Primary Care Utilization Among Older Adults Experiencing Elder Mistreatment

As many as ten percent of community-dwelling older adults experience mistreatment by a trusted person each year. Such mistreatment, which includes neglect, financial exploitation, and other abuse, may lead to exacerbated chronic illness, increased risk of disability, depression, and early mortality.  

Research has shown that older adults experiencing mistreatment have higher emergency department (ED) and hospital utilization and have been shown to use EDs and hospitals in non-optimal ways more commonly than other older adults. In a study in the Journal of the American Geriatrics Society, Dr. Jiani Yu, assistant professor of population health sciences, Dr. Yuhua Bao, professor of population health sciences, Dr. Anthony Rosen, associate professor of emergency medicine, and colleagues used Medicare claims data and a cohort of legally adjudicated elder mistreatment cases to identify patterns of outpatient primary care utilization among older adults experiencing elder mistreatment.  

Results indicate that, altogether, older adults experiencing mistreatment used both outpatient primary care and the ED or hospital more commonly than other older adults in the two years surrounding initial identification of mistreatment. Several potential explanations exist for this finding. For example, chronic health care needs of mistreated older adults may be more poorly managed, requiring them or their caregivers to frequently seek professional evaluation, outpatient care, or ED and hospital care.  

Researchers also found that older adults experiencing mistreatment used primary care at a rate similar to or higher than that of other older adults in the period before identification of mistreatment. This suggests an opportunity for early detection by primary care providers (PCPs), as they may lack adequate training in recognizing elder mistreatment or face barriers to addressing suspected mistreatment. However, this outpatient care was also more fragmented across multiple clinicians in the year before identification. Additional research is needed to understand the mechanisms behind these results and explore opportunities to improve detection and intervention in primary care.