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Zhang H, Bao Y, Baek D, Clark S, Elman A, Hancock D, Chang ES, Jeng P, Gassoumis Z, Fettig N, Zhang Y, Wen K, Lachs MS, Pillemer K, Rosen T. Healthcare costs for legally adjudicated elder mistreatment victims in comparison to non-mistreated older adults. J Am Geriatr Soc 2024; 72:236-245. [PMID: 38112382 PMCID: PMC10872321 DOI: 10.1111/jgs.18712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/20/2023] [Accepted: 11/26/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Elder mistreatment (EM) is associated with adverse health outcomes and healthcare utilization patterns that differ from other older adults. However, the association of EM with healthcare costs has not been examined. Our goal was to compare healthcare costs between legally adjudicated EM victims and controls. METHODS We used Medicare insurance claims to examine healthcare costs of EM victims in the 2 years surrounding initial mistreatment identification in comparison to matched controls. We adjusted costs using the Centers for Medicare and Medicaid Services Hierarchical Condition Categories (CMS-HCC) risk score. RESULTS We examined healthcare costs in 114 individuals who experienced EM and 410 matched controls. Total Medicare Parts A and B healthcare costs were similar between cases and controls in the 12 months prior to initial EM detection ($11,673 vs. $11,402, p = 0.92), but cases had significantly higher total healthcare costs during the 12 months after initial mistreatment identification ($15,927 vs. $10,805, p = 0.04). Adjusting for CMS-HCC scores, cases had, in the 12 months after initial EM identification, $5084 of additional total healthcare costs (95% confidence interval [$92, $10,077], p = 0.046) and $5817 of additional acute/subacute/post-acute costs (95% confidence interval [$1271, $10,362], p = 0.012) compared with controls. The significantly higher total costs and acute/sub-acute/post-acute costs among EM victims in the post-year were concentrated in the 120 days after EM detection. CONCLUSIONS Older adults experiencing EM had substantially higher total costs during the 12 months after mistreatment identification, driven by an increase in acute/sub-acute/post-acute costs and focused on the period immediately after initial EM detection.
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Affiliation(s)
- Hao Zhang
- Department of Population Health Sciences, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY
- Department of Health Policy and Organization, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yuhua Bao
- Department of Population Health Sciences, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY
| | - Daniel Baek
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York
| | - David Hancock
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York
| | - E-Shien Chang
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY
| | - Philip Jeng
- Department of Population Health Sciences, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY
| | - Zach Gassoumis
- Department of Family Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | | | - Yiye Zhang
- Department of Population Health Sciences, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY
| | - Katherine Wen
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
- Vanderbilt University, Nashville, TN, USA
| | - Mark S. Lachs
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY
| | - Karl Pillemer
- College of Human Ecology, Cornell University, Ithaca, NY
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York
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Parks CG, Pettinger M, de Roos AJ, Tindle HA, Walitt BT, Howard BV. Life Events, Caregiving, and Risk of Autoimmune Rheumatic Diseases in the Women's Health Initiative Observational Study. Arthritis Care Res (Hoboken) 2023; 75:2519-2528. [PMID: 37230960 PMCID: PMC10798355 DOI: 10.1002/acr.25164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Growing evidence suggests psychosocial stressors may increase risk of developing autoimmune disease. We examined stressful life events and caregiving in relation to incident rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) in the Women's Health Initiative Observational Study cohort. METHODS The sample of postmenopausal women included 211 incident RA or SLE cases reported within 3 years after enrollment, confirmed by use of disease-modifying antirheumatic drugs (i.e., probable RA/SLE), and 76,648 noncases. Baseline questionnaires asked about life events in the past year, caregiving, and social support. We used Cox regression models to calculate hazard ratios (HR) and 95% confidence intervals (95% CIs), adjusting for age, race/ethnicity, occupational class, education, pack-years of smoking and BMI. RESULTS Incident RA/SLE was associated with reporting 3 or more life events (e.g., age-adjusted HR 1.70 [95% CI 1.14, 2.53]; P for trend = 0.0026). Elevated HRs were noted for physical (HR 2.48 [95% CI 1.02, 6.04]) and verbal (HR 1.34 [0.89, 2.02]) abuse (P for trend = 0.0614), 2 or more interpersonal events (HR 1.23 [95% CI 0.87, 1.73]; P for trend = 0.2403), financial stress (HR 1.22 [95% CI 0.90, 1.64]), and caregiving 3 or more days per week (HR 1.25 [95% CI 0.87, 1.81]; P for trend = 0.2571). Results were similar, excluding women with baseline symptoms of depression or moderate-to-severe joint pain in the absence of diagnosed arthritis. CONCLUSION Our findings support the idea that diverse stressors may increase risk of developing probable RA or SLE in postmenopausal women, supporting the need for further studies in autoimmune rheumatic diseases, including childhood adverse events, life event trajectories, and modifying psychosocial and socioeconomic factors.
