title: Violent crime victimization increases the risk of nursing home placement in older adults.
abstract: OBJECTIVE
  We estimate the independent contribution of crime victimization to nursing home placement in a cohort of older adults who were community dwelling at baseline.
  
  
  METHODS
  The data come from an observational cohort study of 2,321 community-residing older adults who were members of the New Haven Established Populations for Epidemiological Studies in the Elderly cohort in 1985. Participants had annual evaluations using standardized instruments. We defined the major outcome, custodial nursing home placement, as a stay of at least 30 days; mean length of nursing home stay was 413 days. We determined crime victimization by matching police records in the same catchment area as the cohort for the period 1985-1995. We determined nursing home placement through linkage to the Connecticut Long Term Care Registry. We used growth curve modeling to estimate the risk of placement in victimized and nonvictimized participants, and we used multivariable models to adjust for other factors known to predict nursing home placement.
  
  
  RESULTS
  There were 482 members of the cohort (21%) who experienced victimization over the 10-year follow-up; 747 (32%) experienced nursing home placement. Most victimization episodes were nonviolent and noninjurious. However, violent victimization conferred an independent increased risk of nursing home placement (odds ratio = 2.1; 95% confidence interval = 1.0-4.6) that exceeded the increased risk associated with other variables traditionally thought to be predictive of placement (such as functional and cognitive impairment, and social network size).
  
  
  CONCLUSIONS
  Violent crime victimization increases the risk of nursing home placement. Future research should be directed at determining the mechanism of this increased risk and developing interventions directed at victimized older adults that might avert nursing home placement in this uniquely vulnerable population.
authors.affiliation: Division of Geriatric Medicine and Gerontology, The Weill Medical College of Cornell University, 1300 York Avenue, Box 39, New York, NY 10021, USA. mslachs@mail.med.cornell.edu
authors.forename: Mark
authors.initials: M
authors.lastname: Lachs
authors.forename: Ronet
authors.initials: R
authors.lastname: Bachman
authors.forename: Christianna S
authors.initials: CS
authors.lastname: Williams
authors.forename: Alice
authors.initials: A
authors.lastname: Kossack
authors.forename: Carolyn
authors.initials: C
authors.lastname: Bove
authors.forename: John R
authors.initials: JR
authors.lastname: O'Leary
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003237:Connecticut / Q000453:epidemiology; D019548:Crime Victims; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D010343:Patient Admission; D012306:Risk; D014754:Violence