Elder self-neglect and abuse and mortality risk in a community-dwelling population.
BACKGROUND
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.


METHODS
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.


METHODS
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.


CONCLUSIONS
Both elder self-neglect and abuse reported to social services agencies were associated with increased risk of mortality.
Dong
XinQi
X
Rush University Medical Center, Chicago, Illinois, USA. xinqidong@gmail.com
Simon
Melissa
M
Mendes de Leon
Carlos
C
Fulmer
Terry
T
Beck
Todd
T
Hebert
Liesi
L
Dyer
Carmel
C
Paveza
Gregory
G
Evans
Denis
D
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002641:Chicago; D003071:Cognition; D004552:Elder Abuse / Q000401:mortality* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D019221:Mandatory Reporting; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D014505:Urban Population