ELDER MISTREATMENT, MORTALITY, AND HOSPITAL READMISSION AMONG MEDICARE BENEFICIARIES, 2015–2018

Abstract Elder mistreatment (EM) is a growing public health and safety crisis, with long-term consequences for individuals, families, and communities. We explored whether older adults hospitalized with a primary diagnosis of EM was associated with an increased risk of mortality and unplanned hospital readmission compared to those with a secondary EM diagnosis. We further examined whether EM type and hospital setting was associated with risk of mortality and unplanned hospital readmission. Using 100% of 2015-2018 Medicare files of hospitalized Medicare Fee-for-Service beneficiaries aged 66 and over, we used Kaplan-Meier and Cox proportional hazard models to estimate mortality and unplanned readmission rates by primary versus secondary EM diagnosis, EM type, and facility type. 11,023 patients were hospitalized with an EM diagnosis. The majority were female (64.1%) and Non-Hispanic/Latinx White (74.3%). Neglect was the most common EM type. The three-year mortality rate was 56.7% and one-year readmission rate was 53.8%. Compared to other EM types, patients diagnosed with neglect had a 2.20 (95% Confidence Interval [CI]=1.88-2.56) and 3.21 (95% CI=2.32-4.43) times greater risk for mortality within and after 50-days from discharge, respectively. Patients discharged from a skilled nursing facility (SNF) were at an increased risk of mortality and unplanned readmission compared to those discharged from an acute hospital. Hospitalized patients with a primary EM diagnosis were associated with an increased risk of mortality and readmission compared to those with a secondary diagnosis. Future work should explore care patterns before and after EM diagnosis to identify potential time points for medical and social intervention.

Measures to which a person resits and/or does not provide consent for are defined as involuntary treatment. The use of involuntary treatment violates the autonomy of (older) persons and causes more harm than benefit. Moreover, it contradicts the values of person-centred care. Nevertheless, its use among Persons Living with Dementia (PLWD) is still common practice and remains difficult to prevent and/or reduce. The aim of this study was to gain insights into the barriers towards the prevention and/or reduction of involuntary treatment in long-term geriatric care. We conducted a cross-sectional, mixed-methods study, including an online survey for professional caregivers, and a semi-structured focus group interview with professional caregivers. A total of 218 participants completed the questionnaire. The percentage of participants that experienced barriers in one of the twenty-two survey items ranged from 15% to 42%. Lack of time; the experienced need to use involuntary treatment; uncertainty about responsibilities of stakeholders; and a lack of knowledge on methods to prevent and/or reduce its use were most seen as barriers. Nursing staff experienced a lack of time more often than other professional caregivers. Working in home care and having no former experience with involuntary treatment usage increased perceived barriers. Participants of the focus group interview confirmed these findings. One out of four professional caregivers experience barriers hindering prevention and/or reduction of involuntary treatment. More research is needed to gain better understanding on how professional caregivers can be supported aiming to, remove barriers and consequently prevent and/or reduce the use of involuntary treatment.

ELDER MISTREATMENT, MORTALITY, AND HOSPITAL READMISSION AMONG MEDICARE BENEFICIARIES, 2015-2018
Monique Pappadis 1 , Leila Wood 2 , Allen Haas 2 , Yong-Fang Kuo 2 , and Charles Mouton 2 , 1. University of Texas Medical Branch,Galveston,Texas,United States,2. University of Texas Medical Branch at Galveston,Galveston,Texas,United States Elder mistreatment (EM) is a growing public health and safety crisis, with long-term consequences for individuals, families, and communities. We explored whether older adults hospitalized with a primary diagnosis of EM was associated with an increased risk of mortality and unplanned hospital readmission compared to those with a secondary EM diagnosis. We further examined whether EM type and hospital setting was associated with risk of mortality and unplanned hospital readmission. Using 100% of 2015-2018 Medicare files of hospitalized Medicare Fee-for-Service beneficiaries aged 66 and over, we used Kaplan-Meier and Cox proportional hazard models to estimate mortality and unplanned readmission rates by primary versus secondary EM diagnosis, EM type, and facility type. 11,023 patients were hospitalized with an EM diagnosis. The majority were female (64.1%) and Non-Hispanic/ Latinx White (74.3%). Neglect was the most common EM type. The three-year mortality rate was 56.7% and one-year readmission rate was 53.8%. Compared to other EM types, patients diagnosed with neglect had a 2.20 (95% Confidence Interval [CI]=1.88-2.56) and 3.21 (95% CI=2.32-4.43) times greater risk for mortality within and after 50-days from discharge, respectively. Patients discharged from a skilled nursing Innovation in Aging, 2022, Vol. 6, No. S1 facility (SNF) were at an increased risk of mortality and unplanned readmission compared to those discharged from an acute hospital. Hospitalized patients with a primary EM diagnosis were associated with an increased risk of mortality and readmission compared to those with a secondary diagnosis. Future work should explore care patterns before and after EM diagnosis to identify potential time points for medical and social intervention.

