Incidence of Elder Abuse in a U.S. Chinese Population: Findings From the Longitudinal Cohort PINE Study

A Systematic Review: Risk and Protective Factors of Elder Abuse for Community-Dwelling Racial Minorities

Elder abuse is related to numerous adverse health and mental health conditions in older adults and some studies indicated higher rates of elder abuse in ethnic and racial minority populations than non-Hispanic Whites. This current study aims to summarize the risk and protective factors associated with elder abuse in community-dwelling racial minorities. A systematic review was conducted following Preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. AgeLine, Medline, PsycINFO, and CINAHL were searched without limitation on time periods of publication. Two authors independently screened the search results and assessed the eligibility and quality of the retrieved articles. A total of 718 articles were screened and 25 articles were included in the review. The 25 included studies' publication dates range from 1989 to 2019. Five racial categories were generated: African Americans, Asian Americans, Native Americans, Hispanic Americans, and racial minorities in Canada. Risk and protective factors of elder abuse and its subtypes (e.g., physical and psychological abuse) for these racial groups were summarized. There are some common risk factors across racial minorities, such as dependence on caregivers and health issues. The review identified gaps and conflicting findings regarding culture and education that are worthy of further investigation. In particular, there is a lack of current research on elder abuse in racial minority older women, race minority subgroups, and protective factors of elder abuse. The results guide helping professionals to consider the role of traditional culture and identify warning signs of potential abuse among racial minority older adults.

How to prove neglect in the context of the post-mortem examination

Understanding the causes, extent, and period of neglect is not only a medical but also a forensic task when it comes to legal investigations. In this study, we evaluated 46 autopsied cases where there was clear evidence of physical neglect during the last period of the deceased's life. The age of the deceased ranged from 21 to 96 years; most of them were female (71.7%). The majority of cases (89.9%) took place in a domestic environment, with partners or relatives providing care. The most frequent post-mortem findings were pressure sores, followed by inflammatory skin changes, and signs of malnutrition and dehydration. Neglect was the cause or co-cause of death in 23% of the cases. More than half of the deceased showed severe contamination of the skin surface by excrement, and in almost 40% of the cases, fly infestation was found. The majority of insects belonged to the group of house flies (Diptera: Muscidae), mainly the common house fly, Musca domestica. By analyzing the entomological evidence, it was possible to prove an insect infestation period of at least several days ante-mortem. Since the period of neglect may be relevant in terms of legal proceedings, the present work demonstrates the particular importance of insect traces in providing this evidence. While prosecution and conviction of caregivers remain challenging, it is all the more essential that entomology and legal medicine collaborate on the analysis of findings of neglect.

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.

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.

Elder abuse in Europe's "most elderly" city: an update of the phenomenon based on the cases reported to the Penal Court of Genoa from 2015 to 2019 and literature review

BACKGROUND

Elder abuse is currently a worldwide problem. The literature reports that one elderly person out of six is a potential victim.

AIMS

To analyse cases reported to the judicial authorities in the territory of Genoa in the period 2010-2019, to investigate the features of elder abuse, to assess the trend of this phenomenon and to propose preventive strategies.

METHODS

We analysed the data on reports of abuse passed by the Court of Genoa in the period 2015-2019 concerning physical and mental maltreatment, abandonment and financial exploitation of elderly subjects. These data were compared with those recorded in the previous 5-year period and in the literature.

RESULTS

In the period 2015-2019, 156 cases of elder abuse were identified (versus 63 in the previous period): 18 cases of domestic violence, 5 cases of abuse of the means of correction, 18 cases of caregiver neglect, 76 cases of physical injury and 39 cases of financial exploitation.

DISCUSSION

Abuse was seen to be perpetrated most frequently in the domestic setting and by the victims' relatives. The main risk factors were female gender and the victim's dependence on others, the maltreating subject's mental illness and substance abuse.

