Different Definitions of Elder Mistreatment and Mortality: A Prospective Cohort Study From 2011 to 2017

OBJECTIVES: To investigate the relationship between different definitions and subtypes of elder mistreatment (EM) and yearly mortality. DESIGN: Population-based epidemiological study. SETTING: Greater Chicago area. PARTICIPANTS: Chinese Americans aged 60 and older (N=3,157). MEASUREMENTS: Data were collected from 2011 to 2017, with mortality data collected over the subsequent 4 years. Face-to-face in-home interviews were conducted. EM was measured using a brief screening tool (10 items) and a detailed assessment (56 items) and defined using different criteria for overall and specific subtypes of EM. Mortality was ascertained during follow-up. Cox proportional hazards models were used. RESULTS: Four hundred seventy-five (15.2%) participants reported EM. Severe and moderate EM were associated with greater risk of 1-year (hazard ratio (HR)=2.51, 95% confidence interval (CI)=1.04–6.03; HR=2.55, 95% CI=1.08–6.03), 2-year (HR=1.68, 95% CI=1.01–2.78; HR=1.69, 95% CI=1.04–2.74), 3-year (HR=1.73, 95% CI=1.17–2.55; HR=1.73, 95% CI=1.19–2.51) and 4-year (HR=1.51, 95% CI=1.08–2.10; HR=1.48, 95% CI=1.08–2.04) mortality. A broad definition of EM was associated with greater risk of 3-year and 4-year mortality. With respect to subtypes of EM, psychological mistreatment and caregiver neglect were associated with greater mortality risk, whereas the relationships between psychological mistreatment, caregiver neglect and mortality risk varied according to definitional criteria. DISCUSSION: Different definitions and subtypes of EM had different associations with mortality in Chinese-American older adults. This study challenges assumptions about consequences of EM and calls for customized interventions for EM in minority populations. J Am Geriatr Soc 67:S506–S512, 2019.