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Mark S. Lachs, MD, MPH; Christianna S. Williams, MA; Shelley O'Brien, MS; Karl A. Pillemer, PhD; Mary E. Charlson, MD

JAMA. 1998;280:428-432.

Context  Although elder mistreatment is suspected to be life threatening in some instances, little is known about the survival of elderly persons who have been mistreated.

Objective  To estimate the independent contribution of reported elder abuse and neglect to all-cause mortality in an observational cohort of community-dwelling older adults.

Design  Prospective cohort study with at least 9 years of follow-up.

Setting and Patients  The New Haven Established Population for Epidemiologic Studies in the Elderly cohort, which included 2812 community-dwelling adults who were older than 65 years in 1982, a subset of whom were referred to protective services for the elderly.

Main Outcome Measures  All-cause mortality among (1) elderly persons for whom protective services were used for corroborated elder mistreatment (elder abuse, neglect, and/or exploitation), or (2) elderly persons for whom protective services were used for self-neglect.

Results  In the first 9 years after cohort inception, 176 cohort members were seen by elderly protective services for verified allegations; 10 (5.7%) of these were for abuse, 30 (17.0%) for neglect, 8 (4.5%) for exploitation, and 128 (72.7%) for self-neglect. At the end of a 13-year follow-up period from cohort inception, cohort members seen for elder mistreatment at any time during the follow-up had poorer survival (9%) than either those seen for self-neglect (17%) or other noninvestigated cohort members (40%) (P<.001). In a pooled logistic regression that adjusted for demographic characteristics, chronic diseases, functional status, social networks, cognitive status, and depressive symptomatology, the risk of death remained elevated for cohort members experiencing either elder mistreatment (odds ratio, 3.1; 95% confidence interval, 1.4-6.7) or self-neglect (odds ratio, 1.7; 95% confidence interval, 1.2-2.5), when compared with other members of the cohort.

Conclusions  Reported and corroborated elder mistreatment and self-neglect are associated with shorter survival after adjusting for other factors associated with increased mortality in older adults.

From the Divisions of Geriatrics and Gerontology (Dr Lachs) and General Internal Medicine (Dr Charlson), Cornell University Medical College, New York, NY; the Departments of Medicine and Epidemiology, Yale University School of Medicine, New Haven, Conn (Ms Williams); the Connecticut Department of Social Services, Hartford (Ms O'Brien); and the Cornell College of Human Ecology, Ithaca, NY (Dr Pillemer).

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