Estimated Incidence and Factors Associated With Risk of Elder Mistreatment in New York State

Identifying social determinants of health from clinical narratives: A study of performance, documentation ratio, and potential bias

OBJECTIVE

To develop a natural language processing (NLP) package to extract social determinants of health (SDoH) from clinical narratives, examine the bias among race and gender groups, test the generalizability of extracting SDoH for different disease groups, and examine population-level extraction ratio.

METHODS

We developed SDoH corpora using clinical notes identified at the University of Florida (UF) Health. We systematically compared 7 transformer-based large language models (LLMs) and developed an open-source package - SODA (i.e., SOcial DeterminAnts) to facilitate SDoH extraction from clinical narratives. We examined the performance and potential bias of SODA for different race and gender groups, tested the generalizability of SODA using two disease domains including cancer and opioid use, and explored strategies for improvement. We applied SODA to extract 19 categories of SDoH from the breast (n = 7,971), lung (n = 11,804), and colorectal cancer (n = 6,240) cohorts to assess patient-level extraction ratio and examine the differences among race and gender groups.

RESULTS

We developed an SDoH corpus using 629 clinical notes of cancer patients with annotations of 13,193 SDoH concepts/attributes from 19 categories of SDoH, and another cross-disease validation corpus using 200 notes from opioid use patients with 4,342 SDoH concepts/attributes. We compared 7 transformer models and the GatorTron model achieved the best mean average strict/lenient F1 scores of 0.9122 and 0.9367 for SDoH concept extraction and 0.9584 and 0.9593 for linking attributes to SDoH concepts. There is a small performance gap (∼4%) between Males and Females, but a large performance gap (>16 %) among race groups. The performance dropped when we applied the cancer SDoH model to the opioid cohort; fine-tuning using a smaller opioid SDoH corpus improved the performance. The extraction ratio varied in the three cancer cohorts, in which 10 SDoH could be extracted from over 70 % of cancer patients, but 9 SDoH could be extracted from less than 70 % of cancer patients. Individuals from the White and Black groups have a higher extraction ratio than other minority race groups.

CONCLUSIONS

Our SODA package achieved good performance in extracting 19 categories of SDoH from clinical narratives. The SODA package with pre-trained transformer models is available at https://github.com/uf-hobi-informatics-lab/SODA_Docker.

Psychometric Properties of The Five-Item Victimization of Exploitation (FIVE) Scale: A Measure of Financial Abuse of Older Adults

BACKGROUND AND OBJECTIVES

Elder mistreatment affects at least 1 in 10 older adults. Financial abuse, or exploitation, of older adults is among the most commonly reported forms of abuse. Few validated measures exist to measure this construct. We aim to present a new psychometrically validated measure of financial abuse of older adults.

RESEARCH DESIGN AND METHODS

Classical test theory and item response theory (IRT) methodologies were used to examine a five-item measure of financial abuse of older adults, administered as part of the New York State Elder Mistreatment Survey.

RESULTS

Factor analysis revealed a single factor best fits the data, which we labeled as financial abuse. Moreover, IRT analyses revealed that these items discriminated well between abused and nonabused persons and provided information at high levels of the latent trait θ, as is expected in cases of abuse.

DISCUSSION AND IMPLICATIONS

The Five-Item Victimization of Exploitation Scale has acceptable psychometric properties and has been used successfully in large-scale survey research. We recommend this measure as an indicator of financial abuse in elder abuse, or mistreatment prevalence research studies.

Elder abuse prevalence and risk factors: findings from the Canadian Longitudinal Study on Aging

Elder abuse (EA) is a pervasive problem with serious consequences. Previous population-based EA risk factor research has largely used cross-sectional designs that limit causal inferences, or agency records to identify victims, which threatens external validity. Based on a national, prospective, population-based cohort sample of older adults (n = 23,468) over a 3-year period from the Canadian Longitudinal Study on Aging, the current study sought to estimate the prevalence of EA and identify risk and protective factors. Past-year prevalence of any EA was 10.0%. Older adults with greater vulnerability related to physical, cognitive and mental health, childhood maltreatment and shared living were at higher EA risk, while social support was protective against EA. Older adults identifying as Black or reporting financial need were at heightened EA risk. This longitudinal, population-based study advances our understanding of EA risk/protective factors across several domains and informs the development of EA prevention strategies.

Emergency assistance in situations of abuse, neglect, and self-neglect: exploring the complexity and challenges

Health and social care professionals are often called upon to provide emergency intervention without the adult's consent in situations of abuse, neglect, and self-neglect. Little is known about this process despite implications related to health care costs and individual rights. In this qualitative study, 17 health care professionals with experience enacting emergency legislation in BC were interviewed to better understand what leads to an emergency response and how these professionals carry out their role. Five components emerged in the provision of emergency assistance: assessing intolerable risks, assessing incapability, balancing ethical values, exploring resources, and consulting/collaborating. Attention is drawn to the significance of social location, including age, socio-economic, and Indigenous background for influencing the process, sometimes in unintended ways. The challenges in providing emergency interventions may result in social inequities and delay in providing care at times. The importance of bringing a reflexive and intersectional lens to providing interventions is highlighted.

Lack of Association of Elder Mistreatment With Mortality

BACKGROUND

Prior research is limited and inconsistent on the degree to which elder mistreatment (EM) is associated with mortality. This study uses data from a 10-year, prospective, population-based study of EM to determine the adjusted effects of EM on older adult mortality, after controlling for other health and socioeconomic covariates.

METHODS

The New York State Elder Mistreatment Prevalence Study conducted a random-sample telephone survey of older adults (n = 4 156) in 2009 (Wave 1). The current study employs EM and covariate data from Wave 1 and data on mortality status through Wave 2 (2019). EM was operationalized both as experiencing EM and as severity of EM. The survey measured overall EM and separate subtypes (emotional, physical, and financial abuse, and neglect).

RESULTS

The hypothesis was not supported that abused and neglected older people would have higher rates of death over the study. Individuals who were victims of EM were no more likely to die over the following 10 years, compared with those who were not mistreated, after controlling for covariates. Furthermore, the severity of EM, as measured by the frequency of mistreatment behaviors, also was not associated with mortality risk.

CONCLUSIONS

The finding that self-reported EM did not raise the risk of earlier death in this sample is encouraging. Future research should work to identify factors that may moderate the relationship between EM and mortality, such as social support/isolation, quality of family relationships, or involvement with formal support service systems.