Researchers from Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs Medical Center at Houston have developed an innovative method to determine whether older, frail adults likely to have difficulty living independently because of social issues, impaired reasoning skills or other chronic conditions, are not adequately caring for themselves and needed assistance. “We tried to create a clinical protocol that provided both assessment and intervention at the same time," said Dr. Aanand Naik, assistant professor of medicine at BCM and a health services research investigator at DeBakey. The first step involves getting referrals from family members, social workers or a county’s adult protective services agency about an older adult who may not have the capacity to live alone. Next, a geriatrician, social worker and case worker visit the elder to conduct an assessment in the patient’s home to get a clear sense of their living environment. "People who self-neglect usually have some sort of cognitive dysfunction, and it may be difficult to identify until the decision-making interview, during which they are asked about self-care, hygiene and financial management," said Felicia Skelton, first author of the paper published in the Archives of Gerontology and Geriatrics and a fourth-year medical student at BCM. Afterwards, the geriatrician, social worker and family members meet to discuss the situation and possible interventions, which can vary from frequent visits by a family caregiver to recommending placement in a nursing home. "We want the least invasive intervention as possible so that the adult can still remain independent," said Skelton. "It’s important to get everyone on the same page," said Naik. "We are hoping that other physicians are able to incorporate this evaluation as well."
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