Publication:

Decoding self-neglect in an elderly woman with chronic foot ulcer using COM-B model

Self-neglect among the elderly is an increasingly recognised yet under-addressed issue in global health. Defined as the inability to meet one’s basic needs for health and well-being, self-neglect is often driven by psychological, social, and cultural factors. This study presents the case of Mrs. P, a 60-year-old woman from rural South India, with a nine-year history of a progressively worsening large ulcer over the lateral malleolus of her right leg. Despite multiple opportunities for medical intervention, she repeatedly refused surgery, influenced by deep-rooted magico-religious beliefs, caregiving responsibilities for her daughters with schizophrenia, and fear of disrupting familial duties. This case highlights the complex interaction of these factors in an elderly woman with a chronic, non-healing ulcer. The COM-B (Capability, opportunity, motivation-behaviour) model was used to analyse the barriers behind her prolonged self-neglect and refusal of surgical care. This case shows how reduced psychological capability (lack of knowledge), limited physical and social opportunities (absence of alternative caregiving support), and poor motivation (belief in supernatural causes rather than medical solutions) collectively sustained her self-neglect. Chronic self-neglect in elderly patients is often maintained by complex biopsychosocial factors. The COM-B model provides a useful framework for systematically identifying and addressing these barriers. Interventions should go beyond medical advice, incorporating family involvement, cultural understanding, and psychological support to empower elderly individuals towards health-promoting behaviours.