Financial exploitation of older adults: a population-based prevalence study

Subjective Age Moderates the Relationship Between Global Cognition and Susceptibility to Scams

This study examined the interactive effect of subjective age on the relationship between global cognition and susceptibility to scams. Sixty-five participants underwent an assessment of global cognition (Mini Mental State Examination; MMSE), reported their perceived age (i.e., subjective age), and responded to a self-report questionnaire assessing scam susceptibility. A main effect of global cognition on scam susceptibility was found (p = .028); there was no main effect of subjective age (p = .819). An interaction between global cognition and subjective age was found (p = .016). Examination of conditional effects demonstrated that the relationship between cognition and scam susceptibility was not significant amongst those with subjective ages below one standard deviation of the mean, but was significant for those whose subjective ages fell around or above the mean. Findings suggest that individuals with older subjective ages may be particularly vulnerable to the negative effects of lower cognition on scam susceptibility.

Phishing vulnerability compounded by older age, apolipoprotein E e4 genotype, and lower cognition

With technological advancements, financial exploitation tactics have expanded into the online realm. Older adults may be particularly susceptible to online scams due to age- and Alzheimer's disease-related changes in cognition. In this study, 182 adults ranging from 18 to 90 years underwent cognitive assessment, genotyping for apolipoprotein E e4 (APOE4), and completed the lab-based Short Phishing Email Suspicion Test (S-PEST) as well as the real-life PHishing Internet Task (PHIT). Across both paradigms, older age predicted heightened susceptibility to phishing, with this enhanced susceptibility pronounced among older APOE4 allele carriers with lower working memory. Additionally, performance in both phishing tasks was correlated in that reduced ability to discriminate between phishing and safe emails in S-PEST predicted greater phishing susceptibility in PHIT. The current study identifies older age, APOE4, and lower cognition as risk factors for phishing vulnerability and introduces S-PEST as an easy-to-administer, ecologically valid tool for assessing phishing susceptibility.

Neuropsychological profile associated with financial exploitation vulnerability in older adults without dementia

Objective: Reports of financial exploitation have steadily increased among older adults. Few studies have examined neuropsychological profiles for individuals vulnerable to financial exploitation, and existing studies have focused on susceptibility to scams, one specific type of financial exploitation. The current study therefore examines whether a general measure of financial exploitation vulnerability is associated with neuropsychological performance in a community sample. Methods: A sample (n = 116) of adults aged 50 or older without dementia completed a laboratory visit that measures physical and psychological functioning and a neuropsychological assessment, the Uniform Data Set-3 (UDS-3) and California Verbal Learning Test-II. Results: After covarying for demographics, current medical problems, financial literacy, and a global cognition screen, financial exploitation vulnerability was negatively associated with scores on the Multilingual Naming Test, Craft Story Recall and Delayed Recall, California Verbal Learning Test-II Delayed Recall and Recognition Discriminability, Phonemic Fluency, and Trails B. Financial exploitation vulnerability was not associated with performance on Digit Span, Semantic Fluency, Benson Complex Figure Recall, or Trails A. Conclusions: Among older adults without dementia, individuals at higher risk for financial exploitation demonstrated worse verbal memory, confrontation naming, phonemic fluency, and set-shifting. These tests are generally sensitive to Default Mode Network functioning and Alzheimer's Disease neuropathology. Longitudinal studies in more impaired samples are warranted to further corroborate and elucidate these relationships.

Disclosure and Reporting of Abuse Against Older Adults: Perspectives of Older Adults with Abuse Histories and Service Providers in Alberta, Canada

This exploratory qualitative study seeks to understand the barriers and facilitators of disclosure and reporting of abuse against older adults by conducting interviews with older adults with lived experience of abuse and service providers working directly with this population in Alberta, Canada. Thematic analysis revealed three key themes: (1) Barriers to disclosure and reporting of abuse; (2) Facilitators to disclosure and reporting; and (3) Key tensions between service providers' and older adults' perceptions of the disclosure and reporting process. Based on these findings, we offer recommendations to increase awareness, promote disclosure, and improve services for older adults experiencing abuse.

Reflective Functioning and Financial Exploitation Vulnerability in Older Adults: The Importance of Significant Others

OBJECTIVES

Financial exploitation of older adults results in devastating economic, social, and psychological losses to older adults, their families, and society at large. This study examined the relationship between reflective functioning and financial exploitation vulnerability (FEV) and whether relationship status moderated the association.

METHODS

A community-based sample of 156 Israeli older adults age 60 and over responded to demographic questions and questionnaires assessing reflective functioning and FEV.

RESULTS

A hierarchical linear regression analysis covarying for age, sex, education, income, and sum of illnesses, revealed that higher reflective functioning was associated with lower FEV (p = .011). A main effect of relationship status was not found, but a significant interaction of reflective functioning × relationship status was discovered (p = .008), adding 4.2% to the total variance of the model. Probing the interaction revealed that the reflective functioning-FEV association was significant only for older adults not in a relationship.

CONCLUSIONS

Findings suggest that low reflective functioning may be associated with increased risk of financial exploitation, specifically in certain populations of older adults.

CLINICAL IMPLICATIONS

Care providers of older adults may consider assessing for, and identifying older adults with low reflective functioning, in order to prevent or intervene in the event of a potentially exploitative situation.

Adult Maltreatment Risk Factors: Adding Community-Level Factors to an Individual-Level Field

Adult maltreatment is a pervasive problem in the United States and has serious individual and societal consequences. Adult protective services (APS) agencies are the social services programs responsible for serving older adults and adults with disabilities who may be experiencing adult maltreatment. The adult maltreatment literature differentiates elder maltreatment from the maltreatment of adults with disabilities, yet APS agencies serve both groups. Understanding the etiology of adult maltreatment as well as the associated risk and protective factors is crucial for APS workers, clinical practitioners, researchers, and policymakers. To advance the evidence in this area, we undertook a scoping review to examine recent evidence on risk and protective factors associated with adult maltreatment. Searches of nine electronic databases were conducted in 2020 to identify studies published in peer-reviewed journals since 2010. A total of 29 studies were included in the final review. The findings identified several categories of risk factors associated with the individual: demographic traits, socioeconomic characteristics, physical and mental health, interpersonal issues, and historical events. Several studies identified caregiver and alleged perpetrator risk factors. However, the current body of research lacks community and contextual risk and protective factors. Therefore, we present several potential data sources that may be leveraged to examine the links between social-contextual characteristics and adult maltreatment. These data may be combined with APS data to advance the field's understanding of risk and protective factors through advanced analytic techniques.

Financial Fraud and Deception in Aging

Financial exploitation among older adults is a significant concern with often devastating consequences for individuals and society. Deception plays a critical role in financial exploitation, and detecting deception is challenging, especially for older adults. Susceptibility to deception in older adults is heightened by age-related changes in cognition, such as declines in processing speed and working memory, as well as socioemotional factors, including positive affect and social isolation. Additionally, neurobiological changes with age, such as reduced cortical volume and altered functional connectivity, are associated with declining deception detection and increased risk for financial exploitation among older adults. Furthermore, characteristics of deceptive messages, such as personal relevance and framing, as well as visual cues such as faces, can influence deception detection. Understanding the multifaceted factors that contribute to deception risk in aging is crucial for developing interventions and strategies to protect older adults from financial exploitation. Tailored approaches, including age-specific warnings and harmonizing artificial intelligence as well as human-centered approaches, can help mitigate the risks and protect older adults from fraud.

