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. 2025 May 9;8:100350. doi: 10.1016/j.ijnsa.2025.100350

Self-neglect in older adults: an evolutionary concept analysis

Man Zhang a,b, Xiaoling Zhang a,⁎
PMCID: PMC12146015  PMID: 40491902

Abstract

Background

Self-neglect in older adults is a global public health concern, affecting millions of older adults. It is, therefore, important to define the concept of self-neglect to enable recognition and intervention.

Objective

The objective was to analyze the concept of older adults’ self-neglect, providing a reference to help healthcare professionals understand it.

Methods

A systematic search of relevant literature on older adults’ self-neglect was conducted in the Chinese National Knowledge Infrastructure, Wanfang database, Chinese Biomedical Literature Database, PubMed, Web of Science and CINAHL database. Rodgers' evolutionary method of concept analysis was used as a framework for the paper.

Results

A total of 68 articles were included. Older adults’ self-neglect included four defining characteristics: failure or inability to meet basic needs, risky or unsafe behaviors, diagnostic challenges in recognition, and social isolation or lack of interaction. Antecedents included physical, psychological, socio-environmental, and other related factors. Consequences included effects on the older adults themselves and effects on others and society.

Conclusions

A theoretical definition and conceptual model of older adults’ self-neglect was developed. The identified attributes, antecedents, and consequences can be utilized in nursing education, research, and intervention approaches.

Keywords: Older adults, Self-neglect, Healthy aging, Concept analysis, Review

What is already known.

- Older adults’ self-neglect is becoming a global public health concern, affecting millions of older adults.

- Because researchers have differing views about self-neglect in older adults, its common characteristics, antecedents, and consequences are unclear.

What this paper adds

- We used Rodgers' evolutionary concept analysis to redefine the concept of older adults’ self-neglect in the current context.

- We defined four attributes and analyzed the main antecedents and consequences of older adults’ self-neglect.

- By analyzing the concept of self-neglect in older adults, healthcare providers can target interventions to promote healthy ageing.

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1. Introduction

Around the world, populations are ageing at a faster pace than in the past, and this demographic transition will have effects on all aspects of societies (Jensen et al., 2025). The population of older adults worldwide is growing disproportionately and is projected to nearly double by 2050, from 12 % to 22 % (Friedman et al., 2019). According to the World Health Organization (2024), the global population of individuals aged 60 or older is expected to reach 1.4 billion by 2030 and 2.1 billion by 2050. In May 2020, the United Nations General Assembly declared 2021–2030 the decade of healthy ageing, highlighting the importance for policy makers across the world to focus on improving the lives of older people, both today and in the future (UNDESA, 2024). As the population ages, older adults’ self-neglect is becoming a global public health concern, affecting millions of older adults each year (Dong and Gorbien, 2005). Self-neglect is recognized as a globally widespread public health problem that threatens the health and safety of the elderly. Previous researchers have indicated that self-neglect in older adults can lead to adverse health outcomes, such as malnutrition, depression, disability, and cognitive decline (Dong et al., 2014; Dahl et al., 2020). These outcomes negatively impact older adults’ quality of life and hinder their process of healthy aging by reducing psychological resilience, exacerbating social isolation, and impairing their ability to manage daily living activities (Hildebrand, 2014).

Elder abuse is the physical, psychological, or sexual abuse; caregiver neglect; or financial exploitation of people ages 60 and older (Acierno et al., 2010). Dong et al. (2009) reported that elder abuse or self-neglect was associated with significantly increased risk of overall mortality. Some researchers have identified several factors that relate to self-neglect, such as living alone, low monthly income, or cognitive impairment (Lee, 2014; Abrams, 2002). Dong and associates (2014) concluded that older adults with dementia were particularly vulnerable to abuse or self-neglect. Researchers have also shown that self-neglect can affect older adults' physical and mental health and quality of life, as well as increase mortality (Dong et al., 2013; Lachs et al., 1998) and impact on the use of public health services (Dong and Simon, 2015). It is, therefore, important to define the concept of self-neglect to enable recognition and intervention.

