Different Definitions of Elder Mistreatment and Mortality: A Prospective Cohort Study From 2011 to 2017

Risk Factors for Post-Discharge Adverse Outcomes Following Hospitalization Among Older Adults Diagnosed With Elder Mistreatment

Using 100% Medicare data files, this study explored whether primary elder mistreatment (EM) diagnosis, EM type, and facility type were associated with 3-year mortality and 1-year unplanned hospital readmission among older patients diagnosed with EM with hospital discharge from 10/01/2015 through 12/31/2018 (n = 11,023). We also examined outcome differences between older patients diagnosed with EM and matched non-EM patient controls. Neglect by others was the most common EM diagnosis. Three-year mortality was 56.7% and one-year readmission rate was 53.8%. Compared to matched non-EM patient controls, older EM patients were at an increased risk of mortality and readmission. Among patients diagnosed with EM, patients with a secondary (vs. primary) diagnosis and those discharged from a skilled nursing facility (vs. acute hospital) were at an increased risk for both mortality and readmission. Compared to other EM types, patients diagnosed with neglect by others had a greater risk for mortality following discharge.

Elder Mistreatment as a Risk Factor for Depression and Suicidal Ideation in Korean Older Adults

Older adults suffering from mistreatment are especially vulnerable to adverse health outcomes. The current study examined the associations of elder mistreatment (single- and multi-type mistreatment) with depression or suicidal ideation in a Korean representative sample. The data were derived from the 2017 National Survey of Living Conditions and Welfare Needs of Korean Older Persons (unweighted n = 10,059 and weighted n = 10,055). Descriptive statistics and multivariate logistic regression analyses were performed. In the weighted population, 9.8% of older adults had mistreatment experiences. Results indicated that single- and multi-type mistreatment experiences were associated with increased risks of depression (OR = 1.93, 95% CI = [1.61, 2.32] and OR = 3.51, 95% CI = [2.52, 4.87], respectively), after adjusting for the confounding factors (socio-demographic, health-related, and social relation characteristics). Experiences of single- and multi-type mistreatment were also associated with suicidal ideation (OR = 2.48, 95% CI = [1.97, 3.12] and OR = 3.19, 95% CI = [2.25, 4.51], respectively), even after adjusting for the above confounding factors and depression. Similar results were found in sensitivity analyses using unweighted data. The current findings expanded our knowledge of the associations of mistreatment with depression and suicidal ideation in later life.

Elder abuse and cognitive function among community-Dwelling older adults: Does abuse history matter?

BACKGROUND AND AIM

The World Health Organization has identified child abuse, intimate partner violence (IPV), and elder abuse (EA) as common types of interpersonal violence. Research showed individuals exposed to interpersonal violence in one life stage were at higher risks of exposure to interpersonal violence in other life stages. This study aims to examine the relationship between cumulative interpersonal violence and cognitive function.

METHODS

Data were derived from the PINE Study in which 3,157 Chinese older adults aged 60 and above received interviews in Chicago. We used a 56-item modified Conflict Tactics Scale to evaluate EA. Abuse history was defined as exposure to child abuse (before age 18) and/or IPV (age 18-59) measured respectively by the Extended Hurt, Insult, Threaten, Scream scale. We divided participants into four groups: EA and abuse history (n = 204), EA only (n = 439, reference group), abuse history only (n = 310), and no interpersonal violence (n = 2181). Global cognition was evaluated by episodic memory, working memory, processing speed, and MMSE. Linear regression was used.

RESULTS

Older adults with EA and abuse history (b = 0.147, SE = 0.052, p < .01) or abuse history only (b = 0.118, SE = 0.046, p < .01) had higher global cognition than the EA only group.

CONCLUSIONS

Individuals with abuse history might develop resilience in the face of interpersonal violence in old age through gaining a sense of mastery and developing effective coping skills from prior experience. Healthcare professionals could assess older adults' prior victimizations and recent victimizations to plan family violence counseling and promote healthy cognitive aging.

Social Networks and Depressive Symptoms among Chinese Older Immigrants: Does Quantity, Quality, and Composition of Social Networks Matter?

Objectives: This study aims to investigate the relationship between quantity, quality, and composition of social networks and depressive symptoms among U.S. Chinese older adults. Methods: Data were derived from the Population Study of Chinese Elderly (PINE) (N = 3,157), a study of Chinese older adults aged 60 and above in Chicago. We assessed quantitative (network size and volume of contact), qualitative (emotional closeness), and composition (proportion kin, proportion female and proportion coresident) aspects of social networks. Depressive symptoms were measured by the Patient Health Questionnaire-9. Negative binomial and logistic regressions were conducted. Results: Older adults who had three to five network members with strong ties, a medium level of contact, and a high level of emotional closeness were less likely to experience depression than their counterparts. Quantitative and qualitative dimensions of social networks have stronger protective effects than the composition dimension. Conclusions: U.S. Chinese older immigrants with different levels of social network characteristics have different risks of depression, suggesting targeted subpopulation assessments to facilitate the delivery of more appropriate and effective treatment to those most in need. Clinical Implications: Health-care professionals and social service agencies are suggested to develop intervention programs to promote mental health through increasing strong ties and improving the quality of social networks for U.S. Chinese older immigrants.

