Medical Implications of Elder Abuse and Neglect

Developing a model for providing feedback to reporters of elder abuse

Lack of feedback about reports made to Adult Protective Services (APS) is an important barrier to elder mistreatment reporting. To better understand barriers and facilitators to APS-reporter communication, we conducted an environmental scan of state policies and practices. We gathered publicly available information from 52 states and territories on APS administrative structure, reporting, intake, investigation, and feedback processes; performed a secondary analysis of focus groups with Emergency Medical Services providers and APS staff; and interviewed 44 APS leaders in 24 states/territories. Results revealed variation in information-sharing with reporters. Qualitative analyses revealed three overarching themes related to whether, when, and how information is shared. Results were used to develop a model illustrating factors influencing APS decisions on sharing information. This model incorporates the type of reporter (professional or nonprofessional), their relationship with the APS client (brief or ongoing), and the potential risks and benefits of sharing information with the reporter.

Nature, prevalence, and risk factors for self-neglect among older people: a pilot study from Vellore, South India

Changes in demography in developing countries haves led to new issues among older rural populations, such as self-neglect which is under researched.Self-neglect identified as poor self-care, unsafe living quarters, inadequate medical care and poor utilization of services increase the odds of morbidity and mortality.Methods Our study was conducted in Kaniyambadi, a rural block in Vellore district in the state of Tamil Nadu, India. Ten villages were randomly selected. The study was conducted among people older than 60 years who were selected by random sampling using a computer-generated list. The following assessments were done: (i) A 19-item questionnaire was used to assess self-neglect, (ii) Katz index of daily living to assess functional activity, (iii) Mini Mental State Examination to evaluate cognition, (iv) Geriatric Depression Scale to identify depression, (v) Duke Social Support Index to measure social supports. Clinical data and anthropometric data were also collected. Data were entered into Epidata v3.1. All analyses were performed using SPSS v23.0.Results One hundred fourteen people above 60 years of age participated. The prevalence of self-neglect was 21.1% (95% CI 14.9%-29%); about half of the elderly population (47.38%) refused to seek or follow medical advice. Lower levels of education (OR 3.678, 95% CI 1.017 - 13.301), lower social class (OR 4.455, 95% CI 1.236 - 16.050) and functional impairment (3.643, 95% CI 1.373 - 9.668) were found to be significant factors associated with self-neglect. Though prevalence of comorbidities (70%) and depression (27%) were high, there was no statistical evidence of association with self-neglect.

The relationship between activities of daily living and abuse in the elderly: cross-sectional study during covid 19

To determine the relationship between activities of daily living in the elderly and elder abuse, the research was conducted during the COVID-19 process. This study was performed as descriptive and cross -sectional. For data collection, the Standardized Mini-Mental State Examination (SMMSE), Personal Information Form, Barthel Index of Activities of Daily Living (BIADL) and Hwalek-Sengstock Elder Abuse Screening Test (HS/EAST) were used. It was determined that 43.8% of the elderly participants were moderately dependent while performing activities of daily living, and 63.4% were exposed to some kind of abuse. The HS/EAST total mean scores of elderly people who were highly dependent while performing activities of daily living were found to be higher. It was determined that as the dependency levels of the elderly in their activities of daily living increased, the rate of exposure to abuse increased.

Early Stages of COVID-19 Pandemic Had No Discernable Impact on Risk of Elder Abuse and Neglect Among Dementia Family Caregivers: A Daily Diary Study

There is widespread concern that elder abuse and neglect (EAN) incidents increased during the onset of the COVID-19 pandemic due in part to increases in risk factors. Initial reports relying on administrative systems such as adult protective services records produced mixed results regarding whether or not there was a change in EAN incidents. Using data from an ongoing longitudinal study on EAN in dementia family caregiving that started before the pandemic, we assessed the hypothesis that the pandemic is related to a change in probability of EAN and EAN protective factors. Family caregivers to persons with dementia completed two waves of 21 daily diaries, 6-months apart, assessing their daily use of EAN behaviors. The first group (n = 32) completed their first wave before the pandemic and their second wave during the pandemic. The second group (n = 32) completed both waves during the pandemic. For this cohort, the generalized linear mixed logistic model results showed inconsistent associations between the onset of COVID-19 and the probability of a caregiver engaging in elder abuse or neglect behaviors. In terms of protective factors, the use of formal services was not significantly impacted by COVID-19; however, the likelihood of receiving informal support from family and friends increased significantly during the pandemic period. Dementia family caregivers were not likely impacted negatively by initial pandemic restrictions, such as shelter-in-place orders, as anticipated. These findings contribute to our understanding of how distal, disruptive processes may influence more proximal caregiver stresses and the likelihood of EAN.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10896-022-00392-8.

Association of elder abuse, crime victimhood and perceived neighbourhood safety with major depression among older adults in India: a cross-sectional study using data from the LASI baseline survey (2017-2018)

OBJECTIVE

The study aims to explore the associations of elder abuse, crime victimhood and perceived safety with depression among older adults and examine the interactive effects of sex and place of residence in those associations.

DESIGN

A cross-sectional study was conducted using a large survey data.

SETTING AND PARTICIPANTS

The study used data from the Longitudinal Ageing Study in India wave 1 (2017-2018). The effective sample size was 31 464 older adults (aged 60 years or older).

PRIMARY AND SECONDARY OUTCOME MEASURES

The outcome variable was major depression, calculated using Short Form Composite International Diagnostic Interview. Descriptive statistics along with bivariate and multivariate analyses were performed to fulfil the objectives.

RESULTS

5.22% of the older adults (n=1587) experienced abuse in the past 1 year. 1.33% of the older individuals (n=402) were victims of a violent crime, and 14.30% (n=1886) perceived an unsafe neighbourhood. Also, 8.67% of the older adults (n=2657) were suffering from depression. Older adults who were abused had 2.5 odds of suffering from depression (adjusted OR (AOR): 2.47, CI: 1.96 to 3.10) and victims of a violent crime were 84% more likely to be depressed (AOR: 1.84, CI: 1.15 to 2.95) compared with their counterparts. Besides, older individuals who perceived as living in unsafe neighbourhood were 61% more likely to be depressed (AOR: 1.61, CI: 1.34 to 1.93) compared with their counterparts. In the interaction analysis, older women who reported abuse had higher odds of suffering from depression (AOR: 3.27; CI: 2.34 to 4.57) compared with older men who were not abused. Similar result was found in older adults reporting abuse and residing in rural areas (AOR: 3.01, CI: 2.22 to 4.07) compared with those urban residents reporting no abuse.