However, self-neglect is often hidden and underreported (Dong, 2012). It is important for community health nurses to assess older adults for self-neglect, as they are well-placed to recognize and manage this problem. Different scholars currently hold different views of self-neglect in older adults. Its characteristics, antecedents, and consequences remain unclear; the distinctions and connections between concepts of older adults’ self-neglect are vague and imprecise (Zhang and Feng, 2022). Hence, there is a need to categorize the concept of self-neglect and distinguish it from proximate concepts so that self-neglect can be more precisely applied.

2. Background

According to the United States (U.S.) National Center on Elder Abuse (2006), self-neglect is defined as the behavior of older adults that threatens their own health and safety. It mainly refers to the inability of older adults to better care for and protect themselves or for them to act in ways that threaten health, personal safety, or public safety, either intentionally or unintentionally (Calaresi et al., 2025). It usually results from an inability or unwillingness to access potential remedial services (Ilhan et al., 2025). Researchers have shown that self-neglect in older adults can lead to social isolation, which can seriously affect their physical and mental health, reduce their quality of life, or even threaten their safety and increase the risk of death (Dahl et al., 2020; X. Dong, 2017; LI Bingnan, 2021). It has not been possible to estimate prevalence because of the lack of standard definitions and the potentially large number of unreported cases of self-neglect. Previous cross-sectional studies and systematic reviews have shown that the prevalence of self-neglect in older adults varies between 13.62 % and 36 % (Mao et al., 2025; Guo et al., 2024; Ayaz et al., 2024). Therefore self-neglect appears to be a growing epidemic that can affect people around the world and can occur in a variety of socio-economic or cultural contexts (Dahl et al., 2020). Although in recent years researchers have gradually turned their attention to the problem of older adults’ self-neglect, which spans a wide range of disciplines such as medicine, psychology, public health, psychology, sociology and law, a common understanding of the concept and meaning of older adults’ self-neglect has not yet emerged, and the analysis is not sufficiently systematic and comprehensive (Ilhan et al., 2025).

The ambiguity of the definition of the concept is not conducive to the development of relevant basic research, hinders academic communication, and restricts the in-depth study of the phenomenon of self-neglect among older adults (Bonis, 2013). Concept analysis is an effective method for clarifying concepts that are widely used across multiple disciplines but are vaguely defined (Rodgers et al., 2018). Rodgers argues that concepts evolve dynamically over time and that there is a need to redefine them in terms of their context, attributes, related terms, antecedents, typical cases, and consequences. This is both to clarify the current use of the concept and to provide a clear and normative conceptual basis for further research or practice. Rodgers' Evolutionary Concept Analysis clarifies, describes, and explains vague or abstract concepts by analyzing their use within the discipline. In this study, we applied Rodgers' evolutionary concept analysis (Rodgers, 1989) to self-neglect in older adults to clarify its concepts and attributes, with the aim of providing a basis for conducting relevant theoretical and intervention studies for healthy ageing.

3. Methods

3.1. Literature search strategy

To improve coverage, we applied the search in PubMed and Web of Science. As the topic is also relevant to public health, it was important to include the Cumulative Index for Nursing and Allied Health Services (CINAHL), The keywords "older adults*, older, ageing, aging, aged senior*" and self-neglect, selfneglect. were used in combination with the alternative terms "senile breakdown", "senile breakdown*","Senile Squalor Syndrome", "Diogenes Syndrome", and similar. The Chinese National Knowledge Infrastructure, Wanfang database, and Chinese Biomedical Literature Database were also systematically searched from the date of inception to 5 May 2024.

3.2. Inclusion and exclusion criteria

Inclusion criteria: We aimed at older adults’ self-neglect and covered the conceptual connotations, defining characteristics, antecedents, and consequences associated with self-neglect in older adults. We included all observational, case–control, randomized controlled trials, qualitative, or review studies that were relevant to self-neglect. The language was either Chinese or English.

