![]() ![]() safety risks (including readiness for change and assessment of capacity).Įngagement: Build trust.functional impairment due to hoarding or squalor.the person and contributing conditions (mental and physical health, cognition).the environment and symptom severity (including use of hoarding/clutter and squalor severity- specific tools).The team undertaking the initial assessment screens for underlying health issues, evaluates individual needs and can then refer on to specialist services for more targeted assessment and management. 27 Assessmentĭetailed multidisciplinary assessment is important in moderate to severe cases ( Box 4). The person tasked with the initial assessment may be from a general or aged-care health service, mental health, welfare and community services or the local council. Hoarding behaviour may first come to light through a variety of sources including neighbours, relatives, service providers, police, fire services, local council and accommodation providers. Unless GPs do home visits, it is often not immediately obvious that a patient has hoarding disorder. It is uncommon for GPs to receive referrals for hoarding and squalor, but it is important for them to be aware of how to screen for the severity of hoarding and squalor along with the risk to safety, and pathways for assessment and referral. 3 People living in squalor may be malnourished and mortality is high. The majority of people living in squalor also have a psychiatric disorder ( Box 3), 1 yet only half have had contact with a mental health service in the preceding year. 19 Neglect and elder abuse can also be potential factors. 1, 18 Presentation is often precipitated by the loss of a partner, increasing frailty or symptoms of a neurocognitive disorder. ![]() 1 About half are over 65 years old, and at least one in a 1000 people over 65 live in squalor. People living in severe domestic squalor often refuse intervention, withdraw socially and lack insight into their living conditions. There are two main pathways to squalor – domestic neglect such as failure to remove rubbish, and hoarding such as excessive accumulation of items. 17 This is not a diagnostic entity in current classification systems, but an epiphenomenon of other diagnoses. Severe domestic squalor describes a home that is so unclean, messy and unhygienic that people of a similar culture and background would consider extensive clearing and cleaning essential. 5 The risk of fire and associated mortality is high. Accumulated objects increase the risk of falls, and insect or rodent infestations lead to health hazards. 4, 5 People who hoard, and other household members, have been found dead after being trapped by falling items. Hoarding and squalor can pose safety risks to the individual, other household occupants, pets and neighbours. 1, 2 A quarter of people with hoarding and squalor have a physical health problem that contributes to the state of their living environment, such as incontinence, immobility, or severe visual impairment. Hoarding disorder is a mental illness whereas squalor describes an unsanitary living environment, which may be the end result of extreme domestic neglect or hoarding. Intervention is recommended due to a risk to the health and safety of the individual or others.Īlthough hoarding and squalor can at times appear similar in the home environment, they are two different, albeit sometimes overlapping, conditions. In both conditions there is an accumulation of possessions or rubbish. Some of these behaviours could be explained by functional and financial constraints, as well as personal or lifestyle choices.Hoarding and squalor are complex conditions with diverse underlying aetiologies. Research also points to behaviours such as an unwillingness to take medication, and feelings of isolation. The behaviours and characteristics of living with self-neglect can include: Behaviours and characteristics of self-neglect A decrease in motivation can also be a side effect of psychiatric medications, putting those who require them at a higher risk of self-neglect than might be caused by mental illness alone. It can be a result of any mental or physical illness which has an effect on the person's physical abilities, energy levels, attention, organisational skills or motivation. Self-neglect can happen as a result of a brain injury, dementia or mental illness. grossly inadequate housing or homelessness.inappropriate and/or inadequate clothing, lack of the necessary medical aids (e.g.animal / insect infestation, no functioning toilet, faecal / urine smell) unsanitary or unclean living quarters (e.g.improper wiring, no indoor plumbing, no heat, no running water) hazardous or unsafe living conditions / arrangements (e.g.dehydration, malnutrition, untreated or improperly attended medical conditions, and poor personal hygiene.unwillingness or inability to care for oneself or one’s environment.
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