Older adults subjected to abuse or self-neglect at greater risk of mortality

August 04, 2009

Older adults who are subjected to abuse or self-neglect face a greater risk of premature death than other seniors, according to a study published in the August 5 issue of JAMA.

Moreover, contrary to widely held views that elders who are physically or cognitively impaired are more likely to suffer adverse consequences from abuse or self-neglect, the researchers found that even more capable seniors also faced a higher risk of dying.

Elder abuse and self-neglect are serious, common and under-recognized public health issues, according to Dr. XinQi Dong, a researcher and geriatrician at Rush University Medical Center and the study's lead author. There are an estimated 2 million cases of elder abuse and self-neglect in the United States each year.

"Our findings demonstrate the dire health consequences for these vulnerable older adults," Dong said. "Health care professionals and others who serve the elderly need to identify and report suspected cases of abuse or self-neglect early and act quickly to ameliorate the problems."

The researchers examined records for 9,318 individuals 65 years of age and older who were enrolled between 1993 and 2005 in the Chicago Health and Aging Project, a longitudinal epidemiological study of a community-dwelling population. In-person interviews were conducted to assess the participants' health history, physical function, cognitive function, health behaviors and psychosocial factors.

Of the 9,318 participants, 1,657 came to the attention of social agencies because of reports of abuse or self-neglect. Abuse refers to psychological/emotional abuse, physical abuse, sexual abuse, caregiver neglect or financial exploitation. Self-neglect refers to behaviors that threaten the person's own health and safety.

The study found that elder abuse was associated with a more than two-fold increased risk of premature death from all causes and an almost 4-fold increased risk of premature death from heart disease specifically. Self-neglect was associated with an even greater risk of premature death, particularly during the first year after self-neglecting behavior was identified. During that year, the risk of premature death from all causes was five times as likely as for elders who did not neglect themselves, and the risk of premature death from heart disease specifically was eight times more likely.

The researchers considered alternative explanations for the increased risk of dying prematurely -- including differences in sociodemographic characteristics, medical conditions, health habits, cognitive function, physical function, depression and social networks -- but none of these factors significantly altered the findings.

The study also found that increased mortality was significant for older adults subjected to abuse or self-neglect no matter what their level of physical or cognitive function, except for one group: abused elders with the highest level of functioning. The researchers speculated that these individuals perhaps had more insights into the dangers of the abusive behaviors, were more likely to seek help, or had the ability to modify the relationship with the perpetrator, and so were able to escape the threats to their safety and well-being.

According to Dong, the field of elder abuse is estimated to have lagged more than 20 years behind that of child abuse or intimate partner violence.

"With the rapidly growing aged population in this country, problems of elder abuse will likely become even more pervasive, affecting our family, friends and loved ones," Dong said. "We hope our study will stimulate more discussion about these problems and help advocate for additional research and resources, as well as national policy initiatives, to improve the health and well-being of this vulnerable population."
Other researchers involved in the study were Dr. Denis Evans, Liesi Hebert, ScD, Carlos Mendes de Leon, PhD, and Todd Beck, MS, all at Rush University Medical Center; Dr. Melissa Simon, at Northwestern University Medical Center; Terry Fulmer, PhD, at the College of Nursing, New York University; Dr. Carmel Dyer, at the University of Texas, Houston; and Gregory Paveza, PhD, at Southern Connecticut State University.

The study was funded by the Paul B. Beeson Research in Aging Program, the National Institute on Aging, the American Federation for Aging Research, the Starr Foundation, the John A. Hartford Foundation and the Atlantic Philanthropies.Rush University Medical Center includes a 674-bed (staffed) hospital; the Johnston R. Bowman Health Center; and Rush University (Rush Medical College, College of Nursing, College of Health Sciences and the Graduate College).

Rush University Medical Center

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