Cognitive Profiles of Elder Adult Protective Services Clients Living in Squalor

The purpose of this study was to determine whether squalor-dwelling Adult Protective Services (APS) clients were more cognitively impaired than non–squalor-dwelling APS clients referred for decision-making capacity assessments. The authors performed a retrospective medical record review of neuropsychological and demographic data gathered during decisional capacity assessments. Squalor dwelling was defined by unsanitary living conditions that posed a danger to the occupant’s health or safety. Mean neuropsychological test scores were compared between squalor-dwelling (n = 50) and non–squalor-dwelling (n = 180) subjects. Squalor-dwelling clients were significantly younger than non–squalor-dwelling clients. There were no distribution differences among gender, education, race, or rural-dwelling status. Although both groups performed poorly on each neuropsychological measure, squalor dwellers demonstrated better memory and general cognitive performance. Cognition, depression, gender, race, education, dementia diagnosis, and rural-dwelling status seem insufficient to explain squalor-dwelling behaviors. Other biological and psychosocial variables should be considered.