Lachs M S, Williams C S, O'Brien S, Pillemer K A, Charlson M E
Division of Geriatrics and Gerontology, Cornell University Medical College, New York, NY 10021, USA.
JAMA. 1998 Aug 5;280(5):428-32. doi: 10.1001/jama.280.5.428.
Although elder mistreatment is suspected to be life threatening in some instances, little is known about the survival of elderly persons who have been mistreated.
To estimate the independent contribution of reported elder abuse and neglect to all-cause mortality in an observational cohort of community-dwelling older adults.
Prospective cohort study with at least 9 years of follow-up.
The New Haven Established Population for Epidemiologic Studies in the Elderly cohort, which included 2812 community-dwelling adults who were older than 65 years in 1982, a subset of whom were referred to protective services for the elderly.
All-cause mortality among (1) elderly persons for whom protective services were used for corroborated elder mistreatment (elder abuse, neglect, and/or exploitation), or (2) elderly persons for whom protective services were used for self-neglect.
In the first 9 years after cohort inception, 176 cohort members were seen by elderly protective services for verified allegations; 10 (5.7%) of these were for abuse, 30 (17.0%) for neglect, 8 (4.5%) for exploitation, and 128 (72.7%) for self-neglect. At the end of a 13-year follow-up period from cohort inception, cohort members seen for elder mistreatment at any time during the follow-up had poorer survival (9%) than either those seen for self-neglect (17%) or other noninvestigated cohort members (40%) (P<.001). In a pooled logistic regression that adjusted for demographic characteristics, chronic diseases, functional status, social networks, cognitive status, and depressive symptomatology, the risk of death remained elevated for cohort members experiencing either elder mistreatment (odds ratio, 3.1; 95% confidence interval, 1.4-6.7) or self-neglect (odds ratio, 1.7; 95% confidence interval, 1.2-2.5), when compared with other members of the cohort.
Reported and corroborated elder mistreatment and self-neglect are associated with shorter survival after adjusting for other factors associated with increased mortality in older adults.
尽管在某些情况下，人们怀疑虐待老年人会危及生命，但对于遭受虐待的老年人的生存情况却知之甚少。
在一个社区居住的老年人观察队列中，评估报告的虐待和忽视老年人行为对全因死亡率的独立影响。
前瞻性队列研究，随访至少9年。
纽黑文老年流行病学研究既定人群队列，其中包括1982年2812名年龄超过65岁的社区居住成年人，其中一部分被转介到老年人保护服务机构。
（1）因经证实的虐待老年人行为（虐待、忽视和/或剥削）而使用保护服务的老年人的全因死亡率，或（2）因自我忽视而使用保护服务的老年人的全因死亡率。
在队列开始后的前9年，176名队列成员因经证实的指控接受了老年人保护服务；其中10人（5.7%）是因虐待，30人（17.0%）是因忽视，8人（4.5%）是因剥削，128人（72.7%）是因自我忽视。从队列开始进行13年随访期结束时，在随访期间任何时候因虐待老年人而接受检查的队列成员的生存率（9%）低于因自我忽视而接受检查的成员（17%）或其他未接受调查的队列成员（40%）（P<0.001）。在一项综合逻辑回归分析中，对人口统计学特征、慢性病、功能状态、社会网络、认知状态和抑郁症状进行了调整，与队列中的其他成员相比，经历过虐待老年人行为（优势比，3.1；95%置信区间，1.4 - 6.7）或自我忽视（优势比，1.7；95%置信区间，1.2 - 2.5）的队列成员的死亡风险仍然升高。
在对与老年人死亡率增加相关的其他因素进行调整后，报告并经证实的虐待老年人行为和自我忽视与较短的生存期相关。
