Melissa A. Simon

Elder Self-neglect and Abuse and Mortality Risk in a Community-Dwelling Population

CONTEXT Both elder self-neglect and abuse have become increasingly prominent public health issues. The association of either elder self-neglect or abuse with mortality remains unclear. OBJECTIVE To examine the relationship of elder self-neglect or abuse reported to social services agencies with all-cause mortality among a community-dwelling elderly population. DESIGN, SETTING, AND PARTICIPANTS Prospective, population-based cohort study (conducted from 1993 to 2005) of residents living in a geographically defined community of 3 adjacent neighborhoods in Chicago, Illinois, who were participating in the Chicago Health and Aging Project (CHAP; a longitudinal, population-based, epidemiological study of residents aged > or = 65 years). A subset of these participants had suspected elder self-neglect or abuse reported to social services agencies. MAIN OUTCOME MEASURES Mortality ascertained during follow-up and by use of the National Death Index. Cox proportional hazard models were used to assess independent associations of self-neglect or elder abuse reporting with the risk of all-cause mortality using time-varying covariate analyses. RESULTS Of 9318 CHAP participants, 1544 participants were reported for elder self-neglect and 113 participants were reported for elder abuse from 1993 to 2005. All CHAP participants were followed up for a median of 6.9 years (interquartile range, 7.4 years), during which 4306 deaths occurred. In multivariable analyses, reported elder self-neglect was associated with a significantly increased risk of 1-year mortality (hazard ratio [HR], 5.82; 95% confidence interval [CI], 5.20-6.51). Mortality risk was lower but still elevated after 1 year (HR, 1.88; 95% CI, 1.67-2.14). Reported elder abuse also was associated with significantly increased risk of overall mortality (HR, 1.39; 95% CI, 1.07-1.84). Confirmed elder self-neglect or abuse also was associated with mortality. Increased mortality risks associated with either elder self-neglect or abuse were not restricted to those with the lowest levels of cognitive or physical function. CONCLUSION Both elder self-neglect and abuse reported to social services agencies were associated with increased risk of mortality.

First trimester surgical abortion practices: a survey of National Abortion Federation members

BACKGROUND Designated providers in specialized clinics perform the majority of approximately 1.1 million first-trimester abortions carried out in the United States each year. Our objective was to assess the first-trimester surgical abortion practices of National Abortion Federation (NAF) members. STUDY DESIGN We mailed questionnaires to NAF administrators and providers at their 364 active-member facilities in 2002. RESULTS Two hundred eighty-nine (79%) facilities responded; we received administrative questionnaires from 273 facilities and 293 individual clinicians. NAF facilities provided at least 325,000 first-trimester surgical abortions in the United States in 2001. The majority of providers are obstetrician-gynecologists (63%), male (62%) and at least 50 years old (64%). Half of clinicians (49%) selectively utilize manual vacuum aspiration. Almost half (47%) routinely use a metal curette to verify procedure completion; these providers are more likely to be over 50 years of age or to have 20 years or more of abortion experience. Other practices are more uniform, including routine tissue examination (93%), postoperative antibiotics (88%) and contraceptive provision (oral contraceptives, 99%; depot medroxyprogesterone acetate, 79%). CONCLUSIONS Most perioperative practices for first-trimester abortions are similar among these respondents, in accord with evidence-based guidelines. The aging of skilled practitioners raises concerns about the future availability of surgical abortion.

Study Design and Implementation of the PINE Study

Objective: Multiple barriers in research participation have excluded the Chinese older adults from benefitting the recent advancement of aging sciences. The paucity of systematic understanding of Chinese aging population necessitated the P opulation-Based Study of Ch IN ese E lderly in Chicago (PINE). Method: Guided by community-based participatory research approach, the PINE study is a population-based epidemiological study of Chinese older adults aged 60 and above in the Greater Chicago area. Results: We described study design and implantation of the PINE study, highlighting strategies in adapting a population-based study design to the Chinese community. These measures included community-engaged recruitment, innovative data collection methods, and culturally and linguistically sensitive study infrastructure. Discussion: The intricate cultural and linguistic diversity among U.S. Chinese older adults, coupled with their demographic characteristics and residential pattern, present challenges and opportunities in implementing a population-based study of older adults. Implications for the research and practice in relation to future minority aging and social sciences studies are discussed.

