Elder Abuse, Neglect Make Early Death Far More Likely

TUESDAY, Aug. 4 (HealthDay News) -- When seniors stop taking proper care of themselves, their risk for death increases nearly sixfold, a new study shows.

In addition, elderly people who are abused physically, emotionally, financially or through withdrawal of care don't fare much better. Their risk for dying more than doubles, the researchers report.

"Elder self-neglect and abuse really have severe consequences," said study author Dr. XinQi Dong, an associate professor of medicine at Rush University Medical Center in Chicago.

Though people often associate dementia or Alzheimer's disease with self-neglect, the researchers found that "it's not just the cognitively impaired" who are affected, Dong said. "Even more capable seniors face a higher risk of premature death from self-neglect."

The findings are reported in the Aug. 5 issue of the Journal of the American Medical Association.

Elder self-neglect is the most common reason that someone is referred to adult protective services, according to Dr. Thomas Gill, author of an accompanying editorial in the same issue of the journal. The inability to care for oneself, which characterizes self-neglect, can include failing to provide adequate food, water, clothing, shelter and necessary medications and not following basic hygiene practices, according to the study and editorial.

Abuse can include physical or sexual abuse, confinement, emotional abuse, caregiver neglect, deprivation or financial exploitation, the study reported.

Dong and his colleagues followed a group of 9,318 Chicago residents, all older than 65, who were participating in the Chicago Health and Aging Project. During the study period, from 1993 to 2005, social service agencies received reports of self-neglect on 1,544 of the participants, and 113 were reported as being abused. During about seven years of follow-up, 4,306 of the participants died.

The researchers found that elder self-neglect was associated with a 5.82 times increased risk for mortality in the year after a report of self-neglect. For abused seniors, the chance that they would die in the year after the abuse was reported was more than twice as great as it was for seniors who were not abused.

Dong said the researchers controlled the data to account for numerous factors -- such as medical conditions, socioeconomic status, health habits and memory -- but still found a strong association between abuse and self-neglect and the risk for premature death.

That suggests, he said, that it's the abuse and self-neglect that lead to the physical decline that ends in death.

"This degree of mortality risk is usually reserved for acute conditions, like an acute heart attack or stroke, and these findings really emphasize the importance of reporting abuse and self-neglect as well as the need to respond promptly with social service and medical intervention and prevention," Dong said.

The study points to an imminent problem, according to Dr. Karin Ouchida, medical director of the Montefiore Medical Center Home Health Agency in New York City.

"The situation is kind of grim right now," Ouchida said. "The population is going to get larger, and the population of people armed to care for them is getting smaller. I think this study really raises a red flag."

"Whether it was some decline in medical function that led to self-neglecting behavior, or the other way around, these people are in crisis, and social services and medical services need to have more communication and interaction," she said.

Anyone who suspects that an older family member, neighbor or friend is being abused or might be self-neglecting need to report those suspicions, both Ouchida and Dong said. A sudden change in weight, hygiene, or worsening medical conditions, such as being more short of breath, are clues that people might be neglecting themselves. Abuse can be harder to detect, but any unexplained bruises or sudden change in doctors could be clues.

Financial abuse and exploitation are probably getting worse in the recession, they said. Possible signs of this can include more telephone, mail and even in-person solicitations. Or, if older people start running out of money when they never did before or things are suddenly missing from their home, they could be in trouble.

"The tragedies of elder abuse are a reflection on all of us," Don said. "It can be a difficult topic to talk about, but this study demonstrated the adverse health outcomes that can result."

More information

The American Psychological Association has more on elder abuse and neglect.

SOURCES: XinQi Dong, M.D., associate professor, medicine, Rush University Medical Center, Chicago; Karin Ouchida, M.D., assistant professor, medicine, Montefiore Medical Center, and medical director, Montefiore Medical Center Home Health Agency, New York City; Aug. 5, 2009, Journal of the American Medical Association

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