Novel methods for assessment of vulnerability to financial exploitation (FE)

Financial exploitation (FE) is a complex problem influenced by many factors. This article introduces two novel methods for assessment of FE vulnerability: (1) performance-based measures of financial skills using web-based simulations of common financial tasks; (2) scam vulnerability measures based on credibility ratings of common scam scenarios. Older adults who were male, younger, Hispanic, more educated, with higher incomes performed better on the simulated financial tasks. Better performance was also related to higher cognitive function and numeracy, and more experience with technology. On the scenario-based measures, older adults who were male, younger, African American, less educated, and lower income showed higher FE vulnerability. Higher scam vulnerability was also related to poorer performance on the simulated financial tasks, lower cognitive function, less experience with technology, more financial conflict/anxiety, more impulsivity, and more stranger-initiated FE. Findings indicate that these novel measures show promise as valid indicators of vulnerability to FE.

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.

Frailty predicts referral for elder abuse evaluation in a nationwide healthcare system-Results from a case-control study

BACKGROUND

Elder abuse (EA) is common and has devastating health impacts. Frailty may increase susceptibility to and consequences of EA for older adults, making healthcare system detection more likely, but this relationship has been difficult to study. We examined the association between a recently validated frailty index and referral to social work (SW) for EA evaluation in the Veterans Administration (VA) healthcare system.

METHODS

We conducted a case-control study of veterans aged ≥60 years evaluated by SW for suspected EA between 2010 and 2018 (n = 14,723) and controls receiving VA primary care services in the same 60-day window (n = 58,369). We used VA and Medicare claims data to measure frailty (VA Frailty Index) and comorbidity burden (the Elixhauser Comorbidity Index) in the 2 years prior to the index. We used adjusted logistic regression models to examine the association of frailty or comorbidity burden with referral to SW for EA evaluation. We used Akaike Information Criterion (AIC) values to evaluate model fit and likelihood ratio (LR) tests to assess the statistical significance of including frailty and comorbidity in the same model.

RESULTS

The sample (n = 73,092) had a mean age 72 years; 14% were Black, and 6% were Hispanic. More cases (67%) than controls (36%) were frail. LR tests comparing the nested models were highly significant (p < 0.001), and AIC values indicated superior model fit when including both frailty and comorbidity in the same model. In a model adjusting for comorbidity and all covariates, pre-frailty (aOR vs. robust 1.7; 95% CI 1.5-1.8) and frailty (aOR vs. robust 3.6; 95% CI 3.3-3.9) were independently associated with referral for EA evaluation.

CONCLUSIONS

A claims-based measure of frailty predicted referral to SW for EA evaluation in a national healthcare system, independent of comorbidity burden. Electronic health record measures of frailty may facilitate EA risk assessment and detection for this important but under-recognized phenomenon.

Elder Mistreatment Experienced by Older Caregiving Adults: Results from a National Community-Based Sample

BACKGROUND

With an aging population, older adults are increasingly serving as caregivers to others, which may increase their risk of adverse interpersonal experiences.

OBJECTIVE

To investigate the prevalence and types of elder mistreatment experienced by older caregiving adults.

DESIGN

Cross-sectional analysis PARTICIPANTS: National sample of community-dwelling US adults over age 60 in 2015-2016.

MAIN MEASURES

Caregiving (assisting another adult with day-to-day activities) was assessed by interviewer-administered questionnaires. Experience of elder mistreatment was assessed by participant-reported questionnaire in three domains: emotional, physical, and financial. Multivariable logistic regression models examined associations between caregiving status and each domain of elder mistreatment, adjusting for age, race, ethnicity, gender, education, marital status, concomitant care-receiving status, overall physical and mental health, and cognitive function. Additional logistic regression models examined associations between being the primary caregiver (rather than a secondary caregiver) and each domain of mistreatment among older caregivers.

KEY RESULTS

Of the 1898 participants over age 60 (including 1062 women and 836 men, 83% non-Hispanic white, and 64% married or partnered), 14% reported serving as caregivers for other adults, including 8% who considered themselves to be the primary caregiver. Among these older caregivers, 38% reported experiencing emotional, 32% financial, and 6% physical mistreatment after age 60. In multivariable models, caregiving was associated with experiencing both emotional mistreatment (AOR 1.61, 95% CI 1.15-2.25) and financial mistreatment (AOR 1.72, 95% CI 1.18-2.50). In analyses confined to caregiving older adults, those who served as primary rather than secondary caregivers for other adults had an over two-fold increased odds of emotional mistreatment (AOR 2.17, 95% CI 1.07, 4.41).

CONCLUSION

In this national cohort of older community-dwelling adults, caregiving was independently associated with experiencing emotional and financial mistreatment after age 60. Findings suggest that efforts to prevent or mitigate elder mistreatment should put more emphasis on vulnerable older caregivers.

Interpersonal dysfunction predicts subsequent financial exploitation vulnerability in a sample of adults over 50: a prospective observational study

OBJECTIVES

The goal of this study was to test whether interpersonal dysfunction, characterized by loneliness and/or dissatisfaction with relationships, is an imminent predictor of financial exploitation vulnerability (FEV) among adults age 50+ within a 6-month observation period. This study also tests whether FEV prospectively predicts interpersonal dysfunction.

METHODS

Twenty-six adults aged 50 or older completed a study involving baseline data collection and 13 follow-ups over 6 months. Linear mixed models were used for primary analyses.

RESULTS

After adjustment for demographic, psychological and cognitive covariates, there were between-person effects of FEV and interpersonal dysfunction across follow-ups, suggesting that those with generally higher interpersonal dysfunction compared to other participants also reported greater FEV (B(SE) = 1.09(.33), p = .003). There was a within-person effect (B(SE) = .08(.03), p = .007) of elevated interpersonal dysfunction predicting greater FEV two weeks later across all follow-ups. Within-person effect of FEV was not predictive of interpersonal dysfunction (B(SE) = .25(.15), p = .10). There was also a significant effect of age (B(SE) = -.06(.02), p = .007), such that older individuals had lower FEV throughout follow-ups.

CONCLUSION

Among adults age 50+, individuals with higher interpersonal dysfunction relative to others in the study reported greater FEV throughout the 6-month observation period. Increased loneliness and social dissatisfaction, relative to one's average level, predicts subsequent increases in FEV, and may be an imminent risk factor for exploitation.

Association of Stroke and Cerebrovascular Pathologies With Scam Susceptibility in Older Adults

Importance

Scam susceptibility is associated with adverse financial and health outcomes, including an increased risk of cognitive decline and dementia. Very little is known about the role of cerebrovascular pathologies with scam susceptibility.

Objective

To examine the association of diverse cerebrovascular pathologies (globally and regionally) with scam susceptibility.

Design, setting, and Participants

This clinical-pathological cohort study included participants from 2 ongoing studies of aging that began enrollment in 1994 and 1997. In 2010, participants were enrolled in the decision-making and behavioral economics substudy and were followed up for a mean (SD) of 3.4 (2.6) years prior to death. From 1365 older persons with clinical evaluations, 69 were excluded for having dementia at baseline. From 538 older persons who died, 408 had annual assessments for scam susceptibility, cardiovascular risk burden, and cognitive function and consented to brain donation for detailed neuropathologic examination. Data were analyzed from June 2021 through September 2022.

Exposures

Neuropathologic examination identified the presence of macroscopic and microscopic infarcts, atherosclerosis, arteriolosclerosis, cerebral amyloid angiopathy, and common neurodegenerative pathologies (Alzheimer disease, limbic-predominant age-related transactive response DNA-binding protein 43 encephalopathy, and Lewy bodies).