CONCLUSIONS

Healthcare providers should pay more attention to the mental health implications of elder abuse, crime victimhood and perceived safety to grasp the underlying dynamics of the symptomology of late-life depression.

Factors associated with health care providers speaking with older patients about being subjected to abuse

Health care providers have difficulties responding to elder abuse. This study aimed to investigate factors associated with health care providers speaking with older patients about being subjected to abuse, and what facilitating measures staff preferred to help them achieve this. A cross-sectional questionnaire survey was conducted among hospital health care providers (n = 154) in Sweden. Half of the respondents had experience of speaking about elder abuse. A high sense of professional responsibility (OR 3.23) and being less concerned about inflicting damage to the therapeutic relationship (OR 3.97) were associated with having spoken with older patients about being subjected to abuse. Written guidelines about elder abuse and a patient information sheet were the most preferred facilitating measures. Our findings indicate that increasing care providers' sense of responsibility and addressing concerns about damaging the therapeutic relationship might be important factors to target in future interventions to improve health care response to elder abuse.

Prevalence and Factors Associated With Elder Abuse in Community-Dwelling Elderly in Korea: Mediation Effects of Social Support

OBJECTIVE

The objectives of this study were to investigate the factors associated with elder abuse and the mediation effects of social support in a community-dwelling elderly population in Korea.

METHODS

This study analyzed a dataset of 10,674 individuals aged 65 years and older in Korea. Data were reviewed from a study conducted by the Korea Institute for Health and Social Affairs in 2011.

RESULTS

In our study, 12.6% of the elderly reported elder abuse, and 29.2% reported having depression (a score ≥8 on the short version geriatric depression scale). Our results revealed that younger age, low economic status, poor social support (odds ratio [OR]=1.448) and depression (OR=2.039) were significantly associated with elder abuse after controlling for all confounding factors. In addition, mediation analysis showed that the OR for depression was reduced from 2.124 to 2.039 after social support was controlled, which indicates that the association between depression and elder abuse is partially mediated by social support.

CONCLUSION

Depression and lack of social support were associated with abuse in community-dwelling Korean elderly. In particular, social support was revealed to buffer the association between depression and elder abuse.

Developing a tool to assess and monitor institutional readiness to address elder mistreatment in hospital emergency departments

Hospital emergency departments (EDs) lack the tools and processes required to facilitate consistent screening and intervention in cases of elder abuse and neglect. To address this need, the National Collaboratory to Address Elder Mistreatment has developed a clinical care model that ED's can implement to improve screening, referral, and linkage to coordinated care and support services for older adults who are at risk of mistreatment. To gauge ED readiness to change and facilitate adoption of the care model, we developed an organizational assessment tool, the Elder Mistreatment Emergency Department Assessment Profile (EM-EDAP). Development included a phased approach in which we reviewed evidence on best practice; consulted with multidisciplinary experts; and sought input from ED staff. Based on this formative research, we developed a tool that can be used to guide EDs in focusing on practice improvements for addressing elder mistreatment that are most responsive to local needs and opportunities.

Global Research Activity on Elder Abuse: A Bibliometric Analysis (1950-2017)

Elder abuse is an emerging worldwide public health, human right, and social priority for governments and health policy makers. The aim of the current study was to provide an in-depth quantitative analysis of literature on elder abuse published in academic journals. A bibliometric method was implemented using Scopus database for the study period from 1950 to 2017. The search strategy utilized specific keywords to retrieve relevant documents. One thousand eight hundred seventy-two documents appeared in Scopus when using the search strategy. The annual number of publications showed a fluctuating pattern in the past four decades. Publications on elder abuse originated mainly from Northern America and Western Europe. International research collaboration on elder abuse was relatively low. The mean number of authors per document was 1.4. The Journal of Elder Abuse and Neglect published almost one third of the retrieved documents. The Rush University was the most active institution and Professor Dong, X.Q. was the most active author in this field. The most frequently encountered keywords were risk factors, prevalence, intervention, prevention, dementia, and nursing homes. Physical abuse was the most common type of elder abuse studied followed by psychological and financial abuse. Elder abuse is under-researched and of limited priority in most world regions. Governments need to take into consideration preventive policies of elder abuse based on research findings.

Impact of Sensitization of Family Caregivers upon Treatment Compliance among Geriatric Patients Suffering from Elder Abuse and Neglect

Geriatric patients in various outpatient department (OPDs) have been found to agonize from elder abuse and neglect (EAN). Such suffering imposes depressive states within individuals, which in turn affects treatment compliance. The objective of this study was to evaluate the impact of sensitization (psychotherapeutic) of family caregivers (FCGs) upon two denture treatment parameters (maintenance and treatment satisfaction) among EAN patients and compare the differences in outcome with non-abused patients. A survey of completely edentulous subjects (n = 860, aged 41–80 years) provided a sampling frame of 332 EAN patients from which 150 patients (including FCGs) fulfilling the study criteria were distributed (simple random, convenient) into two groups (Group A—control, Group B—test). FCG sensitization for subjects in Group B was performed by a clinical psychologist in 2–4 short (30 min) sessions. Demographic characteristics (frequency) were measured using a self-reported questionnaire, denture maintenance was measured using a denture hygiene index (scores), and treatment satisfaction was analyzed on a 10-point visual analog scale. Relevant data were calculated for means and absolute/relative frequencies. Any difference between two groups was estimated using an unpaired t-test while the level of relationship was determined by Karl Pearson’s test at a p-value of < 0.05. The results showed highest frequency (38.6%) for neglect, with elder neglect (EN) being most common (38.14% alone and 14% in combination). EN was found more if the FCG was a son (52%), in the age group (21–30 years), and with low education and low income (75%). Patients whose FCGs were counselled (Group B) demonstrated low denture plaque scores (mean = 1.38 ± 0.618), while demonstrating comparatively higher scores in six different parameters of treatment satisfaction. Differences between the two groups for both parameters were also found to be statistically significant. Psychotherapeutic counselling in the form of FCG sensitization brings better results of denture maintenance and treatment satisfaction.