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Affiliation(s)
- Christine G. Parks
- National Institute of Environmental Health Sciences, National Institute of Health, Research Triangle Park, NC
| | - Mary Pettinger
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA
| | - Anneclaire J. de Roos
- Department of Environmental & Occupational Health, Drexel University Dornsife School of Public Health, Philadelphia, PA
| | - Hilary A. Tindle
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
- Geriatric Research Education and Clinical Centers, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN
| | - Brian T. Walitt
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD
| | - Barbara V. Howard
- Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, USA; MedStar Health Research Institute, Hyattsville, MD, USA
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Rosen T, Zhang H, Wen K, Clark S, Elman A, Jeng P, Baek D, Zhang Y, Gassoumis Z, Fettig N, Pillemer K, Lachs MS, Bao Y. Emergency Department and Hospital Utilization Among Older Adults Before and After Identification of Elder Mistreatment. JAMA Netw Open 2023; 6:e2255853. [PMID: 36787139 PMCID: PMC9929702 DOI: 10.1001/jamanetworkopen.2022.55853] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 12/25/2022] [Indexed: 02/15/2023] Open
Abstract
Importance Elder mistreatment is common and has serious health consequences. Little is known, however, about patterns of health care utilization among older adults experiencing elder mistreatment. Objective To examine emergency department (ED) and hospital utilization of older adults experiencing elder mistreatment in the period surrounding initial mistreatment identification compared with other older adults. Design, Setting, and Participants This retrospective case-control study used Medicare insurance claims to examine older adults experiencing elder mistreatment initially identified between January 1, 2003, and December 31, 2012, and control participants matched on age, sex, race and ethnicity, and zip code. Statistical analysis was performed in April 2022. Main Outcomes and Measures We used multiple measures of ED and hospital utilization patterns (eg, new and return visits, frequency, urgency, and hospitalizations) in the 12 months before and after mistreatment identification. Data were adjusted using US Centers for Medicare and Medicaid Services Hierarchical Condition Categories risk scores. Chi-squared tests and conditional logistic regression models were used for data analyses. Results This study included 114 case patients and 410 control participants. Their median age was 72 years (IQR, 68-78 years), and 340 (64.9%) were women. Race and ethnicity were reported as racial or ethnic minority (114 [21.8%]), White (408 [77.9%]), or unknown (2 [0.4%]). During the 24 months surrounding identification of elder mistreatment, older adults experiencing mistreatment were more likely to have had an ED visit (77 [67.5%] vs 179 [43.7%]; adjusted odds ratio [AOR], 2.95 [95% CI, 1.78-4.91]; P < .001) and a hospitalization (44 [38.6%] vs 108 [26.3%]; AOR, 1.90 [95% CI, 1.13-3.21]; P = .02) compared with other older adults. In addition, multiple ED visits, at least 1 ED visit for injury, visits to multiple EDs, high-frequency ED use, return ED visits within 7 days, ED visits for low-urgency issues, multiple hospitalizations, at least 1 hospitalization for injury, hospitalization at multiple hospitals, and hospitalization for ambulatory care sensitive conditions were substantially more likely for individuals experiencing elder mistreatment. The rate of ED and hospital utilization for older adults experiencing elder mistreatment was much higher in the 12 months after identification than before, leading to more pronounced differences between case patients and control participants in postidentification utilization. During the 12 months after identification of elder mistreatment, older adults experiencing mistreatment were particularly more likely to have had high-frequency ED use (12 [10.5%] vs 8 [2.0%]; AOR, 8.23 [95% CI, 2.56-26.49]; P < .001) and to have visited the ED for low-urgency issues (12 [10.5%] vs 8 [2.0%]; AOR, 7.33 [95% CI, 2.54-21.18]; P < .001). Conclusions and Relevance In this case-control study of health care utilization, older adults experiencing mistreatment used EDs and hospitals more frequently and with different patterns during the period surrounding mistreatment identification than other older adults. Additional research is needed to better characterize these patterns, which may be helpful in informing early identification, intervention, and prevention of elder mistreatment.
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Affiliation(s)
- Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York
| | - Hao Zhang
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Katherine Wen
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York
| | - Philip Jeng
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Daniel Baek
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York
| | - Yiye Zhang
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Zach Gassoumis
- Department of Family Medicine, University of Southern California Keck School of Medicine, Los Angeles
| | | | - Karl Pillemer
- College of Human Ecology, Cornell University, Ithaca, New York
| | - Mark S. Lachs
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York
| | - Yuhua Bao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
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Firdaus MAM, Mohd Yunus R, Hairi NN, Choo WY, Hairi F, Suddin LS, Sooryanarayana R, Ismail N, Peramalah D, Ali ZM, Ahmad SN, Razak IA, Othman S, Bulgiba A. Elder abuse and hospitalization in rural Malaysia. PLoS One 2022; 17:e0270163. [PMID: 35749384 PMCID: PMC9231721 DOI: 10.1371/journal.pone.0270163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/03/2022] [Indexed: 11/19/2022] Open
Abstract
Our study aims to describe and determine factors associated with hospitalization among victims of elder abuse and neglect (EAN) in rural Malaysia. A cross sectional study based on the baseline data of the Malaysian Elder Mistreatment Project (MAESTRO) collected from November 2013 until July 2014 involving 1927 older adults in Kuala Pilah, Negeri Sembilan was conducted. EAN was determined using the modified Conflict Tactics Scale (CTS) and hospitalization rates were determined based on self-report. The prevalence of overall EAN was 8.1% (95%CI 6.9–9.3). Among male respondents, 9.5% revealed history of abuse and among female respondents, 7.2% reported experiencing EAN. The annual hospitalization rates per 100 persons within the past one year among EAN victims and non-victims were 18 per 100 persons (SD = 46.1) and 15 per 100 persons (SD = 64.1) respectively. Among respondents with history of EAN, 16.0% (n = 21) had been hospitalized in the past 12 months while among respondents with no EAN experience, 10.2% (n = 153) were hospitalized. Multivariable analyses using Poisson regression did not show any significant association between EAN and hospitalization. This could be due to the complex interactions between medical and social circumstances that play a role in hospital admissions, factors affecting the health care system, and access to health care among EAN victims.
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Affiliation(s)
| | - Raudah Mohd Yunus
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
- Department of Social and Preventive Medicine, Centre for Epidemiology and Evidence-Based Practice, University of Malaya, Kuala Lumpur, Malaysia
| | - Noran Naqiah Hairi
- Department of Social and Preventive Medicine, Centre for Epidemiology and Evidence-Based Practice, University of Malaya, Kuala Lumpur, Malaysia
- Health and Well-being Research Cluster, Institute of Research Management and Monitoring, Research Management and Innovation Complex, University of Malaya, Kuala Lumpur, Malaysia
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
- * E-mail:
| | - Wan Yuen Choo
- Department of Social and Preventive Medicine, Centre for Epidemiology and Evidence-Based Practice, University of Malaya, Kuala Lumpur, Malaysia
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Farizah Hairi
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Leny Suzana Suddin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | - Rajini Sooryanarayana
- Family Health Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Norliana Ismail
- Disease Control Division, Tobacco Control Unit, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Devi Peramalah
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Zainudin M. Ali
- Negeri Sembilan Health State Department, Seremban, Negeri Sembilan, Malaysia
| | - Sharifah N. Ahmad
- Negeri Sembilan Health State Department, Seremban, Negeri Sembilan, Malaysia
| | - Inayah A. Razak
- Negeri Sembilan Health State Department, Seremban, Negeri Sembilan, Malaysia
| | | | - Awang Bulgiba
- Department of Social and Preventive Medicine, Centre for Epidemiology and Evidence-Based Practice, University of Malaya, Kuala Lumpur, Malaysia
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Prevalence of elder abuse and its related factors in Iran: A community-based study. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03024-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Crowder J, Burnett C, Byon HD, Laughon K, Acierno R, Yan G, Hinton I, Teaster PB. Exploration and Comparison of Contextual Characteristics and Mistreatment Prevalence Among Older American Indian and Alaska Native Respondents: Secondary Analysis of the National Elder Mistreatment Study. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:1456-1483. [PMID: 32478601 DOI: 10.1177/0886260520922356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Limited research on elder abuse among American Indians and Alaska Natives (AIANs) suggests a higher prevalence of abuse. Using data from the National Elder Mistreatment Study (NEMS), we compared contextual characteristics and elder mistreatment prevalence rates from a community-based sample of AIAN (n = 195) and Black (n = 437) and White (n = 5,013) respondents. There were differences in the prevalence of 16 abuse types and the 23 contextual variables. AIAN respondents had more similarities compared with Black respondents than White respondents, though differences existed. The cumulative prevalence of emotional, physical, and sexual mistreatment in the past year, neglect, and financial abuse by a family member for the AIAN group was 33%, almost double the 17.1% reported in the NEMS study. Over their lifetime, 29.7% of AIAN respondents reported experiencing two or more types of neglect, exploitation, or mistreatment. Almost one fourth of AIAN respondents reported emotional abuse since 60 years of age (the most commonly occurring abuse type)-nearly double that of White respondents. This is the first study to offer comparative prevalence of elder abuse for both AIAN older males and females that draws from a nationally representative sample. The study also provides descriptive analysis of important contextual information within the AIAN population, an underrepresented racial group in elder abuse research. Disaggregating nonmajority racial groups to examine contextual variables and the prevalence of elder mistreatment in the NEMS data set specific to AIAN respondents fills a knowledge gap. Known prevalence of various abuse typologies among AIAN elders can be useful in setting priorities for community planning and response, and in prioritization of funding for future research on causative mechanisms by abuse type, screening, and interventions at various levels. Findings may facilitate development of culturally specific evidence-based prevention and intervention practices aimed at needs specific to AIAN older adults.