Exclusion criteria: Studies or papers that did not discuss older adults’ self-neglect or examine the concept from the elder’s perspective were excluded. Examples of excluded articles were those focusing only on psychological/emotional abuse, sexual abuse, abandonment, or similar. Case reports, conference proceedings, abstracts only, commentaries, editorials, newsletters, duplicate literature, and literature for which the full text was not available were excluded.

3.3. Selection process

Rodgers argues that conceptual analysis requires a random selection of 20 % of the total literature included or >30 papers to be analyzed in order to draw reliable conclusions (Tofthagen and Fagerstrom, 2010). The initial search yielded 2699 articles, of which 578 duplicates were removed, leaving 2121 abstracts for screening. We found 1834 titles ineligible to be included. Among the 287 eligible papers, 152 did not discuss older adults’ self-neglect, and the authors of 62 articles did not explain the relation of older adults’ self-neglect to the work presented in each paper; we could not access five full articles. We included 68 studies in the final analysis, which met the requirements for the number of documents that must included. A flow chart of data selection of older adults’ self-neglect is shown in Fig. 1. Included articles are shown in Supplementary Material Table 1.

Fig. 1.

Fig 1

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PRISMA flow chart for the concept analysis of older adults’ self-neglect.

3.4. Methodological approach

We used the concept analysis methodology to examine older adults’ self-neglect. The method was used to synthesize existing views of the concept in existent literature in order to characterize the concept for use within a new discipline (Tofthagen and Fagerstrøm, 2010). We analyzed the literature using Rodgers' evolutionary concept analysis as a theoretical framework. Rodgers' method allows for special consideration of how context affects the nature of concepts and recognizes that concepts change as factors within the profession and in society change. Concepts are not static but can evolve or change cyclically over time. For these reasons, Rodgers' method was chosen for exploring the dynamic concept of older adults’ self-neglect. The approach is inductive and is divided into seven steps that are iterative and not necessarily sequential. See Table 1 for the seven steps taken.

Table 1.

Steps of Rodgers' evolutionary method for concept analysis.

1. Name the concept of interest. Identify surrogate terms and uses of the concept in existent literature.
2. Select an appropriate realm (sample) for data collection
3. Collect relevant data to identify the attributes of the concept and the contextual basis, interdisciplinary and socio-cultural variations
4. Identify attributes, or defining characteristics, of the concept
5. Identify references, antecedents, and consequences of the concept
6. Identify other concepts that are related to the concept of interest and exemplar, if available
7. Identify implications, that may inform development or guide further theorization of the concept
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Rodgers, B. L. (1989, Apr). Concepts, analysis and the development of nursing knowledge: the evolutionary cycle. J Adv Nurs, 14(4), 330–335.

4. Results

4.1. Conceptual evolution of self-neglect in older adults

Older adults’ self-neglect was first introduced in the 1960s (Day et al., 2016) and originated from research on older adults’ abuse. Macmillan and Shaw (1966) initiated research on 'self-neglect'. Through a series of clinical and community case reports and the term's use in medicine and sociology, self-neglect in older adults took on a site-specific conceptual meaning. In 2006, the National Center on Elder Abuse (2006) in the U.S. proposed a definition of older adults’ self-neglect as “behaviors that threaten the health and safety of older adults due to physical or mental impairment or diminished capacity, as evidenced by their own refusal or inability to provide themselves with adequate food, clothing, medical care, and safety protection”. In many parts of the U.S., elder adults’ self-neglect is considered a subset of abuse. However, elder abuse takes place in a trusting relationship that is inconsistent with elder adults’ self-neglect, where both the abuser and the abused are older themselves. Furthermore, there are many scholars who give clearer concepts from a medical perspective. Duke (1997) argued that: older adults’ self-neglect was caused by physical deterioration or health problems that prevent them from self-care; reluctance to share information with others; low awareness of the risk of their behavior; refusal to accept social or domestic services and to undergo health checks; refusal to cooperate with others or accept community or domestic services; reluctance to share information with others; low awareness that their behavior was risky.

