Self-neglect among older people is on the rise, an expert has warned.
Poor personal hygiene, malnourishment and vermin-infested living conditions are among the signs of self-neglect.
Dr Mary Rose Day, a leading expert in self-neglect, older adults and public health nursing, said more cases of self-neglect would arise because of the ageing population.
She has called for a multi-agency approach to what was a very complex and challenging area.
Dr Day said some people chose to live in appalling circumstances but if they had full mental capacity and refused any help then health professionals were very limited in what they could do.
“People have a right to self-determination and if they refuse to be assessed by health professionals it can be quite challenging," she said.
"Health professionals just can't go into a person's home when they have no right of entry.”
Dr Day, who lectured at the School of Nursing and Midwifery, University College Cork, until 2015, led a Sage Advocacy workshop on self-neglect in Dublin.
There were 493 cases of self-neglect recorded in Ireland last year by the HSE but those figures only account for 'exceptional' cases.
Like elder abuse, such cases are largely hidden, but data in the United States suggests that up to one-in-ten people over the age of 65 are self-neglecting.
Dr Day believes that in Ireland the rate of self-neglect could be around 144 per 100,000.
“These people are usually living alone and have very poor social networks; they may have several physical issues and may not be able to cope.”
Unfortunately, cases of self-neglect often only come to light when an individual has a fall or condition that brings them into contact with health services.
Dr Day said self-neglect was included in the HSE's Safeguarding Vulnerable Adults Policy that was published in 2014.
There is a new policy currently in a draft format that defined those at risk of self-neglect.
“Life involves risks and we can't protect everyone. Sometime things will go wrong but it is very important that we have documented that we have done our best at each stage of the process.
"We can't just walk away and say this is a lifestyle choice.”
Dr Day is the co-author of the textbook Self-Neglect in Older Adults: A Global, Evidence-Based Resource for Nurses and Other Healthcare Providers.