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Affiliation(s)
| | | | - Ha Do Byon
- University of Virginia, Charlottesville, USA
| | | | - Ronald Acierno
- The University of Texas Health Science Center at Houston, USA
| | - Guofen Yan
- University of Virginia, Charlottesville, USA
| | | | - Pamela B Teaster
- Virginia Polytechnic Institute and State University, Blacksburg, USA
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Durfee A, Goodmark L. Gender, Protection Orders, and Intimate Partner Violence in Later Life: A Study of Protective Order Filings in Arizona. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:10479-10498. [PMID: 31686596 DOI: 10.1177/0886260519884688] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Most analyses of domestic violence and older adults focus on abuse by children and non-intimate caregivers. However, a significant percentage of elder abuse is perpetrated by an intimate partner. This article addresses a gap in the current literature on elder abuse by addressing how older survivors of intimate partner violence use the legal system as a tool to achieve safety by filing for a civil protection order. We critically examine 607 Arizona protection order filings in 2015, comparing those petitions filed by adults 50 and older (n = 83) with those younger than 50 (n = 524). We find significant differences in the forms of violence described in the protection order petition, as well as the types of relationships between the petitioner and respondent, the likelihood that an order will be issued, and the provisions requested and granted. Most importantly, gender is a critical component of our analysis-older petitioners are far more likely to be men than younger petitioners, and both petitions and outcomes are very different for older men than for older women. These results are then discussed in the context of the dynamics of older relationships, current firearm laws, and the barriers older adults face when attempting to use resources intended to help survivors achieve safety.
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Affiliation(s)
| | - Leigh Goodmark
- University of Maryland Carey School of Law, Baltimore, USA
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Dash K, Breckman R, Lees-Haggerty K, Elman A, Lachs M, Stoeckle RJ, Fulmer T, Rosen T. Developing a tool to assess and monitor institutional readiness to address elder mistreatment in hospital emergency departments. J Elder Abuse Negl 2021; 33:311-326. [PMID: 34496716 DOI: 10.1080/08946566.2021.1965930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
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.
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Affiliation(s)
- Kim Dash
- Health Promotion, Practice, and Innovation, US Division, Education Development Center, Waltham, MA, USA
| | - Risa Breckman
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine/Ne York Presbyterian Hospital, New York, NY, USA
| | - Kristin Lees-Haggerty
- Health Promotion, Practice, and Innovation, US Division, Education Development Center, Waltham, MA, USA
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Mark Lachs
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine/Ne York Presbyterian Hospital, New York, NY, USA
| | - Rebecca Jackson Stoeckle
- Health Promotion, Practice, and Innovation, US Division, Education Development Center, Waltham, MA, USA
| | - Terry Fulmer
- The John A. Hartford Foundation, New York, NY, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
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Rosen T, Bao Y, Zhang Y, Clark S, Wen K, Elman A, Jeng P, Bloemen E, Lindberg D, Krugman R, Campbell J, Bachman R, Fulmer T, Pillemer K, Lachs M. Identifying patterns of health care utilisation among physical elder abuse victims using Medicare data and legally adjudicated cases: protocol for case-control study using data linkage and machine learning. BMJ Open 2021; 11:e044768. [PMID: 33550264 PMCID: PMC7925867 DOI: 10.1136/bmjopen-2020-044768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Physical elder abuse is common and has serious health consequences but is under-recognised and under-reported. As assessment by healthcare providers may represent the only contact outside family for many older adults, clinicians have a unique opportunity to identify suspected abuse and initiate intervention. Preliminary research suggests elder abuse victims may have different patterns of healthcare utilisation than other older adults, with increased rates of emergency department use, hospitalisation and nursing home placement. Little is known, however, about the patterns of this increased utilisation and associated costs. To help fill this gap, we describe here the protocol for a study exploring patterns of healthcare utilisation and associated costs for known physical elder abuse victims compared with non-victims. METHODS AND ANALYSIS We hypothesise that various aspects of healthcare utilisation are differentially affected by physical elder abuse victimisation, increasing ED/hospital utilisation and reducing outpatient/primary care utilisation. We will obtain Medicare claims data for a series of well-characterised, legally adjudicated cases of physical elder abuse to examine victims' healthcare utilisation before and after the date of abuse detection. We will also compare these physical elder abuse victims to a matched comparison group of non-victimised older adults using Medicare claims. We will use machine learning approaches to extend our ability to identify patterns suggestive of potential physical elder abuse exposure. Describing unique patterns and associated costs of healthcare utilisation among elder abuse victims may improve the ability of healthcare providers to identify and, ultimately, intervene and prevent victimisation. ETHICS AND DISSEMINATION This project has been reviewed and approved by the Weill Cornell Medicine Institutional Review Board, protocol #1807019417, with initial approval on 1 August 2018. We aim to disseminate our results in peer-reviewed journals at national and international conferences and among interested patient groups and the public.
