Home- and Community-Based Services Use Is Not Associated With Lower Elder Abuse Likelihood

As more older adults use home- and community-based services (HCBS) to support aging in place, it is critical to understand the benefits and possibilities of these services. One that has not been previously considered is whether use of HCBS assists in elder abuse prevention.

Cross-sectional secondary analysis of a national sample of adults aged 60 and older.

Participants in the 2008 National Elder Mistreatment Study (N = 5513 for the primary model).

Multivariable models were used to examine differences in elder abuse likelihood among HCBS consumers and nonconsumers. The exposure was HCBS use, and the outcome was elder abuse occurrence, defined as physical, emotional, or sexual abuse in the last year or financial abuse or neglect as an older adult, given the survey design. All models controlled for demographic and health characteristics. The primary model (N = 5513) was an inverse propensity-weighted logistic regression model with multiple imputation to recover missing household income (n = 1298, 23.5%) given means-tested programs in HCBS. Three sensitivity and inverse propensity-weighted logistic regression models were performed: adding a missing indicator, limiting the outcome to abuse in the last year, and using complete case analysis (N = 4233).

The primary sample was 67.9% female and 83.7% non-Hispanic White, with an average age of 71.9 years (SD, 8.4). HCBS consumers made up 19.1% of participants, and 12.4% of participants reported elder abuse. Primary (odds ratio, 1.07; CI, 0.86-1.32) and sensitivity models found no association between HCBS use and elder abuse occurrence.

These findings suggest that HCBS as an aggregate service category is not associated with reduced elder abuse. Future research is needed to examine the role of individual services in elder abuse prevention.