title: Older adults. An 11-year longitudinal study of adult protective service use.
abstract: BACKGROUND
  Little is known about the epidemiology of adult protective services agency (APS) utilization, the state entities charged with assessment and advocacy for disenfranchised older adults.
  
  
  OBJECTIVE
  To determine the prevalence of utilization by older adults and risk factors for APS.
  
  
  METHODS
  A longitudinal study using the New Haven Established Population for Epidemiologic Studies in the Elderly population, a cohort of 2812 community-dwelling adults who were older than 65 years in 1982. The main outcome measure was referral to the state ombudsman on aging for protective services.
  
  
  RESULTS
  Over the 11-year follow-up period, 209 cohort members (7.4%) were referred to the ombudsman 302 times as protective service cases for a community prevalence of 6.4% after adjusting for the sampling strategy of the cohort. Self-neglect was the most common indication for referral (73% of the cases). While in bivariate analyses a variety of baseline sociodemographic features, functional impairments, medical conditions, and social network factors were associated with APS use, in multivariable analysis only sociodemographic variables remained independent risk factors including low income (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.8 to 3.9), nonwhite race (OR, 2.2; 95% CI, 1.3 to 3.7), and age older than 75 years at cohort inception (OR, 1.9; 95% CI, 1.1 to 3.0).
  
  
  CONCLUSIONS
  Prevalence of APS use by older adults is substantial, and sociodemographic features were the most compelling risk factors in our cohort. As the population ages, the number of older adults at risk for abuse, neglect, self-neglect, exploitation, and abandonment will increase; physicians will need to become familiar with APS referral pathways and mandatory reporting laws in their states.
authors.affiliation: Department of Medicine, Cornell University School of Medicine, New York NY, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Lachs
authors.forename: C
authors.initials: C
authors.lastname: Williams
authors.forename: S
authors.initials: S
authors.lastname: O'Brien
authors.forename: L
authors.initials: L
authors.lastname: Hurst
authors.forename: R
authors.initials: R
authors.lastname: Horwitz
mesh_terms: D000368:Aged; D003237:Connecticut; D004552:Elder Abuse / Q000517:prevention & control*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010344:Patient Advocacy; D012017:Referral and Consultation; D012307:Risk Factors; D012947:Social Work / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014481:United States