Self-Neglect in Elderly Linked to Increased Risk of Dying
XinQi Dong, MD and colleagues report in the August 5th Journal of the American Medical Association that elderly self-neglect is associated with a nearly six-fold increase in risk of dying within a year.
Elder self-neglect and abuse are serious, common, and under recognized. There are an estimated 2 million cases of elder self-neglect and abuse in the United States. Self-neglect is defined as the behavior of an elderly person that threatens his/her own health and safety such as refusing to adequately feed, shelter, or clothe himself and/or refusing medications or medical care.
Elder abuse is defined as the intentional or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult.
Dong and colleagues data from the Chicago Health and Aging Project (CHAP) gathered over the years 1993 to 2005. Of the 9,318 participants over 65 years of age living in three Chicago neighborhoods, there were 1544 participants were reported for elder self-neglect and 113 participants were reported for elder abuse. The mean age of the participants was 73.3 years.
There were 4,306 deaths in the total cohort during the 14 years of follow-up. Of these deaths, 927 occurred in the group of reported self-neglect participants and 69 in the elder abuse group of participants.
Participants with reported or confirmed self-neglect had a one-year mortality rate of 246.36 deaths per 100 person-years and mortality for participants after one year was 9.46 deaths per 100 person-years.
That compares to a rate of 5.01 deaths per 100 person-years for participants who did not report self neglect.
Mortality for participants with confirmed elder abuse was 18.33 deaths per 100 person-years.
Self-neglect was noted to be a marker for increased mortality regardless of cognitive or physical function. This was not true for elder abuse individuals with high levels of cognitive and physical function. The authors suggest that high-functioning elders might be more capable of recognizing abuse and of seeking help to end the abuse.
For more information on elderly abuse visit the National Center on Elder Abuse website.
Dong XQ, et al "Elder self-neglect and abuse and mortality risk in a community-dwelling population" JAMA 2009; 302: 517-26.
Gill, TM "Elder self-neglect: medical emergency or marker of extreme vulnerability" JAMA 2009; 302: 570-71.