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Thomas M Gill - One of the best experts on this subject based on the ideXlab platform.
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elder self neglect medical emergency or marker of extreme vulnerability
JAMA, 2009Co-Authors: Thomas M GillAbstract:To address the vulnerability that often accompanies aging, a Social contract was established with older Americans in the 1960s through legislation leading to the creation of the Social Security and Medicare programs. This contract was augmented in 1975 through passage of Title XX of the Social Security Act, which required states to develop and maintain protective service Agencies for senior citizens. In most states, these Agencies are the first responders to reports of elder abuse, including physical abuse, neglect and financial exploitation. The most common reason for referral to adult protective services, however, is self-neglect, an ill-defined syndrome characterized by the inability to meet one’s basic needs to an extend that it poses a threat to personal health and safety (1,2). The absence of a caregiver distinguishes self-neglect from neglect, which is the most common subtype of elder abuse (3). In this issue of JAMA, Dong and colleagues (4) evaluate the mortality related to self-neglect and abuse in a large biracial cohort of community-living persons aged 65 years or older who were followed for a median of 6.9 years. Confirming prior work (5), the number of reported cases of self-neglect dwarfed that of abuse by a ratio of nearly 14 to 1. While both self-neglect and abuse were independently associated with mortality, the short-term affect of self-neglect was particularly pronounced, with a nearly 6-fold elevation in the risk of death within 1 year. Such elevations in risk are usually reserved for acute and highly morbid medical conditions such as myocardial infarction, stroke, or hip fracture, and suggest that a report of self-neglect should be considered a medical emergency, warranting immediate referral for diagnosis and treatment. Alternatively, some older persons reported for self-neglect may be at the end of their life. Supporting this supposition, the median time to death for cancer, the prototypical terminal condition, was only 3.5 months. While self-neglect could have led to advanced cancers being diagnosed only after referral to the Social services agency, it is more likely, given the short survival period, that the diagnosis of cancer predated the referral, and it is even possible that the cancer led to the self-neglecting behaviors. Whether the cause of death was cancer or another condition, this chicken-egg dilemma cannot be adequately addressed by the data available in this well-designed epidemiologic study. Information on medical conditions and other relevant factors such as cognitive status and physical function was obtained during comprehensive assessments that were completed a median of 19 months before the report of self-neglect. Prior work has shown that older persons experience high rates of illnesses or injuries leading to hospitalization or restricted activity, over intervals shorter than 19 months (6), and that these intervening events commonly precipitate significant declines in functional status (7). Hence, the health and functional status documented in the preceding comprehensive assessment may not accurately reflect a participant’s status at the time of self-neglect referral. Supporting this possibility, Dyer et al. found that the prevalence of physical and cognitive impairments and poor-to-fair self-reported health was high in a large sample of older persons with self-neglect who were referred by adult protective services for comprehensive geriatric assessment (8). Consequently, the authors’ findings that the mortality risks associated with self-neglect and elder abuse were not restricted to persons with the lowest levels of cognitive or physical function must be interpreted cautiously. Whether considered a medical emergency, a manifestation of a terminal condition, or simply an indicator of extreme vulnerability, self-neglect poses significant challenges to the health care system and Social safety net. The number of cases of self-neglect has been increasing (3) and will likely continue to increase with the graying of the baby boom generation. Accelerating this trend, the number of informal caregivers has been decreasing, as evidenced by the marked reduction in the the oldest old support ratio, which denotes the number of people aged 50 to 74 years who are potentially available to care for one person aged 85 years or older. This value, which was as high as 30.9 in 1970, is projected to further fall from 9.9 in 2010 to 4.1 in 2050 (9). Of considerable concern, despite an increasing demand, recent budget cuts due to the deepening recession are forcing protective service Agencies in some states to lay off caseworkers (10). Given the high short-term mortality risk attributable to self-neglect, caseworkers must be particularly adept at triaging affected individuals and implementing a care plan. One tool, used by the Social service Agencies in the current study, is a 15-item scale that assesses self-neglect severity (11). Short-term mortality was particularly high among persons with scores greater than 30, denoting severe self-neglect. Ideally, the caseworker could refer high-risk individuals back to their personal physician, but self-neglect is often characterized by Social isolation and, despite the availability of Medicare, many individuals may not have an ongoing relationship with a personal physician (1). The current study provides no information about the receipt of health care services or other interventions. In the absence of a personal physician, referral for a geriatric assessment may be warranted. Individuals who are acutely ill or at imminent risk may need to be