MENTAL HEALTH RESILIENCE IN SWISS OLDER ADULT SURVIVORS OF CHILD WELFARE-RELATED MALTREATMENT
Myriam Thoma 1 , Florence Bernays 2 , Andreas Maercker 1 , and Shauna L. Rohner 1 , 1. University of Zurich,Zurich,Zurich,Switzerland,2. University of Zurich,Zürich,Zurich,Switzerland Minors affected by child welfare practices in Switzerland during the last century had a high risk for exposure to childhood trauma and maltreatment. Several studies with this cohort demonstrated substantially higher levels of clinically-relevant psychopathology in older adult survivors in comparison to non-affected control individuals. However, these studies also revealed that not all affected individuals developed mental health disorders over their lifespan. To date, this mental health resilience in survivors of an advanced age is still insufficiently understood. Therefore, this study aimed to assess and compare the resilience profiles of older adults who were formerly affected by child welfare-related trauma and maltreatment (risk group, RG; n = 132; Mage = 71 years) and non-affected, age-matched controls (control group, CG; n = 125). Within the RG, approximately one-third of the individuals had no current or lifetime DSM-5 mental health disorders. In comparison to the survivors with a history of mental ill-health, these individuals were older, had a higher income, and expressed a higher subjective satisfaction with their socio-economic status. Furthermore, they reported less early-life physical abuse, and had lower levels of neuroticism, as well as empathy-related characteristics. In addition, they showed higher levels of self-esteem and trait resilience. Group differences between the RG and CG highlight the importance of considering past adversity in the understanding of mental health resilience in later life.

SELF-ADMINISTRATED ELDER ABUSE INTERVENTION FOR OLDER ADULTS WITH COGNITIVE IMPAIRMENT
Fuad Abujarad 1 , Chelsea Edwards 2 , Brent Vander Wyk 2 , Laura Mosqueda 3 , Ula Hwang 2 , Judith Neugroschl 4 , and Richard Marottoli 2 , 1. Yale University,Orange,Connecticut,United States,2. Yale University,New Haven,Connecticut,United States,3. University of Southern California,Alhambra,California,United States,4. Mount Sinai,New York,New York,United States Many elder abuse interventions and tools designed to screen for abuse exclude older adults with cognitive impairments (CI) due to the challenges associated with screening and whether the older adult with CI can reliably report elder abuse. However, it has been shown that older adults with CI are among the most vulnerable to experiencing elder abuse. VOICES is an innovative, automated tablet-based elder abuse screening and prevention intervention that is self-administered by the older adult in the provider's waiting room or office. The VOICES Elder Abuse Intervention (EAI) provides screening, educational modules, and brief psychoeducational intervention to enhance and improve identification of elder abuse when there are no visible signs of abuse. The VOICES EAI was already proven successful in terms of feasibility and acceptability in cognitively intact older adults in a busy emergency department setting with (N=1,002). In this study we tested the VOICES EAI with (N=30) participants 60 and above with cognitive impairment at a geriatric center using the Montreal Cognitive Assessment (MoCA) to determine cognitive capacity. Experts in the field of geriatrics and cognitive impairment assisted in grouping participants within three cognitive categories: Mild cognitive impairment (MoCA 23-25), mild dementia (MoCA 16-22) or moderate dementia (MoCA 8-15). Of the (N=30) participants, 29 were able to successfully use the VOICES EAI independently, and most participants were satisfied with the tool. We will discuss the findings of this preliminary study and the implications for future research with older adults with CI.

ADULTS' VIEWS OF AGING AS AN UNDERESTIMATED RISK FACTOR FOR HEALTH, WELL-BEING, AND LONGEVITY
Chair: Manfred Diehl Co-Chair: Susanne Wurm Discussant: Becca Levy Worldwide population aging has greatly increased the diversity of the "aging enterprise." Research has established a solid portfolio of evidence showing that positive and negative views of aging represent independent resilience or risk factors for health, well-being, and longevity. Indeed, the effects of views of aging remain significant beyond the effects of other risk factors for health and mortality. This raises the following questions: What do we currently know about the effect of self-perceptions of aging (SPA) and subjective age (SA) on health, well-being, and longevity? What are recent advancements and perspectives? Which research questions should be addressed to stimulate further, sustainable developments in research and practice? This symposium addresses these questions with a diverse set of presentations and from different perspectives. Wahl and colleagues will discuss the role of SPA in the clinical context, namely in a sample of older adults with terminal cancer comparing them to older adults without a terminal illness. Based on a populationbased sample, Wurm and Schaefer will report findings on the impact of different gain-and loss-related SPA and SA on mortality over a 23-year period. Building on an earlier metaanalysis, Westerberg and colleagues evaluated data from over 100 studies and will present the findings of a systematic review on the role of SPA and SA for health and longevity. Finally, Nehrkorn-Bailey et al. will present findings from a clinical trial that addressed views of aging as a mechanism to promote physical activity. Dr. Becca Levy will serve as the discussant.