In 2006, Gibbons et al. (2006) proposed that self-neglect in older adults included both intentional and unintentional types, which are behaviors that threaten the safety of older adults themselves and the public by failing to complete self-care. They argued that self-neglect involves neglect in three areas: home environment, personal image, and personal health behaviors.

Alternative terms are those have the same meaning as 'self-neglect' but are expressed in other words. In the course of the literature review, it became clear that alternative terms for self-neglect in older adults included the following. (1) Senile breakdown: refers to older adults without mental illness who no longer maintain the standards of cleanliness and hygiene accepted in their local community (Macmillan and Shaw, 1966). (2) Senile squalor syndrome: refers to severe self-neglect, social isolation, and extreme squalor in older adults (Clark, 1999). (3) Diogenes syndrome: characterized by squalor, extremely-low self-esteem, compulsive hoarding, inability to give up possessions, excessive desire to buy, strong desire to live in seclusion, refusal of help from others, and sometimes dementia (Cooney and Hamid, 1995). Early researchers used these terms to describe apparent self-neglect, but in recent years, as research on self-neglect has intensified, researchers have become less likely to use these.

4.2. Defining attributes

Defining attributes are a central component of concept analysis, and clear defining attributes help to deepen understanding and comprehension of a concept and distinguish it from other similar concepts (Tofthagen and Fagerstrom, 2010). An analysis of the literature summarises four core attributes of self-neglect in older adults.

4.2.1. Failure or inability to meet basic needs

This attribute refers to the inability of older adults to maintain a normal residential living environment, such as not paying attention to home hygiene, living in a dirty environment, and hoarding large amounts of clutter in the home, resulting in a crowded and chaotic home. In China, Xu (2021) conducted qualitative interviews with 15 nurses to explore their perceptions of the behaviors and manifestations of self-neglect in hospitalized older adults and found that older adults with self-neglect behaviors tended to be indifferent to the dirty and cluttered environment, placed things haphazardly, and hoarded waste, resulting in a poor environment in their wards. Self-neglecting older adults are unable to maintain personal hygiene, as manifested by conditions such as unkempt hair, infrequent bathing, and dirty, tattered clothes. They may also neglect their diet, eating spoiled food and not paying attention to their nutritional status. At the same time, they may give up their hobbies and expectations.

4.2.2. Risky or unsafe behaviors

Self-neglectors with higher levels of cognitive and physical function may refuse suggested interventions by healthcare professionals and social services agencies, which then respect the older adult's autonomy and rights to self-determination and will not intervene further. Older adults may have poor medication compliance or poor self-care skills due to memory loss or impaired cognitive function. Self-neglect is particularly serious in older adults, who often take or miss doses of medication at will due to lack of care, leading to a worsening of their condition. Older adults who engage in self-neglect may ignore safety hazards in their environment, such as not replacing old wiring, forgetting to lock the door when leaving the house, not buying anti-slip mats for slippery floors, and similar behaviors (Peng, 2018). Papaioannou et al. (2012) suggested that a feature of self-neglect in older adults is that there are always unsafe behaviors that put them in dangerous situations. For example, they are gullible, lack vigilance towards others, are likely to believe telephone scams, and lack safety awareness.