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Affiliation(s)
- Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Yuhua Bao
- Department of Health Policy & Research, Weill Cornell Medical College, New York, New York, USA
| | - Yiye Zhang
- Department of Health Policy & Research, Weill Cornell Medical College, New York, New York, USA
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Katherine Wen
- Department of Policy Analysis and Management, Cornell University, Ithaca, New York, USA
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Philip Jeng
- Department of Health Policy & Research, Weill Cornell Medical College, New York, New York, USA
| | - Elizabeth Bloemen
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Daniel Lindberg
- The Kempe Center for the Prevention & Treatment of Child Abuse & Neglect, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Richard Krugman
- The Kempe Center for the Prevention & Treatment of Child Abuse & Neglect, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jacquelyn Campbell
- John Hopkins University School of Nursing, John Hopkins University, Baltimore, Maryland, USA
| | - Ronet Bachman
- Department of Criminology, University of Delaware, Newark, Delaware, USA
| | - Terry Fulmer
- John A Hartford Foundation, New York, New York, USA
| | - Karl Pillemer
- Department of Policy Analysis and Management, Cornell University, Ithaca, New York, USA
| | - Mark Lachs
- Division of Geriatrics and Palliative Care, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
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Rosen T, LoFaso VM, Bloemen EM, Clark S, McCarthy TJ, Reisig C, Gogia K, Elman A, Markarian A, Flomenbaum NE, Sharma R, Lachs MS. Identifying Injury Patterns Associated With Physical Elder Abuse: Analysis of Legally Adjudicated Cases. Ann Emerg Med 2020; 76:266-276. [PMID: 32534832 DOI: 10.1016/j.annemergmed.2020.03.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 03/04/2020] [Accepted: 03/23/2020] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE Elder abuse is common and has serious health consequences but is underrecognized by health care providers. An important reason for this is difficulty in distinguishing between elder abuse and unintentional trauma. Our goal was to identify injury patterns associated with physical elder abuse in comparison with those of patients presenting to the emergency department (ED) with unintentional falls. METHODS We partnered with a large, urban district attorney's office and examined medical, police, and legal records from successfully prosecuted cases of physical abuse of victims aged 60 years or older from 2001 to 2014. RESULTS We prospectively enrolled patients who presented to a large, urban, academic ED after an unintentional fall. We matched 78 cases of elder abuse with visible injuries to 78 unintentional falls. Physical abuse victims were significantly more likely than unintentional fallers to have bruising (78% versus 54%) and injuries on the maxillofacial, dental, and neck area (67% versus 28%). Abuse victims were less likely to have fractures (8% versus 22%) or lower extremity injuries (9% versus 41%). Abuse victims were more likely to have maxillofacial, dental, or neck injuries combined with no upper and lower extremity injuries (50% versus 8%). Examining precise injury locations yielded additional differences, with physical elder abuse victims more likely to have injuries to the left cheek or zygoma (22% versus 3%) or on the neck (15% versus 0%) or ear (6% versus 0%). CONCLUSION Specific, clinically identifiable differences may exist between unintentional injuries and those from physical elder abuse. This includes specific injury patterns that infrequently occur unintentionally.
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Affiliation(s)
- Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY.
| | - Veronica M LoFaso
- Division of Geriatrics and Palliative Care, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | | | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | | | - Christopher Reisig
- Department of Emergency Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | - Kriti Gogia
- Department of Emergency Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | - Arlene Markarian
- Elder Abuse Unit, King's County District Attorney's Office, Brooklyn, NY
| | - Neal E Flomenbaum
- Department of Emergency Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | - Rahul Sharma
- Department of Emergency Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | - Mark S Lachs
- Division of Geriatrics and Palliative Care, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
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11
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Makaroun LK, Brignone E, Rosland AM, Dichter ME. Association of Health Conditions and Health Service Utilization With Intimate Partner Violence Identified via Routine Screening Among Middle-Aged and Older Women. JAMA Netw Open 2020; 3:e203138. [PMID: 32315066 PMCID: PMC7175082 DOI: 10.1001/jamanetworkopen.2020.3138] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The US Preventive Services Task Force recently determined that there is insufficient evidence to recommend routine screening for intimate partner violence (IPV) in women who are middle-aged and older. Certain Veterans Health Administration (VHA) clinics have been routinely screening women of all ages for IPV since 2014. OBJECTIVES To examine the proportion of women older than childbearing age (ie, ≥45 years) who have positive results when routinely screened for past-year IPV at VHA clinics and to evaluate the associations of a positive screening result with health conditions and health service utilization. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 4481 women aged 45 years and older who were screened for past-year IPV in 13 VHA outpatient clinics in 11 states between April 2014 and April 2016. Data analysis was conducted from March 2019 to August 2019. EXPOSURE Positive screening result for past-year IPV. MAIN OUTCOMES AND MEASURES Mental and physical health conditions (identified using International Classification of Diseases, Ninth Edition [ICD-9] and ICD-10 codes from VHA medical record data) and VHA health services utilization (identified using inpatient and outpatient VHA encounter data) in the 20 months after screening. RESULTS In this study, 2937 of 4481 women (65.5%) were middle-aged (ie, aged 45 to 59 years), and 1544 (34.5%) were older (ie, aged ≥60 years), with 1955 (43.6%) black participants. A total of 255 middle-aged women (8.7%; mean [SD] age, 51 [4] years) and 79 older women (5.1%; mean [SD] age, 64 [5] years) screened positive for past-year IPV. In adjusted logistic regression models among middle-aged women, screening positive for IPV was associated with subsequent diagnoses of anxiety (adjusted odds ratio [aOR], 2.00; 95% CI, 1.50-2.70; P < .001), depression (aOR, 2.30; 95% CI, 1.80-3.00; P < .001), posttraumatic stress disorder (aOR, 2.30; 95% CI, 1.80-3.00; P < .001), suicidal ideation and/or behavior (aOR, 3.80; 95% CI, 2.10-6.90; P < .001), and substance use disorder (aOR, 2.50; 95% CI, 1.80-3.50; P < .001). Similar but attenuated associations were seen for older women (eg, substance use disorder: aOR, 2.20; 95% CI, 1.10-4.40; P = .04). In adjusted negative binomial regression models among middle-aged women, screening positive for IPV was associated with a higher rate of subsequent psychosocial (eg, mental health) visits (adjusted rate ratio [aRR], 2.40; 95% CI, 2.00-2.90; P < .001), primary care visits (aRR, 1.20; 95% CI, 1.10-1.30; P < .001), and emergency department visits (aRR, 1.50; 95% CI 1.20-1.80; P < .001). Older women screening positive for IPV had a higher rate of psychosocial visits (aRR, 1.90; 95% CI, 1.30-2.70; P < .001) but not of other visit types. CONCLUSIONS AND RELEVANCE To our knowledge, this study was the largest to evaluate routine screening for IPV among women aged 45 years and older, and it found that IPV remained prevalent and was associated with morbidity for these women. Screening for IPV in women older than 44 years may improve detection and provision of evidence-based services to this growing population.
