Reported Elder Self-Neglect and Abuse Associated
With Increased Risk of Death
Confirmed elder abuse was associated with about a
two times higher risk of death
Aug. 4, 2009 A study of elderly people, who have
been reported to a social service agency for self-neglect or abuse,
finds these senior citizens had an increased risk of death, according to
a study in the August 5 issue of the Journal of the American Medical
Association (JAMA), a theme issue on violence and human rights.
Elder self-neglect and abuse are serious, common
and under-recognized public health issues in the U.S., and a 2000 survey
from social service agencies suggests that these cases are increasing.
But the association of either elder self-neglect or abuse with an
increased risk of death had not been studied before.
Jan. 9, 2006 A professional study in 2002 found that "animal-assisted
therapy can effectively reduce the loneliness of residents in long-term
care facilities.
The risk of death associated with reported elder
self-neglect or abuse in a large and socio-demographically diverse group
and across different levels of cognitive and physical function, were
investigated by XinQi Dong, M.D., of Rush University Medical Center,
Chicago, and colleagues.
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).
Editorial:Elder Self-neglect - Medical
Emergency or Marker of Extreme Vulnerability?
Thomas M. Gill, M.D., of Yale University
School of Medicine, New Haven, Conn., writes in an accompanying
editorial that elder self-neglect poses significant challenges
to the health care system and social service agencies.
"The number of cases of reported
self-neglect has been increasing and will likely continue to
increase with the graying of the baby boom generation," Dr. Gill
writes.
"Assuming that the mortality related to
elder self-neglect and abuse is causal, it could be interpreted
as a failure of society and the health care system to adequately
protect the most vulnerable older adults. To better address the
complex needs of this burgeoning population, a stronger work
force well prepared to care for older adults will be needed, as
highlighted in a recent Institute of Medicine report.
While awaiting evidence-based answers to
the myriad unanswered questions regarding the epidemiology and
management of elder self-neglect and abuse, health care
professionals caring for older adults should act to renew the
social contract with older individuals in the United States by
supporting and expanding model programs for these potentially
devastating disorders."
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
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Aug. 4, 2009 A study of elderly people, who have
been reported to a social service agency for self-neglect or abuse,
finds these senior citizens had an increased risk of death, according to
a study in the August 5 issue of the Journal of the American Medical
Association (JAMA), a theme issue on violence and human rights.