Elder self-neglect and abuse associated with
increased risk of death
Elderly individuals who have a report of
self-neglect or abuse submitted to a social
service agency have an associated increased
risk of death, according to a study in the
August 5 issue of JAMA, a theme issue
on violence and human rights.
Elder self-neglect and
abuse are serious, common and
underrecognized public health issues in the
U.S., and a 2000 survey from social service
agencies suggests that these cases are
increasing, according to background
information in the article.
But the association of
either elder self-neglect or abuse with an
increased risk of death has been unclear.
XinQi Dong, M.D., of
Rush University Medical Center, Chicago, and
colleagues investigated the risk of death
associated with reported elder self-neglect
or abuse in a large and sociodemographically
diverse group and across different levels of
cognitive and physical function.
The study included
residents living in three adjacent
neighborhoods in Chicago who were
participating in the Chicago Healthy and
Aging Project (CHAP; a population-based,
epidemiological study of residents age 65
years or older).
A subset of these
participants had suspected elder
self-neglect or abuse reported to social
services agencies.
The 9,318 CHAP
participants had an average age of 73 years.
About 40 percent were men, 63 percent were
black, and the average education was 12.2
years.
The 1,544 cases reported
as elder self-neglect and the 113 cases
reported as elder abuse tended to be older,
female, black, and have a lower income and
education. There were 4,306 deaths (46
percent) during the 14 years of follow-up.
In the fully adjusted
analysis, reported self-neglect was
associated with a significantly increased
risk of death within 1 year.
The mortality risk for
reported and confirmed cases after 1 year
was lower, but remained increased (nearly
twice the risk).
White participants and
men had a higher risk of death relative to
others.
"This mortality risk is
especially alarming during the first year
after the report of elder self-neglect.
"These findings may have
direct implications for health care
professionals and social services agencies
to promote early identification of elder
self-neglect and prompt interventions after
the discovery of self-neglect," the authors
write.
Analysis also indicated
that reported elder abuse was significantly
associated with increased risk of overall
mortality (about 40 percent).
Confirmed elder abuse
was associated with about a two times higher
risk of death.
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.
"… this study is the
first, to our knowledge, to demonstrate
increased mortality risk for reported and
confirmed elder self-neglect across
different levels of cognitive and physical
function, challenging a belief that
self-neglect and the potential for adverse
health outcomes are confined to those with
the most impaired cognitive and physical
function.
"Rather, our findings
suggest that even among those individuals
with milder levels of cognitive and physical
functional impairment, elder self-neglect is
associated with substantially increased risk
of death."
"These results may be
useful not only in informing future research
efforts into elder self-neglect and abuse,
but also to inform relevant clinical,
social, and policy guidelines developed to
treat and prevent elder self-neglect and
abuse on a national level," the researchers
conclude.
