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Purpose <p>Older adult self-neglect, the inability to perform essential self-care, is an emerging public health problem. We aimed to evaluate imaging utilization and outcomes of patients with self-neglect compared to matched controls.</p> Methods <p>This IRB-approved retrospective study, conducted at two major academic medical centers, utilized the enterprise data warehouse to identify patients of &gt; 60&#xa0;years receiving a self-neglect mandate in the emergency department (ED) during 2019. Our study cohort consisted of 108 cases and 108 matched controls by age, gender, race, and time of ED presentation.</p> Results <p>During the index visit, cases had significantly higher imaging utilization (<i>p</i> &lt; 0.001). Revisit and readmission rates over the 5-year study period were significantly higher among cases (526 versus 290 revisits (<i>p</i> &lt; 0.001) and 254 versus 88 readmissions (<i>p</i> &lt; 0.001)), with increased imaging utilization on follow-up for CT (<i>p</i> &lt; 0.0001), X-ray (<i>p</i> &lt; 0.0001), US (<i>p</i> &lt; 0.0001), and MRI (<i>p</i> = 0.003). There were 44 deaths among cases versus 7 among controls. Subgroup analysis revealed that noncompliant cases had significantly higher CT use and an elevated mortality risk over the 5-year study period (both <i>p</i> = 0.02). Significantly higher number of cases lived alone (<i>p</i> &lt; 0.001), had a higher substance use (<i>p</i> = 0.044), and had a higher prevalence of psychiatric illness (<i>p</i> &lt; 0.001).</p> Conclusions <p>Older adult self-neglect patients experience increased ED revisits/readmissions and use more imaging services yet exhibit poorer clinical outcomes, particularly those who do not adhere to discharge recommendations. Identifying at-risk patients and implementing early interventions can mitigate healthcare burdens and improve patient outcomes.</p>

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Imaging utilization and health outcomes for older adults with self-neglect mandates in the emergency department

  • 期刊论文

  • 发表日期：

    2025年12月4日

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  • Sharmila Duraisamy,
  • Haley Nicole Bayne,
  • Zhou Lan,
  • Omar Yaghi,
  • Isabella Rose Pompa,
  • Lisette Dunham,
  • Karon Konner,
  • Bharti Khurana

摘要

Purpose

Older adult self-neglect, the inability to perform essential self-care, is an emerging public health problem. We aimed to evaluate imaging utilization and outcomes of patients with self-neglect compared to matched controls.

Methods

This IRB-approved retrospective study, conducted at two major academic medical centers, utilized the enterprise data warehouse to identify patients of > 60 years receiving a self-neglect mandate in the emergency department (ED) during 2019. Our study cohort consisted of 108 cases and 108 matched controls by age, gender, race, and time of ED presentation.

Results

During the index visit, cases had significantly higher imaging utilization (p < 0.001). Revisit and readmission rates over the 5-year study period were significantly higher among cases (526 versus 290 revisits (p < 0.001) and 254 versus 88 readmissions (p < 0.001)), with increased imaging utilization on follow-up for CT (p < 0.0001), X-ray (p < 0.0001), US (p < 0.0001), and MRI (p = 0.003). There were 44 deaths among cases versus 7 among controls. Subgroup analysis revealed that noncompliant cases had significantly higher CT use and an elevated mortality risk over the 5-year study period (both p = 0.02). Significantly higher number of cases lived alone (p < 0.001), had a higher substance use (p = 0.044), and had a higher prevalence of psychiatric illness (p < 0.001).

Conclusions

Older adult self-neglect patients experience increased ED revisits/readmissions and use more imaging services yet exhibit poorer clinical outcomes, particularly those who do not adhere to discharge recommendations. Identifying at-risk patients and implementing early interventions can mitigate healthcare burdens and improve patient outcomes.