Addressing the measurement challenge in elder abuse interventions: need for a severity framework

On tackling abuse of older people: The forensic challenges in fatal cases investigation

The World Health Organization recently presented the priorities for tackling abuse of older people in a coordinated and strategic way. However, data on the forensic scenario is still lacking. In this context, the aim of the present work was to provide a comprehensive literature review of this inherently complex phenomenon in the post-mortem setting, in order to better characterize it from a forensic point of view. A comprehensive literature search was performed in three electronic databases following the PRISMA guidelines. Sociodemographic and medical data of victims and perpetrators, post-mortem data, types of abuse and risk factors were extracted from non-aggregated data. Forty-eight papers dealing with abuse in the post-mortem setting were included, with a predominance of case reports and case series. The review showed that neglect was the most common type of abuse and victims are predominantly older women who are abused in a domestic setting by trusted family member. To generate more and better data, expanded research in the forensic field requires standardized methods and the raise of professional awareness about abuse of older people.

Exploring Factors Associated with Perceived Changes in Severity of Elder Abuse: A Population-Based Study of Older Adults in Korea

Elder abuse is a pressing problem that demands social attention in South Korea. This study aims to examine the characteristics of older adults and their family perpetrators that may influence the perceived severity of abuse by older adults using a nationally representative sample among older Koreans. We analyzed 952 community-dwelling older Koreans from a population-based survey of the Survey of Elderly Care and Welfare Need. The analytic sample of this study consisted of older adults who self-reported having been emotionally, physically, and financially abused or neglected by their family members or other primary caregivers. We used multinomial logistic regression models to predict perceived change in severity of abuse. Results showed that the abuse type and duration of abuse were significantly associated with the perceived change in the severity of abuse. Older victims' age, being female, and being married were also associated with greater risk for increased severity of abuse relative to no change, while older adults' better health status was associated with lower risk for increased severity of abuse. The findings of this study can help social work professionals identify older adults with heightened risk of abuse and protect the human rights of the most vulnerable aging population.

OUP accepted manuscript

Background and Objectives

Adult Protective Services (APS) are the frontline agencies investigating elder mistreatment and providing/coordinating postinvestigation services. Yet, their effectiveness in reducing different types of mistreatment in relation to services is unknown. This study aimed to address the knowledge gap by identifying services provided by mistreatment type, and examining the associations of services with mistreatment reduction.

Research Design and Methods

A pretest–post-test design was implemented using the Identification, Services, and Outcomes (ISO) Matrix to assess mistreatment levels during case investigation and at case closure after services were provided. San Francisco and Napa APS participated in a 6-month data collection.

Results

The 4 most prevalent types of mistreatment were examined: emotional, physical, financial abuse, and neglect by others. On average, level of mistreatment decreased across mistreatment types after APS intervention. Care/case management, mental health, and other services were most common, while specific services differed depending on type of mistreatment. Care/case management services were associated with physical and emotional abuse reduction, legal services further correlated with emotional abuse reduction; financial planning services were associated with financial abuse reduction; care/case management and other services were associated with neglect reduction.

Discussion and Implications

This is the first study to address APS services by mistreatment type and the outcomes of services. Adoption of the ISO Matrix by APS programs opens the possibility of research and practice collaboration in APS outcomes research using a standardized approach.

Lack of Association of Elder Mistreatment With Mortality

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Bringing Advances in Elder Abuse Research Methodology and Theory to Evaluation of Interventions

The elder abuse field needs high-quality intervention research to assess the best strategies to combat the problem, but few such studies exist. Significant advances have been made in elder abuse research methodology, measurement, justice theory, and other relevant areas, which may remedy this gap. Particular advances include the use of elder abuse severity measures and goal attainment scaling, and the application of restorative justice theory to intervention. Elder abuse research also may benefit from advances in biomedical clinical trial methodology, including characterizing and following up with subjects excluded from trials or those who drop out, estimating numbers needed to treat to assess cost-effectiveness, and a priori stopping rules for when an intervention proves quickly beneficial or harmful. In this article, we argue these advances can and should inform elder abuse intervention research, propose a theoretical framework to guide such efforts, and demonstrate how this framework can inform practice, using elder abuse multidisciplinary teams and nursing home shelters as examples.

