An Examination of Risk and Violence Indicators among a Subset of Elder Deaths in Fulton County, GA

INTRODUCTION: Elder Abuse, Neglect and Exploitation (ANE) is considered as one of the hidden problems in public health. Recent studies report a prevalence of rate of 7.6-10% among individuals 65 and older; however, further research indicates only 1 in 14 cases come to the attention of the authorities. As the US population demographic continues to age (expected to reach 20% of the general population by the year 2030), there is an urgent need to understand ANE through research so that effective prevention measures can be developed, so that older adults can live with dignity and avoid needless suffering at the end of life. The purpose of this study is to examine the saliency of ANE internal and external risk factors in a subset of elder deaths collected from the Fulton County, GA Medical Examiner database of death records. METHODS: A retrospective cohort design was used to examine death records of 101 cases from individuals recorded to be 65 and older at death from Fulton County for the period from April to May in 2014. Associations of risk factors identified in previous ANE research were examined among the cases having markers/notations of possible violence. Bivariate analysis was performed using Chi-square, and Fisher’s exact and logistic regression were run to determine significant associations. RESULTS: The original dataset included 101 cases for the two-month period selected for this study. Of the 101 cases, 55 cases were included in the analysis after removing cases with missing observations. Out of the 55 eligible cases, 16 (29%) were identified as suspicious of ANE. A chi-square test was run for 7 risk factors that were suggested by the literature (higher age groups, African American, female gender, dementia and chronically ill, living alone or with family, and having an informal caregiver), only 1 risk factors maintained a statistical significance (living situation), after adjusting for living alone as reference group, logistic regression showed that living with family members maintained a statistical significance association (OR= 0.12, P=0.017). DISCUSSION: While this study utilized a small sample of cases, the results indicate that it is worthwhile to conduct a larger study in the future. The results of this study are important, as the detection of risk factors that may exist during older adults’ lives-may reveal important potential windows of opportunity for early intervention and prevention of escalating ANE