Jim Proffitt remembers the mummified kittens.
A recent study conducted in England supports that view The investigators visited and interviewed 81 clients of a special team employed by the city of Lewisham to dean the homes of people who live in squalid conditions. To measure the level of squalor, they used the living conditions rating scale (LCRS), which rates a patient's living environment and level of personal hygiene or neglect. Scores on each item range from 0, indicating acceptable, to 3, indicating extremely filthy or abnormal. For interior living environment, the maximal score is 39; for personal hygiene, it is 12.Psychiatrists can take a proactive approach by identifying high-risk individuals and intervening whenever possible before conditions deteriorate, Dr. Rabheru says. Any psychiatrist who works with elderly patients, or who consults for a hospital or nursing home should pay particular attention to patients who live alone; have few social skills or support systems, have early dementia or a longstanding personality disorder; or who have medical comorbidities that they're neglecting.The investigators also determined how many patients met the diagnostic criteria for primary Diogenes syndrome, which the authors defined as presence of domestic squalor; evidence of self neglect (LCRS personal hygiene score >4); living alone; evidence of hoarding; and lack of concern about their surroundings.--John Dublin, "You Can Profit from the Carter Era"Management of these cases is difficult. Many patients have severed ties with family and friends; and they mistrust doctors, so they don't seek medical care. Because they don't see anything wrong with the way they live, they often don't come to the attention of medical or legal authorities until they're reported by an outsider such as a mail carrier, utility company employee, or neighbor who becomes alarmed (or just disgusted). By that time the squalor is almost unimaginable. "If you ever go on one of these investigations, don't open the refrigerator," Mr. Proffitt warns.--Robert Poole Jr., "Saccharin and Human Liberty"More Americans live in squalor than people realize, Dr. Bennett Blum, director of the geriatric division of the forensic consulting firm of Park Dietz and Associates, told this newspaper.Dr. Kiran Rabheru, who spoke at the annual meeting of the American Association for Geriatric Psychiatry said few systematic studies of the problem have been conducted. He's not sure why this is so, but speculates that some communities, especially the more affluent ones, may minimize the problem or deny that it exists, he told this newspaper.Most of these patients appear to have some type of frontal lobe deficit, which in turn affects executive function. Many patients have no formal psychiatric diagnosis, but, says Dr. Rabheru, "Who in his right mind would live like that? I think there's a deficit there, but we just don't have the diagnostic tools to identify it yet." A little digging beneath the surface often reveals that the person involved has always been isolated, antisocial, or hostile: the neighbor whom others might describe as "eccentric, a loner," or "weird."Dr. Blum has developed a protocol for assessing an individual's cognitive function that will be included in the next edition of the "Comprehensive Textbook of Psychiatry" by Dr. Harold I. Kaplan and Dr. Benjamin J. Sadock, which is slated for publication in 2005.Typically, people living in squalor suffer from illnesses such as strokes, dementia, schizoid or schizotypal personality disorder, or schizophrenia, said Dr. Rabheru, chair of the division of geriatric psychiatry at the University of Western Ontario, London. Patients might also be depressed or delusional. The tendency to hoard certain items such as rocks, cans, newspapers, packets of sugar, or plastic bags, makes these patients' symptoms resemble those of patients with obsessive-compulsive disorder (OCD). "The difference is that people with OCD realize their actions are illogical," Dr. Rabheru says. "People who live in squalor don't.""In March the FDA announced a ban on saccharin, effective July 1, based on tests in which rats fed the equivalent of 1,000 cans of soda per day developed bladder cancer."The authors concluded that "squalid living conditions were more likely to be associated with a mental or physical disorder than with the narrowly defined Diogenes syndrome" (Lancet 355[9207]:882-86, 2000).The final report of the National Elder Abuse Incidence Study can be viewed at
http://www.aoa.gov.The study participants ranged from 18 to 94 years of age. Their mean LCRS interior scale score was 17, and the mean score on personal hygiene was 5. At least one chronic physical illness was present in 69 people (85%). Fifty-seven (70%) of the participants were diagnosed in the interview with an ICD-10 mental disorder, as defined by the schedules for clinical assessment in neuropsychiatry However, only 18 (22%) of the patients met all five criteria for Diogenes syndrome, and when the authors added a sixth criterion--absence of an active mental disorder--that number dropped even further, to four (5%)."Lowell Ponte, in his book The Cooling, carefully analyzes all the climatic evidence and theories and concludes that the world is definitely cooling rapidly, with the chances of another ice age rather high."Several studies conducted since the middle 1990s have shown consistently that only about 1 in 12 to 1 in 14 of all cases of elder abuse, including self-neglect, come to the attention of community agencies, Dr. Blum said. Mr. Proffitt, an attorney and supervising deputy in the conservatorship division of the Office of the Public Administrator and Public Guardian of San Diego (Calif.) County; estimates that about 100 of the 225 cases he investigates each year involve some degree of squalor.
The final report of the National Elder Abuse Incidence Study can be viewed at http://www.aoa.gov.
Author: Norra MacReady
