Mark Lachs

OBJECTIVES: To determine the frequency and nature of police contact with a well‐characterized cohort of originally community‐dwelling older adults who were subsequently placed in long‐term care facilities and to describe in more quantitative and qualitative detail episodes of resident‐to‐resident elder mistreatment (RREM), which constituted the most common reason for police involvement in long‐term care facilities. DESIGN: Qualitative and quantitative study of the characteristics of nursing home residents who engaged in resident‐to‐resident mistreatment. The study melded longitudinal data from an observational cohort of community‐dwelling older adults subsequently placed in long‐term care facilities and cross‐sectional data from nursing home and police records. SETTING: Nursing homes. PARTICIPANTS: Forty‐two of 747 older adults placed in long‐term care facilities who were members of the original New Haven Established Populations for Epidemiological Studies in the Elderly (EPESE) were involved in 79 separate incidents. These 747 nursing home residents were derived from 2,321 subjects in the study who were alive and community dwelling in 1985 and then subsequently placed in nursing homes between 1985 and 1995. EPESE cohort members who were placed in nursing homes were identified through a linkage to the Connecticut Long‐Term Care Registry. The cohort was also linked to police records in the same community for the follow‐up years 1985 to 1995. MEASUREMENTS: Simple descriptive statistics were used to explicate reasons for police calls to the long‐term care facilities where these individuals resided. Demographic and clinical data were obtained from annual EPESE interviews, which continued after long‐term care placement. Police incident reports were abstracted to determine the reasons for police involvement; transcripts of police reports were reviewed qualitatively for episodes of RREM. RESULTS: During the follow‐up period, police were called to investigate 79 incidents involving 42 cohort members placed in nursing homes. The most common reason (89% of incidents) for police to investigate an episode involving a cohort member was for simple assault in which the subject was the perpetrator or victim of resident‐to‐resident mistreatment. Several qualitative typologies of this phenomenon emerged. Less common causes for police interdiction were elopement, theft, and alleged staff abuse. Cohort members were more likely to interact with police when community dwelling than after they entered the nursing home (30.2% vs 5.6%, P <.001). When police contact occurred with nursing home residents, it was much more likely to be for violent episodes than in community‐dwelling subjects (90% vs 17%, P <.001). CONCLUSION: Police had substantial contact with cohort members who became nursing home residents in this study, primarily to investigate RREM but also for other incidents. Further research should be conducted on the epidemiology, causes, and prevention of resident‐to‐resident aggressive behaviors in long‐term care facilities, which were the major reason for police involvement.

Purpose: We estimate the independent contribution of crime victimization to nursing home placement in a cohort of older adults who were community dwelling at baseline. Design and Methods: The data come from an observational cohort study of 2,321 community-residing older adults who were members of the New Haven Established Populations for Epidemiological Studies in the Elderly cohort in 1985. Participants had annual evaluations using standardized instruments. We defined the major outcome, custodial nursing home placement, as a stay of at least 30 days; mean length of nursing home stay was 413 days. We determined crime victimization by matching police records in the same catchment area as the cohort for the period 1985–1995. We determined nursing home placement through linkage to the Connecticut Long Term Care Registry. We used growth curve modeling to estimate the risk of placement in victimized and nonvictimized participants, and we used multivariable models to adjust for other factors known to predict nursing home placement. Results: There were 482 members of the cohort (21%) who experienced victimization over the 10-year follow-up; 747 (32%) experienced nursing home placement. Most victimization episodes were nonviolent and noninjurious. However, violent victimization conferred an independent increased risk of nursing home placement (odds ratio = 2.1; 95% confidence interval = 1.0–4.6) that exceeded the increased risk associated with other variables traditionally thought to be predictive of placement (such as functional and cognitive impairment, and social network size). Implications: Violent crime victimization increases the risk of nursing home placement. Future research should be directed at determining the mechanism of this increased risk and developing interventions directed at victimized older adults that might avert nursing home placement in this uniquely vulnerable population.

Purpose: 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. Design and Methods: 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. Results: 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. Implications: APS use is an independent risk factor for nursing home placement; persons identified by APS as self-neglecting are at the highest risk.