Prevalence of Elder Polyvictimization in the United States: Data From the National Elder Mistreatment Study

Elder abuse, including emotional, physical, sexual, financial, and neglectful mistreatment is widespread in the United States, with as much as 11% of community-residing older adults experiencing some form of abuse in the past year. Little data exist regarding the prevalence of polyvictimization, or experience of multiple forms of abuse, which may exacerbate negative outcomes over that of any one form of victimization in isolation. This study evaluates the prevalence of elder polyvictimization among a nationally representative sample of community-residing U.S. older adults. Data from the National Elder Mistreatment Study were examined using bivariate and logistic regression analyses. Approximately, 1.7% of older adults experienced past-year polyvictimization, for which risk factors included problems accomplishing activities of daily living (odds ratio [OR] = 2.47), low social support (OR = 1.64), and past experience of traumatic events (OR = 4.81). Elder polyvictimization is a serious problem affecting community-residing older adults with identifiable targets for intervention.

Elder mistreatment and psychological distress among U.S. Chinese older adults

OBJECTIVE

This study aimed to examine the associations between different types of elder mistreatment, anxiety symptoms, and depressive symptoms among U.S. Chinese older adults.

METHODS

Data were derived from the Population Study of Chinese Elderly (PINE), a study of Chinese older adults aged 60 years and above in the greater Chicago area from 2011-2013. Measurements include elder mistreatment screening tools, Hospital Anxiety and Depression Scale, and Patient Health Questionnaire-9. Negative binomial regressions and logistic regressions were performed.

RESULTS

Participants with any mistreatment, psychological mistreatment, physical mistreatment, financial exploitation, and caregiver neglect were more likely to have anxiety symptoms and depressive symptoms. Sexual mistreatment was not associated with symptoms of anxiety and depression.

CONCLUSION AND IMPLICATIONS

The rate of psychological distress differs based on the types of mistreatment among U.S. Chinese older adults. The findings underline the need for public and community awareness and improved education for health care professionals.

[Bibliometric analysis of the scientific evidence on violence perpetrated against the elderly]

The scope of this study is violence perpetrated against the elderly. It aims to analyze the international scientific production on violence against the elderly. It involved bibliometric research carried out in the ISI Web of Knowledge/Web of ScienceTM database, in which the search terms "elder,"violence" or "abuse" and "health care" were used, in the period between the years 1991 and 2016. The data were analyzed considering the evolution of the annual publications, the journals with the highest number of records, the authors with the highest number of publications, the number of articles distributed by authors' country of origin, and articles with the highest impact. A total of 267 published records in 174 different journals indexed to the database in question were identified and were written by 901 authors with links to 410 institutions located in 39 countries. In the descriptive analysis of the content of the top journals on the topic and of the most cited articles there was potential for the development of the topic, since there is a need for more data on interventions in cases of violence against the elderly, with a multidisciplinary approach, as well as conducting more research on clinical manifestations, quality of life and its economic impact on the use of health services.

Elder abuse and mistreatment: results from medicare claims data

Elder abuse and mistreatment (EM) continues to be a growing problem as the US population ages. Despite the growth, detection of EM continues to lag. However, Medicare claims data and the electronic health record might provide an opportunity to encourage better detection. We evaluated Medicare claims data from 2012-2014 for beneficiaries who had a diagnostic code for EM discharged from any types of facility. We extracted records for 10,181 individuals examining demographic characteristics, residential characteristics, residential location, type of facility providing care, disease co-morbidities, and disability-related conditions. Of our sample, most were female (65.1%), white (78.8%), over 75 years of age (52.6%), and from an urban setting (85.2%). While the greatest number were discharged from acute care settings, almost one-third were hospitalized in psychiatric hospitals (34.6%). Mood disorders (27.5%) and dementia (14.2%) were the most common primary diagnoses. Hypertension (67.7%), depression (44.6%), fluid and electrolyte disorder (43.6%), and cardiac arrhythmia (28.2%) were the most common co-morbidities. In Medicare claims data, we found unique features and co-morbidities associated with EM. These findings could be used to develop a clinical algorithm predictive of older adults requiring screening for EM.

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.

Scam Awareness Related to Incident Alzheimer Dementia and Mild Cognitive Impairment: A Prospective Cohort Study

BACKGROUND

Decreased scam awareness may be an early indicator of impending Alzheimer dementia and its precursor, mild cognitive impairment, but prior studies have not systematically examined the associations between scam awareness and adverse cognitive outcomes.

OBJECTIVE

To test the hypothesis that low scam awareness is associated with increased risk for incident Alzheimer dementia, mild cognitive impairment, and Alzheimer disease pathology in the brain.

DESIGN

Prospective cohort study of aging.

SETTING

Community-based study in the greater Chicago metropolitan area.

PARTICIPANTS

935 older persons initially free of dementia.

MEASUREMENTS

Scam awareness was measured via questionnaire, incident Alzheimer dementia and mild cognitive impairment were documented in detailed annual cognitive and clinical evaluations, and Alzheimer disease neuropathology was quantified after death among a subset of persons who died (n = 264). Proportional hazards models examined associations between scam awareness and incident Alzheimer dementia and mild cognitive impairment. Regression models examined associations between scam awareness and Alzheimer disease pathology, particularly β-amyloid burden and tau tangle density.

RESULTS

During a mean of about 6 years (SD, 2.4) of observation, 151 persons (16.1%) developed Alzheimer dementia. Low scam awareness was associated with increased risk for Alzheimer dementia (hazard ratio [HR], 1.56 [95% CI, 1.21 to 2.01]; P < 0.001), such that each 1-unit increase in scam score (indicating lower awareness) was associated with about a 60% increase in dementia risk. Low scam awareness was also associated with increased risk for mild cognitive impairment (HR, 1.47 [CI, 1.20 to 1.81]; P < 0.001). These associations persisted even after adjustment for global cognitive function. Finally, low scam awareness was associated with a higher burden of Alzheimer pathology in the brain, particularly β-amyloid (estimated increase [±SE] in β-amyloid per 1-unit increase in scam score, 0.22 ± 0.10 unit; P = 0.029).

