Primary Care Utilization Among Legally Adjudicated Elder Mistreatment Cases in Comparison to Other Older Adults

BACKGROUND: Elder mistreatment is associated with adverse health outcomes and increased Emergency Department (ED) and hospital utilization patterns in the period surrounding initial mistreatment identification. Less is known about outpatient primary care utilization, but it has been hypothesized that elder mistreatment victims may use this care less frequently than other older adults due to isolation and poor connection to outpatient providers. METHODS: We used multiple measures of outpatient primary utilization patterns including fractured care (continuity of care index (COCI) and usual provider of care (UPC) index) in the 360 days before and after mistreatment identification. Data were adjusted using US Centers for Medicare and Medicaid Services Hierarchical Condition Categories risk scores. RESULTS: This study included 114 cases and 410 controls. Median age was 72 years (IQR, 68-78 years), and 340 (64.9%) were women. During the 720 days surrounding mistreatment identification, cases were more likely to have had at least one outpatient primary care visit (adjusted odds ratio [AOR], 2.05 [95% CI, 1.12-3.73]; p = 0.02) and visits to multiple primary care providers (AOR, 1.51 [95% CI, 0.99-2.29]; p = 0.05). In unadjusted and adjusted models, both COCI and UPC were significantly lower in cases than controls during the 360 days prior to identification but not in the 360 days post-identification or when examining the entire 720 days. More cases received both outpatient primary care and ED/hospital care during the 720 days (58.8% vs. 33.7%; p < 0.001). CONCLUSION: Contrary to hypotheses, older adults experiencing mistreatment were not less likely to use outpatient primary care than other older adults during the period surrounding mistreatment. Additional research is needed to examine potential explanations and explore opportunities to improve detection and intervention in primary care.