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Affiliation(s)
- Lena K. Makaroun
- VA Center for Health Equity Research and Promotion, Pittsburgh, Pennsylvania
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Emily Brignone
- VA Center for Health Equity Research and Promotion, Pittsburgh, Pennsylvania
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Ann-Marie Rosland
- VA Center for Health Equity Research and Promotion, Pittsburgh, Pennsylvania
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Melissa E. Dichter
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
- Temple University School of Social Work, Philadelphia, Pennsylvania
- VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania
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12
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Mouton CP, Haas A, Karmarkar A, Kuo YF, Ottenbacher K. Elder abuse and mistreatment: results from medicare claims data. J Elder Abuse Negl 2019; 31:263-280. [PMID: 31631814 DOI: 10.1080/08946566.2019.1678544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- Charles P Mouton
- Department of Family Medicine, University of Texas Medical Branch, Galveston, TX
| | - Allen Haas
- Department of Preventive Medicine and Population Health
| | - Amol Karmarkar
- Department of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Population Health
| | - Kenneth Ottenbacher
- Department of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX
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13
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Filipska K, Biercewicz M, Wiśniewski A, Kędziora-Kornatowska K, Ślusarz R. Prevalence of elder abuse and neglect: screening in Poland families. Eur Geriatr Med 2019; 10:817-825. [PMID: 34652705 DOI: 10.1007/s41999-019-00224-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/24/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE Elder abuse and neglect is one of the most important problems of social and health policy among countries around the world. Making a real and reliable assessment of the occurrence of abuse is difficult to implement. The aim of this work is to show the frequency of physical, psychological, sexual abuse and financial exploitation among older adults. METHODS Older adults, who were aged ≥ 60 years (N = 200) were qualified for the study. The studied population consisted of 112 women (56.0%) and 88 men (44.0%). The whole project procedure only included filling in the survey questionnaire. The verification of hypotheses was based on tests: Chi square test, Chi square test with continuity correction and logistic regression models. RESULTS Within the obtained own results, out of 200 older adults, 77 respondents (38.5%) experienced abuse and neglect during the last 12 months. Most of the respondents (68.8%) experienced various forms of abuse simultaneously. Among those who experienced abuse, 75.3% experienced psychological abuse, 68.8% financial exploitation, 48.1% physical abuse, and 22.1% experienced sexual abuse. The rate of physical (OR 2.48; 95% CI 1.13, 5.44; p = 0.02), verbal (OR 1.94; 95% CI 1.02, 3.67; p = 0.04), sexual (OR 4.05; 95% CI 1.13, 14.5; p = 0.03) and economic (OR 1.98; 95% CI 1.02, 3.83; p = 0.04) abuse is statistically significantly higher, respectively, in women than in men. The level of education is a risk fact for physical abuse (p = 0.02). It has also been shown that singles, people with the income < 233 EUR and people living in urban areas are most often victims of elder abuse and neglect. CONCLUSIONS The results suggest that elder abuse and neglect is a fairly common phenomenon. Our data also provide confirmation of other researches conducted in this area.
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Affiliation(s)
- Karolina Filipska
- Neurological and Neurosurgical Nursing Department, Faculty of Health Science, Collegium Medicum, Nicolaus Copernicus University, Łukasiewicza 1 Street, 85-821, Bydgoszcz, Toruń, Poland.
| | - Monika Biercewicz
- Clinic of Geriatrics, Faculty of Health Science, Collegium Medicum, Nicolaus Copernicus University, Toruń, Poland
| | - Adam Wiśniewski
- Department of Neurology, Faculty of Medicine, Collegium Medicum, Nicolaus Copernicus University, Toruń, Poland
| | | | - Robert Ślusarz
- Neurological and Neurosurgical Nursing Department, Faculty of Health Science, Collegium Medicum, Nicolaus Copernicus University, Łukasiewicza 1 Street, 85-821, Bydgoszcz, Toruń, Poland
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14
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Rosen T, Elman A, Dion S, Delgado D, Demetres M, Breckman R, Lees K, Dash K, Lang D, Bonner A, Burnett J, Dyer CB, Snyder R, Berman A, Fulmer T, Lachs MS. Review of Programs to Combat Elder Mistreatment: Focus on Hospitals and Level of Resources Needed. J Am Geriatr Soc 2019; 67:1286-1294. [PMID: 30901078 PMCID: PMC6561817 DOI: 10.1111/jgs.15773] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/13/2018] [Accepted: 12/15/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Elder mistreatment is common and has serious social and medical consequences for victims. Though programs to combat this mistreatment have been developed and implemented for more than three decades, previous systematic literature reviews have found few successful ones. OBJECTIVE To conduct a more comprehensive examination of programs to improve elder mistreatment identification, intervention, or prevention, including those that had not undergone evaluation. DESIGN Systematic review. SETTING Ovid MEDLINE, Ovid EMBASE, Cochrane Library, PsycINFO Elton B. Stephens Co. (EBSCO), AgeLine, CINAHL. MEASUREMENTS We abstracted key information about each program and categorized programs into 14 types and 9 subtypes. For programs that reported an impact evaluation, we systematically assessed the study quality. We also systematically examined the potential for programs to be successfully implemented in environments with limited resources available. RESULTS We found 116 articles describing 115 elder mistreatment programs. Of these articles, 43% focused on improving prevention, 50% focused on identification, and 95% focused on intervention, with 66% having multiple foci. The most common types of program were: educational (53%), multidisciplinary team (MDT) (21%), psychoeducation/therapy/counseling (15%), and legal services/support (8%). Of the programs, 13% integrated an acute-care hospital, 43% had high potential to work in low-resource environments, and 57% reported an attempt to evaluate program impact, but only 2% used a high-quality study design. CONCLUSION Many programs to combat elder mistreatment have been developed and implemented, with the majority focusing on education and MDT development. Though more than half reported evaluation of program impact, few used high-quality study design. Many have the potential to work in low-resource environments. Acute-care hospitals were infrequently integrated into programs.