Elder abuse and neglect in an urban chinese population

ABSTRACT This study aims to investigate the prevalence of elder abuse and neglect in an urban Chinese population. A cross-sectional study was performed in a major urban medical center in NanJing, China. A total of 412 participants completed the survey and 145 (35%) participants screened positive for elder abuse and neglect. The mean age of the victims was 69 years and 59% were male. Caregiver neglect was the most common form of abuse, followed by financial exploitation, psychological abuse, physical abuse, sexual abuse, and abandonment. Thirty-six percent of the victims suffered multiple forms of abuse and neglect. In the logistical regression analyses of the data, female gender, lower education and lower income were demographic risk factors associated with elder abuse and neglect. A better understanding of these and additional risk factors associated with elder abuse and neglect in older Chinese people is needed.

Impact of Patient Navigation on Timely Cancer Care: The Patient Navigation Research Program

BACKGROUND Patient navigation is a promising intervention to address cancer disparities but requires a multisite controlled trial to assess its effectiveness. METHODS The Patient Navigation Research Program compared patient navigation with usual care on time to diagnosis or treatment for participants with breast, cervical, colorectal, or prostate screening abnormalities and/or cancers between 2007 and 2010. Patient navigators developed individualized strategies to address barriers to care, with the focus on preventing delays in care. To assess timeliness of diagnostic resolution, we conducted a meta-analysis of center- and cancer-specific adjusted hazard ratios (aHRs) comparing patient navigation vs usual care. To assess initiation of cancer therapy, we calculated a single aHR, pooling data across all centers and cancer types. We conducted a metaregression to evaluate variability across centers. All statistical tests were two-sided. RESULTS The 10521 participants with abnormal screening tests and 2105 with a cancer or precancer diagnosis were predominantly from racial/ethnic minority groups (73%) and publically insured (40%) or uninsured (31%). There was no benefit during the first 90 days of care, but a benefit of navigation was seen from 91 to 365 days for both diagnostic resolution (aHR = 1.51; 95% confidence interval [CI] = 1.23 to 1.84; P < .001)) and treatment initiation (aHR = 1.43; 95% CI = 1.10 to 1.86; P < .007). Metaregression revealed that navigation had its greatest benefits within centers with the greatest delays in follow-up under usual care. CONCLUSIONS Patient navigation demonstrated a moderate benefit in improving timely cancer care. These results support adoption of patient navigation in settings that serve populations at risk of being lost to follow-up.

The role of the social network in contraceptive decision-making among young, African American and Latina Women

PURPOSE Understanding reasons for contraception decisions is critical to improving our ability to reduce rates of unintended pregnancies. We used an in-depth qualitative approach to examine the contraceptive decision-making process, with special attention to the role of the social network, among a group of young, postpartum urban minority women. METHODS Brief surveys and semi-structured interviews were conducted with 30 consenting postpartum women. In-person one-on-one interviews were then reviewed for themes using an iterative process. Qualitative analysis techniques identifying emergent themes were applied to interview data. RESULTS In this cohort of African American (63%) and Hispanic (37%) women (median age, 26), 73% had unplanned pregnancies. The social network, including friends, mothers, and partners, were key sources of contraception myths, misconceptions, and vicarious experiences. Women also utilized media, including the internet, as an additional source of information. Information relayed by the social network had a direct influence on contraceptive decisions for many women. CONCLUSIONS The experiences and opinions of the social network influence contraceptive decisions in this population of young, minority women. The social network, including friends, family members, and media sources, is a key source of contraceptive information for many women. Comprehensive contraception counseling should explore the experiences and opinions of the patients social network to the extent possible.

