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Lachs MS, Williams CS, O'Brien S, Pillemer KA, Charlson ME. The Mortality of Elder Mistreatment. JAMA. 1998;280(5):428–432. doi:10.1001/jama.280.5.428
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).
Context Although elder mistreatment is suspected to be life threatening in some
instances, little is known about the survival of elderly persons who have
Objective To estimate the independent contribution of reported elder abuse and
neglect to all-cause mortality in an observational cohort of community-dwelling
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
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.
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