Citation

Dong X, Simon M, Mendes de Leon C, Fulmer T, Beck T, Hebert L, Dyer C, Paveza G, Evans D. J. Am. Med. Assoc. JAMA 2009; 302(5): 517-526.

Affiliation

Rush University Medical Center, Chicago, Illinois, USA. xinqidong@gmail.com

Copyright

(Copyright © 2009, American Medical Association)

DOI

10.1001/jama.2009.1109

PMID

19654386

PMCID

PMC2965589

Abstract

CONTEXT: Both elder self-neglect and abuse have become increasingly prominent public health issues. The association of either elder self-neglect or abuse with mortality remains unclear. OBJECTIVE: To examine the relationship of elder self-neglect or abuse reported to social services agencies with all-cause mortality among a community-dwelling elderly population. DESIGN, SETTING, AND PARTICIPANTS: Prospective, population-based cohort study (conducted from 1993 to 2005) of residents living in a geographically defined community of 3 adjacent neighborhoods in Chicago, Illinois, who were participating in the Chicago Health and Aging Project (CHAP; a longitudinal, population-based, epidemiological study of residents aged > or = 65 years). A subset of these participants had suspected elder self-neglect or abuse reported to social services agencies. MAIN OUTCOME MEASURES: Mortality ascertained during follow-up and by use of the National Death Index. Cox proportional hazard models were used to assess independent associations of self-neglect or elder abuse reporting with the risk of all-cause mortality using time-varying covariate analyses. RESULTS: Of 9318 CHAP participants, 1544 participants were reported for elder self-neglect and 113 participants were reported for elder abuse from 1993 to 2005. All CHAP participants were followed up for a median of 6.9 years (interquartile range, 7.4 years), during which 4306 deaths occurred. In multivariable analyses, reported elder self-neglect was associated with a significantly increased risk of 1-year mortality (hazard ratio [HR], 5.82; 95% confidence interval [CI], 5.20-6.51). Mortality risk was lower but still elevated after 1 year (HR, 1.88; 95% CI, 1.67-2.14). Reported elder abuse also was associated with significantly increased risk of overall mortality (HR, 1.39; 95% CI, 1.07-1.84). Confirmed elder self-neglect or abuse also was associated with mortality. Increased mortality risks associated with either elder self-neglect or abuse were not restricted to those with the lowest levels of cognitive or physical function. CONCLUSION: Both elder self-neglect and abuse reported to social services agencies were associated with increased risk of mortality.

Language: en