Health and Functional Characteristics of Older Adults Neglected by Their Caregivers: An Exploratory Study

Purpose: The neglect of older adults by their caregivers is the most common and least understood type of elder mistreatment (perpetrated by others) reported to Adult Protective Services (APS). Previous research on elder neglect uses a risk and vulnerability framework to examine the contributions of characteristics of both the older person and the caregiver to the neglectful situation (Fulmer et al., 2005). Few studies of risk factors for any type of elder mistreatment have compared mistreated and non-mistreated older adults. This study compared the health and functional characteristics of older adults who have been confirmed as neglected by APS with a group of non-neglected older adults who had been assessed for medical eligibility for the state's Medicaid Home and Community Based Services Waiver program in order to identify if neglected older adults have unique health-related vulnerabilities. Methods: This retrospective study used data from the administrative records of the aging and disability unit of a county-wide department of social services located in a mid-Atlantic state. The data file was derived from an amalgamation of four administrative data sets – an APS risk assessment database, a database which tracks Medicaid Waiver cases, the statewide Client Information Services database, and Adult Evaluation and Review Services (AERS)assessments completed by nurses on all Medicaid Waiver cases and a majority of APS cases. These data sets were downloaded, merged, unduplicated, and converted to a single file that contained 2412 unique records. Adults aged 65 and older who were confirmed as neglected and who had been evaluated by an AERS nurse (n = 61) between 2000 and 2007 were compared with adults who had had no prior contact with the APS system (n = 790) and who were assessed for the Medicaid Waiver program during the same time period. The two groups were compared on health-related conditions (e.g., presence or absence of edema, heart problems, seizures, and incontinence), the use of multiple medications, defined as six or more, and functional status as measured by an Activities of Daily Living (ADL) scale. Data were analyzed using measures of association appropriate to the level of measurement. Results: The neglect group and the comparison group were similar in age (mean = 81) gender (65% female), race (the majority were white), marital status (over half were widowed), and ADL scores. The neglected older adults were significantly more likely to be incontinent, to have problems with speaking, to suffer from contractures and seizures, and to be nutritionally frail. The neglected older adults were significantly less likely to use six or more medications, to receive Medicaid, and to have an identified vision problem (i.e., cataracts or blindness). Implications: Despite limitations, using administrative data is a non-intrusive way to compare demographically similar neglected and non-neglected older adults to determine characteristics associated with confirmed neglect. Because the health consequences of caregiver neglect are dire, information that increases the ability to recognize signs, symptoms, and contextual information pointing to caregiver neglect will aid in its identification, prevention, and treatment.