The specific aims of this research are (1) to identify risk factors for crime victimization in an observational cohort of community dwelling older adults, and to estimate the independent contribution of crime victimization to (2) erosion in health-related quality of life (functional status and self-rated health), (3) institutional health care utilization (hospitalization and nursing home placement), and (4) all-cause mortality in the cohort. This research hypothesizes that a broad variety of attributes predict crime victimization in older adults which may be medical (e.g. chronic disease), psychosocial (e.g. depression), or sociodemographic (e.g. poverty). The work also hypothesizes that crime victimization erodes health-related quality life, results in increased institutional health care utilization, and causes excess mortality. This influence on quality of life, health care utilization, and mortality persist even after adjusting for other factors that predict these morbid and mortal outcomes. Little is known about the epidemiology of crime committed against older adults, and virtually nothing is known about its health consequences. The investigators propose linking an established cohort of older adults (The New Haven EPESE cohort) who have been followed annually with standardized measures of medical, functional, and psychosocial health for over a decade, with Police Records from the cohort's catchment area. This would permit the largest community-based study of crime victimization in older adults ever conducted, at a fraction of the expense of assembling a new inception cohort for this purpose. Pilot data provided in this application demonstrate that a linkage with police records is indeed feasible, and would produce adequate events to test the study's hypotheses. This project joins the clinical and epidemiological expertise of the Principal Investigator, Mark Lachs, M.D., M.P.H., with the expertise of Ronet Bachman PhD, a criminologist who conducted an analysis of elderly crime subjects as part of the National Crime Victimization Survey for the National Institute of Justice. Additionally, the New Haven Police Department and the Yale School of Medicine (home to the New Haven EPESE cohort) participate in this innovative project which links community and academic resources. The broad, long-term goal of the research is to develop strategies to identify older adults at high risk for crime so that victimization might be prevented. If indeed victimization does occur, another long-term goal is to develop intervention strategies which avert or forestall mortality (and other morbid outcomes).
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