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Affiliation(s)
- Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital
| | - Sarah Dion
- University of Cincinnati College of Medicine
| | - Diana Delgado
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medical College
| | - Michelle Demetres
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medical College
| | - Risa Breckman
- Division of Geriatrics and Palliative Care, Weill Cornell Medical College / NewYork-Presbyterian
| | | | | | - Debi Lang
- Department of Family Medicine and Community Health, University of Massachusetts Medical School
| | - Alice Bonner
- School of Nursing, Bouve College of Health Sciences, Northeastern University
- Executive Office of Elder Affairs, Commonwealth of Massachusetts
| | - Jason Burnett
- Department of Internal Medicine, University of Texas Medical School
| | - Carmel B. Dyer
- Department of Internal Medicine, University of Texas Medical School
| | | | | | | | - Mark S. Lachs
- Division of Geriatrics and Palliative Care, Weill Cornell Medical College / NewYork-Presbyterian
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15
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Yon Y, Mikton C, Gassoumis ZD, Wilber KH. The Prevalence of Self-Reported Elder Abuse Among Older Women in Community Settings: A Systematic Review and Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2019; 20:245-259. [PMID: 29333977 DOI: 10.1177/1524838017697308] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The abuse of older women appears to be a significant problem. Developing a better understanding of the extent of the problem is an important step toward preventing it. We conducted a global systematic review and meta-analysis of existing prevalence studies, in multiple languages, that occurred in the community settings from inception to June 26, 2015, in order to determine the extent of abuse against women aged 60 years and over. To disentangle the wide variations in prevalence estimates, we also investigated the associations between prevalence estimates and studies' demographic and methodological characteristics. A total of 50 studies were included in the meta-analysis. The combined prevalence for overall elder abuse in the past year was 14.1% (95% confidence interval (CI) [11.0, 18.0]). Pooled prevalence for psychological abuse was 11.8% (95% CI [9.2%, 14.9%]), neglect was 4.1% (95% CI [2.7%, 6.3%]), financial abuse was 3.8% (95% CI [2.5%, 5.5%]), sexual abuse was 2.2% (95% CI [1.6%, 3.0%]), and physical abuse was 1.9% (95% CI [1.2%, 3.1%]). The studies included in the meta-analysis for overall abuse were heterogeneous indicating that significant differences among the prevalence estimates exist. Significant associations were found between prevalence estimates and the following covariates: World Health Organization-defined regions, countries' income classification, and sample size. Together, these covariates explained 37% of the variance. Although robust prevalence studies are sparse in low- and middle-income countries, about 1 in 6, or 68 million older women experience abuse worldwide. More work is needed to understand the variation in prevalence rates and implications for prevention.
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Affiliation(s)
- Yongjie Yon
- 1 Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Christopher Mikton
- 2 Department of Social Sciences, University of the West of England, Bristol, United Kingdom
| | - Zachary D Gassoumis
- 1 Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Kathleen H Wilber
- 1 Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
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16
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Alipour A, Shamsalinia A, Ghaffari F, Fotokian Z. The Development and Psychometric Evaluation of a Questionnaire on the Nurses’ Recognition of Elder Abuse by Family Caregiver. Open Nurs J 2019. [DOI: 10.2174/1874434601913010066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
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.
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17
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Crowder J, Burnett C, Laughon K, Dreisbach C. Elder Abuse in American Indian Communities: An Integrative Review. JOURNAL OF FORENSIC NURSING 2019; 15:250-258. [PMID: 31764529 DOI: 10.1097/jfn.0000000000000259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND American Indian elders have one of the lowest life expectancies in the United States. Disproportionate disease burden, socioeconomic disparities, and higher rates of violence across the lifespan are thought to contribute to higher rates of elder abuse. Elder abuse and higher rates of trauma exposure are linked with adverse outcomes. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines informed the methodology and assessment of the literature on elder abuse among American Indians. RESULTS Of the nine studies published in the last 30 years, rates of elder abuse varied by study, location, and tribal affiliation from 4.3% to 45.9%. Large studies with comparison populations found higher rates for American Indians. There was a consensus for three risk factors: substance abuse, mental health problems, and caregiving issues. Importance of tribal norms, the notion of respect conferred to elders, and the concept of acculturation were major culturally relevant themes. Perceived tribal norms and strengths, for example, respect for elders, were at odds with abuse experiences, particularly financial exploitation and neglect. Historical trauma, shame, and fear impacted reporting. There was little consistency in study designs, most were qualitative or mixed methods, samples were small, there was no common measurement tool or time frame for abuse, and there was only one intervention study. IMPLICATIONS High rates of abuse suggest healthcare providers should be encouraged to screen and intervene despite the lack of empirical evidence. Providers should not assume that traditional culturally ascribed strengths, such as honor and respect for elders, provide any degree of protection against elder abuse.
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18
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Rosen T, Stern ME, Elman A, Mulcare MR. Identifying and Initiating Intervention for Elder Abuse and Neglect in the Emergency Department. Clin Geriatr Med 2018; 34:435-451. [PMID: 30031426 PMCID: PMC6057151 DOI: 10.1016/j.cger.2018.04.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Elder abuse and neglect are common and may have serious medical and social consequences but are infrequently identified. An emergency department (ED) visit represents a unique but usually missed opportunity to identify potential abuse and initiate intervention. ED assessment should include observation of patient-caregiver interaction, comprehensive medical history, and head-to-toe physical examination. Formal screening protocols may also be useful. ED providers concerned about elder abuse or neglect should document their findings in detail. ED interventions for suspected or confirmed elder abuse or neglect include treatment of acute medical, traumatic, and psychological issues; ensuring patient safety; and reporting to the authorities.