hospitalized, while others who are at the end of life may benefit from hospice services. During the course of the assessment, particular attention should be focused on ascertaining the presence of dementia (including impairments in executive function), psychiatric disorders, and substance abuse since each can have pronounced deleterious affects on decision-making capacity. Individuals with self-neglect who lack decision-making capacity (12) and refuse help from Social Agencies and family may be unsafe to remain at home (13). In such cases, when a legally designated durable power of attorney or close family member is not available, referral to the courts for appointment of a legal guardian should be pursued so that important decisions can be made (14). Although differences in analytic strategies preclude a direct comparison, the mortality risk associated with self-neglect appears to be much higher in the current study than that in the only prior population-based study (5). The most obvious difference between the two study populations is race, with a much larger percentage of blacks (63% versus less than 18%) in the current study. Surprisingly, however, while reports of self-neglect in the current study were four times more likely in blacks than whites (23% versus 5.5%), the mortality risk associated with self-neglect was significantly lower in blacks. A similar, although less striking phenomenon was observed for gender. Women were more likely than men to be reported for self-neglect (18% versus 14%), but were less likely to die. The reasons for these racial and gender differences are uncertain. One possibility is that the threshold for referral to the Social services Agencies was lower for blacks and women, respectively, but the severity of self-neglect did not differ according to race or gender. Alternatively, there may be racial or gender differences in the conditions leading to self-neglect or in the subsequent management of self-neglect after referral to the Social services Agencies. The mortality related to self-neglect and abuse could be interpreted as a failure of society and the health care system to adequately protect the most vulnerable older adults. To better address the complex needs of this burgeoning population, a stronger geriatric work force will be needed, as highlighted in a recent Institute of Medicine report (15). While awaiting evidence-based answers to the myriad of unanswered questions regarding the epidemiology and management of self-neglect and abuse (1,16), we should act to renew our Social contract with older Americans by supporting and expanding model programs for these potentially devastating disorders (8,17).
James G Obrien - One of the best experts on this subject based on the ideXlab platform.
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self neglect in old age
Aging Health, 2011Co-Authors: James G ObrienAbstract:Self-neglect represents a unique set of challenges to society and, in particular, practitioners in healthcare and Social Agencies. Despite the fact that self-neglect has been recognized for millennia, our ability to understand, prevent and successfully intervene has hardly improved. Self-neglect seems to particularly affect women, increases mortality and imposes a huge cost on society. Ethical challenges arise for the provider attempting to balance patient autonomy, safety and an approach that emphasizes beneficence, which may violate patient wishes. Given expected demographic trends, an increase in the older population, a decline in Social service programs, a decline in the economy and less family support, the incidence of self-neglect is likely to increase; however, there have been few advances in the management of this condition.
Ian B Hickie - One of the best experts on this subject based on the ideXlab platform.
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targeted primary care based mental health services for young australians
The Medical Journal of Australia, 2012Co-Authors: Elizabeth M Scott, Daniel F Hermens, Nick Glozier, Sharon L Naismith, Adam J Guastella, Ian B HickieAbstract:Objective To assess the extent to which youth-specific, mental health care centres engage young people (12-25 years of age) in treatment, and to report the degree of psychological distress, and the diagnostic type, stage of illness, and psychoSocial and vocational impairment evident in these young people. Design and setting Standardised clinical and self-report assessments of consecutive presentations at two youth-specific centres from October 2007 to December 2009. Both sites are operated by the Brain and Mind Research Institute in Sydney, Australia, as part of headspace: the National Youth Mental Health Foundation mental health care service. Results Of 1260 young people assessed, 53% were male, and the mean (SD) age was 18.1 (3.9) years. Over 40% of the young people were self-referred, or their assessment was arranged by family or friends, or by other Social Agencies; 30% of young people were referred from other primary health providers. Almost 70% reported high or very high levels of psychological distress. More than 60% of subjects reported having 2 or more days "unable to function" within the past month, and clinicians rated over 50% as having at least moderate difficulty in Social/occupational functioning. Importantly, 25% of subjects were receiving income support. Two-thirds of subjects were rated as being at the early stage of an illness, and almost half were diagnosed with anxiety or depressive syndromes. Conclusions Targeted youth-specific mental health services, based in primary care settings, are able to engage young Australians, particularly young men, in treatment. Many of these young people report established patterns of psychoSocial and vocational impairment.
Pino Morán, Juan Andrés - One of the best experts on this subject based on the ideXlab platform.