LIMITATION

The measure of scam awareness used here is too weak for prediction at the individual level.

CONCLUSION

Low scam awareness among older persons is a harbinger of adverse cognitive outcomes and is associated with Alzheimer disease pathology in the brain.

PRIMARY FUNDING SOURCE

National Institute on Aging.

The Development and Psychometric Evaluation of a Questionnaire on the Nurses’ Recognition of Elder Abuse by Family Caregiver

Introduction:

Exploring the nurses’ recognition of elder abuse and related signs may lead to the knowledge development solutions through the In-Service programs. To develop an instrument for the assessment of nurses’ recognition of elder abuse by family caregivers within the Iranian context and psychometrically evaluate its reliability and validity.

Methods:

The sequential combination exploratory mixed methods design was used to develop the questionnaire format, which involved two sections: the quantitative and qualitative step. The qualitative step included probing the Nurses’ recognition of elder abuse by family caregivers in two steps including the literature and related tools review and semi-structured interviews with nurses. The quantitative step was accomplished in two parts. The validity of questionnaire was checked using face, content, construct, and formal validity; and the reliability was probed using cronbach’s alpha reliability. The analyzed data were categorized into 67 items (three main groups namely evident signs of abuse, elder’s potential to get abused, and family caregiver’s potential to abuse and 6 sub-groups including inadvertency, physical abuse, financial misconduct, psychological abuse, sexual abuse, and risk factors). Three components from the exploratory content analysis gained 58.8% variance totally. The cronbach’s alpha for the 3 components were 0.79, 0.76, and 0.78, respectively.

Results:

The questionnaire on the nurses’ recognition of elder abuse by family caregiver can be applied to a wide variety of settings because of the broad range of methods utilised to generate items and domains, its comprehensive consideration of the principles of elder abuse, and its initial reliability and validity.

Elder Abuse

Elder abuse is generally defined as the maltreatment of individuals over the age of 60, although no precise definition exists in the literature. Types of abuse include, but are not limited to, psychological/emotional, physical, sexual abuse, and financial exploitation. Certain risk factors exist leaving an individual more susceptible to abuse, and many obstacles exist preventing the elimination of abuse. There are also identifiable risk factors that increase the likelihood of perpetration of abuse. This systematic review provides an overview of the scope of the problem, types of abuse, risk factors, characteristics of abusers, and key aspects of elder abuse prevention.

Relationship between Emotional Abuse and Depression among Community-Dwelling Older Adults in Korea

Despite recent advances, there is little research on factors associated with emotional abuse among Korean older adults. The present study investigated the relationships between depression and emotional abuse among community-dwelling Korean older adults. We analyzed the dataset from the Survey of Living Conditions and Welfare Needs of Korean Older Persons conducted by the Korea Institute for Health and Social Affairs in 2011. Older adults (aged >65 years, n=10674) were randomly selected. Multivariate logistic regression was used to investigate factors associated with emotional abuse in terms of sociodemographic, health-related, and psychological variables, including depression using the short version of the Geriatric Depression Scale. In our study, 9.4% of the older adults reported experiencing emotional abuse in the previous year. In addition, 44.0% of those experiencing emotional abuse suffered from depression. Multiple logistic regression modeling showed that depression in older adults was independently associated with emotional abuse [odds ratio (OR)=1.788, p<0.001]. Along with depression, poor social support (OR for no social support=1.712, p<0.001) and having chronic illnesses (OR for more than 3=1.481, p<0.005) were associated an increased risk of emotional abuse. Our results showed that emotional abuse among older adults in Korea is prevalent. Our findings suggest that depression, poor social support, and having chronic illnesses are significant factors associated with emotional abuse among the Korean older adult population. Addressing these factors with preventive interventions could have significant public health implications. Further studies are warranted to gain a better understanding of emotional abuse in older Korean adults.

Elder mistreatment predicts later physical and psychological health: Results from a national longitudinal study

Stress process theory predicts that elder mistreatment leads to declines in health, and that social support buffers its ill effects. We test this theory using nationally representative, longitudinal data from 2,261 older adults in the National Social Life Health and Aging Project. We regress psychological and physical health in 2010/2011 on verbal and financial mistreatment experience in 2005/2006 and find that the mistreated have more anxiety symptoms, greater feelings of loneliness, and worse physical and functional health 5 years later than those who did not report mistreatment. In particular, we show a novel association between financial mistreatment and functional health. Contrary to the stress buffering hypothesis, we find little evidence that social support moderates the relationship between mistreatment and health. Our findings point to the lasting impact of mistreatment on health but show little evidence of a buffering role of social support in this process.

The Impact of Community-Based Supports and Services on Quality of Life Among the Elderly in China: A Longitudinal Study

Community-based supports and services (CBSS) have been developing rapidly in China as a new way of satisfying the needs of elderly people. However, it is not clear how pervasive these services are or whether the availability of CBSS impacts quality of life. This study examines trends in CBSS and the impact of the perceived CBSS availability on self-reported quality of life among the elderly in China. We found a significant increase in perceived CBSS availability from 2005 to 2011, but the perceived availability of CBSS varies by the type of CBSS. Multivariate analyses show that home medical visits (β = .181, p = .03), psychological support (β = .332, p = .02), social and recreation activities (β = .231, p = .02), and legal consulting services (β = .271, p = .02) were each significantly associated with a good quality of life. Results from this study provide insight that can inform CBSS strategies and the development of new services for the elderly in China.

