The Social Relationship Context of Elder Mistreatment

Training Senior Companion Volunteers to Identify and Report Adult Abuse, Neglect, and Exploitation

Elder abuse is a national public health challenge that can have dire consequences for the older adults who experience it in any form. The Senior Companion Program presents a unique opportunity to address this public health challenge. An in-person training for Senior Companion volunteers across Ohio on how to recognize and report elder abuse was developed, implemented, and evaluated prior to the COVID-19 pandemic. Evaluation consisted of surveys distributed prior to and at the conclusion of the training. A total of 302 volunteers were trained with a survey response rate of 76%. While there was significant knowledge improvement in one of the five knowledge items (p < .000, all other ps ≥ .065), volunteers' subjective rating of their knowledge on abuse significantly improved (p = .029). Training older adult volunteers working with other community-dwelling adults is likely a valuable strategy to educate and protect against elder abuse.

The relationship between social support and dimensions of elder maltreatment: a systematic review and Meta-analysis

INTRODUCTION AND AIMS

Many studies have investigated the relationship between social support and the prevention of elder abuse; however, their results are somehow inconsistent in terms of the association. This systematic review and meta-analysis aimed to investigate the published studies on the relationship between social support and the prevention of elder maltreatment.

MATERIALS AND METHODS

An electronic search was conducted until January 2023, using such databases as PubMed, Scopus, and Web of Science. The present research included cross-sectional, longitudinal, and case-control studies. Study selection, data extraction, and risk of bias assessment were conducted by two researchers independently. The Newcastle-Ottawa checklist was utilized to evaluate the quality of studies. The random effects model was employed to perform a meta-analysis.

RESULTS

In total, 32 studies were included in this systematic review, out of which 26 articles were eligible for meta-analysis. The results showed that 68.75% of the studies were of high quality, and there is a significant relationship between social support and elder maltreatment. Accordingly, the lack of social support increased overall maltreatment (odds ratio: 1.24, 95% confidence interval: 1.16-1.33; I2 = 92.3%, p = 0.000)). Moreover, lack of social support had an increasing effect on the level of psychological abuse (1.55, 1.18-2.04; 88.7%, p = 0.000), physical abuse (1.31, 0.42-4.11; 76.3%, p = 0.005), and neglect (2.02, 0.86-4.72; 87.9%, p = 0.000), which shows heterogeneities among the results of the included studies. On the contrary, the lack of social support showed a decreasing effect on financial abuse (0.92, 0.70-1.21; 62.1%, p = 0.022).

CONCLUSION

This systematic review provides evidence that social support in the form of structural or functional support may plays an important role in improving the quality of life of the elderly.

Conceptualizing Person-Centered Care in Elder Mistreatment Intervention: Use of a Well-Being Framework

BACKGROUND AND OBJECTIVES

Person-centered care (PCC) applied to elder mistreatment interventions is an approach to include victim priorities. Although PCC may improve outcomes by supporting choice, victim preferences are often difficult to support, especially in high-risk situations. We studied the adaptation of PCC structures and process to a pilot intervention, aimed at including client preferences in a multidisciplinary team's plans to address complex elder mistreatment.

RESEARCH DESIGN AND METHODS

Case study analysis was used to examine the process of integrating client priorities into a risk-reduction plan. A well-being framework was used to understand the relationship between safety and preferences. Purposive sampling identified a case study of a high-risk victim with history of refusing help who agreed to work with the Service Advocate, a member of a multidisciplinary team.

RESULTS

PCC required a relationship of trust, honed over several weeks by prioritizing the clients' perspective. Client preferences included remaining at home, continuing the relationship with the abuser, and maintaining a sense of mastery. Individualized definitions of "safety" were unrelated to elder mistreatment risk. Assistance included working with the suspected perpetrator, which is not offered by most elder mistreatment interventions, and resulted in some risk reduction. Reasons for refusing help were a desire for control and fear of loss of well-being assets.

DISCUSSION AND IMPLICATIONS

Individualized definitions of well-being should be considered in measuring intervention success. Future research could determine guidelines on what levels of elder mistreatment risk are acceptable, and how to monitor clients for safety while supporting autonomy.

Family Networks, Social Networks, and Life Satisfaction of Older Adults in China

Older adults’ family networks and social networks are important factors that influence life satisfaction, but their transmission mechanisms have not been adequately discussed. The objective of this study was to examine the mechanisms through which family networks and social networks influence the life satisfaction of older adults. We empirically examined the effects and mechanisms of older adults’ family networks and social networks on their life satisfaction using the 2018 China Longitudinal Aging Social Survey with a sample size of 11,418 older adults aged 60 years and older. In the research sample, 6.47% of older adults were subjected to at least one form of mistreatment. The research results indicate that family networks (β = 0.0060, p < 0.05) and social networks (β = 0.0122, p < 0.01) have a significant positive effect on older adults’ life satisfaction. The mechanism-of-action test found that family networks and social networks enhance older adults’ life satisfaction, mainly by reducing the level of physical mistreatment they experience, but these networks cannot improve the life satisfaction of the elderly by reducing their emotional mistreatment. Further research found that community-provided medical escorts, home chores, and meal delivery services can all alleviate the decline in life satisfaction among older adults due to emotional mistreatment. This study deepens our understanding of how older adults’ family and social networks affect their life satisfaction as we examine the mediating role of the physical and emotional mistreatment of older adults and discuss the effects of potential policy interventions.

Predictors of Physical Abuse in Elder Patients With Fracture

INTRODUCTION

Elder abuse is a public health issue requiring attention. Unlike abuse in the pediatric population, predictors of elder abuse in patients with fracture have not been well defined.