Results

There was a total of 408 participants. The mean (SD) age at death was 91 (6.1) years, the mean (SD) amount of education was 15.6 (3.1) years, and 297 (73%) were women. Participants included 4 Latino individuals (1%), 7 non-Latino Black individuals (2%), and 397 non-Latino White individuals (97%). The frequency of participants with macroscopic infarcts was 38% (n = 154), microinfarcts was 40% (n = 163), and moderate to severe vessel disease; specifically, atherosclerosis was 20% (n = 83), arteriolosclerosis was 25% (n = 100), and cerebral amyloid angiopathy was 35% (n = 143). In linear regression models adjusted for demographics and neurodegenerative pathologies, macroscopic infarcts were associated with greater scam susceptibility (estimate [SE], 0.18 [0.07]; P = .009). This association persisted after adjusting for cardiovascular risk burden and global cognition. Regionally, infarcts localized to the frontal, temporal, and occipital lobes and thalamus were associated with greater scam susceptibility. Neither arteriosclerosis, atherosclerosis, cerebral amyloid angiopathy, nor microinfarcts were associated with scam susceptibility.

Conclusions and Relevance

Cerebrovascular pathologies, specifically cerebral infarcts, is linked with greater scam susceptibility in older adults, independent of common neurodegenerative diseases such as Alzheimer disease. Future studies examining in vivo magnetic resonance imaging markers of cerebrovascular pathologies with scam susceptibility and related decision-making outcomes will be important.

Self-reported fraud victimization and objectively measured blood pressure: Sex differences in post-fraud cardiovascular health

BACKGROUND

Over 5 million older Americans are victims of financial exploitation, schemes, and/or scams per year. Such victimization is associated with increased hospitalizations, admittance to skilled nursing facilities, and lower 5-year all-cause mortality survival rates. Despite this, associations with medical comorbidities like elevated blood pressure (BP) have not been examined.

METHODS

We investigated the association of self-reported fraud victimization (presence/absence) with objectively measured BP metrics leveraging cross-sectional and longitudinal data from over 1200 non-demented adults (75% female; age ~81 years) from the Rush Memory and Aging Project. We first examined cross-sectional associations between baseline fraud victimization and BP, then used longitudinal data to test the hypothesis that fraud victimization is associated with increases in BP after incident fraud. During up to 11 years of annual observation, participants were queried for fraud victimization and underwent serial BP measurements to calculate per visit averages of systolic and diastolic BP, mean arterial pressure (MAP), and pulse pressure.

RESULTS

Cross-sectional analyses established that fraud victimization at baseline was associated with higher BP values. Next, using longitudinal changepoint analyses, we showed that fraud victimization was associated with elevations in BP among men but not women. Specifically, men who reported incident fraud exhibited increases in all BP metrics post-fraud.

CONCLUSION

Results suggest an important link between fraud victimization and BP, particularly among men. Older men showed significant elevations in BP after incident fraud that, compounded over time, may portend other adverse health outcomes.

Aging is associated with maladaptive episodic memory-guided social decision-making

Older adults are frequent targets and victims of financial fraud. They may be especially susceptible to revictimization because of age-related changes in both episodic memory and social motivation. Here we examined these factors in a context where adaptive social decision-making requires intact associative memory for previous social interactions. Older adults made more maladaptive episodic memory-guided social decisions but not only because of poorer associative memory. Older adults were biased toward remembering people as being fair, while young adults were biased toward remembering people as being unfair. Holding memory constant, older adults engaged more with people that were familiar (regardless of the nature of the previous interaction), whereas young adults were prone to avoiding others that they remembered as being unfair. Finally, older adults were more influenced by facial appearances, choosing to interact with social partners that looked more generous, even though those perceptions were inconsistent with prior experience.

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.

Injury Patterns and Associated Demographics of Intimate Partner Violence in Older Adults Presenting to U.S. Emergency Departments

Intimate partner violence (IPV) is a global public health issue and occurs in intimate relationships regardless of age or sexual orientation. Several studies, most of them relying on small-scale samples, have explored the prevalence and risk factors of IPV in older adults. Still, none have focused on the demographics and injury patterns in older adult victims. Using the National Electronic Injury Surveillance System (NEISS) All Injury Program (AIP) data, we performed a retrospective analysis from 2005 through 2015 of the demographics and injuries of older adult IPV patients (>60 years old) presenting to emergency departments (EDs) compared to younger adult IPV patients (<60 years old). IPV accounted for 2,059,441 ED visits (.61%) with 37,534 (1.8%) visits in the older adults. Older adults were more frequently male (36.1% vs 16.8%), White (65.3% vs 52.8%), sustained fewer neck/head injuries (47.6% vs 59.4%), fewer contusions/abrasions (34.6% vs 47.2%), had more trunk fractures (38.4% vs 11.9%), trunk strains/sprains (39.5% vs 15.4%) and more hospital admissions (15.7 vs 4.2%), compared to younger IPV patients. Within the older adult cohort, females were more commonly White (71.2% vs 56.0%) while males were more commonly Black (36.3% vs 19.0%). Injuries in older adult males were more commonly lacerations (40.6% vs 14.2%%) and less commonly contusions/abrasions (33.8% vs 43.5%) compared to elderly females. Older adult females had more internal organ injuries than older adult males (18.9% vs 12.9%) and nearly all involved the head. Knowledge of these injury patterns in older adults can equip the health care providers when to be more suspicious of unexplained or suspicious injuries as the victim's symptoms at the presentation might not be directly related to violence.

The association between subjective age and financial exploitation vulnerability among older adults: The moderating role of social support

Financial exploitation of older adults bears detrimental physical and psychological consequences. However, risk factors of financial exploitation vulnerability (FEV) remain elusive. In line with a growing awareness of the importance of subjective perceptions of the aging process for older adults' functioning and well-being, this study examined the connection between subjective age (feeling younger/older than one's chronological age) and FEV, and the moderating effect of social support on this connection. Data were collected from a convenience sample of 137 Israeli older adults (age range 60-89, M = 69.90, SD = 6.85), who completed scales of FEV, subjective age, and social support, as well as relevant socio-demographic information. Older subjective age was associated with increased FEV when social support was low, but not when social support was high. Results are discussed in line with Socio-Emotional Selectivity Theory and provide initial information pertaining to the relevance of subjective age perceptions to FEV in older adults.

An Examination of Conditions Exposing Older Adults to Economic Abuse: Logistic Regression Analysis

The aim of this study was to determine factors affecting the economic abuse status of older adults. The study was conducted with 385 individuals aged 65 years and above, living in the Bahçelievler district of Istanbul. Data were collected using a Sociodemographic Form, and a Determination of Economic Abuse of Older Adults Form. Logistic regression analysis was applied to determine the factors affecting the economic abuse status of the older adults. The study participants comprised 51.4% males and 48.6% females with a mean age of 70.44 ± 6.73 years. It was determined that 9.4% of the older adults were exposed to economic abuse. As a result of the logistic regression analysis, the factors found to affect the situations of exposure to economic abuse of the older adults were age, income status, number of children, exposure to emotional abuse, and exposure to physical abuse.

