![]() K, a 70-year-old Asian woman, was visited by a concerned neighbor, who found her living in filth with hoards of plastic bags on almost every surface of the sitting room. All efforts to initiate psychiatric assistance in terms of medication and self-care skills were rejected, and Adult Protective Services (APS) was notified. The patient’s home was condemned, and arrangements were made for him to share a subsidized apartment with a sibling. He was hostile and resentful throughout his stay, refusing to talk to anyone. He was also admitted to the internal medicine service to conduct a thorough medical assessment including coronary artery disease workup. J was brought to the ED and was admitted to the psychiatric unit of the hospital for an inability to care for himself. Later it was discovered that the house had neither electricity nor a working toilet. A box containing the remains of the patient’s dead dog was also found. All of the windows were boarded up and the doors were nailed closed, and, upon forced entry, the officer found that every square inch of the living space was filled with newspapers, piles of refuse, bottles filled with urine, and traces of decomposing food. A police officer came to his home after concerned neighbors reported no activity in his house for several days. J was a 92-year-old white man, who was a retired construction worker with no known psychiatric history. Arrangements were made for a day program, a daily home health aide, and a weekly cleaning service, and an appointment was made for the patient to see a primary care physician. Superficial cooperation was obtained with the promise of accelerated discharge. W blamed the entire state of New Jersey and its “flawed system” for what she called her “life’s disruption.” She remained isolated and suspicious of the staff’s motives when they approached her. She refused to provide collateral information, stating that it would make her position more vulnerable for further exploitation. She was admitted involuntarily to the psychiatric unit of the hospital due to an inability to care for herself. Upon evaluation in the emergency department (ED), the patient was hostile, insisting that she be left alone. The patient was found in the living room, attired in a winter coat in the middle of August with her hair matted and her skin ingrained with dirt. Officers discovered a filthy living space, cramped with all kinds of refuse, including decomposing food and excrement. She was brought to the attention of the police when her neighbors reported an offensive odor emanating from her home. W was a 78-year-old white woman, who was a retired office clerk with no previous psychiatric history until after the death of her husband 7 years earlier. By increasing awareness of DS, it is the objective of this article to improve the outcome for this at-risk population. This article examines various possible etiologies of DS, including the complex interaction of environmental and psychopathological factors, and reviews treatment options, including behavioral, social, and pharmacological interventions. These case presentations call attention to this seemingly forgotten population of individuals who are deemed not only risks to themselves, primarily due to chronic untreated medical conditions or acute incidents such as falls, but also to the public, because of the hazards that the hoarding and unsanitary living conditions present. In this article, we will engage in a critical discussion of DS based on three actual case examples. ![]() DS is characterized by an extreme self-neglect of environment, health, and hygiene, combined with a compulsive hoarding of refuse and the patient’s complete denial of his or her surroundings or symptoms. ![]() Senile squalor syndrome, otherwise known as Diogenes syndrome (DS), is a complex spectrum of behaviors found in persons who are living reclusively, and is becoming a growing concern as the elderly population increases. However, is it not a prerequisite to have sound judgment in order to make a lifestyle choice? Some may argue that these conditions are a personal choice and are at the heart of being a free and independent adult. Additionally, many older persons do not have adequate social networks and are apathetic about their living conditions. Unfortunately, over the most recent decades, an increasing number of elderly individuals in the United States have been found to be living in squalor without access to medical assistance. In this regard, additional strides have been made to ensure that our nation’s elderly population not only receive the healthcare that they need, but are reserved the right to live their lives independently with dignity. 1 As older persons are living longer, expectations about their health and quality of life are increasing. Medical advances and public health strategies have led to a 30-year increase in life expectancy since the dawn of the 20th century. ![]()
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