Investigating the connection between ageism and elder mistreatment

Elder mistreatment is recognized as a pervasive public health problem with detrimental consequences for older adults and society. Although considerable research has examined elder mistreatment risk factors at the individual level, there is a growing call for the field to move beyond proximal causes and consider underlying structural factors that influence elder mistreatment. Illustrating this shift, organizations, advocacy groups and researchers have proposed a connection between ageism and elder mistreatment. However, despite the assertion that ageism is a causal factor for elder mistreatment, there is a scarcity of research to demonstrate this relationship. In this Perspective, we examine the proposed conceptual pathways and limited empirical research connecting ageism and elder mistreatment. After identifying critical gaps in current knowledge, we propose a model that links ageism and elder mistreatment and a research agenda to bring conceptual clarity and empirical evidence to the study of this topic.

Elder Abuse Assessment Tools and Interventions for use in the Home Environment: a Scoping Review

Background and Aim

Caregivers in the home environment have an important role in timely detecting and responding to abuse. The aim of this review was to provide insight into both the existing tools for the assessment of and interventions for elder abuse by formal and informal caregivers in the home environment, and to categorize them according to a public health perspective, into primary, secondary, tertiary or quaternary prevention.

Methods

We selected the assessment tools and interventions that can be used by caregivers in the home environment included in previous reviews by Gallione et al (2017) and Fearing et al (2017). To identify published studies after these reviews, a search was performed using PubMed, Cochrane Database, CINAHL and Web of Science.

Results

In total, fifteen assessment tools and twelve interventions were included. The number of assessment tools for elder abuse for use in the home environment is increasing; however, tools must be validated over different cultures and risk groups. In addition, the tools lack attention for the needs of vulnerable older persons such as persons with dementia. Existing interventions for caregivers in the home environment lack evidence for addressing elder abuse and do not address potential adverse effects (quaternary prevention).

Conclusion

Assessment tools for elder abuse need further testing for validity and reliability for use by caregivers in the home environment. For interventions, meaningful outcome measures are needed. Important to note is that quaternary prevention requires more attention. This argues for taking into account perspectives of (abused) older persons and caregivers in the development of assessment tools and interventions protocols.

Cumulative lifetime violence severity scale: development and initial testing among men

BACKGROUND

Knowledge of the relationship between men's health and violence is flawed by narrow and faulty conceptualization and measurement of violence that often results in attribution of health problems to one form or type of violence without consideration of other exposures. Our purpose is to describe the development and initial testing of the Cumulative Lifetime Violence Severity scale designed for use in health research to measure men's perceptions of the severity of their cumulative lifetime violence.

METHODS

We framed the dimensions of violence severity as: type (physical, psychological, sexual), timing (childhood, adulthood), focus (perpetrator, target), context, frequency, and degree of distress. Items reflecting these dimensions were vetted by local experts including individuals who identified as men, with particular attention to meaningful language for men. The measure was pretested, revised to 64 items, and tested for test-retest reliability prior to use in a study of 685 English-speaking Eastern Canadian men, ages 19 to 65 years. We used Principal Components Analysis to illuminate the underlying dimensionality of the items.

RESULTS

Principal Components Analysis yielded a 44-item 11 component solution that accounted for 64.06% of variance with good model fit and a Cronbach's alpha of .92. All dimensions of our conceptualization of violence severity were reflected in the components, except Adult Target Sexual Violence. Convergent validity between the Cumulative Lifetime Violence Severity-44 Scale and a global lifetime violence rating scale was r = .750 (p < .001) and concurrent validity was moderate and significant between the Cumulative Lifetime Violence Severity-44 scale and measures of mental health problems commonly experienced by people with violence histories.

CONCLUSIONS

The Cumulative Lifetime Violence Severity-44 scale shows promise as the first comprehensive measure of cumulative lifetime violence for health research that considers gender, individual distress and experiences as both perpetrator and target. Next steps include further exploratory analysis with a more diverse sample of men and confirmatory factor analysis.