Violence and associated health outcomes among older adults in India: A gendered perspective

BACKGROUND

Since older population in India continue to rely on family and social networks for care and support, understanding the health outcomes associated with violence within and outside family may direct the development of policies and measures to aid the victims of violence. The present paper examines the health consequences of violence against older adults and its gender differentials in India.

METHODS

Using data from Building Knowledge Base on Population Ageing in India (BKPAI), we employed bivariate and logistic regressions on a sample of 9181 older adults to fulfil the aims and objective of the paper.

RESULTS

About 10.7% and 11.3% of men and women faced violence after turning 60 years respectively. Older adults who ever faced violence after turning age 60 years had 60%, 41% and 33% higher likelihood to have poor-SRH, low ADL and low IADL respectively in comparison to their counterparts. Further, it was found that older adults who ever faced violence after turning age 60 years had 97% and 62% higher likelihood to have lower psychological health and low subjective well-being. Additionally, it was found that women who faced violence had higher odds of having low psychological health [OR: 1.18, CI: 1.06, 1.63], low subjective well-being [OR: 1.70, CI: 1.24, 2.33] and low cognitive ability [OR: 1.32, CI: 1.04, 1.79] in comparison to men who faced violence.

CONCLUSION

Violence against older adults must be recognized as a key public health issue for older adults in India. Study findings indicate the immediate need for assessing victim health outcomes following any type of violence in later years to determine related policies and programs to protect the victims. Reducing violence will have a positive impact on physical and mental health outcomes late in life as well as the functional abilities of older adults, especially older women.

Association Between Different Forms of Elder Mistreatment and Cognitive Change

Objectives: Elder mistreatment (EM) is associated with worse physical health and psychological well-being, but little is known regarding its cognitive consequences. Methods: Data were derived from the T1-T2 PINE (n = 2713). EM was measured by psychological, physical, and sexual mistreatment; financial exploitation; and caregiver neglect. Cognitive function was evaluated by global cognition, episodic memory, working memory, processing speed, and Mini-Mental State Examination. Linear regression was used. Results: At baseline, physical mistreatment and caregiver neglect were associated with lower global cognition and cognitive domains, while psychological mistreatment was associated with higher cognitive function. Older adults with incident psychological mistreatment, physical mistreatment, and caregiver neglect had a faster decrease in global cognition and cognitive domains over 2 years. Discussion: This study is among the first to examine the association between different forms of EM and cognitive change. These findings provide a basis for engaging ethnic minorities with EM to maintain cognitive health.

Elder Mistreatment and Psychological Well-Being among Older Americans

Elder mistreatment is a major public health issue both in the US and around the globe. While extensive research has elucidated the association between elder mistreatment and health in older adults, little is known about the relationship between elder mistreatment and more eudaimonic measures of psychological well-being. Using data from the 2011 wave of the Wisconsin Longitudinal Study, this project examined the association between older adults’ experience with varied forms of elder mistreatment and eudaimonic dimensions of psychological well-being including autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance. Ordinary least squares regression analyses found significant associations between experiences of elder mistreatment and psychological well-being. In particular, older adults who reported feeling that someone was too controlling over their daily lives and older adults who reported making donations to organizations they later worried were not legitimate reported significantly lower scores on all six psychological well-being dimensions. The results of this study suggest the negative effects of elder mistreatment can extend to more eudaimonic feelings of well-being, and programs designed to treat victims of elder mistreatment should incorporate strategies that help strengthen psychological well-being.

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.

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.

Leveraging Technology to Improve Health Disparity Research: Trilingual Data Collection Using Tablets

Survey research is an essential component of epidemiological research to understand the health of older adults. However, there are several limitations to conventional data collection methods that may serve as barriers for recruitment and retention of research participants, especially from minority populations. With recent technological advancements, our research team developed an innovative data collection and management system to address linguistic and cultural barriers, data quality, data security, and data preparation issues. This platform has been utilized in the Population Study of Chinese Elderly in Chicago since 2011. Future use and improvement of this system will facilitate research among minority older adults and increase research participation and representativeness to ultimately understand and improve the health and well-being of diverse populations. J Am Geriatr Soc 67:S479-S485, 2019.