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Cuerpo(s) en luchas: itinerarios disidentes de la discapacidad en Chile
'Universitat Autonoma de Barcelona', 2021Co-Authors: Pino Morán, Juan AndrésAbstract:Les diferències corporals s’han tractat al llarg de la història per diferents mecanismes Socials, jurídics, polítics, ètics i culturals que han estat objecte per a diferents disciplines i àmbits d’acció. En l’actualitat, les ciències Socials crítiques, ha pres interès en la visibilització i problematització de les corporeïtats contra hegemòniques -en el sentit Gramsciano- que permeten analitzar les imperfeccions, desviacions i sortides a el règim dominant-normatiu de la ciència, societat i cultura. Per tant, que contribueixen a les lluites i desafiaments d’inici de segle XXI. En aquest context, la investigació realitzada va tenir per objectiu, analitzar com es construeixen els itineraris corporals de les persones dissidents de la discapacitat que viuen a Xile. Per això, faci una aproximació qualitativa a través de 11 entrevistes en profunditat, 6 conversatorios i material de difusió de 8 dels i les activistes que utilitzaven xarxes Socials. Es destaca de la investigació la seva proposta epistemològica i el seu enfocament metodològic que trenca amb la participació medicalitzada de la democràcia, que agrupa les investigacions de les dissidències segons criteris diagnòstics. De la mateixa manera, es va incorporar una perspectiva feminista descolonial de la discapacitat als estudis de la sociologia de el cos. Per tant, va involucrar qüestionaments fonamentals a les relacions que construeixen les societats sexistes occidentals. Per aquest motiu vaig posar especial atenció a l’impacte de sistema sexe-gènere en les lluites de les persones dissidències per incorporar-se en igualtat de condicions a totes les dinàmiques Socials, que segueixen marcant el patró patriarcal, androcèntric i capacitista a les demandes i reivindicacions de justícia Social . Per això, els itineraris corporals de les persones dissidents de la discapacitat han de situar-se com línies de fuites (Guattari, 2013) a la heteronormativitat indolent i com corporeïtats rebels (De Sousa Santos, 2016) que desestabilitzen la cultura capacitista o com a part d’un moviment global de revolució somatopolítico (Preciado, 2019) de desviació en l’organització neoliberal. Els resultats mostren les corporeïtats transitant per la vulnerabilitat corporal, l’agència corporal i els discursos polítics que van donar compte de les trajectòries existencials d’un grup particular de cossos, que serveixen per mostrar i exemplificar les vides en moviments, amb tensions, fracassos i èxits. Aquests itineraris ajuden a conscienciar les variades necessitats que requereixen les nostres corporeïtats, que cobreixen un ampli ventall de possibilitats com mostren les diverses interrelacions entre les agències Socials i les ideologies polítiques. Finalment, es va poder comprovar com l’etiquetatge de la discapacitat ve a fer una actualització modern colonial que entrecreua la lògica de les societats disciplinàries amb les societats de control, pel que fa ja no només vol conduir els règims mèdics-patològics dels cossos, sinó també, quines seran les formes de “”inclusió”” atorgant un caràcter negatiu-positiu en els nostres afectes i un caràcter institucional / comunitari per les seves respostes i propostes públiques ciutadanes.Las diferencias corporales se han tratado a lo largo de la historia por diferentes mecanismos Sociales, jurídicos, políticos, éticos y culturales que han sido objeto para diferentes disciplinas y ámbitos de acción. En la actualidad, las ciencias Sociales críticas, ha tomado interés en la visibilización y problematización de las corporeidades contra hegemónicas -en el sentido Gramsciano- que permiten analizar las imperfecciones, desviaciones y salidas al régimen dominante-normativo de la ciencia, sociedad y cultura. Por lo tanto, que contribuyen a las luchas y desafíos de inicio de siglo XXI. En ese contexto, la investigación realizada tuvo por objetivo, analizar como se construyen los itinerarios corporales de las personas disidentes de la discapacidad que viven en Chile. Para eso, realice una aproximación cualitativa a través de 11 entrevistas en profundidad, 6 conversatorios y material de difusión de 8 de los y las activistas que utilizaban redes Sociales. Se destaca de la investigación su propuesta epistemológica y su enfoque metodológico que rompe con la participación medicalizada de la democracia, que agrupa las investigaciones de las disidencias según criterios diagnósticos. De la misma manera, se incorporó una perspectiva feminista descolonial de la discapacidad a los estudios de la sociología del cuerpo. Por lo tanto, involucró cuestionamientos fundamentales a las relaciones que construyen las sociedades