Nonaccidental Injury in the Elderly: What Radiologists Need to Know

Elder abuse may result in serious physical injuries and long-term psychological consequences and can be life threatening. Over the past decade, attention to elder abuse has increased owing to its high prevalence, with one in six people aged 60 years and older experiencing some form of abuse worldwide. Despite this, the detection and reporting rates remain relatively low. While diagnostic imaging is considered critical in detection of child abuse, it is relatively underused in elder abuse. The authors discuss barriers to use of imaging for investigation and diagnosis of elder abuse, including lack of training, comorbidities present in this vulnerable population, and lack of communication among the intra- and interdisciplinary care providers. Moreover, imaging features that should raise clinical concern for elder abuse are reviewed, including certain types of fractures (eg, posterior rib), characteristic soft-tissue and organ injuries (eg, shoulder dislocation), and cases in which the reported mechanism of injury is inconsistent with the imaging findings. As most findings suggesting elder abuse are initially discovered at radiography and CT, the authors focus mainly on use of those modalities. This review also compares and contrasts elder abuse with child abuse. Empowered with knowledge of elderly victims' risk factors, classic perpetrator characteristics, and correlative imaging findings, radiologists should be able to identify potential abuse in elderly patients presenting for medical attention. Future recommendations for research studies and clinical workflow to increase radiologists' awareness of and participation in elder abuse detection are also presented. An invited commentary by Jubanyik and Gettel is available online. Online supplemental material is available for this article. ^©RSNA, 2022.

Anxiety and Depressive Symptoms are Associated with Perceived Financial Exploitation in Israeli Older Adults

OBJECTIVES

There are no studies that have investigated mental health correlates of financial exploitation (FE) in Israel. Israel has diverse cultural traditions that emphasize strong family ties and social embeddedness, factors which may impact FE correlates. This study aimed to examine mental health correlates of perceived FE in Israel.

METHODS

Israeli older adults (N = 137; mean age = 67.86, SD = 6.86, 51.5% female) were surveyed for history of FE, demographic measures, and depressive (CES-D) and anxiety symptoms (GAD-7).

RESULTS

Twenty-one participants self-reported a FE history (perceived FE group), and 115 denied a history (non-FE group). After controlling for age, sex, and education, the perceived FE group reported significantly more anxiety (F(1, 108) = 7.16, p = .009) and depressive symptoms (F(1, 103) = 13.90, p < .001) than the non-FE group. A greater frequency of perceived FE participants surpassed clinical cutoffs of anxiety and depression.

CONCLUSIONS

Perceived FE was associated with anxiety and depressive symptoms, and in some cases at clinically significant levels. Future studies aimed at understanding mechanisms of these relationships are needed.

CLINICAL IMPLICATIONS

Findings support the need for clinical evaluations for those who have experienced FE in order to provide mental health services when appropriate.

Financial Decision-Making in Neurological Patients

Financial abilities (FA) are a multi-dimensional domain comprising a wide range of conceptual, pragmatical, and judgmental skills ranging from basic abilities, such as bill payment, to high level abilities, such as financial decision-making (FDM). Preserved FDM abilities include the capacity to recognize fraud attempts, and they are fundamental for a person’s independence. Previous studies have reported decreased FDM in older adults and in patients with mild cognitive impairment (MCI), who consequently become more susceptible to fraud attempts. However, FDM has scarcely been investigated in other neurological populations, and it is unclear whether FDM may be predicted by more basic FA. The aim of the present study was to investigate FDM across patients with MCI, Parkinson’s disease (PD), or stroke, as well as healthy controls (HC), and to explore to what extent FDM could be inferred by other FA. We collected FDM and FA performances using the NADL-F short battery. Performances in the NADL-F short subtests were compared among groups. Additionally, the relationship between the scores at the FDM subtest and the performance obtained in other financial subtests of the NADL-F short were investigated for each group of participants. MCI patients performed worse than HC in FDM and in several FA domains. Conversely, FDM was relatively preserved in our sample of PD and stroke patients. In HC, FDM was associated with numeracy and financial knowledge applied to everyday situations, whereas this was true with some basic FA in both MCI and PD patients. No significant association was observed in stroke patients. Our results suggest that FDM is a complex ability, only partially inferable from other FA.

Bullying in Old Age: A Qualitative Study on Older Adults' Perceptions About Being Bullied

Significant demographic changes and a growing aging population increasingly emphasize the importance of assessing phenomena of violence against older adults, who constitute a vulnerable population. Therefore, bullying in old age is a poorly studied phenomena, but of growing importance. This study aims to analyze the perspectives of bullying in old age, using qualitative research at a cross-national level. We interviewed 173 older participants aged 65-91 years. Participants were Portuguese and English and lived in the community. Participants were subjected to semi-structured interviews. All the interviews went through a process of content analysis. Sample recruitment occurred through initial telephone contact, followed by a request to participate. Outcomes of content analysis produced seven themes, all of them associated with bullying experiences such as compromised learning capacity, loss of sense of agency and decision-making, asexuality, less attractive appearance, less social skills, gender discrimination, and less financial resources. Portuguese older adults felt mostly bullied for their loss of sense of agency and decision-making, less attractive appearance, less social skills, and less financial resources, while English participants mostly felt bullied for their compromised learning capacity, gender discrimination, and asexuality. The themes identified as being the most prominent in bullying are valuable guidelines for social policies and interventions toward bullying among older adults. Considering the scarcity of studies on bullying in older adults, this study is relevant for understanding the experience of older adults in relation to being bullied and for implementing psychosocial intervention programs including bullying situations that affect community-dwelling older adults.

Use of Telephone- and Internet-Based Support to Elicit and Address Financial Abuse and Mismanagement in Dementia: Experiences from the Care Ecosystem Study

BACKGROUND

Financial mismanagement and abuse in dementia have serious consequences for patients and their families. Vulnerability to these outcomes reflects both patient and contextual factors.

OBJECTIVE

Our study aimed to assess how multidisciplinary care coordination programs assist families in addressing psychosocial vulnerabilities and accessing needed resources.

METHODS

Our study was embedded in a clinical trial of the Care Ecosystem, a telephone- and internet-based supportive care intervention for patients with dementia and caregivers. This program is built around the role of the Care Team Navigator (CTN), an unlicensed dementia care guide who serves as the patient and caregiver's primary point of contact, screening for common problems and providing support. We conducted a qualitative analysis of case summaries from a subset of 19 patient/caregiver dyads identified as having increased risk for financial mismanagement and abuse, to examine how Care Ecosystem staff identified vulnerabilities and provided support to patients and families.

RESULTS

CTNs elicited patient and caregiver needs using templated conversations to address common financial and legal planning issues in dementia. Sources of financial vulnerability included changes in patients' behavior, caregiver burden, intrafamily tension, and confusion about resources to facilitate end-of-life planning. The Care Ecosystem staff's rapport with their dyads helped them address these issues by providing emotional support, information on how to access financial, medical, and legal resources, and improving intra-familial communication.

CONCLUSION

The Care Ecosystem offers a scalable way to address vulnerabilities to financial mismanagement and abuse in patients and caregivers through coordinated care by unlicensed care guides supported by a multidisciplinary team.

Elder Financial Abuse and Electronic Financial Instruments: Present and Future Considerations for Financial Capacity Assessments

Personal economic stability is one of the core social determinants of health and longevity, and managing one's finances is an instrumental activity of daily living. Impaired financial decision-making can lead to poor health, emotional distress, and loss of independence and safety. Older adults in the United States lose billions of dollars annually to elder financial abuse (EFA), which may be preceded by a decline of capacity to make financial decisions. A literature review regarding EFA, electronic financial instruments (EFI), medical and financial decision-making capacity evaluations, and biomedical ethics was performed. Currently, there is no gold standard clinical assessment tool for evaluating financial capacity. The instruments in use have yet to formally integrate modern EFI that present novel mechanisms through which EFA can occur. This article summarizes the current state of EFA in the United States, risk factors and strategies for prevention, and offers a clinician administered screening questionnaire for addressing EFI use along with a semi-structured approach to clinical financial capacity assessments.

