Lachs Mark S, Williams Christianna S, O'Brien Shelley, Pillemer Karl A
Division of Geriatrics and Gerontology, The Joan and Sanford Weill Medical College of Cornell University, 525 East 68th Street, New York, NY 10021, USA.
Gerontologist. 2002 Dec;42(6):734-9. doi: 10.1093/geront/42.6.734.
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.
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.
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.
APS use is an independent risk factor for nursing home placement; persons identified by APS as self-neglecting are at the highest risk.
成人保护服务（APS）是负责为遭受虐待或自我忽视的老年人提供支持的官方州级机构。然而，有人推测，APS的干预可能会导致养老院安置（NHP）的比例过高。这些分析旨在确定使用APS是否是NHP的独立风险因素。
样本为1982年年龄在65岁及以上的2812名社区居住老年人，他们来自纽黑文老年流行病学研究既定人群队列，其中一部分人在队列开始后的9年随访期内被转介至老年保护服务机构。确定了该时间段内队列成员的NHP情况。
随后的NHP发生率分别为：自我忽视者为69.2%，受虐待者为52.3%，未与APS接触者为31.8%（两次比较，p <.001）。在包含与NHP相关的其他人口统计学、医学、功能和社会因素的比例风险模型中，安置的最强风险因素是因自我忽视而被转介至APS（风险比[HR]，5.23；95%置信区间[CI]，4.07 - 6.72），以及因老年人受虐待而被转介至APS（HR，4.02；95% CI，2.50 - 6.47）。这些风险远超过其他医学、功能和社会因素。
使用APS是养老院安置的独立风险因素；被APS认定为自我忽视的人风险最高。
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