4.2.3. Diagnostic challenges in recognition

Self-neglect is a growing epidemic that may affect people across the globe and may occur in different socio-economic or cultural contexts (Dahl et al., 2020). However, it remains difficult for lay people and health professionals to understand (X. Dong, 2017). One reason is that physicians meet regularly with older adults in a clinical setting and, therefore, are unable to assess some behaviors and conditions of self-neglect (e.g., housing, hoarding behavior, or similar), other than observations of personal hygiene (e.g., hair, clothing). Few healthcare professionals have direct observation of the self-neglector’s home environment to further assess the severity. Cases of self-neglect in older adults are most often identified and reported after they have shown obvious signs of abnormality (Johnson, 2015). Furthermore, some self-neglect behaviours may appear to others to be a threat to the older adults' health, but the older adults doesn't perceive it as such and doesn't accept being labelled as self-neglecting by other staff.

4.2.4. Social isolation or lack of interaction

Loneliness is often defined in psychological terms as an unpleasant feeling that people experience when they perceive their social relationships to be qualitatively or quantitatively inadequate (Goldman et al., 2024). Among older adults, those living alone are more likely to experience self-neglect, possibly because of the lack of interaction with the outside world. Older adults who experience self-neglect are more likely to feel helpless and useless because of the impact on their physical and mental health and social functioning, so they actively reduce their contact with the outside world, often staying at home, not participating in social activities, and choosing an isolated lifestyle. Peng (2018) suggested that older adults did not want to bother their children, thus contributing to their increased loneliness. Nicholson (2009) defined social isolation as “a state in which the individual lacks a sense of belonging socially, lacks engagement with others, has a minimal number of social contacts, and they are deficient in fulfilling and quality relationships”. Pavlou (2008) argued that older adults have a low perception of their current social status and that social isolation in the form of ageist attitudes towards themselves is the main characteristic.

4.3. Identify a model case

An understanding of the connotations of self-neglect in older adults is deepened through the analysis of typical cases. Here is a case summary from Lee and LoGiudice (2012). An elderly couple was referred by their local doctor. The initial assessment was performed at their doctor's clinic at the couple's request. They were articulate, but their embarrassment about the state of their house had prevented them from seeking help earlier even though they had difficulty coping. After several meetings in a fast-food restaurant, they finally agreed to let the assessor into their home. However, to make matters worse, the wife had been admitted to the hospital with a medical condition. The house had three bedrooms, each of which was littered from floor to ceiling with hoarded items. These included books, magazines, board games, soft toys, sewing materials, and clothes. The front door was completely blocked off, and it was impossible to find the kitchen and shower. For 20 years, they had not been able to cook a meal or wash up in their own home. They ate in fast-food restaurants and scrubbed themselves in communal bathrooms. They both had diabetes, high blood pressure, obesity, and obstructive sleep apnea. They did not meet the diagnostic criteria for a mental disorder, and their neuropsychological assessment did not reveal dementia or cognitive impairment. The husband repeatedly stated that he could not explain how the hoarding had become so severe, was ashamed of the state of his home, and agreed to tidy the hallway, one bedroom, kitchen, and bathroom. He understood that tidying up was necessary to enable service providers to provide domestic cleaning, meals, and hygiene support. He was present during the tidying up, and his consent was sought before any items were discarded. However, on the second day of the clean-up, he became concerned about some of the items that were missing. He accused the cleaners of stealing. He wrote numerous letters of complaint and reported the matter to the police. A case manager was appointed as an ongoing coordinator, and she was able to continue the cleaning slowly, making it more acceptable to him. When the service provider cleaned the house, his wife was discharged home, and they were able to take advantage of a living space that was previously inaccessible. This case fit the typical profile of self-neglect and can help to better identify this concept and understand its implications.

4.4. Antecedents

Antecedents are events or pre-existing situations that occur prior to the concept. The main antecedents of self-neglect in older adults include physical, psychological, social, and other related factors.