Elder Mistreatment Methods and Measures in Round 3 of the National Social Life, Health, and Aging Project

OBJECTIVES

Elder mistreatment has negative consequences for older adults' health and well-being. As such, scholars aim to understand its causes, the contexts in which it occurs, how to prevent victimization, and how to design interventions for mistreated older adults. This paper provides a detailed overview of the 2015-2016 National Social Life, Health, and Aging Project (NSHAP) Round 3 Elder Mistreatment Module (EMM) to encourage further research on the topic.

METHOD

This paper reviews previous elder mistreatment scholarship, describes the EMM, provides descriptive analyses of elder mistreatment among community-dwelling older adults, and discusses promising approaches and limitations to future research with these data.

RESULTS

The EMM includes 10 stem questions to measure elder mistreatment behaviors experienced since age 60 and 2 follow-up questions about perceived severity and the identity of the perpetrator. The stem questions can be analyzed individually or combined into a scale, and researchers can account for severity as a robustness check. Analysts can also group the measures into specific types of elder mistreatment. A major strength of the EMM is its ability to identify perpetrators in victims' core social networks.

DISCUSSION

The NSHAP Round 3 EMM provides scholars an opportunity to study older Americans' mistreatment experiences, particularly as they relate to their physical and mental health, their social networks and personal relationships, and their broader social contexts.

Financial abuse of older people by third parties in banking institutions: a qualitative exploration

Financial abuse is a significant form of elder maltreatment and is frequently ranked in the top two most common forms of abuse perpetration. Despite this, it is under-identified, under-reported and under-prosecuted. Financial institutions, such as banks, are important environments for identifying and responding to the financial abuse of older people. Traditionally, banks have not always been part of inter-sectorial responses to financial abuse, yet are important stakeholders. The aim of this study is to explore perceptions and experiences of financial abuse in five national banks. Data were collected from 20 bank managers and five members of the National Safeguarding Committee in the Republic of Ireland. Using thematic analysis, four themes were identified: defining a vulnerable adult; cases of financial abuse of vulnerable adults; case responses to financial abuse of vulnerable adults; and contextual issues. The data demonstrate the multiplicity of manifestations and the complexity of case investigation and management. Findings point to the need to enhance banks’ responses, through additional education and training, and promote integrated inter-sectorial collaboration. In addition, a change in societal beliefs is needed regarding financial entitlement, responding to ageism, public awareness of the consequences of financial decisions and types of financial abuse, as well as ensuring such crimes are addressed within the legal system.

The neglected contributions of self-efficacy to older adults’ financial capacity

Purpose

An ageing population comes with its own set of challenges such as impaired financial capacity and resultant dependency on others to manage financial affairs. Dependency, in turn, as the evidence suggests, creates opportunities for financial exploitation of older adults. Related studies have primarily examined the clinical features and correlates of financial capacity or have attempted to develop its multidimensional measures. Both of which do little to resolve issues associated with impaired financial capacity. This paper aims to make a case for future researchers to assess older adults’ financial capacity from a non-clinical aspect.

Design/methodology/approach

Drawing on the notion of self-efficacy, as encapsulated within the social cognitive theory, this paper presents evidence from a host of different domains to demonstrate the potential contributions of self-efficacy to older adults’ financial capacity.

Findings

The contributions of self-efficacy in preserving older adults’ financial capacity appear to be much more profound than is currently acknowledged in the literature, thereby overlooking potentially promising and cost-effective interventions for autonomous ageing.

Originality/value

This paper presents a novel application of self-efficacy to autonomous ageing. Within this context, potential routes to the deployment of self-efficacy-based interventions are also discussed.

Elder Abuse Vulnerability and Risk Factors: Is Financial Abuse Different From Other Subtypes?

Elder abuse (EA) affects one in six older adults, and financial EA, a common subtype, severely impacts victims and society. Understanding victim vulnerability and perpetrator risk factors is essential to EA prevention and management. The limited existing evidence about these factors in relation to EA types suggests that financial EA is different. In a cross-sectional quantitative analysis of secondary data (N = 1,238), we investigated EA vulnerability and risk factors, and victim-perpetrator family relationship, with respect to different EA types (financial only, financial co-occurring with other types, and nonfinancial abuse). Financial abuse-only cases had the lowest prevalence of vulnerability and risk factors. Most of these factors, and a familial relationship, were significantly more common in cases involving other EA types. Findings indicate that financial abuse, occurring in isolation, is distinct from other EA types. Risk assessment and future research should consider financial abuse separately to other EA forms.

Association of Amyloid-β Pathology with Decision Making and Scam Susceptibility

BACKGROUND

Recent findings suggest that poor decision making and increased scam susceptibility are harbingers of Alzheimer's disease (AD) dementia and may be among the earliest behavioral manifestations of pathologic cognitive aging. However, the degree to which poor decision making and scam susceptibility reflect accumulating Alzheimer's disease (AD) pathology remains unclear.

OBJECTIVE

To investigate the associations of AD pathology with decision making and scam susceptibility in older adults without dementia.

METHODS

Data came from 198 deceased participants without clinical dementia (mean age at death = 90 years; 69%women) from two ongoing studies of aging. All underwent annual clinical evaluations, completed assessments of healthcare and financial decision making and scam susceptibility, and brain donation. Neuropathologic evaluations quantified pathologic hallmarks of AD, amyloid-β and tau-tangles, Lewy body pathology, and TDP-43 proteinopathy.

RESULTS

In linear regression models adjusted for demographics, amyloid-β pathology was associated with lower decision making (estimate = -0.35; SE = 0.16, p = 0.03), particularly healthcare decision making (estimate = -0.20; SE = 0.09, p = 0.03), as well as greater scam susceptibility (estimate = 0.12; SE = 0.04, p = 0.003); tau-tangle pathology was not related. Further, TDP-43 pathology was associated with greater scam susceptibility (estimate = 0.10; SE = 0.04; p = 0.02).

CONCLUSION

Accumulating AD pathology, particularly amyloid-β, is associated with poor decision making and increased scam susceptibility among older persons without overt cognitive impairment. These findings provide compelling evidence that decision making and scam susceptibility are sensitive to the earliest pathological changes of AD.

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

IMPORTANCE

Elder mistreatment is associated with major health and psychosocial consequences and is recognized by clinicians, policy makers, and researchers as a pervasive problem affecting a rapidly aging global population.

OBJECTIVE

To estimate the incidence of elder mistreatment and identify factors associated with the risk of new cases.

DESIGN, SETTING, AND PARTICIPANTS

This research is a 10-year, longitudinal, population-based, cohort study of the incidence of elder mistreatment in New York State households conducted between 2009 (wave 1) and 2019 (wave 2). At wave 1, random digit-dial (landline and cellular telephones) stratified sampling was done to recruit English-speaking and/or Spanish-speaking, cognitively intact, community-dwelling older adults (aged ≥60 years) across New York State. The current study conducted computer-assisted telephone interviews with older adults who participated in wave 1 and gave permission to be contacted again for wave 2 interviews (response rate, 60.7%). Data analysis was performed from October 2020 to January 2021.

EXPOSURES

Physical factors (health status, functional capacity, and age), living arrangement (coresidence), and sociocultural characteristics (sex, race/ethnicity, geocultural context, and household income).

MAIN OUTCOMES AND MEASURES

Ten-year incidence for overall elder mistreatment and subtypes (financial abuse, emotional or psychological abuse, physical abuse, and neglect) were measured using adapted versions of the Conflict Tactics Scale, the Duke Older Americans Resources and Services scale, and the New York State Elder Mistreatment Prevalence Study financial abuse tool.

