Elder self-neglect and hospitalization: findings from the Chicago Health and Aging Project

Abstract

Objectives: To quantify the relation between reported elder self-neglect and rate of hospitalization in a community population of older adults.

Design: Prospective population-based study.

Setting: Geographically defined community in Chicago.

Participants: Community dwelling older adults who participated in the Chicago Health and Aging Project. One thousand one hundred sixty-five of the 6,864 participants in the Chicago Health and Aging Project was reported to social services agency for suspected elder self-neglect.

Measurements: The primary predictor was elder self-neglect reported to social services agency. The outcome of interest was the annual rate of hospitalization, obtained from the Centers for Medicare and Medicaid Services. Poisson regression models were used to assess these longitudinal relationships.

Results: The average annual rate of hospitalization was 0.6 ± 1.3 for participants without elder self-neglect and 1.8 ± 3.2 for those with reported elder self-neglect. After adjusting for sociodemographic and socioeconomic characteristics, medical commorbidities, and cognitive and physical function, older adults who neglected themselves had significantly higher rate of hospitalization (rate ratio = 1.47, 95% confidence interval = 1.39-1.55). Greater severity of self-neglect (mild: standardized parameter estimate (PE) = 0.24, standard error (0.05); moderate: PE = 0.45 (0.03); severe: PE = 0.54, (0.11), all P < .001) was associated with higher annual rates of hospitalization after adjusting for the same confounders. Interaction term analyses suggest that medical conditions, cognitive impairment, and physical disability did not mediate the significant relationship between self-neglect and hospitalization.

Conclusion: Reported elder self-neglect was associated with higher rates of hospitalization in this community population. Greater severity of self-neglect was associated with a greater rate of hospitalization.

Figure 1. Elder Self-Neglect Severity and Rate of Hospitalization

suggests that there is a gradient association between greater elder self-neglect severity score and rate for hospitalization of 913 self-neglecting older adults. The solid black line indicates the relative risk of hospitalization as the self-neglect severity increase. The dotted grey line indicates the 95% confidence interval of the relative risk of hospitalization. X-axis: represent the elder self-neglect severity score from 1 – 45 Y-axis: represent the increase in the rate of hospitalization calculated based on the number of hospitalization per year.