title: Association between elder self-neglect and hospice utilization in a community population.
abstract: Elder self-neglect is associated with substantial 1-year mortality. However, hospice utilization among those with self-neglect remain unclear. The objective of this study is to quantify the prospective relation between self-neglect and risk for hospice utilization in a community population of older adults. Prospective population-based study in a geographically defined community in Chicago of older adults who participated in the Chicago Health and Aging Project. Of the 8669 participants in the Chicago Health and Aging Project, a subset of 1438 participants was reported to social services agency for suspected elder self-neglect. Outcome of interest was the hospice utilization obtained from the Center for Medicare and Medicaid System. Cox proportional hazard models were used to assess independent association of self-neglect with risk of hospice utilization using time-varying covariate analyses. After adjusting for potential confounding factors, elders who self-neglect was associated with increased risk for hospice utilization (HR, 2.43, 95% CI, 2.10-2.81). Greater self-neglect severity (mild: (HR, 2.12 (1.61-2.79); moderate: (HR, 2.36 (1.95-2.84); severe: (HR, 4.66 (2.98-7.30)) were associated with increased risk for hospice utilization. Interaction term analyses suggest that the significant relationship between self-neglect and hospice utilization was not mediated through medical conditions, cognitive impairment and physical disability. Moreover, self-neglect was associated with shorter length of stay in hospice (PE, -0.27, SE, 0.12, p<0.02) and shorter time from hospice admission to death (PE, -0.32, SE, 0.13, p<0.01). Elder self-neglect was associated with increased risk of hospice use in this community population. Elder self-neglect is associated with shorter length of stay in hospice care and shorter time from hospice admission to death.
authors: Rush Institute for Healthy Aging, Medicine, Nursing, and Behavioral Sciences, Rush University Medical Center, Chicago, IL 60612, United States. xinqi_dong@rush.edu
authors: XinQi
authors: X
authors: Dong
authors: Melissa A
authors: MA
authors: Simon
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000368:Aged / Q000523:psychology*; D002641:Chicago / Q000453:epidemiology; D003072:Cognition Disorders / Q000523:psychology; D004522:Educational Status; D005260:Female; D017051:Hospice Care / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income; D008297:Male; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011584:Psychology; D012307:Risk Factors