title: The utility of the Kohlman Evaluation of Living Skills test is associated with substantiated cases of elder self-neglect.
abstract: OBJECTIVE
  Self-neglect is the most prevalent finding among cases reported to Adult Protective Services (APS) and is characterized by an inability to meet one's own basic needs. The Kohlman evaluation of living skills (KELS) has been validated in geriatric populations to assess performance with both instrumental and basic activities of daily living and as an assessment tool for the capacity to live independently; therefore, the purpose of this analysis was to compare the scores of the KELS between substantiated cases of self-neglect and matched community-dwelling elders.
  
  
  METHODS
  This is a cross-sectional pilot study of 50 adults aged 65 years and older who were recruited from APS as documented cases of self-neglect and 50 control participants recruited from Harris County Hospital District outpatient clinics. Control participants were matched for age, race, gender, and ZIP code. A geriatric nurse practitioner (NP)-led team administered a comprehensive geriatric assessment in homes of all study participants. The assessment included the KELS and mini-mental state examination (MMSE) tests. Chi-square analyses were used to determine if cases of self-neglect were significantly more likely to fail the KELS test than matched controls.
  
  
  CONCLUSIONS
  The analyses revealed that self-neglectors were significantly more likely to fail the KELS than non-self-neglectors (50% vs. 30%, p = .025). When stratified by MMSE scores, self-neglectors with intact cognitive function remained significantly more likely to fail the KELS compared to matched, cognitively intact controls (45% vs. 17%, p = .013). Abnormal results using an in-home KELS test were significantly associated with substantiated cases of self-neglect.
  
  
  CONCLUSIONS
  There is currently no gold-standard measure for identifying capacity with self-care behaviors among cases of self-neglect. As a result, self-neglect may remain unidentified in many clinical settings. The KELS provides clinicians with an objective measure of an individual's capacity and performance with everyday life-supporting tasks and thus, provides information that can help NPs identify elders at risk for self-neglect. These findings suggest that the KELS test has significant utility as part of a comprehensive geriatric assessment to aid clinicians in suspected cases of self-neglect.
authors.affiliation: Department of Internal Medicine, Division of Geriatrics, Baylor College of Medicine, Quentin Mease Hospital, Houston, Texas 77004, USA. sabrina_pickens@hchd.tmc.edu
authors.forename: Sabrina
authors.initials: S
authors.lastname: Pickens
authors.forename: Aanand D
authors.initials: AD
authors.lastname: Naik
authors.forename: Jason
authors.initials: J
authors.lastname: Burnett
authors.forename: P A
authors.initials: PA
authors.lastname: Kelly
authors.forename: Mary
authors.initials: M
authors.lastname: Gleason
authors.forename: Carmel B
authors.initials: CB
authors.lastname: Dyer
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D005851:Geriatric Nursing; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008487:Medical History Taking; D008609:Mental Status Schedule; D009722:Nurse Practitioners; D009730:Nursing Assessment / Q000379:methods; D015403:Nursing Evaluation Research; D010808:Physical Examination; D010865:Pilot Projects; D018570:Risk Assessment / Q000379:methods; D012648:Self Care; D012720:Severity of Illness Index; D013781:Texas