THE MORTALITY OF ELDER MISTREATMENT

Context. - Although elder mistreatment is suspected to be life threate ning in some instances, little is known about the survival of elderly persons who have been mistreated. Objective. - To estimate the indepen dent contribution of reported elder abuse and neglect to all-cause mor tality in an observational cohort of community-dwelling older adults. Design. - Prospective cohort study with at least 9 years of follow-up. Setting and Patients. - The New Haven Established Population for Epid emiologic Studies in the Elderly cohort, which included 2812 community -dwelling adults who were older than 65 years in 1982, a subset of who m were referred to protective services for the elderly. Main Outcome M easures. - All-cause mortality among (1) elderly persons for whom prot ective services were used for corroborated elder mistreatment (elder a buse, neglect, and/or exploitation), or (2) elderly persons for whom p rotective services were used for self-neglect. Results. - In the first 9 years after cohort inception, 176 cohort members were seen by elder ly protective services for verified allegations; 10 (5.7%) of these we re for abuse, 30 (17.0%) for neglect, 8 (4.5%) for exploitation, and 1 28 (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 a ny time during the follow-up had poorer survival (9%) than either thos e seen for self-neglect (17%) or other noninvestigated cohort members (40%) (P < .001), In a pooled logistic regression that adjusted for de mographic characteristics, chronic diseases, functional status, social networks, cognitive status, and depressive symptomatology, the risk o f death remained elevated for cohort members experiencing either elder mistreatment (odds ratio, 3.1; 95% confidence interval, 1.4-6.7) or s elf-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 inc reased mortality in older adults.