Sociodemographic and socioeconomic characteristics of elder self-neglect in an US Chinese aging population

This study aimed to examine the socio-demographic and socioeconomic characteristics associated with prevalence and severity of elder self-neglect in an U.S. Chinese older population. The PINE study is a population-based epidemiological study in the greater Chicago area. In total, 3159 Chinese older adults were interviewed from 2011 to 2013. Elder self-neglect was assessed with systematic observations of a participant's personal and home environment across five domains: hoarding, personal hygiene, house in need of repair, unsanitary conditions, and inadequate utility. Elder self-neglect was prevalent among older adults aged 80 years or over (mild self-neglect: 34.6% 95% CI 30.9-38.4; moderate/severe: 15.6% 95% CI 12.8-18.6), men (mild: 28.6% 95% CI 26.1-31.3; moderate/severe: 13.1% 95% CI 11.2-15.1), those with 0-6 years of education (mild: 32.2% 95% CI 29.7-34.9; moderate/severe: 12.6% 95% CI 10.8-14.5), and those with an annual personal income between $5000 and $10,000 (mild: 30.8% 95% CI 28.4-33.2; moderate/severe: 11.8% 95% CI 10.2-13.5). Older age (mild self-neglect: OR 1.02, 95% CI 1.01-1.03; moderate/severe self-neglect: OR 1.02, 95% CI 1.00-1.03) and lower education levels (mild self-neglect: OR 1.06, 95% CI 1.03-1.08; moderate/severe self-neglect: OR 1.07, 95% CI 1.04-1.09) were associated with significantly increased odds of elder self-neglect. Women (moderate/severe self-neglect: OR 0.73, 95% CI 0.58-0.93) had significantly decreased odds of moderate/severe elder self-neglect. No significant association was found between levels of income and overall elder-self-neglect of all severities. Future research is needed to examine risk/protective factors associated with elder self-neglect in U.S. Chinese older populations.

Development of skills-based competencies for forensic nurse examiners providing elder abuse care

OBJECTIVE

As a critical step in advancing a comprehensive response to elder abuse built on existing forensic nursing-led hospital-based programmes, we developed a list of skills-based competencies for use in an Elder Abuse Nurse Examiner curriculum.

PARTICIPANTS AND SETTING

Programme leaders of 30 hospital-based forensic nursing-led sexual assault and domestic violence treatment centres.

PRIMARY AND SECONDARY OUTCOME MEASURES

149 verbatim recommendations for components of an elder abuse response were identified from a systematic scoping review. In 2 online Delphi consensus survey rounds, these components of care were evaluated by an expert panel for their overall importance to the elder abuse intervention under development and for their appropriateness to the scope of practice of an elder abuse nurse examiner. The components retained after evaluation were translated into skills-based competencies using Bloom's Taxonomy of Learning and, using the Nominal Group Technique, were subsequently reviewed and revised by a subset of members of the expert panel in a consensus meeting.

RESULTS

Of the 148 recommendations evaluated, 119 were rated as important and achieved consensus or high level of agreement. Of these, 101 were determined to be within the scope of practice of an Elder Abuse Nurse Examiner and were translated into skills-based competencies. Following review and revision by meeting experts, 47 final competencies were organised by content into 5 metacompetencies: documentation, legal and legislative issues; interview with older adult, caregiver and other relevant contacts; assessment; medical and forensic examination; and case summary, discharge plan and follow-up care.

CONCLUSIONS

We determined the skills-based competencies of importance to training forensic nurse examiners to respond to elder abuse in the context of a hospital-based intervention. These findings may have implications for violence and abuse treatment programmes with a forensic nursing component that are considering the provision of a dedicated response to the abuse of older women and men.

Multidimensional measurement within adult protective services: design and initial testing of the tool for risk, interventions, and outcomes

This study describes the development, field utility, reliability, and validity of the multidimensional Tool for Risk, Interventions, and Outcomes (TRIO) for use in Adult Protective Services (APS). The TRIO is designed to facilitate consistent APS practice and collect data related to multiple dimensions of typical interactions with APS clients, including the investigation and assessment of risks, the provision of APS interventions, and associated health and safety outcomes. Initial tests of the TRIO indicated high field utility, social worker "relevance and buy-in," and inter-rater reliability. TRIO concurrent validity was demonstrated via appropriate patterns of TRIO item differentiation based on the type of observed confirmed abuse or neglect; and predictive validity was demonstrated by prediction of the risk of actual APS recurrence. The TRIO is a promising new tool that can help meet the challenges of providing and documenting effective APS practices and identifying those at high risk for future APS recurrence.

Living with 'Hwa-byung': the psycho-social impact of elder mistreatment on the health and well-being of older people

OBJECTIVES

Elder abuse and neglect is an increasing concern that adversely affects the health and well-being of older people in most societies. The purpose of this paper is to describe the psycho-social impact of elder mistreatment on the health and well-being of older Korean people living in New Zealand.

METHOD

Data were collected from in-depth interviews. The lived experiences of elder abuse and neglect were studied with 10 older people who were, or who had been, mistreated in their family context. To analyse the data collected, a combined analysis approach was employed using traditional code-based techniques and a concept-mapping method.

RESULTS

The findings of the study show that the effects of elder mistreatment were complex and multidimensional. The older persons who were mistreated in family settings experienced a range of emotional, psychological distress and physical symptoms. Many of them identified 'Hwa-byung' (literally anger disease) as a health issue associated with suppressed emotions of anger, demoralisation, heat sensation and other somatised symptoms.

CONCLUSION

Elder abuse and neglect is a traumatic life event that has considerable psycho-social impacts on older people experiencing the problem. It is important to recognise the power of multidimensional challenges caused by elder mistreatment in health and well-being.

A triadic perspective on elder neglect within the home care arrangement

The present study evaluates a conceptual model of elder neglect within the home care arrangement that takes into consideration the older adult, his or her family members, and the home care worker. Data from 223 complete care-giving units, which consist of an older adult, a family member and a home care worker, were analysed using structural equation modelling. Overall, 31.5 per cent of the older adults, 18 per cent of the care workers and 32.3 per cent of the family members reported at least one type of elder neglect. The proposed model showed a reasonable fit to the data. There was an inverse effect from type of home care to family member's burden and elder neglect, with live-in (around the clock) care being associated with lower levels of family member burden and elder neglect compared with live-out Israeli home care (provided for several hours per week). The amount of informal assistance provided by family members was inversely related to the amount of burden reported by home care workers, with greater informal assistance being associated with lower levels of worker burden. The findings call for the important role of formal home care by demonstrating a potentially protective effect for live-in migrant home care. The study also emphasises the shared burden between formal and informal sources of care.

Older persons' views and experience of elder abuse in South Western Nigeria: a community-based qualitative survey

OBJECTIVES

Conventionally, existing information on elder abuse has been institution based, professionally driven, and in high-income countries. This study addresses the prevailing gap in knowledge through direct consultation of older persons in the community about their perceptions of elder abuse.

