was an independent risk factor for abuse and neglect (Lachs et al., 1998; Dyer et al., 2000a). In the study by Dyer and colleagues (2000a), dementia was noted in 51 percent of neglected or abused patients and only 30 percent of patients referred to geriatric clinic for other reasons.

Depression. Depression is a significant finding in abused or neglected patients (Benton and Marshall, 1991; Aravanis et al., 1993; Lachs and Pillemer, 1995; Dyer et al., 2000a). Dyer and colleagues found an even greater prevalence of depression than dementia in patients referred for mistreatment: 62 percent of neglected or abused patients had depression compared with 12 percent of patients referred for other reasons. Lachs and coworkers found the same clinical phenomenon using data from Connecticut (personal communication, 2001).

Psychosis. Persons with psychotic disorders are likely to neglect themselves and to be unable to care for themselves as a result of their delusions and hallucinations (Lachs and Pillemer, 1995; Dyer and Goins, 2000).

Alcohol Abuse. Alcohol abuse can lead to a failure to fulfill major role obligations, to alcohol use in situations that are physically hazardous, and to social or interpersonal problems (American Psychiatric Association, 1994). This pattern of behaviors puts persons at risk of perpetrating or being the victim of abuse and neglect, especially neglect (Goodyear-Smith, 1989; Fanslow et al., 1998; Marshall et al., 2000). Abuse of substances other than alcohol may have similar consequences.

Medical practitioners consider hygiene, defined as the ability to maintain cleanliness, an important component of good health and disease prevention.

There are no changes in one’s hygiene that occur strictly with age. Occasionally, impaired eyesight may make it more difficult to keep one’s home or clothes clean; however, if cognitive ability remains normal, elders are able to perform the activities of daily living and maintain appropriate hygiene. Demented or psychotic individuals, on the other hand, often lack the ability to care for themselves, and depressed individuals may become less inclined to care for themselves and display poor personal hygiene.