CONCLUSIONS

We documented a progressive increase in the number of abuses reported to the judicial authority; this reflects greater awareness of the problem. However, our figures remained well below the incidence estimated in the literature. It is necessary to train healthcare personnel to identify and manage cases of suspected abuse, and to provide adequate support in situations at risk.

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.

Formal and informal social participation and elder mistreatment in a national sample of older adults

BACKGROUND/OBJECTIVES

Older adults' susceptibility to mistreatment may be affected by their participation in social activities, but little is known about relationships between social participation and elder mistreatment.

DESIGN

Cross-sectional analysis.

SETTING/PARTICIPANTS

National probability sample of older community-dwelling U.S. adults interviewed in 2015-2016, including 1268 women and 973 men (mean age 75 years and 76 years, respectively; 82% non-Hispanic white).

MEASUREMENTS

Frequency of participation in formal activities (organized meetings, religious services, and volunteering) and informal social activities (visiting friends and family) was assessed by questionnaire. Elder mistreatment included emotional (four items), physical (two items), and financial mistreatment (two items) since age 60. Multivariable logistic regression examined associations between each type of social participation and elder mistreatment among men and women, adjusting for age, race/ethnicity, education, and comorbidity.

RESULTS

Forty percent of women and 22% of men reported at least one form of mistreatment (emotional, physical, or financial). Women reporting at least monthly engagement in formal social activities were more likely to report emotional mistreatment (adjusted odds ratio (AOR) 1.59, 95% confidence interval (CI) 1.09-2.33). Among men, monthly organized meeting attendance was associated with increased odds of emotional mistreatment (AOR 1.34, 95% CI 1.01-1.93). Weekly informal socializing was inversely associated with emotional mistreatment (AOR 0.59, 95% CI 0.44-0.78) and financial mistreatment (AOR 0.59, 95% CI 0.42-0.85) among women.

CONCLUSION

In this national cohort, older adults who were frequently engaged in formal social activities reported similar or higher levels of mistreatment than those with less frequent organized social participation. Older women with regular informal contact with family or friends were less likely to report some kinds of mistreatment. Strategies for detecting and mitigating elder mistreatment should consider differences in patterns of formal and informal social participation and their potential contribution to mistreatment risk.

Financial Maltreatment of Chinese American Elders: An Inquiry through a Cultural Lens

This study examined financial maltreatment from the perspectives of Chinese American elders via a mixed method approach. Three focus groups of Chinese American elders and one group of service professionals recruited from Phoenix metropolitan areas shared their insights of financial maltreatment and contributed to the refinement of questions in the followed survey that included 325 elders (M_age = 75.6, SD = 7.00). Two types of financial maltreatment: Financial exploitation and financial neglect were identified from focus group discussions. About 9.2% experienced financial exploitation and 1.5% experienced financial neglect. Both financial exploitation and neglect were related to higher vulnerability scores for abuse assessed using the H-S/EAST elder abuse screening scale. Financial maltreatment needs to be understood in legal, cultural, and family contexts, incorporating the perspectives of older adults. Prevention of financial maltreatment hinges on increased awareness and knowledge of this issue among elders, families and service professionals, and the collaborative efforts of stakeholders from ethnic communities.

Association between personality traits and elder abuse in a community-dwelling Chinese population: findings from the PINE study

Elder abuse is a pervasive public health issue. The relationship between personality traits and elder abuse remains unclear. This study aims to examine the associations between neuroticism, conscientiousness, and elder abuse. Data were derived from the Population Study of Chinese Elderly (PINE), a community-engaged study of 3,157 US Chinese older adults in the greater Chicago area from 2011-2013. Elder abuse included psychological, physical, and sexual abuse, financial exploitation, and caregiver neglect. The assessments of neuroticism and conscientiousness were derived from the NEO Five-Factor Inventory. Logistic regression was used. Higher neuroticism (score range: 6-30, OR = 1.14, CI = 1.11-1.18) and lower conscientiousness (score range: 16-60, OR = 0.97, CI = 0.96-0.99) were associated with a higher risk of elder abuse. With respect to different forms of elder abuse, higher neuroticism was associated with an increased risk of psychological abuse (OR = 1.14, CI = 1.10-1.17), financial exploitation (OR = 1.03, CI = 1.00-1.07), and caregiver neglect (OR = 1.06, CI = 1.03-1.09). Higher conscientiousness was associated with a higher risk of financial exploitation (OR = 1.02, CI = 1.00-1.05). Intervention programs could reduce neuroticism and raise conscientiousness of elder abuse victims.

