Abuse associated with increased risk of death for older people
Mistreatment and neglect of older people are associated with a significant increase in their chances of dying, according to a groundbreaking study by researchers at Cornell University and colleagues at Yale University. The study, which traced the survival of a group of older adults, found that only 9 percent of those with a reported incident of mistreatment and 17 percent of those suffering from self-neglect survived during a 13-year follow-up period. Their experience compared with a more typical survival of 40 percent among older people in the study with no known history of mistreatment or self-neglect.
The study, described in the August 5, 1998, issue of the Journal of the American Medical Association (JAMA), is the first to compare mortality of people who have been mistreated to that of their non-victimized counterparts. It is initial confirmation, investigator Mark S. Lachs, M.D., M.P.H., of Cornell's medical college, and colleagues say, of what they have long suspected -- that elder abuse and mistreatment may be an insidious threat to life. There were no direct, injury-related deaths in the group that was mistreated, Lachs found. Instead, the research suggests a more general association with increased risk of death. Even when adjustments were made to account for chronic diseases, social factors, and other conditions associated with increased death rates among the elderly, mistreated older people were three times more likely to die than older people who were not mistreated.
Scientists at the National Institute on Aging (NIA), which funded the research, said the findings are an important step in understanding and preventing abuse of older people. Sidney M. Stahl, Ph.D., of NIA's Behavioral and Social Research Program and project officer for the research, called the study findings "startling." He noted, "The fact that nearly one-tenth of the older people in a large study population had been referred to adult protective services is certainly cause for concern." In addition, Stahl said, the increased level of mortality among the mistreated elderly was greater than expected.
"We need to know more about elder abuse," Stahl said. In the future, NIA will be interested in examining: the prevalence of abuse among older people; risk factors leading to abuse and neglect, such as family dynamics; and the consequences of abuse and neglect in addition to death, such as those affecting general health status and family interactions.
The research linked data on 2,812 people age 65 and older participating in the Yale University, New Haven, Conn., Established Populations for Epidemiologic Studies of the Elderly (EPESE) with records from the Connecticut adult protective services agency. The average age of the participants at the beginning of the study was 74. The EPESE population was divided into three groups: 1) those who were referred to protective services for mistreatment by another person, including abuse, neglect, or exploitation, 2) those who required protective services for self-neglect, and 3) people who had no referral to protective services. The study covered 1982, when the EPESE in New Haven began, through the 1995 EPESE follow-up period.
Researchers found that at any time during the follow-up period, people seen for mistreatment or self-neglect had a poorer survival and an increased risk of death. Mistreated elderly had a 3.1 times greater risk of dying than those with no reported mistreatment. The self-neglected had a 1.7 times increased risk. This increase in risk takes into account factors associated with death in older people, such as dementia, depression, chronic disease, functional problems, and socioeconomic status.
The NIA, part of the National Institutes of Health, leads the Federal effort to conduct and support studies on health and aging, including basic, clinical, epidemiological, and social and behavioral research.
Lachs also received support from the American Federation for Aging Research.