Factors Associated With an Elder Mistreatment Diagnosis Among Medicare Home Health Care Recipients

J Am Med Dir Assoc. 2025 Dec;26(12):105955. doi: 10.1016/j.jamda.2025.105955. Epub 2025 Nov 5.

ABSTRACT

OBJECTIVES: To identify risk factors of elder mistreatment (EM) diagnosis among Medicare fee-for-service beneficiaries receiving Medicare Home Health Care (HHC).

DESIGN: Longitudinal retrospective cohort study.

SETTING AND PARTICIPANTS: Beneficiaries aged 66 and older receiving HHC in 2016, without an EM diagnosis in 2015 or 2016, and Medicare Part A/B/D eligible with no HMO through 2018 were included (N = 270,935).

METHODS: Predictor variables from 20% national Medicare claims (eg, demographics, health conditions, social determinants of health) and the Outcomes and Assessment Information Set (OASIS; eg, cognition, mobility, behavioral problems, living situation) were included. Cox proportional hazards regression assessing beneficiary health and social characteristics associated with an EM diagnosis was conducted.

RESULTS: HHC patients were mostly women (66.7%) and non-Hispanic White (81.3%) with 27.2% Medicaid dual eligible. EM diagnosis prevalence was 0.3%. Significant EM diagnosis risk factors through a 3-year period were illiteracy [hazard ratio (HR), 17.82; 95% CI, 6.26-50.73], housing and income problems (HR, 4.38; 95% CI, 2.21-8.69), history of traumatic brain injury (HR, 2.32; 95% CI, 1.11-4.88), and chronic conditions such as learning disabilities (HR, 2.83; 95% CI, 1.32-6.08), posttraumatic stress disorder (HR, 1.86; 95% CI, 1.06-3.28), alcohol use disorder (HR, 1.64; 95% CI, 1.17-2.31), and mobility impairment (HR, 1.52; 95% CI, 1.16-1.99). Medicare due to disability (HR, 1.66; 95% CI, 1.34-2.06) and HHC behavioral diagnoses (HR, 1.34; 95% CI, 1.02-1.75) also showed increased EM diagnosis risk.

CONCLUSIONS AND IMPLICATIONS: Findings underscore the utility of combining Medicare claims data and clinician-assessed patient outcomes to provide a comprehensive examination of factors contributing to EM diagnosis.

PMID:41429695 | DOI:10.1016/j.jamda.2025.105955