the current literature, elder self-neglect is a complex concept that is seen simultaneously as: (a)The older people intentionally or unintentionally fail to complete self-care or maintain living conditions; and (b) this behaviour is potentially threatening to themselves and to society(Gibbons et al., 2006; O'Brien et al., 1999). The results of our conceptual analysis show that older people with self-neglect share some common characteristics, such as failure to maintain environmental and personal hygiene, hoarding, poor medical compliance behaviour, poor safety awareness, poor social skills, etc. Healthcare professionals need to recognise symptoms early and implement appropriate interventions to improve behaviour(Hildebrand et al., 2014). Broadly speaking, the antecedents of self-neglect represent a balance between the individual and the environment. These antecedents fall into two broad categories: individual factors (including physical and psychological factors) and social circumstances. A number of other factors have also been found to be associated with self-neglect, such as old age, living alone, low income, male gender and alcohol abuse(Halliday et al., 2000; M. M. Yu et al., 2019). The defining attributes that characterize people with self-neglect include: (a) disorderliness, self-neglected older people have a disorganised living and personal environment; and (b) dangerousness, elder self-neglect will have serious consequences for themselves, others and society; (c) Invisible, self-neglect can be difficult to identify; and (d) enclosed, self-neglect older people often have a lack of social interaction(Dong et al., 2010).
Lastly, the findings of this analysis proposed a definition of elderly self-neglect, providing a practical guide to practice strategies in a culturally diverse society. A clear and standardised conceptual definition of elder self-neglect facilitates communication within the nursing discipline and with other disciplines. In addition, a clear conceptual definition will help nurses to remain sensitive to elder self-neglect and improve their ability to recognise it so that they can more accurately identify and assess possible self-neglect-related problems in older people and explore effective community intervention strategies to reduce elder self-neglect and the adverse health outcomes that result from self-neglect.
5 LIMITATIONS
Although we tried our best to perfect the whole process, there are some limitations to this paper. Firstly, the definitions of self-neglect vary, we may not be able to describe these terms comprehensively, so the result of the search may have some weaknesses. Therefore, the concept of self-neglect discussed in this paper needs to be tested and developed in further research. Furthermore, this paper only included the articles published in English and Chinese, it may not be applicable to other cultural contexts, which may lead to socio-cultural bias in the description of the findings in this paper. The author therefore calls for more cross-cultural research on this issue.