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Elder Self-neglect and Abuse and Mortality Risk in a Community-Dwelling Population
XinQi Dong, MD;
Melissa Simon, MD, MPH;
Carlos Mendes de Leon, PhD;
Terry Fulmer, PhD, RN;
Todd Beck, MS;
Liesi Hebert, ScD;
Carmel Dyer, MD;
Gregory Paveza, PhD, MSW;
Denis Evans, MD
JAMA. 2009;302(5):517-526.
Context 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.
Design, Setting, and Participants 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  65 years). A subset of these participants had suspected elder self-neglect or abuse reported to social services agencies.
Main Outcome Measures 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.
Conclusion Both elder self-neglect and abuse reported to social services agencies were associated with increased risk of mortality.
Author Affiliations: Rush University Medical Center, Chicago, Illinois (Drs Dong, Mendes de Leon, Hebert, and Evans and Mr Beck); Northwestern University Medical Center, Chicago, Illinois (Dr Simon); College of Nursing, New York University, New York, New York (Dr Fulmer); Department of Medicine, University of Texas, Houston (Dr Dyer); and School of Health and Human Services, Southern Connecticut State University, New Haven (Dr Paveza).
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