METHOD

Eight focus group discussions were carried out among males and females aged 60 years and above in a rural and an urban community in south western Nigeria. Data were transcribed and analyzed based on emergent themes.

RESULTS

Findings from the study show that the perception of abuse by the respondents included the standard typologies except sexual abuse as well as societal issues such as disrespect and lack of recognition.

DISCUSSION

Our study revealed a high level of awareness and experience of elder abuse among the participants in both communities. Effective social welfare and health services aided by targeted government policies are needed to improve the quality of life of the elderly.

Self-neglect in an elderly community-dwelling U.S. Chinese population: findings from the Population Study of Chinese Elderly in Chicago study

This study aimed to examine the prevalence of self-neglect and its specific behaviors in an elderly community-dwelling U.S. Chinese population through a population-based cohort study (PINE Study) in the greater Chicago area. Community-dwelling population of older Chinese adults were interviewed from 2011 to 2013 (n = 3,159). The personal and home environment of participants was rated based on prevalence of hoarding behavior, personal hygiene, repairs needed on the home, sanitary condition of the home, and adequacy of utilities. Prevalence estimates were presented according to self-reported quality of life (QOL). It was found that the prevalence of self-neglect was 18.2% for mild self-neglect and 10.9% for moderate to severe self-neglect. Unsanitary conditions (17.0%) was the most prevalent, followed by need for home repair (16.3%), hoarding behavior (14.9%), poor personal hygiene (11.3%), and inadequate utilities (4.2%). The prevalence of elder self-neglect of all severities and of all types was higher in older adults with fair or poor QOL than in those with good or very good QOL. Poorer QOL was significantly associated with greater risk of self-neglect of all severities (mild self-neglect: odds ratio (OR) = 1.93, 95% confidence interval (CI) = 1.26-2.96, P < .001; moderate to severe self-neglect: OR = 3.58, 95% CI = 1.79-7.13, P < .001) and specific personal and environmental hazards. The study's authors conclude that elder self-neglect is prevalent, especially in elderly adults with poorer QOL. Future research is needed to examine risk and protective factors associated with elder self-neglect.

Association between Elder Abuse and Metabolic Syndromes: Findings from the Chicago Health and Aging Project

BACKGROUND

Elder abuse and metabolic syndromes are both important public health issues and are associated with increased morbidity and mortality. This study aimed to examine the associations between elder abuse and risk for metabolic syndromes.

METHODS

The Chicago Health and Aging Project (CHAP) cohort is a population-based study (n = 4,586). We identified 676 participants with some form of elder abuse reported to a social services agency. The primary independent variable was elder abuse reported to a social services agency. Outcomes were metabolic syndrome as categorized by World Health Organization (WHO), American Heart Association (AHA) and International Diabetes Federation (IDF) criteria. Bivariate and logistic regression analyses were used to assess the association between elder abuse and different definitions of metabolic syndromes.

RESULTS

In the bivariate analyses, elder abuse victims were more likely than those without elder abuse to have metabolic syndromes [22.4 vs. 10.7% (WHO), 50.7 vs. 40.0% (AHA) and 47.7 vs. 33.5% (IDF)]. After adjusting for potential confounding factors, elder abuse was associated with an increased risk for metabolic syndromes according to WHO [OR, 3.95 (2.86-5.47)], AHA [OR, 2.03 (1.56-2.64)] and IDF [OR, 2.55 (1.97-3.29)] criteria. Interaction term analyses indicate that the association between elder abuse and metabolic syndromes may be moderated by sociodemographic characteristics but not by health-related or psychosocial factors.

CONCLUSION

Elder abuse is associated with an increased risk for metabolic syndromes. Research is needed to examine the association between elder abuse and cardiovascular disease.

Decline in cognitive function and elder mistreatment: findings from the Chicago Health and Aging Project

OBJECTIVE

This study aimed to examine the longitudinal association between decline in cognitive function and elder mistreatment (EM).

METHODS

Chicago Health and Aging Project (CHAP) is an epidemiologic study conducted in a geographically defined community (N = 6,159). We identified 143 CHAP participants who had longitudinal cognitive data and EM reported to social services agency. The primary predictor was cognitive function, which was assessed using the Mini-Mental State Examination (MMSE), the Symbol Digit Modalities Test (Perceptual Speed), and both immediate and delayed recall of the East Boston Memory Test (Episodic Memory). An index of global cognitive function scores was derived by averaging z scores of all tests. Logistic regression models were used to assess the association of cognitive function domains and risk for EM.

RESULTS

After adjusting for potential confounders, every one-point decline in global cognitive function (odds ratio [OR]: 1.57 [1.21-2.03]), MMSE (OR: 1.07 [1.03-1.10]), Episodic Memory (OR: 1.46 [1.14-1.86]), and Perceptual Speed (OR: 1.05 [1.02-1.07]) scores were associated with increased risk for EM. Lowest tertiles in global cognitive function (OR: 2.71 [1.49-4.88]), MMSE (OR: 2.02 [1.07-3.80]), Episodic Memory (OR: 2.70 [1.41-5.16]), and Perceptual Speed (OR: 4.41 [2.22-8.76]) scores were associated with increased risk for EM.

CONCLUSION

Decline in global cognitive function, MMSE, and Perceptual Speed scores were associated with increased risk for EM.

Elder abuse and dementia: a review of the research and health policy

Older adults with dementia may be at high risk for abuse, but the topic has not been well studied. We conducted a literature review to examine the relationships between elder abuse and dementia. We found that psychological abuse was the most common form of abuse among older adults, with estimates of its prevalence ranging from 27.9 percent to 62.3 percent. Physical abuse was estimated to affect 3.5-23.1 percent of older adults with dementia. We also found that many older adults experienced multiple forms of abuse simultaneously, and the risk of mortality from abuse and self-neglect may be higher in older adults with greater levels of cognitive impairment. We summarize programs and policies related to the abuse of older adults with dementia, including adult protective services, mandatory elder abuse reporting, and the Long-Term Care Ombudsman Program. We also summarize aspects of the National Alzheimer's Project Act, the Older Americans Act, and the Elder Justice Act. In spite of a recent increase in research and policy developments on elder abuse, challenges such as insufficient funding, limited knowledge about elder abuse, a lack of funding for the implementation of federal and state programs relevant to elder abuse and dementia, and a lack of dementia-specific training for front-line health care staff persist. Stronger programs targeting the well-being of older adults with dementia are needed.