4.4.1. Physiological factors

This refers mainly to the decline in cognitive and physical function caused by physical complaints, such as illness and accidental injury. Cognitive impairment is the most important predisposing factor for self-neglect in older adults, and a 9-year study of a cohort of older adults found that those with dementia were four times more likely to self-neglect than those without dementia (Abrams et al., 2002). Dong and Simon (2016) studied Chinese older adults living in Chicago and found that the lower cognitive function, the higher prevalence of self-neglect. Similar findings were found by Yi et al. (2021) in China, who concluded that cognitive impairment was the main reason for the occurrence of self-neglect in older adults. Wei et al. (2020), who investigated the factors influencing self-neglect among older adults in a province, found that older adults with physical pain and a high number of chronic diseases had high levels of self-neglect. Naik et al. (2008) found a high prevalence of self-neglect among older adults with poor daily self-care skills.

4.4.2. Psychological factors

Anxiety and depression are common psychological problems in older adults, and researchers have found that psychological problems, such as depression, are important factors influencing self-neglect in older adults, with self-neglect becoming more prevalent with higher levels of depression. In one study, depression more than doubled the risk of self-neglect (Lee and Kim, 2014). Hansen et al. (2016) studied 96 cases of adults 65 years of age or older and found that the incidence rate of depression among those who experienced self-neglect was 51 %−62 %. The findings of Li (2021) in China were similar, possibly because the onset of depression makes self-care more difficult for older adults, and they tend to develop poor lifestyles, which reduces their physical and mental health.

4.4.3. Social environmental factors

Good interpersonal networks are an important means of accessing social support, and Dong et al. (2016) showed that smaller social networks and social engagement were significantly associated with the risk of developing self-neglect. Many older adults who experience self-neglect live in isolated environments without adequate social support or health services, and Burnett et al. (2014) suggested that living alone, having little contact with children, family, friends, or neighbors may contribute to self-neglect in older adults. Yi et al. (2021) also found that the higher the frequency of communication with children, the lower the level of self-neglect in older adults living alone. Luo (2019) surveyed 460 older adults patients with chronic diseases and found that individuals with higher levels of family care had lower levels of self-neglect.

4.4.4. Other factors

Ages, sex, economic income and educational level all influence self-neglect among older adults. Ji (2018) used data from the Chinese Geriatric Health Influence Follow-up Survey to explore factors influencing self-neglect among older adults in China and found that lower levels of self-neglect favored older adults with lower age, greater literacy, and higher income levels. Abrams et al. (2002) conducted a 9-year longitudinal study of 2161 community residents and found that male sex, older age, lower income, and living alone were risk factors for self-neglect. Older adults living alone may be a vulnerable group in need of care in all aspects of their lives, and Yu et al. (2019) found a self-neglect rate of 23.2 % among older adults living alone in China. A possible reason for this is that many older adults are strongly influenced by traditional Chinese culture and are more concerned about their children and grandchildren than themselves. Alcohol or drug abuse has also been shown to contribute to self-neglect in older adults, leading to serious medical problems, malnutrition, and social isolation (Spensley, 2008). In a study by Halliday, 27 % of older adults who experienced self-neglect were found to have alcohol misuse (Halliday et al., 2000).

4.5. Consequences

4.5.1. Effects on older adults

Self-neglect can seriously affect the physical and mental health of older adults, leading to low food intake, weight loss, frailty, multiple nutritional deficiencies, vitamin D deficiency, poor physical function, osteoporosis, falls, and fractures (Smith et al., 2006). It is associated with an increased risk of cardiovascular, neurological, and tumour-related mortality in older adults (Dong and Simon, 2016). Dong et al. (2009) posited that self-neglect was an independent risk factor for early mortality in older adults, with 1-year mortality following a diagnosis of self-neglect six times that of older adults without self-neglect and long-term mortality almost twice that of older adults without self-neglect. In addition, lack of social interaction impairs older adults' ability to interact socially and increases the risk of anxiety. Bitondo et al. (2007) found that abused and neglected older adults were more likely to be depressed and to have dementia than those without neglect and abuse.

In addition to a range of medical consequences, self-neglect has many social, ethical, and legal implications. For example, self-neglecting older adults are unable to maintain their personal and environmental care and are vulnerable to threats to their safety due to unsafe environments and lack of medical care. Self-neglect can also worsen their economic and social situation due to their inability to deal with financial issues.

