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Lonely deaths / Self-neglecting elderly at risk as they shun contact, support

The Yomiuri ShimbunThis is the fourth installment of a series.

Piles of crushed plastic bottles, shabby cardboard boxes and countless dishes — trash was scattered all over the inside and outside of an old two-story house in a residential and commercial area of Tokyo, and the plants and trees in the yard were so overgrown they reached the neighboring houses.

It was mid-April this year when nearby residents noticed a severe stench coming from this “trash house.” The 71-year-old man living there was found dead, as if he was buried by the trash.

“How could he have lived here?”

After being contacted by the police, the man’s 82-year-old brother visited the trash house, which was their parents’ old home. He entered for the first time in more than 10 years and was shocked to see piles of clothing, electric appliances and open cans of food with rotten contents ... the trash was piled as high as a person’s head. It was about three weeks after the man’s death, which was believed to be the result of an illness.

The man had lived there alone. He had let his hair and beard grow wild, and every night he would gather trash wearing ragged clothes.

According to an 81-year-old woman living across the street, the amount of trash started increasing after the man quit his job more than 10 years ago.

Some of the neighbors worried about him, but the neighborhood association chairwoman, 77, shook her head as she said: “I tried to visit him several times but couldn’t. He seemed to be refusing to interact with anyone.”

The man was also witnessed shouting rudely at a ward representative who visited his home, telling him, “Get lost!”

According to his older brother, who lives about a 10-minute drive away, the man was the youngest of six children and started working as a technician at an electrical equipment company after graduating from university. He was good at studying and had a lot of qualifications. His older brother even hired him to tutor his own son.

But after his mother, with whom he lived, passed away about 30 years ago, he started getting into arguments with his siblings about inheritance and borrowing or lending things.

From his brother’s point of view, the man began disturbing people around him and noticeably saying or doing things that inconvenienced others.

“I didn’t want to be involved with him anymore, and we became alienated,” his brother said. No one including this brother was even aware of the rough situation of the man and their parents’ home.

People who live in such “trash houses” have often fallen into a state of self-neglect, meaning they have lost the will or ability to maintain a normal lifestyle due to a mental disorder or deteriorated cognitive function.

Self-neglect can also be brought about by life struggles, or the loss of or separation from a loved one. People suffering like this have the tendency to:

■ Leave trash scattered in and around their houses and neglect home repairs.

■ Wear extremely dirty clothing.

■ Refuse caregiving and other support.

According to 2011 national statistics, from 9,000 to 12,000 elderly people alone are estimated to suffer from self-neglect.

Many of these people risk dying alone because they refuse to interact with others and become isolated from their relatives, like the man described in this article. The NLI Research Institute, based in Tokyo, released a government-commissioned study in 2011 that found about 80 percent of unattended deaths involved people living in a state of self-neglect.

According to Toho University Prof. Emiko Kishi, an expert on public health nursing, leaving a self-neglecting person alone will not improve the problem, and may even endanger their life.

“Relatives and neighbors should recognize that these people need help, and contact administrative or other authorities,” Kishi said. “Administrative representatives should not reprimand self-neglecting people, but be prepared to carefully listen to their troubles.”

“Many of these people can’t trust others because they have had trouble in human relationships, and it’s not easy even for a specialist to ease their concern,” she added.

In the case of the man in the trash house, a ward public health nurse started visiting him about 1½ years before he died, but the man refused caregiving services and all other support until the very end.

A ward representative said, “There was a time when we thought we were just one step away from starting to turn things around, but we never got there.”

After the man died, his older brother took loads of trash away in a truck to his home and factory almost every week. It took five months before he was finished.

“I honestly don’t know what I should have done,” he said.

The older brother said he now feels a mixture of resentment for being inconvenienced again, and a desire to know what his brother was thinking and feeling in his closed-off heart.Speech

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