Self-neglect, abuse ups risk of death in the elderly

NEW YORK (Reuters Health) - Elderly adults, who have a report to a social service agency of abuse or “self-neglect,” such as failing to eat or drink, face a greater risk of premature death than other seniors, suggests a study released this week.

Even “more capable seniors,” who are not physically or mentally impaired, face a higher risk of death from abuse or self-neglect, Dr. XinQi Dong of Rush University Medical Center, Chicago, noted in an email correspondence to Reuters Health.

The findings, appearing in the latest Journal of the American Medical Association, demonstrate that abuse and self-neglect has “dire health consequences for these vulnerable older adults,” Dong added.

Among 9,318 men and women aged 65 and older in the Chicago Healthy and Aging Project (CHAP), there were 1,544 reported cases of self-neglect and 113 reported cases of elder abuse.

During follow up lasting a median of about 7 years, 4,306 people died.

“Elder abuse,” Dong told Reuters Health, “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.”

Elder 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,” Dong noted.

The research team considered alternative explanations for the increased risk of premature death, including medical conditions, health habits, brain and physical function, depression, and social networks, but none of these factors significantly altered the findings.

Elder self-neglect and abuse are serious, common and unrecognized public health issues in the US, the researchers note in their report. “With the rapidly growing aged population in this country, problems of elder abuse and self-neglect will likely become even more pervasive, affecting our family, friends and loved ones,” Dong noted.

“We hope our study will stimulate more discussion about this pervasive public health and human right issue and raise public awareness,” Dong said.

In an accompanying editorial, Dr. Thomas Gill of Yale University School of Medicine, New Haven, Connecticut, wrote: “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.”

SOURCE: Journal of the American Medical Association, August 5, 2009.