RESULTS

The analytical sample included 628 older adults (mean [SD] age at wave 1, 69.20 [6.95] years; age at wave 2, 79.40 [6.93] years; 504 non-Hispanic White individuals [80.9%]; 406 women [64.6%]). Ten-year incidence rates were 11.4% (95% CI, 8.8%-14.3%) for overall elder mistreatment, 8.5% (95% CI, 6.3%-10.9%) for financial abuse, 4.1% (95% CI, 2.6%-5.7%) for emotional abuse, 2.3% (95% CI, 1.2%-3.6%) for physical abuse, and 1.0% (95% CI, 0.3%-1.8%) for neglect. Poor self-rated health at wave 1 was associated with increased risk at wave 2 of new overall mistreatment (odds ratio [OR], 2.86; 95% CI, 1.35-5.84), emotional abuse (OR, 3.67; 95% CI, 1.15-11.15), physical abuse (OR, 4.21; 95% CI, 1.14-13.70), and financial abuse (OR, 2.80; 95% CI, 1.16-6.38). Compared with non-Hispanic White participants, Black participants were at heightened risk of overall mistreatment (OR, 2.61; 95% CI, 1.16-5.70) and financial abuse (OR, 2.80; 95% CI, 1.09-6.91). A change from coresidence to living alone was associated with increased risk of financial abuse (OR, 2.74; 95% CI, 1.01-7.21).

CONCLUSIONS AND RELEVANCE

These findings suggest that health care visits may be important opportunities to detect older adults who are at risk of mistreatment. Race is highlighted as an important social determinant for elder mistreatment requiring urgent attention.

Susceptibility to Scams in Older Black and White Adults

Previous reports on racial differences in scam susceptibility have yielded mixed findings, and few studies have examined reasons for any observed race differences. Older Black and White participants without dementia (N = 592) from the Minority Aging Research Study and the Rush Memory and Aging Project who completed a susceptibility to scam questionnaire and other measures were matched according to age, education, sex, and global cognition using Mahalanobis distance. In adjusted models, older Black adults were less susceptible to scams than older White adults (Beta = -0.2496, SE = 0.0649, p = 0.0001). Contextual factors did not mediate and affective factors did not moderate this association. Analyses of specific items revealed Black adults had greater knowledge of scam targeting of older adults and were less likely to pick up the phone for unidentified callers. Older Black adults are less susceptible to scams than demographically-matched older White adults, although the reasons remain unknown.

Correlates of Susceptibility to Scams in Community-Dwelling Older Black Adults

INTRODUCTION

Evidence suggests that older Black adults are frequent victims of financial fraud and exploitation. This study aims to identify the factors associated with scam susceptibility in older Black adults.

METHODS

Participants were 383 older Black adults living in the Chicago metropolitan area (mean age = 78 years and 82% female). A scam susceptibility measure assessed perceptions and behaviors that predispose older adults to fraud and scams. Categories of age-associated factors, including cognition, physical health, psychosocial factors, personality, and behavioral economics, were measured using uniform systematic assessments. For each category separately, measures associated with scam susceptibility were identified via stepwise variable selection.

RESULTS

Older age was associated with greater scam susceptibility. Further, the analysis revealed a robust association of cognitive health with scam susceptibility, particularly the domains of semantic and working memory. Psychological well-being was associated with susceptibility, as was neuroticism. Behavioral economic measures including financial and health literacy and financial and health decision-making ability were also implicated. In a final model that included all the measures initially retained by variable selection, semantic memory, psychological well-being, and financial and health literacy were independently associated with scam susceptibility. Moreover, the association of age was attenuated and no longer significant after adjusting for these correlates.

DISCUSSION

Age-associated vulnerabilities, rather than age itself, predispose older Black adults to financial fraud and scams. The correlates of scam susceptibility in community-living older Black adults primarily involve cognitive health, psychological, and behavioral economic factors.

Age and intranasal oxytocin effects on trust-related decisions after breach of trust: Behavioral and brain evidence

Age-related differences in cognition and socioemotional functions, and in associated brain regions, may reduce sensitivity to cues of untrustworthiness, with effects on trust-related decision making and trusting behavior. This study examined age-group differences in brain activity and behavior during a trust game. In this game, participants received "breach-of-trust" feedback after half of the trials. The feedback indicated that only 50% of the monetary investment into their fellow players had resulted in returns. The study also explored the effects of intranasal oxytocin on trust-related decisions in aging, based on suggestions of a modulatory role of oxytocin in response to negative social stimuli and perceptions of trust. Forty-seven younger and 46 older participants self-administered intranasal oxytocin or placebo, in a randomized, double-blind, between-subjects procedure, before they engaged in the trust game while undergoing functional magnetic resonance imaging (fMRI). Younger participants invested less into their game partners after breach-of-trust feedback, while older participants showed no significant difference in their investment after breach-of-trust feedback. Oxytocin did not modulate the behavioral effects. However, after breach-of-trust feedback, older participants in the oxytocin group showed less activity in the left superior temporal gyrus. In contrast, older participants in the placebo group showed more activity in left superior temporal gyrus after breach of trust. The findings may reflect reduced responsiveness to cues of untrustworthiness in older adults. Furthermore, the modulatory effect of oxytocin on left superior temporal gyrus activity among older adults supports the neuropeptide's age-differential role in neural processes in aging, including in the context of trust-related decision making. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Financial Presentation of Alzheimer Disease and Related Dementias

IMPORTANCE

Alzheimer disease and related dementias (ADRD), currently incurable neurodegenerative diseases, can threaten patients' financial status owing to memory deficits and changes in risk perception. Deteriorating financial capabilities are among the earliest signs of cognitive decline, but the frequency and extent of adverse financial events before and after diagnosis have not been characterized.

OBJECTIVES

To describe the financial presentation of ADRD using administrative credit data.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective secondary data analysis of consumer credit report outcomes from 1999 to 2018 linked to Medicare claims data included 81 364 Medicare beneficiaries living in single-person households.

EXPOSURES

Occurrence of adverse financial events in those with vs without ADRD diagnosis and time of adverse financial event from ADRD diagnosis.

MAIN OUTCOMES AND MEASURES

Missed payments on credit accounts (30 or more days late) and subprime credit scores.

RESULTS

Overall, 54 062 (17 890 [33.1%] men; mean [SD] age, 74 [7.3] years) were never diagnosed with ADRD during the sample period and 27 302 had ADRD for at least 1 quarter of observation (8573 [31.4%] men; mean [SD] age, 79.4 [7.5] years). Single Medicare beneficiaries diagnosed with ADRD were more likely to miss payments on credit accounts as early as 6 years prior to diagnosis compared with demographically similar beneficiaries without ADRD (7.7% vs 7.3%; absolute difference, 0.4 percentage points [pp]; 95% CI, 0.07-0.70:) and to develop subprime credit scores 2.5 years prior to diagnosis (8.5% vs 8.1%; absolute difference, 0.38 pp; 95% CI, 0.04-0.72). By the quarter after diagnosis, patients with ADRD remained more likely to miss payments than similar beneficiaries who did not develop ADRD (7.9% vs 6.9%; absolute difference, 1.0 pp; 95% CI, 0.67-1.40) and more likely to have subprime credit scores than those without ADRD (8.2% vs 7.5%; absolute difference, 0.70 pp; 95% CI, 0.34-1.1). Adverse financial events were more common among patients with ADRD in lower-education census tracts. The patterns of adverse events associated with ADRD were unique compared with other medical conditions (eg, glaucoma, hip fracture).

