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COMMUNITY-BASED SERVICES |
a Division of Geriatrics and Gerontology, The Joan and Sanford Weill Medical College of Cornell University, New York, NY
b The Departments of Medicine and Epidemiology, Yale University School of Medicine, New Haven, CT
c Connecticut Department of Social Services, Protective Services for the Elderly Division, Hartford
d Department of Human Development and Cornell Gerontology Research Institute, Cornell University, Ithaca, NY
Correspondence: Mark S. Lachs, MD, MPH, Co-Chief, Division of Geriatrics and Gerontology, The New York Hospital–Cornell University Medical College, 525 East 68th Street, Box 39, New York, NY 10021. E-mail: mslachs{at}mail.med.cornell.edu.
Decision Editor: Laurence G. Branch, PhD
Purpose: Adult Protective Services (APS) is the official state entity charged with advocacy for older adults who are victims of elder abuse or self-neglect. However, it has been speculated that APS intervention may lead disproportionately to nursing home placement (NHP). These analyses seek to determine if APS use is an independent risk factor for NHP. Design and Methods: The sample was 2,812 community-dwelling older adults who were aged 65 years or older in 1982 in the New Haven Established Populations for Epidemiologic Studies in the Elderly cohort, a subset of whom were referred to elder protective services over a 9-year follow-up period from cohort inception. NHP of cohort members over that time period was determined. Results: Rates of subsequent NHP were: 69.2% for self-neglecting subjects, 52.3% for mistreated subjects, and 31.8% for subjects who had no contact with APS (p < .001, both comparisons). In proportional hazard models that included other demographic, medical, functional, and social factors associated with NHP, the strongest risk factors for placement were APS referral for self-neglect (hazard ratio [HR], 5.23; 95% confidence interval [CI], 4.07–6.72), and for elder mistreatment (HR, 4.02; 95% CI, 2.50–6.47). These hazards far exceeded those for other medical, functional, and social factors. Implications: APS use is an independent risk factor for nursing home placement; persons identified by APS as self-neglecting are at the highest risk.
Key Words: Adult protective services • Nursing home placement • Elder abuse • Self-neglect
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| All GSA journals | Journals of Gerontology Series A: Biological Sciences and Medical Sciences | Journals of Gerontology Series B: Psychological Sciences and Social Sciences |