METHODS

Elderly patients with physical abuse and fracture were abstracted using the 2007 to 2017 National Emergency Department Sample database. Univariate comparisons, multivariate regression, and adjusted odds ratios were used to determine independent predictors of elder abuse compared with nonabuse fracture controls.

RESULTS

Thirteen percent of elder physical abuse patients presenting to the emergency department had fracture. Of all patients with fracture, elder abuse patients tended to be younger; be female; belong to lower income quartiles; and have codiagnoses of volume depletion, mental disorders, dementia, and intellectual disability. Presentation with other forms of elder abuse, such as psychological abuse, neglect, and sexual abuse, and multiple fractures were also associated with elder physical abuse. Multivariate regression found elder abuse to be more likely in the setting of skull and rib fractures and less likely in the setting of femur and foot and ankle fractures.

DISCUSSION

This study identified predictors of elder physical abuse in fracture patients older than 60 years. As with pediatric abuse, heightened awareness of potential physical abuse should be considered, especially in higher risk patients.

Everyday discrimination in later life: A social network approach

What factors shape everyday discrimination among older adults? Existing perspectives focus on individual identities and social group membership (e.g., race/ethnicity, age) as key determinants of perceived discrimination. This paper examines the idea that individuals' broader social contexts - including their personal social networks - also shape perceived discrimination, and in ways that may differ across racial groups. Using data from Round 3 of the National Social Life, Health, and Aging Project (N = 3312), I consider how properties of personal networks are associated with how frequently older adults report everyday discrimination. Results indicate that more kin-centric personal networks protect against more frequent everyday discrimination, but that this protective effect may be stronger among White older adults. I propose why more kin-centric networks may play a different role in the perceived discrimination of White and Black older adults, and close by suggesting that social network composition may be a source of heterogeneity in the link between everyday discrimination and inequality in later life outcomes such as health.

Social Support and Depressive Symptoms Among Men and Women With Same-Sex Experiences in Later Life

BACKGROUND AND OBJECTIVES

Social support is a vital psychological health resource for well-being in later life. However, research on the associations of social support has largely excluded sexual minorities. This study compares the association between sources of social support and depressive symptoms across groups of older heterosexual and sexual minority men and women. Sexual minority status herein is based on self-reported sexual histories of having same-sex and opposite-sex only experiences (SSE and OSO).

RESEARCH DESIGN AND METHODS

Based on a pooled cross-sectional dataset drawn from three waves of the National Social Life, Health, and Aging Project (NSHAP), we used OLS regression and moderation tests to evaluate how three sources of social support - partner, family, friend - are related to depressive symptoms for SSE and OSO men and women.

RESULTS

Results show OSO men and women both had significant negative associations between depressive symptoms and social support regardless of the source. SSE women, in contrast, only have a significant association between high levels of friend support, and SSE men only show significant effects in relation to high levels of partner support.

DISCUSSION AND IMPLICATIONS

These results suggest the effects of social support on psychological health are significantly constrained/circumscribed for sexual minority men and women. Interventions designed to decrease symptoms of depression in older sexual minorities through social support are discussed.

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

OBJECTIVES

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

METHOD

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

RESULTS

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

DISCUSSION

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

Social Health in the National Social Life, Health, and Aging Project

OBJECTIVES

In this article, we present the theoretical framework that guided the development of the National Social Life, Health, and Aging Project (NSHAP) including the measures of social health. We discuss the literature that links social measures to other outcomes, and we discuss in detail how researchers might construct common measures of social health, including those that reflect social relationships, sexuality, social networks, social resources, and social participation.

METHODS

The NSHAP includes multiple detailed measures of social health, collected in the rounds of data collection carried out in 2005, 2010, and 2015, allowing for study of changes over time and as people age among a nationally representative sample of the community-dwelling population of older adults in the United States.

RESULTS

We define indicators of social health, describe measures of each in the 2015 round of NSHAP, and show the distribution of the measures by gender and age. We present scales of dimensions of social health that have been developed elsewhere and describe their properties.

DISCUSSION

We briefly discuss the distribution of these measures by age and gender in the 2015 round of NSHAP. Simple analyses of these categorized measures reveal differences by age and gender that deserve closer attention in future investigations using the NSHAP data.

Detecting Risk of Neglect in NSHAP Round 3 Using New Follow-Up Questions to Activities of Daily Living Measures

OBJECTIVES

Elder neglect is a type of elder abuse wherein an older adult's basic needs remain unmet through negligence. The risk of neglect and its harmful consequences coincides with the need for care that arises with difficulties completing activities of daily living (ADLs) and instrumental activities of daily living (IADLs). In this paper, we describe how new questions included in Round 3 (2015-2016) of the National Social Life, Health, and Aging Project (NSHAP-R3) can help detect the risk of elder neglect.

METHODS

Based on the 2,340 respondents who indicated problems with at least one ADL or IADL, we categorized respondents as at a higher risk of neglect if they were either: (a) not getting wanted help (WANTHELP) or (b) getting help from an undependable caregiver (UNRELIABLE). We tested the external validity of these indicators by examining their association with NSHAP-R3 measures of physical and mental health, personal hygiene, home tidiness, social support, and elder mistreatment, using t tests and chi-square tests.

RESULTS

Those labeled higher neglect risk based on the WANTHELP variable showed significantly worse self-rated physical health, personal hygiene, room tidiness, mental health, partner support, family support, and elder mistreatment. The same correlates were significantly associated with higher neglect risk based on the UNRELIABLE variable, except for self-rated physical health, personal hygiene, and room tidiness.

DISCUSSION

Findings suggest that these new measures can be useful for identifying NSHAP respondents who are at risk of types of neglect that can be associated with having I/ADL limitations.

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.