Sauvageau and Hunter modified the Self-Neglect Scale of the Consortium for Research in Elder Self-Neglect of Texas (CREST). This version is simplified for use by medical examiners during death investigation. The authors are from the Office of the Chief Medical Examiner in Edemonton and Genessee County Medical Examiner in Flint. Michigan.


(1) hygiene

(2) cognitive, health and safety issues

(3) environment


External examination of the body and personal hygiene (from 0 to 4 or NA):

(1) hair

(2) nails

(3) skin

(4) clothing

(5) insect infestation

(6) untreated medical condition

(7) body weight (0 if not underweight; 4 if underweight)


Assessment of cognitive, health and safety issues (either 0, 4 or NA)

(1) evidence of a delusional state

(2) able to respond to an emergency

(3) usual source of care

(4) time since last medical visit


Environment, external (from 0 to 4 or NA)

(1) condition of yard

(2) condition of roof

(3) condition ofwindows

(4) condition of walls


Environment, interior (from 0 to 4)

(5) interior odors

(6) kitchen cleanliness

(7) bathroom cleanliness

(8) living room cleanliness

(9) clutter kitchen

(10) clutter bathroom

(11) clutter bedroom

(12) clutter living room

(13) structure of kitchen

(14) structure of bathroom

(15) structure of bedroom

(16) structure of living room

(17) condition of pets

(18) utilities


score for each domain =

= SUM(points for items in domain)



• minimal score: 0

• maximal scorefor hygiene: 28

• maximal scorefor cognitive, health and safety issues: 16

• maximal scorefor environment: 72

• The higher the score the greater the problem of self-neglect.

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