4.5.2. Effects on others and society

In addition to the negative impact on older adults themselves, self-neglect also has a negative impact on others and society because self-neglecting older adults do not care enough for themselves and require additional caregivers, increasing the burden on caregivers and the community. Their inability to maintain their home environment leads to safety hazards, which can have a negative impact on people in the same community and lead to neighborhood conflicts (Sengstock et al., 1999). The medical comorbidities associated with self-neglect may lead to increased use of health and social services, as self-neglect affects the physical and mental well-being of older adults. Researchers have shown that self-neglecting older adults have higher rates of short or long-term of nursing home placement, emergency admissions, hospital admissions and readmissions, and hospice use (Dong and Simon, 2013; Dong et al., 2012). This further increases the burden on hospitals and social services, strains healthcare resources, and increases hospitalization costs and has negative implications for the healthcare system (Dong et al., 2012).

4.6. Conceptual definition and conceptual framework

In summary, we have concluded that self-neglect in older adults refers to a series of behaviors: failure or inability to meet basic needs, risky or unsafe behaviors, diagnostic challenges in recognition, and social isolation or lack of interaction. It is affected by individual psychological, physiological, social, and environmental factors, as well as other factors, such as age, sex, literacy, and living habits, and it has many adverse effects on older adults themselves, as well as on others and society. The conceptual framework is shown in Fig. 2.

Fig. 2.

Fig 2

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Conceptual framework of self-neglect in older adults.

5. Discussion

Because there has been an increase in the number of older adults worldwide, self-neglect has become a public health concern. Reports of older adults’ self-neglect are usually based on serious concerns about the welfare, health, and safety of older persons, the extent of which may indicate that there may be serious concerns about their welfare. These reports can lead to the intervention of relevant agencies to investigate whether self-neglect is, in fact, occurring. However, due to poorly defined concepts, the mechanisms of investigation remain largely unknown. Self-neglect and abuse of older persons are underreported, especially in less serious cases. Self-neglect has several effects on older adults’ health, quality of life, and public health consequences (Dahl et al., 2020). One group of researchers demonstrated increased mortality risk for reported and confirmed older adults self-neglect across different levels of cognitive and physical function, challenging a belief that self-neglect and the potential for adverse health outcomes are confined to those with the most impaired cognitive and physical function (Dong et al., 2009). 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 (Papaioannou et al., 2012).

Concept analysis is an effective way of clarifying concepts that are widely used but vaguely defined. In this concept analysis, we attempted to provide a clearer definition of self-neglect in older adults based on the identification of terms and surrogate expressions used to describe and explain the concept of older adults’ self-neglect. A comprehensive literature review and analysis was carried out using Rodgers' evolutionary method (Rodgers et al., 2018). In the literature, older adults’ self-neglect is a complex concept that is seen simultaneously as: (a) older adults intentionally or unintentionally fail to complete self-care or maintain living conditions, and (b) this behavior is potentially threatening to themselves and to society (Gibbons et al., 2006; O'Brien et al., 1999). From our concept analysis, we have shown that older adults with self-neglect share some common characteristics, such as failure to maintain environmental and personal hygiene, hoarding, poor medical compliance behavior, poor safety awareness, and poor social skills. Healthcare professionals need to recognize symptoms early and implement appropriate interventions to improve behavior (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 sex, and alcohol abuse (Halliday et al., 2000; Yu et al., 2019).

Self-neglect is not a new concept, but the evolution of this concept has been marked by a shift in focus from abuse-related consequences towards a broader understanding that encompasses individual health interventions and public health. Through the literature review, we identified attributes that characterize people with self-neglect, including the following:

  • (a)

    Failure or inability to meet basic needs. Self-neglect older adults may have a disorganized living and personal environment, They may also neglect their diet, eating spoiled food and not paying attention to their nutritional status (Xu, 2021).