sexistas occidentales. De ahí que puse especial atención al impacto del sistema sexo-género en las luchas de las personas disidencias para incorporarse en igualdad de condiciones a todas las dinámicas Sociales, que siguen marcando el patrón patriarcal, androcéntrico y capacitista en las demandas y reivindicaciones de justicia Social. Por eso, los itinerarios corporales de las personas disidentes de la discapacidad deben situarse como líneas de fugas (Guattari, 2013) a la heteronormatividad indolente y como corporeidades rebeldes (De Sousa Santos, 2016) que desestabilizan la cultura capacitista o como parte de un movimiento global de revolución somatopolítico (Preciado, 2019) de desviación en la organización neoliberal. Los resultados muestran las corporeidades transitando por la vulnerabilidad corporal, la agencia corporal y los discursos políticos que dieron cuenta de las trayectorias existenciales de un grupo particular de cuerpos, que sirven para mostrar y ejemplificar las vidas en movimientos, con tensiones, fracasos y éxitos. Estos itinerarios ayudan a concientizar las variadas necesidades que requieren nuestras corporeidades, que cubren un amplio abanico de posibilidades como muestran las diversas interrelaciones entre las agencias Sociales y las ideologías políticas. Finalmente, se pudo comprobar como el etiquetaje de la discapacidad viene a hacer una actualización moderno colonial que entrecruza la lógica de las sociedades disciplinarias con las sociedades de control, en cuanto ya no sólo quiere conducir los regímenes médicos-patológicos de los cuerpos, sino también, cuales serán las formas de "inclusión" otorgando un carácter negativo-positivo en nuestros afectos y un carácter institucional/comunitario para sus respuestas y propuestas públicas ciudadanas.Body differences have been treated throughout history by different Social, legal, political, ethical and cultural mechanisms that have been subject to different disciplines and fields of action. At present, the critical Social sciences, has taken interest in the visibility and problematization of corporations against hegemonics - in the Gramsciano sense - that allow to analyze the imperfections, deviations and exits to the dominant-normative regime of science, society and culture. Therefore, they contribute to the struggles and challenges of the beginning of the 21st century. In this context, the research carried out was aimed at analyzing how the bodily itineraries of people with disabilities who live in Chile are built. For that, make a qualitative approach through 11 in-depth interviews, 6 conversations and dissemination material of 8 of the activists who used Social networks. The research highlights its epistemological proposal and its methodological approach that breaks with the medicalized participation of democracy, which groups the investigations of dissent according to diagnostic criteria. In the same way, a decolonial feminist perspective of disability was incorporated into studies of the sociology of the body. Therefore, it involved fundamental questions to the relationships that build western sexist societies. Hence, I paid special attention to the impact of the sex-gender system on the struggles of people dissidents to incorporate all Social dynamics on equal terms, which continue to mark the patriarchal, androcentric and capacitist pattern in the demands and demands of Social justice . For this reason, the bodily itineraries of the dissidents of disability must be placed as leaking lines (Guattari, 2013) to indolent heteronormativity and as rebel corporations (De Sousa Santos, 2016) that destabilize the capacitist culture or as part of a movement global somatopolitical revolution (Preciado, 2019) of deviation in the neoliberal organization. The results show corporations moving through body vulnerability, body agency and political discourses that gave account of the existential trajectories of a particular group of bodies, which serve to show and exemplify lives in movements, with tensions, failures and successes. These itineraries help raise awareness of the varied needs that our corporations require, which cover a wide range of possibilities as shown by the various interrelationships between Social Agencies and political ideologies.Finally, it could be seen how the labeling of disability comes to make a modern colonial update that intersects the logic of disciplinary societies with control societies, since it no longer wants to only conduct the medical-pathological regimes of the bodies, but also, which will be the forms of "inclusion" granting a negative-positive character in our affections and an institutional / community character for their public responses and public proposals
Da Silva, Márcia Cabral - One of the best experts on this subject based on the ideXlab platform.