Elder abuse as a risk factor for hospitalization in older persons

IMPORTANCE Elder abuse is associated with increased mortality risk. However, the relationship between elder abuse and health care services utilization remains unclear. OBJECTIVE To examine the relationship between overall elder abuse and specific subtypes of elder abuse and rate of hospitalization in a community-dwelling population of older adults. DESIGN Prospective population-based study. SETTING Chicago Health and Aging Project. PARTICIPANTS Of the 6674 community-dwelling older adults who participated in the Chicago Health and Aging Project, 106 were identified by social services agencies for elder abuse. MAIN OUTCOMES AND MEASURES The primary predictor was elder abuse (reported and confirmed) reported to social services agency. The outcome of interest was the annual rate of hospitalization obtained from the Centers for Medicare and Medicaid Services. Poisson regression models were used to assess these longitudinal relationships. RESULTS The unadjusted mean annual rate of hospitalization was 0.62 (95% CI, 0.59-0.66) for those without elder abuse and 1.97 (95% CI, 1.33-2.61) for those with reported elder abuse. After adjusting for sociodemographic and socioeconomic variables, medical comorbidities, cognitive and physical function, and psychosocial well-being, reported elder abuse had higher rates of hospitalization (rate ratio [RR], 2.00 [95% CI, 1.45-2.75]). Psychological abuse (RR, 2.22 [95% CI, 1.44-3.43]), financial exploitation (RR, 1.75 [95% CI, 1.06-2.90]), caregiver neglect (RR, 2.43 [95% CI, 1.60-3.69]), and 2 or more types of elder abuse (RR, 2.59 [95% CI, 1.82-3.66]) were associated with increased rates of hospitalization, after considering the same potential confounders. Results from interaction term analyses suggested that the association between elder abuse and hospitalization did not differ across the levels of medical comorbidities, cognitive and functional impairment, or psychosocial distress. CONCLUSIONS AND RELEVANCE Elder abuse was associated with increased rates of hospitalization in this community population. Future research is needed to explore the causal mechanisms between elder abuse and hospitalization. As we enter the era of health care reform, an improved understanding of factors that increase rates of hospitalization could also have significant implications for social and health policy as well as clinical care of the vulnerable patients.

Demographic characteristics of U.S. Chinese older adults in the Greater Chicago area: Assessing the representativeness of the PINE study

Objective: We aimed to assess the representativeness of the demographic characteristics of the PINE study to the Chinese aging population in the Greater Chicago area. Method: The PINE study is a population-based study of Chinese older adults aged 60 and over in the Greater Chicago area. In preparation of the PINE study, we conducted a random block census study in Chicago. Demographic characteristics of the PINE study were compared with the data drawn from U.S. Census 2010 and random block census study using chi-square tests. Results: The PINE study is representative of the Chinese aging population in the Greater Chicago area. No significant difference was found in key attributes including age, sex, income, education, number of children, and country of origin. Discussion: Our report is critical in understanding the vast socio-demographic diversity of U.S. Chinese older adults. Rigorous studies are needed to explore the heterogeneity among the diverse aging populations.

Elder abuse and mortality: the role of psychological and social wellbeing.

Background: Elder abuse is a pervasive human right and public health issue. Objectives: We aimed to examine the mortality associated with elder abuse across levels of psychological and social factors. Methods: The Chicago Health and Aging Project (CHAP) is a prospective population-based cohort study that began in 1993. A subset of these participants enrolled between 1993 and 2005 had elder abuse reported to social services agencies (n = 113). Mortality was ascertained during follow-up and with the National Death Index. Psychosocial factors (depression, social network and social engagement) were assessed during the CHAP interview. Cox proportional hazard models were used to assess the mortality of elder abuse across levels of psychosocial factors using time-varying covariate analyses. Results: The median follow-up time for the cohort (n = 7,841) was 7.6 years (interquartile range 3.8–12.4 years). In multivariate analyses, those with highest (hazard ratio (HR) 2.60, 95% CI 1.58–4.28) and middle levels (HR 2.18, 95% CI 1.19–3.99) of depressive symptoms had an increased mortality risk associated with elder abuse. For social network, those with lowest (HR 2.50, 95% CI 1.62–3.87) and middle levels (HR 2.65, 95% CI 1.52–4.60) of social network had increased mortality risk associated with elder abuse. For social engagement, those with lowest (HR 2.32, 95% CI 1.47–3.68) and middle levels (HR 2.59, 95% CI 1.65–5.45) of social engagement had increased mortality risk associated with elder abuse. Among those with lowest levels of depressive symptoms, highest levels of social network and social engagement, there was no significant effect of reported or confirmed elder abuse on mortality risk. Conclusion: Mortality risk associated with elder abuse was most prominent among those with higher levels of depressive symptoms and lower levels of social network and social engagement.

Loneliness in older Chinese adults: a risk factor for elder mistreatment

OBJECTIVES: To examine loneliness as a risk factor for elder mistreatment in an urban, community‐dwelling Chinese population.