Factors Associated With an Elder Mistreatment Diagnosis Among Medicare Home Health Care Recipients.
Karen E Schlag, Monique R Pappadis, Jordan Westra and 6 others
PMID 41429695WHAT IT FOUND
Among Medicare home health patients, elder mistreatment diagnoses were rare at 0.3%, but literacy, housing or income problems, TBI, behavioral health, mobility, skin symptoms, and hospitalization risk were associated with higher risk.
Key findings
01An elder mistreatment diagnosis was recorded in 0.3% of the 270,935 home health patients followed for three years.
02Illiteracy, housing and income problems, learning disabilities, and history of traumatic brain injury showed the strongest associations with an elder mistreatment diagnosis.
03Mobility impairment, skin symptoms, PTSD, alcohol use disorder, behavioral health diagnosis, and higher hospitalization risk were associated with increased risk, while peripheral vascular disease, living with others, and admission from post-acute care were associated with decreased risk.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The elder mistreatment diagnosis came from Medicare claims ICD-10 codes, and the authors said no validated optimized ICD-10 case definition exists. Elder mistreatment is underreported, so the 0.3% rate may miss many cases and may capture only extreme occurrences. The study excluded 3.6% of Medicare beneficiaries with a prior elder mistreatment history, so it cannot speak to patients with known prior mistreatment. It included only Medicare fee-for-service beneficiaries aged 66 and older, not Medicare Advantage patients, so results may not apply to them. The data are from 2015 through 2019, before the Patient-driven Groupings Model payment change and current pandemic-era screening practices. The study observed associations only; it did not test whether any factor caused elder mistreatment or whether screening changed outcomes.
Declared interests
The authors declared no potential conflicts of interest. The article is listed as supported by NIH extramural research.
The easy way to misread this
Do not treat these factors as evidence that a patient is being mistreated or that a factor caused mistreatment. The study was observational, elder mistreatment diagnoses were rare and underreported, and no intervention was tested.