CONCLUSIONS AND RELEVANCE

Alzheimer disease and related dementias were associated with adverse financial events years prior to clinical diagnosis that become more prevalent after diagnosis and were most common in lower-education census tracts.

Pent-up demand for care among dual-eligible victims of elder financial exploitation in Maine

Elder financial exploitation (EFE), the misuse of a vulnerable adult's property or resources for personal gain, is a form of elder abuse. This study addresses whether dual-eligible EFE victims were experiencing pent-up demand for health services alleviated through investigation by Adult Protective Services (APS). A quasi-experimental design addressed health service utilization and costs for 131 dual-eligible Maine APS clients over age 60 with substantiated allegations of EFE relative to comparable non-APS controls. APS case files spanning 2007-2012 were linked to 2006-2014 Medicare and Medicaid claims data. Service utilization and costs were analyzed 1 year prior, during, and 2 years after the initial APS investigation. Difference in differences logistic regression and generalized linear models addressed the likelihood of incurring costs and expenditure levels relative to matched controls, respectively. Victims of EFE had higher overall odds of using inpatient and long-term services and supports (LTSS) and higher odds of using LTSS post-investigation than controls. Higher overall levels of outpatient and prescriptions expenditures and higher inpatient expenditures during the APS event year contributed toward APS clients incurring $1,142 higher PMPM total costs than controls. Victims of EFE were experiencing significant pent-up demand for health services post-APS involvement.

Physical and mental health correlates of perceived financial exploitation in older adults: Preliminary findings from the Finance, Cognition, and Health in Elders Study (FINCHES)

Objectives: Financial exploitation (FE) in old age is poorly understood, particularly among those without significant cognitive impairment. The Finance, Cognition, and Health in Elders Study (FINCHES) aims to identify factors associated with FE among cognitively-healthy older adults. Preliminary findings regarding physical and mental health correlates in the pilot phase of FINCHES are reported.Method: Sixteen older adults who self-reported FE were demographically-matched on age, education, sex, and race/ethnicity to eighteen older adults who did not report past FE.Results: Those who believed they were exploited endorsed significantly greater symptoms of depression (p = 0.014) and marginally greater symptoms of anxiety (p = 0.062). Participants trended towards lower perceived successful aging (p = 0.094). Perceived FE participants also endorsed greater medical conditions (p = 0.047), but follow-up individual item analyses suggest that this was driven by problems with sleep (p = 0.030).Conclusions: These preliminary findings from the pilot phase of FINCHES highlight negative mental health factors associated with perceived FE among cognitively-intact older adults.

Elder Abuse in the Out-of-Hospital and Emergency Department Settings: A Scoping Review

This scoping review aimed to synthesize the available evidence on the epidemiology, patient- and caregiver-associated factors, clinical characteristics, screening tools, prevention, interventions, and perspectives of health care professionals in regard to elder abuse in the out-of-hospital or emergency department (ED) setting. Literature search was performed with MEDLINE, EMBASE, the Cumulative Index of Nursing and Allied Health, PsycINFO, and the Cochrane Library. Studies were eligible if they were observational or experimental and reported on elder abuse in the out-of-hospital or ED setting. A qualitative approach, performed independently by 2 reviewers, was used to synthesize and report the findings. A total of 413 citations were retrieved, from which 55 studies published between 1988 and 2019 were included. The prevalence of elder abuse reported during the ED visit was lower than reported in the community. The most commonly detected type of elder abuse was neglect, and then physical abuse. The following factors were more common in identified cases of elder abuse: female sex, cognitive impairment, functional disability, frailty, social isolation, and lower socioeconomic status. Psychiatric and substance use disorders were more common among victims and their caregivers. Screening tools have been proposed, but multicenter validation and influence of screening on patient-important outcomes were lacking. Health care professionals reported being poorly trained and acknowledged numerous barriers when caring for potential victims. There is insufficient knowledge, limited training, and a poorly organized system in place for elder abuse in the out-of-hospital and ED settings. Studies on the processes and effects of screening and interventions are required to improve care of this vulnerable population.

Older and wiser: age differences in susceptibility to investment fraud: the protective role of emotional intelligence

There have been inconsistent results regarding whether older adults are more vulnerable to fraud than younger adults. The two main goals of this study were to investigate the claim that there is an age-related vulnerability to fraud and to examine whether emotional intelligence (EI) may be associated with fraud susceptibility. Participants (N = 281; 18-82 years; M = 53.4) were recruited via Amazon's Mechanical Turk and completed measures of EI, decision-making, and scam susceptibility. Participants who scored higher on "ability" EI were less susceptible to scams. The "younger" group (M = 2.50, SD = 1.06) was more susceptible to scams than the "older" group, p <.001, d = 0.56, while the "older" group (M = 4.64, SD = 1.52) reported the scams as being more risky than the "younger" group, p =.002, d = 0.37. "Older" participants were more sensitive to risk, less susceptible to persuasion, and had higher than average emotional understanding. Emotional understanding was found to be a partial mediator for age-related differences in scam susceptibility and susceptibility to persuasion.

Exploring an Emerging Measurement Issue in Older Adult Maltreatment: Exploitation of Older Adults' Residences

Despite nationwide housing challenges that might lead to the exploitation of older adults' housing resources, exploitation of older adults' residences has not been a focus of measurement in the rapidly developing field of elder abuse and neglect. Rather, measures of older adult abuse and exploitation used in the research literature emphasize specific property, money, or resources being taken. Two composites are used to illustrate exploitation of older adults' residences by trusted others on whom the older adults depended with potentially serious implications for environmental safety and ultimately the older adults' housing stability. As part of a larger study on older adult maltreatment, police reports were coded for abuse and financial exploitation as well as misuse of the older adult's residence that threatened the older adult's housing security and/or exerted control over the older adult. Nearly one in ten (9.2%) police reports involving older adult victims and known/trusted perpetrators described exploitation of residences. Residence exploitation was separable from financial exploitation and less likely to co-occur with neglect. Considering the importance of housing stability to older adult well-being, consequences of maltreatment by a known/trusted other, and a national housing crisis, we propose that exploitation of older adults' residences warrants further measurement and practice attention. Findings are relevant to advancing theory in older adult maltreatment (e.g., application of white-collar crime versus betrayal trauma and family violence theories).

Uncovering Susceptibility Risk to Online Deception in Aging

OBJECTIVES

Fraud in the aged is an emerging public health problem. An increasingly common form of deception is conducted online. However, identification of cognitive and socioemotional risk factors has not been undertaken yet. In this endeavor, this study extended previous work suggesting age effects on susceptibility to online deception.

METHODS

Susceptibility was operationalized as clicking on the link in simulated spear-phishing emails that young (18-37 years), young-old (62-74 years), and middle-old (75-89 years) Internet users received, without knowing that the emails were part of the study. Participants also indicated for a set of spear-phishing emails how likely they would click on the embedded link (susceptibility awareness) and completed cognitive and socioemotional measures to determine susceptibility risk profiles.

RESULTS

Higher susceptibility was associated with lower short-term episodic memory in middle-old users and with lower positive affect in young-old and middle-old users. Greater susceptibility awareness was associated with better verbal fluency in middle-old users and with greater positive affect in young and middle-old users.

DISCUSSION

Short-term memory, verbal fluency, and positive affect in middle-old age may contribute to resilience against online spear-phishing attacks. These results inform mechanisms of online fraud susceptibility and real-life decision-supportive interventions toward fraud risk reduction in aging.