Life Course Violence: Child Maltreatment, IPV, and Elder Abuse Phenotypes in a US Chinese Population

OBJECTIVES

To examine the associations between violence experiences including phenotypes (psychological, physical/sexual abuse, financial exploitation, caregiver neglect) of child maltreatment (CM), intimate partner violence (IPV), and elder abuse (EA).

DESIGN

Cross-sectional data collected during 2011-2013.

SETTING

US Chinese community in Chicago, Illinois.

PARTICIPANTS

A total of 3157 community-dwelling older adults (aged ≥60 y).

MEASUREMENTS

Cases of CM, IPV, and EA.

RESULTS

Prevalence of violence was 11.4% for CM (physical/sexual = 10.2%; psychological = 2.4%), 6.5% for IPV (psychological = 5.3%; physical/sexual = 2.8%), and 15.2% for EA (caregiver neglect = 11.2%; psychological = 9.8%; financial exploitation = 9.3%; physical/sexual = 1.2%). After adjusting for potential confounding variables, CM psychological was associated with increased risks for IPV psychological (odds ratio [OR] = 7.60; 95% confidence interval [CI] = 4.29-13.45), IPV physical/sexual (OR = 4.06; CI = 1.71-9.63), EA psychological (OR = 3.79; 95% CI = 2.20-6.51), and EA financial exploitation (OR = 2.07; 95% CI = 1.12-3.81). CM physical/sexual was associated with increased risks for IPV physical/sexual (OR = 1.86; 95% CI = 1.02-3.38), EA psychological (OR = 1.70; 95% CI = 1.20-2.42), and EA financial exploitation (OR = 2.38; 95% CI = 1.72-3.30). IPV psychological and physical/sexual were associated with 5 to 8 times increased risks for EA psychological, 6 to 9 times increased risks for EA physical/sexual, and 3 times increased risks for EA financial exploitation.

CONCLUSION

Healthcare professionals working with older adults should be informed that a history of violence might further predispose a person to different types of EA. The cumulative impact of violence should also be considered when providing services or care to violence victims. J Am Geriatr Soc 67:S486-S492, 2019.

Imaging of Violence Against the Elderly and the Women

Emergency department assessment is a critical opportunity to identify elder abuse and violence against women, which represent a growing problem, requiring the attention of health care systems. Elder abuse is most frequently perpetrated by family members because of the higher levels of stress, burnout, and financial problems affecting the caregivers that can even lead to deadly consequences. Intimate partner violence is defined as physical, sexual, or psychological harm caused to another by a current or former partner or spouse, and can range from a single acute hit to chronic battering, varying in frequency and severity. Radiologists have a critical role in detecting those injury findings suggestive of abuse and violence. When appropriate, additional information about the social circumstances in which an injury took place, linked with imaging findings, may also be helpful in diagnosing abuse. The purpose of this article is to highlight the role of diagnostic imaging in the detection of lesions compatible with domestic abuse in elderly patients and women, and to allow the recognition of the alterations most frequently associated with this type of violence.

Achieving Health Equity in Asian Populations

Research about Asian Americans and Asian health equity issues have significant gaps, in part, due to lack of funding and support for minority investigators and examinations of health in this population. This special issue is designed to further our understanding of Asian health equity, especially within the context of global Chinese populations to examine how sociocultural contexts impact aging and health. Through the findings reported in this special issue, we call for increased funding and support to minority research scholars to conduct research toward improving Asian health equity, with an emphasis on nuanced cultural contexts of this population.