Elder abuse: what coroners know and need to know

This article presents findings from a survey examining knowledge of elder abuse among Georgia's coroners. More than half of the 116 respondents indicated that they know "almost nothing" or "a little" about distinguishing signs of physical abuse from signs of aging (54%) and mandatory reporting laws and related elder abuse statutes (63%). When asked the frequency with which older adult cases were referred to the medical examiner, 49% indicated "rarely if ever." Study findings reveal specific opportunities for enhancing training efforts aimed at coroners, who play a critical role in the identification of elder abuse.

Urban and rural variations in the characteristics associated with elder mistreatment in a community-dwelling Chinese population

This study compares the urban and rural differences in characteristics associated with elder mistreatment (EM) in a Chinese population. A cross-sectional study of 269 urban and 135 rural participants aged 60 years or greater was performed. Among those with EM, rural participants were more likely to be women, have lower levels of education and income, have lower levels of health status and quality of life, have worse change in recent health, and have lower levels of psychosocial well-being. Both higher levels of depressive symptoms and lower levels of social support were associated with increased risk of EM.

Association between reported elder abuse and rates of admission to skilled nursing facilities: findings from a longitudinal population-based cohort study

BACKGROUND

Elder abuse is common and is a frank violation of an older adult's fundamental rights to be safe and free of violence. Our prior study indicates elder abuse is independently associated with mortality. This study aims to quantify the relationship between overall elder abuse and specific subtypes of elder abuse and rate of admission to skilled nursing facilities (SNF).

METHODS

A prospective population-based study conducted in Chicago of community-dwelling older adults who participated in the Chicago Health and Aging Project (CHAP). Of the 6,674 participants in the CHAP study, 106 participants were reported to the social services agency for elder abuse. The primary predictor was elder abuse reported to the social services agency. The outcome of interest was the annual rate of admission to SNF obtained from the Center for Medicare and Medicaid Services. Poisson regression models were used to assess these longitudinal relationships.

RESULTS

The average annual rate of SNF for those without elder abuse was 0.14 (0.58) and for those with elder abuse was 0.66 (1.63). After adjusting for sociodemographic and socioeconomic variables, medical comorbidities, cognitive and physical function, and psychosocial wellbeing, older adults who have been abused had higher rates of SNF admission (RR 4.60 (2.85-7.42)). Psychological abuse (RR 2.31 (1.17-4.56)), physical abuse (RR 2.36 (1.19-4.66)), financial exploitation (RR 2.81 (1.53-5.17)) and caregiver neglect (RR 4.73 (3.03-7.40)) were associated with increased rates of admission to SNF, after considering the same confounders. Elder abuse is associated with a higher rate of SNF stay longer than 30 days (RR 6.27 (3.68-10.69)).

CONCLUSION

Elder abuse was associated with increased rates of admission to SNF in this community population. Specific subtypes of elder abuse had a differential association with an increased rate of admission to SNF.

Association between elder abuse and use of ED: findings from the Chicago Health and Aging Project

PURPOSE

This study aims to quantify the relationship between overall elder abuse and specific subtypes of elder abuse and rate of emergency department (ED) utilization in a community-dwelling population.

METHODS

A population-based study is conducted in Chicago of community-dwelling older adults who participated in the Chicago Health and Aging Project. Of the 6674 participants in the Chicago Health and Aging Project, 106 participants were reported to a social services agency for suspected elder abuse. The primary predictor was elder abuse reported to a social services agency. The outcome of interest was the annual rate of ED utilization obtained from the Center for Medicare and Medicaid Services. Poisson regression models were used to assess these longitudinal relationships.

RESULTS

The average annual rate of ED visits for those without elder abuse was 0.7(1.4) and, for those with reported elder abuse, was 2.1(3.2). After adjusting for sociodemographics, socioeconomic variables, medical comorbidities, cognitive and physical function, and psychosocial wellbeing, older adults who have been abused had higher rates of ED utilization (RR, 2.33 [1.60-3.38]). Psychological abuse (RR, 1.98[1.29-3.00]), financial exploitation (RR, 1.59 [1.01-2.52]) and caregiver neglect (RR, 2.04 [1.38-2.99]) were associated with increased rates of ED utilization, after considering the same confounders. Interaction terms suggest the association between elder abuse and ED utilization is not mediated through medical comorbidities, cognitive and functional impairment, or psychosocial distress.

CONCLUSION

Elder abuse was associated with increased rates of ED utilization in this community population. Specific subtypes of elder abuse had differential association with increased rate of ED utilization.

Elder self-neglect is associated with increased risk for elder abuse in a community-dwelling population: findings from the Chicago Health and Aging Project

OBJECTIVE

We examined the relationship between self-neglect and risk for subsequent elder abuse report to social services agency.

METHOD

Population-based cohort study conducted Chicago. Primary predictor was elder self-neglect at baseline without concurrent elder abuse. Cox proportional hazard models were used to assess independent associations of elder self-neglect with the risk of subsequent elder abuse using time-varying covariate analyses.

RESULTS

Of 10,333 participants, 1,460 were reported for self-neglect and 180 were reported for elder abuse. The median time from self-neglect to elder abuse was 3.5 years. In multivariable analyses, elder self-neglect was associated with increased risk for subsequent elder abuse (odds ratio, OR, 1.75[1.18-2.59]). Elder self-neglect was also associated with increased risk for subsequent caregiver neglect (OR, 2.09[1.24-3.52]), financial exploitation (OR, 1.73[1.01-2.95]), and multiple forms of elder abuse (HR, 2.06[1.22-3.48]).

CONCLUSION

Elder self-neglect report is associated with increased risk for subsequent elder abuse report to social services agency.

