Association between elder abuse and use of ED: findings from the Chicago Health and Aging Project

Abstract

Purpose: This study aims to quantify the relationship between overall elder abuse and specific subtypes of elder abuse and rate of emergency department (ED) utilization in a community-dwelling population.

Methods: A population-based study is conducted in Chicago of community-dwelling older adults who participated in the Chicago Health and Aging Project. Of the 6674 participants in the Chicago Health and Aging Project, 106 participants were reported to a social services agency for suspected elder abuse. The primary predictor was elder abuse reported to a social services agency. The outcome of interest was the annual rate of ED utilization obtained from the Center for Medicare and Medicaid Services. Poisson regression models were used to assess these longitudinal relationships.

Results: The average annual rate of ED visits for those without elder abuse was 0.7(1.4) and, for those with reported elder abuse, was 2.1(3.2). After adjusting for sociodemographics, socioeconomic variables, medical comorbidities, cognitive and physical function, and psychosocial wellbeing, older adults who have been abused had higher rates of ED utilization (RR, 2.33 [1.60-3.38]). Psychological abuse (RR, 1.98[1.29-3.00]), financial exploitation (RR, 1.59 [1.01-2.52]) and caregiver neglect (RR, 2.04 [1.38-2.99]) were associated with increased rates of ED utilization, after considering the same confounders. Interaction terms suggest the association between elder abuse and ED utilization is not mediated through medical comorbidities, cognitive and functional impairment, or psychosocial distress.

Conclusion: Elder abuse was associated with increased rates of ED utilization in this community population. Specific subtypes of elder abuse had differential association with increased rate of ED utilization.