Assessing dimensions of executive function in community-dwelling older adults with self-neglect

Abstract

Purpose: Self-neglect (SN) is the inability to maintain self-care needs. It is thought that older adults who have impaired executive function (EF) develop the inability to self-care and to protect themselves. The specific aims were to determine the feasibility of using multiple EF measures and assess the different dimensions of EF with community-dwelling elders with SN.

Methods: In this cross-sectional study, 50 adults aged 65 and older were recruited from Adult Protective Services with confirmed SN. A research nurse administered the following measures: Delis-Kaplan Card Sort Test (D-KEFS), Executive Interview (EXIT 25), CLOX Drawing Test (CLOX I, II), Trails Making Test A and B (TMT A & B) and the Mini-Mental State Examination (MMSE). Descriptive analyses and Pearson correlation coefficients were conducted on the different variables used in this study.

Results: Older adults with SN were more likely to fail the CLOX1 and D-KEFS, while passing the other cognitive measures. The low D-KEFS scores indicate difficulties in generating new concepts, inhibiting previous conceptual thoughts, or initiating novel ideas.

Conclusions: Results from this study provide support that individuals with SN will complete a battery of EF tests and that they exhibit the following impairments consistent with executive dysfunction: “concept generation”, “planning, inhibition”, and “spatial working memory”. Utilizing only one EF measure in individuals with intact cognition may result in unidentification of individuals with executive dysfunction, thus delaying necessary treatment.  Future studies should attempt to determine different etiologies of executive dysfunction and determine if early treatment can prevent or reverse SN.