Depression is characterized by sadness, decreased appetite, insomnia, and loss of interest in hobbies. Psychosis is an altered mental state characterized by delusions and hallucinations. Alcohol abuse exists if the intake of alcohol impairs social functioning. Substances other than alcohol may be abused, but in elderly populations, alcohol abuse is most common.

Self-neglect often accompanies dementia and mental health problems in older people. It is an important issue that requires additional research, but it is not addressed in this paper except to the extent that it constitutes a risk factor for or sign of elder abuse and neglect inflicted by others—in effect, a forensic marker. Self-neglect may be a risk factor in that it makes victims more vulnerable to and less able to ward off mistreatment by others who might prey on them. Similarly, as capacity for self-care decreases, dependence on others increases, and if potential caregivers are either unable or unwilling to provide assistance, then the risk for being abused and neglected by caregivers increases. Conversely, someone who has been victimized by abuse or neglect may become depressed and in turn lose the desire or capacity for self-care. Thus, self-neglect also may be a forensic marker that abuse or neglect has been committed by another person.

Age-Related Changes

Dementia. Dementia is present in 15 percent of persons over the age of 65 and 50 percent of persons over the age of 80 (Abrams et al., 1995a). Dementia is by definition a loss of function that often results in increased reliance on others for care. Many with the dementia syndrome refuse needed care, and/or their children are uneasy with becoming caregivers.

Depression. Depression affects from 15 to 50 percent of older persons. Institutionalized elders and those with medical illness have the highest incidences of depression, which can be as high as 70 percent following a stroke. Elderly persons with depression are more prone to psychosis than are younger persons with depression (Abrams et al., 1995b).

Psychosis. Four to five percent of older adults experience psychosis (Abrams et al., 1995b). It is most commonly associated with depression, but elders can experience acute and chronic episodes of paranoid ideation (formation of paranoid ideas).

Alcohol Abuse. Alcohol abuse is present in up to 5 percent of older persons and is more common in men than in women. Older adults can become inebriated at lower levels of alcohol intake than younger adults and are more susceptible to its ill effects, including malnutrition, gastritis, and alcohol dementia (Abrams et al., 1995c).

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