Social care responses to self-neglect among older people: an evidence review of what works in practice

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We report on a review of the international literature available in English (2015-20) focusing on Adult Social Care responses to self-neglect among older people. In addition, we discuss the national law and policy context in England provided by the Care Act 2014 and the Mental Capacity Act 2005.
• A section on definitions outlines our approach and explains why, although hoarding has conventionally been viewed as part of the topic of self-neglect, we have reviewed publications with a specific focus on hoarding separately from this report.
• A narrative synthesis draws together the evidence from the publications we found. We isolate and discuss two overarching themes: relationship building and multi-agency working.
• A section on law and national policy developments examines the formal incorporation of self-neglect within adult safeguarding practice by the guidance accompanying the (English) Care Act 2014. We discuss this in the wider context of care and support under the Act.
• A section on ethical questions and mental capacity addresses the difficulty surrounding individuals with capacity who appear to be acting in ways that may endanger themselves and who are reluctant to accept help. In the context of the Mental Capacity Act 2005 and the inherent jurisdiction of the High Court (England and Wales) we discuss relational autonomy, judicial perspectives, and executive capacity.
• The concluding section appraises the evidence covered by our review, poses a number of research questions for Adult Social Care in England, and closes with a discussion.
• Appendix 1 explains our methods and contains a scope note on the topic of self-neglect. There are further appendices on the risk-factor literature, self-neglect measures, and legislation relevant to self-neglect in England.

This review was undertaken as part of a study (2019-22) funded by the NIHR School for Social Care Research: 'Social care responses to self-neglect and hoarding among older people: what works in practice?'
Project webpage:
Original languageEnglish
Place of PublicationLondon
PublisherNIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute, King's College London
Number of pages51
Publication statusPublished - 6 Jul 2021


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