Association between elder self-neglect and hospice utilization in a community population

Area of Science:

• Gerontology
• Public Health
• Social Work

Background:

• Elder self-neglect is a serious concern associated with high mortality rates.
• Hospice utilization patterns in older adults experiencing self-neglect are not well understood.

Purpose of the Study:

• To investigate the prospective relationship between elder self-neglect and hospice utilization in a community-based population.
• To quantify the risk of hospice use among older adults with varying degrees of self-neglect.

Main Methods:

• A prospective, population-based study using data from the Chicago Health and Aging Project.
• Analysis of 1438 older adults reported for suspected elder self-neglect, with hospice utilization data from Medicare.
• Cox proportional hazard models and time-varying covariate analyses were employed.

Main Results:

• Elder self-neglect was independently associated with a 2.43-fold increased risk of hospice utilization.
• Increased severity of self-neglect correlated with higher hospice utilization risk (severe: HR 4.66).
• Self-neglect was linked to shorter hospice length of stay and time from admission to death.

Conclusions:

• Elder self-neglect is a significant predictor of increased hospice use in older adults.
• The association between self-neglect and hospice utilization is not mediated by medical conditions, cognitive impairment, or physical disability.
• Self-neglect impacts end-of-life care trajectories, leading to shorter hospice experiences.