Growing numbers of elderly people are suffering from self-neglect, which can leave them living in vermin-infested homes while they fail to eat properly.
Their plight can put them at risk and in danger if they are hoarding animals, or perhaps objects that could cause a fire, a meeting hosted by Sage Advo- cacy revealed.
Dr Mary Rose Day, co-author of the r[port Self-Neglect In Older Adults, said an ageing population, rising levels of dementia and functional decline are key factors triggering the rise.
In extreme cases, the person can live in squalor with no running water or electricity, and a growing feature is the hoarding of pets.
The problem has been raised in the wake of the recent discovery of a number of older people who had been dead for some time in their homes before being found.
The High Court heard earlier this month about a woman who suffered "extreme self- neglect" and lived in a "squalid" home. Carers refused work there because of its condition.
There were 483 cases of self-neglect recorded by the HSE last year, but it is claimed they only make up extreme cases and the true prevalence of the "hidden illness" is much higher.
"It happens behind closed doors. It's the iceberg effect - only when someone maybe has a fall do we see how they have been living," said Dr Day, a former public health nurse.
"They might have been attending hospital appointments but their home environment was unknown."
In some cases they may have broken relationships with relatives and can be suffering depression or addiction.
One of the features can be someone who has several health problems and is not coping with a decline in physical function.
"It is one of the most chall- enging issues a health profess- ional can encounter," Dr Day added.
"People have a right to their own self-determination and to make their own choices."
The difficulty for the nurse or doctor is to try to balance safeguarding with the person's own autonomy.