Adult Protective Service Use and Nursing Home Placement

TLDR

Adult Protective Services (APS) is the state agency that advocates for older adults who are victims of abuse or self‑neglect, yet it has been speculated that APS intervention may disproportionately lead to nursing home placement. The study aimed to determine whether APS use independently predicts nursing home placement among community‑dwelling older adults. Using a cohort of 2,812 adults aged 65+ from the New Haven Established Populations for Epidemiologic Studies in the Elderly, researchers followed participants for nine years, identified APS referrals, measured subsequent nursing home placement rates, and applied proportional‑hazard models adjusting for demographic, medical, functional, and social factors. APS referral for self‑neglect (HR 5.23, 95% CI 4.07–6.72) and elder mistreatment (HR 4.02, 95% CI 2.50–6.47) were the strongest predictors of placement, far exceeding other risk factors, confirming APS use as an independent risk factor with self‑neglect posing the highest risk.

Abstract

Adult Protective Services (APS) is the official state entity charged with advocacy for older adults who are victims of elder abuse or self-neglect. However, it has been speculated that APS intervention may lead disproportionately to nursing home placement (NHP). These analyses seek to determine if APS use is an independent risk factor for NHP.The sample was 2,812 community-dwelling older adults who were aged 65 years or older in 1982 in the New Haven Established Populations for Epidemiologic Studies in the Elderly cohort, a subset of whom were referred to elder protective services over a 9-year follow-up period from cohort inception. NHP of cohort members over that time period was determined.Rates of subsequent NHP were: 69.2% for self-neglecting subjects, 52.3% for mistreated subjects, and 31.8% for subjects who had no contact with APS (p <.001, both comparisons). In proportional hazard models that included other demographic, medical, functional, and social factors associated with NHP, the strongest risk factors for placement were APS referral for self-neglect (hazard ratio [HR], 5.23; 95% confidence interval [CI], 4.07-6.72), and for elder mistreatment (HR, 4.02; 95% CI, 2.50-6.47). These hazards far exceeded those for other medical, functional, and social factors.APS use is an independent risk factor for nursing home placement; persons identified by APS as self-neglecting are at the highest risk.