Association between elder self-neglect and hospice utilization in a community population

Elder self-neglect is associated with substantial 1-year mortality. However, hospice utilization among those with self-neglect remain unclear. The objective of this study is to quantify the prospective relation between self-neglect and risk for hospice utilization in a community population of older adults. Prospective population-based study in a geographically defined community in Chicago of older adults who participated in the Chicago Health and Aging Project. Of the 8669 participants in the Chicago Health and Aging Project, a subset of 1438 participants was reported to social services agency for suspected elder self-neglect. Outcome of interest was the hospice utilization obtained from the Center for Medicare and Medicaid System. Cox proportional hazard models were used to assess independent association of self-neglect with risk of hospice utilization using time-varying covariate analyses. After adjusting for potential confounding factors, elders who self-neglect was associated with increased risk for hospice utilization (HR, 2.43, 95% CI, 2.10-2.81). Greater self-neglect severity (mild: (HR, 2.12 (1.61-2.79); moderate: (HR, 2.36 (1.95-2.84); severe: (HR, 4.66 (2.98-7.30)) were associated with increased risk for hospice utilization. Interaction term analyses suggest that the significant relationship between self-neglect and hospice utilization was not mediated through medical conditions, cognitive impairment and physical disability. Moreover, self-neglect was associated with shorter length of stay in hospice (PE, -0.27, SE, 0.12, p<0.02) and shorter time from hospice admission to death (PE, -0.32, SE, 0.13, p<0.01). Elder self-neglect was associated with increased risk of hospice use in this community population. Elder self-neglect is associated with shorter length of stay in hospice care and shorter time from hospice admission to death.

Advancing the field of elder abuse: future directions and policy implications

Elder abuse, sometimes called elder mistreatment or elder maltreatment, includes psychological, physical, and sexual abuse; neglect (caregiver neglect and self-neglect); and financial exploitation. Evidence suggests that one in 10 older adults experiences some form of elder abuse, but only one in 25 cases is reported to social services agencies. At the same time, elder abuse is associated with significant morbidity and premature mortality. Despite these findings, there is a great paucity in research, practice, and policy addressing the pervasive issues of elder abuse. Through my experiences as a American Political Sciences Association Congressional Policy Fellow and Health and Aging Policy Fellow working with the Administration on Community Living (ACL) (previously known as the Administration on Aging) for the last 2 years, I will describe the major functions of the ACL and highlight two major pieces of federal legislation: The Older Americans Act and the Elder Justice Act. I will also highlight major research gaps and future policy relevant research directions for the field of elder abuse.

Advancing the field of elder abuse: future directions and policy implications

Elder abuse, sometimes called elder mistreatment or elder maltreatment, includes psychological, physical, and sexual abuse; neglect (caregiver neglect and self-neglect); and financial exploitation. Evidence suggests that one in 10 older adults experiences some form of elder abuse, but only one in 25 cases is reported to social services agencies. At the same time, elder abuse is associated with significant morbidity and premature mortality. Despite these findings, there is a great paucity in research, practice, and policy addressing the pervasive issues of elder abuse. Through my experiences as a American Political Sciences Association Congressional Policy Fellow and Health and Aging Policy Fellow working with the Administration on Community Living (ACL) (previously known as the Administration on Aging) for the last 2 years, I will describe the major functions of the ACL and highlight two major pieces of federal legislation: The Older Americans Act and the Elder Justice Act. I will also highlight major research gaps and future policy relevant research directions for the field of elder abuse.

Decline in physical function and risk of elder abuse reported to social services in a community-dwelling population of older adults

OBJECTIVES

To examine the longitudinal association between decline in physical function and risk of elder abuse.

DESIGN

Prospective population-based study.

SETTING

Geographically defined community in Chicago.

PARTICIPANTS

One hundred forty-three Chicago Health and Aging Project (CHAP) participants who had elder abuse reported to a social services agency from 1993 to 2010 were identified.

PARTICIPANTS

The primary independent variable was objectively assessed physical function using decline in physical performance testing (tandem stand, measured walk, and chair stand). Secondary independent variables were assessed using decline in self-reported Katz, Nagi, and Rosow-Breslau scale scores. Dependent variables were reported and confirmed elder abuse and specific subtypes of elder abuse (physical, psychological, caregiver neglect, and financial exploitation). Logistic regression models were used to assess the association between decline in physical function measures and risk of elder abuse.

RESULTS

After adjusting for potential confounders, decline in physical performance testing (odds ratio (OR) = 1.13, 95% confidence interval (CI) = 1.06-1.19), Katz impairment (OR = 1.29, 95% CI = 1.15-1.45), Nagi impairment (OR = 1.30, 95% CI = 1.13-1.49), and Rosow Breslau impairment (OR = 1.42, 95% CI = 1.15-1.74) was associated with greater risk for elder abuse. The lowest tertile of physical performance testing (OR = 4.92, 95% CI = 1.39-17.46) and the highest tertiles of Katz impairment (OR = 3.99, 95% CI = 2.18-7.31), Nagi impairment (2.37, 95% CI = 1.08-5.23), and Rosow Breslau impairment (OR = 2.85, 95% CI = 1.39-5.84) were associated with greater risk of elder abuse.

CONCLUSION

Decline in objectively assessed physical function and self-reported physical function are associated with greater risk for elder abuse.

A population-based study of physical function and risk for elder abuse reported to social service agency: findings from the Chicago health and aging project

We examined the association between physical function and the risk for reported elder abuse. In the Chicago Health and Aging Project (N = 8,932), 238 participants had reported elder abuse. The independent variable was objectively assessed physical function using both directly observed physical performance testing and self-reported physical function (Katz activity of daily living scale, Nagi physical activity scale, and Rosow Breslau mobility scales). Outcomes were elder abuse and specific subtypes of elder abuse. After adjusting for confounders, lower levels of physical performance testing (OR, 2.71[1.58-4.64]), Katz impairment (OR, 1.84[1.29-2.59]), Nagi impairment (OR, 1.65[1.15-2.37]) and Rosow Breslau (OR, 1.76[1.26-2.47]) were associated with increased risk for elder abuse. Lowest levels of physical performance testing were associated with increased risk for psychological abuse (OR, 2.69[1.27-5.71]), caregiver neglect (OR, 2.66[1.22-5.79]), and financial exploitation (OR, 2.35 [1.21-4.55]). Our results may have important implications to healthcare professional, social services and other disciplines to prevent and treat elder abuse.