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Affiliation(s)
- Tony Rosen
- Division of Emergency Medicine, Emergency Department, Weill Cornell Medical College, NewYork-Presbyterian/Weill Cornell Medical Center, 525 East 68th Street, Room M130, New York, NY 10065, USA.
| | - Michael E Stern
- Division of Emergency Medicine, Emergency Department, Weill Cornell Medical College, NewYork-Presbyterian/Weill Cornell Medical Center, 525 East 68th Street, Room M130, New York, NY 10065, USA
| | - Alyssa Elman
- Division of Emergency Medicine, Emergency Department, Weill Cornell Medical College, NewYork-Presbyterian/Weill Cornell Medical Center, 525 East 68th Street, Room M130, New York, NY 10065, USA
| | - Mary R Mulcare
- Division of Emergency Medicine, Emergency Department, Weill Cornell Medical College, NewYork-Presbyterian/Weill Cornell Medical Center, 525 East 68th Street, Room M130, New York, NY 10065, USA
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19
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Kurkurina E, Lange BCL, Lama SD, Burk-Leaver E, Yaffe MJ, Monin JK, Humphries D. Detection of elder abuse: Exploring the potential use of the Elder Abuse Suspicion Index© by law enforcement in the field. J Elder Abuse Negl 2017; 30:103-126. [DOI: 10.1080/08946566.2017.1382413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Elina Kurkurina
- Department of Social & Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | | | - Sonam D. Lama
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Erin Burk-Leaver
- Robert N. Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, USA
| | - Mark J. Yaffe
- Departments of Family Medicine, St. Mary’s Hospital & McGill University, Montreal, Canada
| | - Joan K. Monin
- Department of Social & Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Debbie Humphries
- Department of Microbial Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
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Abstract
In contrast to work within the child-abuse field, polyvictimization of older adults did not become a focus of professional attention until this decade. Despite this lack of formal identification, a search of the research and practice literature revealed that prior research investigating single forms of or other elder abuse issues contained evidence of what was variously termed "multiple," "multi-faceted," "co-occurring," or "hybrid" elder abuse. A wide range of victims (1.4%-89.7%) identified in existing elder abuse studies was found to have experienced what constitutes "polyvictimization." This late-life polyvictimization evidence, the contexts in which victims are harmed, and information regarding the impact of multifaceted elder abuse are all presented and discussed in this article. Selected published cases illustrate the clinical dynamics operating in late-life polyvictimization situations.
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Affiliation(s)
- Holly Ramsey-Klawsnik
- a Klawsnik & Klawsnik Associates , Canton , MA , USA.,b National Adult Protective Services Association , Washington , DC , USA
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21
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Mouton CP, Southerland JH. Elder Abuse in the African Diaspora: A Review. J Natl Med Assoc 2017; 109:262-271. [PMID: 29173933 DOI: 10.1016/j.jnma.2017.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/07/2017] [Accepted: 08/18/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND As with many other populations, abuse of older adults is a growing problem across the Africa Diaspora. Modernization and urbanization are eroding the traditional values of respect for older adults. Also, older adults living in environments with limited social and economic resources, and having no means of economic support create a recipe for elder abuse and neglect. METHODS This article reviews the current literature on the epidemiology, risk factors, and interventions used for elder abuse across the African Diaspora. RESULTS Reports of elder abuse range from 24.9% to 81.1% across the Diaspora. Risk factors include cognitive and physical impairment, social isolation, lack of resources and widowhood. CONCLUSION Community-based programs using the unique social networks of older populations of African descent can provide a venue to improve caregiver training and support, reinforce traditional filial and informal caregiving practices, increase the utilization of available governmental and institutional.
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Affiliation(s)
- Charles P Mouton
- Department of Family Medicine, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA.
| | - Janet H Southerland
- Department of Oral and Maxillofacial Surgery, Meharry Medical College School of Dentistry, 1005 Dr. DB Todd, Jr. Blvd., Nashville, TN 37208, USA
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22
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Brignone L, Gomez AM. Double jeopardy: Predictors of elevated lethality risk among intimate partner violence victims seen in emergency departments. Prev Med 2017; 103:20-25. [PMID: 28687475 DOI: 10.1016/j.ypmed.2017.06.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 06/27/2017] [Accepted: 06/30/2017] [Indexed: 11/24/2022]
Abstract
Many intimate partner homicide victims visit emergency departments (EDs) prior to their deaths, yet their lethality risk is not well understood. eHealth interventions for intimate partner violence (IPV) improve provider information, tailor care to victim need and link victims to services. We analyzed ED patients' lethality risk using one such intervention, Domestic Violence Report and Referral (DVRR). DVRR records were assessed for 263 female patients aged 16 and older seen for IPV at an urban, high-traffic, Northern California ED in 2014-15. Multiple linear regression was used to test the association of children's presence at home, pregnancy, age, and abuser-victim relationship with victim's lethality risk using the Danger Assessment (DA) score from the Lethality Risk Assessment for Intimate Partner Femicide. Differences in means were assessed using t- and F-tests. The mean DA score indicated high lethality risk, with a third of respondents (33.1%) reporting very high DA scores. Multiple linear regression models indicated that increasing victim age (β=0.20/year; 95% CI: 0.11-0.29), children's presence at home (β=2.61, 95% CI: 0.63-4.58), and perpetrator reported as dating partner (β=4.50, 95% CI: 1.62-7.38) or ex-partner (β=4.38, 95% CI: 1.10-7.66) were significantly associated with the DA score (p<0.05). Use of DA scores as ED risk assessment tools in response to IPV victimization could help hospital staff and IPV advocates direct resources toward highest-need patients, improving health outcomes without additional burden on hospitals. These results also foreground eHealth interventions' utility in linking providers and IPV advocates and reducing the risk of intimate partner homicide.
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Affiliation(s)
- Laura Brignone
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, United States.
| | - Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity (SHARE) Program, School of Social Welfare, University of California, Berkeley, Berkeley, CA, United States
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23
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Warmling D, Lindner SR, Coelho EBS. Prevalência de violência por parceiro íntimo em idosos e fatores associados: revisão sistemática. CIENCIA & SAUDE COLETIVA 2017; 22:3111-3125. [DOI: 10.1590/1413-81232017229.12312017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 04/18/2017] [Indexed: 11/21/2022] Open
Abstract
Resumo Este artigo tem por objetivo identificar a prevalência de violência por parceiro íntimo (VPI) em idosos e seus fatores associados. Realizou-se revisão sistemática de estudos transversais de base populacional nas bases de dados PubMed, Lilacs e PsycInfo, sem restrições quanto ao período e idioma de publicação. Dois revisores independentes conduziram a seleção, extração dos dados e análise de qualidade metodológica. Dezenove artigos foram selecionados para análise. Houve variação do tipo de violência, sexo dos entrevistados e instrumentos utilizados. A maioria dos estudos apresentou qualidade metodológica moderada ou alta. A VPI ocorreu em homens e mulheres idosos, sendo mais prevalentes a violência psicológica e o abuso econômico. Os fatores associados mais frequentes foram o consumo de álcool, depressão, baixa renda, comprometimento funcional e exposição pregressa à violência.