Mental and Physical Health Correlates of Financial Difficulties Among African-American Older Adults in Low-Income Areas of Los Angeles

Background: While financial difficulties correlate with mental and physical health status, less is known about these associations among economically disadvantaged African-American (AA) older adults. Objective: This study explored mental and physical health correlates of financial difficulties among AA older adults in low-income areas of south Los Angeles. Methods: A cross-sectional study on 740 AA older adults (age ≥ 55 years) conducted in South Los Angeles between 2015 and 2018. Independent variable was financial difficulties. Outcomes were depressive symptoms, chronic pain, chronic medical conditions, self-reported health, and sick days. Age, gender, educational attainment, living alone, marital status, smoking, and drinking were also measured. Zero order (unadjusted) and partial (adjusted) correlates of financial difficulties were calculated for data analysis. Adjusted (partial) bivariate correlations controlled for age, gender, education, marital status, living alone, and health insurance. Results: In adjusted analyses, financial difficulties were positively associated with chronic pain, chronic medical conditions, self-rated health, sick days, and depressive symptoms. Conclusion: Financial difficulties seem to be linked to chronic pain, chronic medical conditions, self-rated health, sick days, and depressive symptoms. The results advocate for evaluation of social determinants of health in providing health care of AA older adults. Addressing financial difficulties may help with the health promotion of low-income AA older adults in urban areas.

Demographic-based risk of reporting psychopathology and poor health among mistreated older adults in the national elder mistreatment study wave II

Objectives: Past year elder mistreatment rate is about 11% of community residing older adults, with significant demographic-based variations in prevalence. However, very little research on demographic variable-based differences in correlates of elder abuse, such as mental health, exist. The National Elder Mistreatment Study 8-year follow-up (NEMS II) specifically investigated the relation between demographic factors and the presence of these correlates (i.e. diagnoses of depression, post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and self-ratings of physical health).Methods: The NEMS II used random digit dial telephone survey methodology to assess demographic variables and reports of depression PTSD, GAD, and poor health, in 774 older adults. RESULTS: a consistent association was observed between demographic factors related to financial status and poor mental and general health ratings.Discussion: A subset of demographic factors associated with increased risk of reporting elder abuse, low income and financial distress, were also associated with increased risk of reporting correlates of elder abuse that included depression, PTSD GAD and poor health.

Prevalence of elder abuse among community-dwelling older adults in Turkey and its associated factors

BACKGROUND

This study was performed to determine the prevalence of elder abuse among community-dwelling older adults and its associated risk factors.

METHODS

The sample in this cross-sectional study consisted of 691 older adults. Data were collected with an elder abuse and neglect assessment form, which had been prepared by the researchers in accordance with the literature. Logistic regression analysis was used to identify factors related to subtypes of elder abuse.

RESULTS

In this study, 13.6% of the elderly subjects (n = 94) were exposed to at least one instance of abusive behaviour within the last year; emotional abuse was the most frequently occurring type of abuse. Risk factors for abuse were being 75 years old or older (odds ratio (OR) = 1.993, 95% confidence interval (CI): 1.105-3.592), being illiterate (OR = 4.863, 95%CI: 2.809-8.417), lack of own income (OR = 2.189, 95%CI: 1.179-4.064), having bad family relationships (OR = 20.564, 95%CI: 5.453-77.554), and lack of own home (OR = 3.945,; 95%CI: 1.167-13.330).

CONCLUSIONS

The results of this study showed that abuse was an important problem for the elderly population. Therefore, elderly individuals, especially those who are 75 years old or older, have a low education level, lack their own home, and lack their own income, should be evaluated for abuse.

Maltrato a las personas mayores: una revisión narrativa

El maltrato a las personas mayores es un tema de interés creciente, tanto así que se considera un problema de salud pública. Hay particularidades que hacen del entorno colombiano un ambiente propicio para generar situaciones de maltrato: la exposición a la “violencia a gran escala”, la diferencia de género y el cambio de la pirámide poblacional. Según el estudio SABE Colombia, el 12,9 % de las personas mayores informó haber sufrido maltrato, del cual el más común es el psicológico, seguido por el físico, el financiero y el sexual. A pesar de que el Estado reconoce al adulto mayor como “sujeto de especial protección”, aún hay desconocimiento por parte de los profesionales de la salud a la hora de enfrentar estos casos. Este debería ser un tema de obligatoriedad moral, por lo que se debe abordar a profundidad para así identificarlo oportunamente y proponer estrategias de prevención de una manera contextualizada. Esta revisión de la literatura tiene por objetivos sintetizar la información epidemiológica disponible, los factores de riesgo y las estrategias de evaluación y plantear las rutas de atención idóneas asentadas en los aspectos legales alrededor del maltrato hacia los ancianos en Colombia.

Elder Abuse Characteristics Based on Calls to the National Center on Elder Abuse Resource Line

Characterizing the types of elder abuse and identifying the characteristics of perpetrators are critically important. This study examined the types of elder abuse reported to the National Center on Elder Abuse (NCEA) resource line. Calls were coded with regard to whether abuse was reported, types of abuse alleged, whether multiple abuse subtypes occurred, and who perpetrated the alleged abuse. Of the 1,939 calls, 818 (42.2%) alleged abuse, with financial abuse being the most commonly reported (449 calls, 54.9%). A subset of calls identified multiple abuse types (188, 23.0%) and multiple abusers (149, 18.2%). Physical abuse was most likely to co-occur with another abuse type (61/93 calls, 65.6%). Family members were the most commonly identified perpetrators (309 calls, 46.8%). This study reports the characteristics of elder abuse from a unique source of frontline data, the NCEA resource line. Findings point to the importance of supportive resources for elder abuse victims and loved ones.

Why are older adults victims of fraud? Current knowledge and prospects regarding older adults' vulnerability to fraud

Older adults are disproportionately targeted by various kinds of fraud, which result in irreversible economic losses and great psychological distress. Over the past years, researchers have conducted systematic research on the prevalence, under-reporting, and research methods of fraud victimization in older adults. Research paradigms regarding fraud victimization among older adults have mainly included cognitive, emotion regulation and motivation, and comprehensive paradigms. Factors shown to influence fraud victimization among older adults include cognitive decline, emotional regulation and motivational changes, their overly trusting nature, psychological vulnerability, social isolation, risk-taking, and a lack of knowledge and information regarding fraud prevention. Based on a review of the literature, future research can benefit from constructing a comprehensive fraud victimization theory, improving research methods, extending existing research, exploring physiological mechanisms of elderly fraud, and strengthening prevention and intervention efforts.

CISDA: Changes in Integration for Social Decisions in Aging

The aging of our population has been accompanied by increasing concerns about older adults' vulnerability to violations of trust and a growing interest in normative age-related changes to decision making involving social partners. This intersection has spurred research on age-related neurocognitive and affective changes underlying social decision making. Based on our review and synthesis of this literature, we propose a specification that targets social decision making in aging to the recently proposed Affect-Integration-Motivation (AIM) framework. Our framework specification, Changes in Integration for Social Decisions in Aging (CISDA), emphasizes three key components of value integration with particular relevance for social decisions in aging: theory of mind, emotion regulation, and memory for past experience. CISDA builds on converging research from economic decision making, cognitive neuroscience, and lifespan development to outline how age-related changes to neurocognition and behavior impact social decision making. We conclude with recommendations for future research based on CISDA's predictions, including implications for the development of interventions to enhance social decision outcomes in older adults. This article is categorized under: Economics > Individual Decision Making Psychology > Reasoning and Decision Making Psychology > Development and Aging Neuroscience > Cognition.