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EN RESCATE DE LA HONOR, DE LOS VALORES FAMILIARES Y DEL FORTALECIMIENTO DE LA NACION: ENLACE DE LA DEFENSA NACIONAL
'Universidade Estadual do Sudoeste da Bahia Edicoes UESB', 2020Co-Authors: De Almeida, Cíntia Borges, Da Silva, Márcia CabralAbstract:La constitución del "moderno" orden republicano se asociaba a la idea de representatividad, de asociación, compromiso, Socialización de un espacio, de una causa, de un movimiento de agentes Sociales en disputa por la construcción de una identidad nacional. La década de 1910 en Brasil está marcada por una fase de desestabilización Social, representada por el protagonismo de una parte de la sociedad políticamente activa, hegemónica, que se apoyaba en el discurso de transformación del país. En esa dirección, se amplía la participación de los sectores militares y de intelectuales pertenecientes a las instituciones Sociales de prestigio, como el IHGB, la ABL, alineados a esos sectores. Con el fin de problematizar espacios y agencias Sociales responsables del proceso educativo, el estudio de las Ligas en ese período señala la existencia de organizaciones que se articulan para la defensa nacional, la organización del trabajo y la propagación de la instrucción popular. En este artículo, se propone investigar la Liga de la Defensa Nacional (LDN), por el análisis de los discursos y de los efectos de verdad que produce (FOUCAULT, 2001), por vía de las noticias diseminadas en la prensa carioca, buscando comprender su papel a desde diferentes versiones de la historia (CHALHOUB, 2012). En el marco de este movimiento, se destaca la presencia de Olavo Bilac, teniendo en la asociación una idea de programa Social, "con vistas antes de cuidar de la educación cívica, buscar en la instrucción primaria, profesional y en la militar, cambiar la faz de las cosas" (O PAIZ, 28/10/1915, p.01). Entre sus propósitos, se buscaba el combate al anarquismo, al extranjerismo, a los comicios ya las huelgas, en el intento del rescate del honor, de los valores familiares y del fortalecimiento de la nación.The constitution of the "modern" republican order was associated with the idea of representativeness, of partnership, of engagement, of Socialization of a space, of a cause, of a movement of Social agents in dispute for the construction of a national identity. The decade of 1910 in Brazil is marked by a phase of Social destabilization, represented by the protagonism of a portion of the politically active, hegemonic society that was based on the discourse of transformation of the country. In this direction, the involvement of military sectors and intellectuals belonging to prestigious Social institutions, such as the IHGB and the ABL, aligned with these sectors. In order to problematize spaces and Social Agencies responsible for the educational process, the study of the Leagues in this period indicates the existence of organizations that are articulated for national defense, the organization of work and the propagation of popular instruction. In this article, we propose to investigate the League of National Defense (LDN), through the analysis of the speeches and the effects of truth that it produces (FOUCAULT, 2001), through the disseminated news in the Rio press, seeking to understand its role from of different versions of the story (CHALHOUB, 2012). Leading this movement, the presence of Olavo Bilac stands out, having in the association an idea of a Social program, "with a view to taking care of civic education, to seek in primary, professional and military education, to change the face of things" (O PAIZ, 10/28/1915, p.01). Among the aims of the League was to combat anarchism, foreigners, rallies and strikes, in an attempt to rescue honor, family values and strengthen the nation.A constituição da “moderna” ordem republicana associava-se à ideia de representatividade, de parceria, engajamento, Socialização de um espaço, de uma causa, de um movimento de agentes sociais em disputa pela construção de uma identidade nacional. A década de 1910 no Brasil é marcada por uma fase de desestabilização Social, representada pelo protagonismo de uma parcela da sociedade politicamente ativa, hegemônica, que se apoiava no discurso de transformação do país. Nessa direção, ampliava-se o envolvimento dos setores militares e de intelectuais pertencentes às instituições sociais de prestígio, como o IHGB, a ABL, alinhados a esses setores. Com o intuito de se problematizar espaços e agências sociais responsáveis pelo processo educativo, o estudo das Ligas nesse período sinaliza a existência de organizações que se articulam para a defesa nacional, a organização do trabalho e a propagação da instrução popular. Propõe-se investigar a Liga da Defesa Nacional (LDN), pela análise dos discursos e dos efeitos de verdade que produz (FOUCAULT, 2001), por via das notícias disseminadas na imprensa carioca, buscando-se compreender o seu papel a partir de diferentes versões da história (CHALHOUB, 2012). À frente desse movimento, destaca-se a liderança de Olavo Bilac, tendo na associação uma ideia de programa Social, “com vistas antes de cuidar da educação cívica, buscar na instrução primária, profissional e na militar, mudar a face das coisas” (O PAIZ, 28/10/1915, p.01). Entre seus propósitos, buscava-se o combate ao anarquismo, ao estrangeirismo, aos comícios e às greves, na tentativa do resgate da honra, dos valores familiares e do fortalecimento da nação