  • (b)

    Risky or unsafe behaviors. Self-neglecting older adults often have unsafe behaviors that put them in dangerous situations. Older adults’ self-neglect may have serious consequences for themselves, others, and society (Peng, 2018) (Papaioannou et al.2012).

  • (c)

    Diagnostic challenges in recognition. It is difficult for lay people and health professionals to understand and identify (Dong et al., 2010).

  • (d)

    Lack of interaction or social isolation (Goldman et al., 2024).

These attributes further underscore the needs for tailored interventions that address the diverse needs of individuals and society. We have proposed a definition of older adults’ self-neglect, providing a practical guide to practice strategies in a culturally-diverse society. A clear and standardized conceptual definition of older adults’ self-neglect facilitates communication within nursing and other disciplines. In addition, a clear conceptual definition will help nurses to remain sensitive to and improve their ability to recognize self-neglect in older adults, to accurately identify and assess possible self-neglect-related problems in older adults, and to explore effective community intervention strategies to reduce their self-neglect.

However, Rodgers' evolutionary concept analysis states that the ultimate purpose of concept analysis is not to arrive at what the concept is but to indicate the direction of research for the further development of the concept, as well as the development of disciplinary knowledge. At the same time, concept analysis is an evolving process influenced by the quantity and quality of the literature included and the stage of development of the concept itself. Our analysis of the concept of self-neglect in older adults represents only the current state of research, and the concept still needs to be further improved and refined as richer information and research content is obtained.

6. Limitations

Despite the strengths and contributions of this study, the results must be interpreted in light of several limitations. Firstly, because the definitions of self-neglect vary, we may not have been able to describe these terms comprehensively, so the results 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. In addition, we screened only a limited number of databases, so articles in other sources may have been missed. We included only articles published in English and Chinese, so the findings may not be applicable to other cultural contexts, which may lead to socio-cultural bias in the description of the findings. The authors, therefore, call for more cross-cultural research on this issue.

7. Conclusions

By analyzing the concept of self-neglect in older adults, we summarized four defining characteristics, highlighting its antecedents and consequences, and attempted to help people to better understand self-neglect in older adults through typical case. The analysis of several risk factors for self-neglect may help in its identification and prevention and in proposing interventions. Given the negative impact on older adults themselves and on society, researchers are encouraged to pay attention to this phenomenon. Future large-scale studies are needed to validate the risk and protective factors associated with self-neglect, and rigorously-designed experimental studies are needed to test best practices for intervention and prevention of self-neglect. At the same time, as the prevalence and characteristics of self-neglect may vary among countries and cultures, future research is encouraged to explore in depth the meaning of self-neglect among older adults based on different national contexts, to analyze its influencing factors, and to develop a localized self-neglect assessment tool for older adults, so that we can improve the quality of life of older adults and actively address the challenges of population ageing and promote healthy ageing.

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Patient consent for publication

Not required.

Availability of data and materials

The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.

Declarations

None declared.

Funding

The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

CRediT authorship contribution statement

Man Zhang: Writing – review & editing, Writing – original draft, Visualization, Software, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. Xiaoling Zhang: Writing – review & editing, Supervision.

Declaration of competing interest

All author have nothing to declare.

Acknowledgements

Not applicable.

Footnotes

Supplementary material associated with this article can be found, in the online version, at doi:10.1016/j.ijnsa.2025.100350.

Contributor Information

Man Zhang, Email: 2020283050113@whu.edu.cn.

Xiaoling Zhang, Email: 13520678095@163.com.

Appendix. Supplementary materials

mmc1.docx (12.7KB, docx)
mmc2.docx (38.8KB, docx)

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

mmc1.docx (12.7KB, docx)
mmc2.docx (38.8KB, docx)

Data Availability Statement

The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.

Articles from International Journal of Nursing Studies Advances are provided here courtesy of Elsevier

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