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Evans CS, Hunold KM, Rosen T, Platts-Mills TF. Diagnosis of Elder Abuse in U.S. Emergency Departments. J Am Geriatr Soc 2016; 65:91-97. [PMID: 27753066 DOI: 10.1111/jgs.14480] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To estimate the proportion of visits to U.S. emergency departments (EDs) in which a diagnosis of elder abuse is reached using two nationally representative datasets. DESIGN Retrospective cross-sectional analysis. SETTING U.S. ED visits recorded in the 2012 Nationwide Emergency Department Sample (NEDS) or the 2011 National Hospital Ambulatory Medical Care Survey (NHAMCS). PARTICIPANTS All ED visits of individuals aged 60 and older. MEASUREMENTS The primary outcome was elder abuse defined according to International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. The proportion of visits with elder abuse was estimated using survey weights. Odds ratios (ORs) were calculated to identify demographic characteristics and common ED diagnoses associated with elder abuse. RESULTS In 2012, NEDS contained information on 6,723,667 ED visits of older adults, representing an estimated 29,056,673 ED visits. Elder abuse was diagnosed in an estimated 3,846 visits, corresponding to a weighted diagnosis period prevalence of elder abuse in U.S. EDs of 0.013% (95% confidence interval (CI) = 0.012-0.015%). Neglect and physical abuse were the most common types diagnosed, accounting for 32.9% and 32.2% of cases, respectively. Multivariable analysis showed greater weighted odds of elder abuse diagnosis in women (odds ratio (OR) = 1.95, 95% CI = 1.68-2.26) and individuals with contusions (OR = 2.91, 95% CI = 2.36-3.57), urinary tract infection (OR = 2.21, 95% CI = 1.84-2.65), and septicemia (OR = 1.92, 95% CI = 1.44-2.55). In the 2011 NHAMCS dataset, no cases of elder abuse were recorded for the 5,965 older adult ED visits. CONCLUSION The proportion of U.S. ED visits by older adults receiving a diagnosis of elder abuse is at least two orders of magnitude lower than the estimated prevalence in the population. Efforts to improve the identification of elder abuse in EDs may be warranted.
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Affiliation(s)
- Christopher S Evans
- School of Medicine, University of California, San Diego, California.,Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Tony Rosen
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York
| | - Timothy F Platts-Mills
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Division of Geriatrics, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Rosen T, Hargarten S, Flomenbaum NE, Platts-Mills TF. Identifying Elder Abuse in the Emergency Department: Toward a Multidisciplinary Team-Based Approach. Ann Emerg Med 2016; 68:378-82. [PMID: 27005448 PMCID: PMC5391043 DOI: 10.1016/j.annemergmed.2016.01.037] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Tony Rosen
- Division of Emergency Medicine, Weill Cornell Medical College, New York, NY.
| | - Stephen Hargarten
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Neal E Flomenbaum
- Division of Emergency Medicine, Weill Cornell Medical College, New York, NY
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Abstract
BACKGROUND Maltreatment of older people (elder abuse) includes psychological, physical, sexual abuse, neglect and financial exploitation. Evidence suggests that 10% of older adults experience some form of abuse, and only a fraction of cases are actually reported or referred to social services agencies. Elder abuse is associated with significant morbidity and premature mortality. Numerous interventions have been implemented to address the issue of elder maltreatment. It is, however, unclear which interventions best serve to prevent or reduce elder abuse. OBJECTIVES The objective of this review was to assess the effectiveness of primary, secondary and tertiary intervention programmes used to reduce or prevent abuse of the elderly in their own home, in organisational or institutional and community settings. The secondary objective was to investigate whether intervention effects are modified by types of abuse, types of participants, setting of intervention, or the cognitive status of older people. SEARCH METHODS We searched 19 databases (AgeLine, CINAHL, Psycinfo, MEDLINE, Embase, Proquest Central, Social Services Abstracts, ASSIA, Sociological Abstracts, ProQuest Dissertations & Theses Global, Web of Science, LILACS, EPPI, InfoBase, CENTRAL, HMIC, Opengrey and Zetoc) on 12 platforms, including multidisciplinary disciplines covering medical, health, social sciences, social services, legal, finance and education. We also browsed related organisational websites, contacted authors of relevant articles and checked reference lists. Searches of databases were conducted between 30 August 2015 and 16 March 2016 and were not restricted by language. SELECTION CRITERIA We included randomised controlled trials (RCTs), cluster-randomised trials, and quasi-RCTs, before-and-after studies, and interrupted time series. Only studies with at least 12 weeks of follow-up investigating the effect of interventions in preventing or reducing abuse of elderly people and those who interact with the elderly were included. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the studies' risk of bias. Studies were categorised as: 1) education on elder abuse, 2) programmes to reduce factors influencing elder abuse, 3) specific policies for elder abuse, 4) legislation on elder abuse, 5) programmes to increase detection rate on elder abuse, 6) programmes targeted to victims of elder abuse, and 7) rehabilitation programmes for perpetrators of elder abuse. All studies were assessed for study methodology, intervention type, setting, targeted audience, intervention components and intervention intensity. MAIN RESULTS The search and selection process produced seven eligible studies which included a total of 1924 elderly participants and 740 other people. Four of the above seven categories of interventions were evaluated by included studies that varied in study design. Eligible studies of rehabilitation programmes, specific policies for elder abuse and legislation on elder abuse were not found. All included studies contained a control group, with five of the seven studies describing the method of allocation as randomised. We used the Cochrane 'Risk of bias' tool and EPOC assessment criteria to assess risk of bias. The results suggest that risk of bias across the included body of research was high, with at least 40% of the included studies judged as being at high risk of bias. Only one study was judged as having no domains at high risk of bias, with two studies having two of 11 domains at high risk. One study was judged as being at high risk of bias across eight of 11 domains.All included studies were set in high-income countries, as determined by the World Bank economic classification (USA four, Taiwan one, UK two). None of the studies provided specific information or analysis on equity considerations, including by socio-economic disadvantage, although one study was described as being set in a housing project. One study performed some form of cost-effectiveness analysis on the implementation of their intervention programmes, although there were few details on the components and analysis of the costing.We are uncertain whether these interventions reduce the occurrence or recurrence of elder abuse due to variation in settings, measures and effects reported in the included studies, some of which were very small and at a high risk of bias (low- and very low-quality evidence).Two studies measured the occurrence of elder abuse. A high risk of bias study found a difference in the post-test scores (P value 0.048 and 0.18). In a low risk of bias study there was no difference found (adjusted odds ratio (OR) =0.48, 95% 0.18 to 1.27) (n = 214). For interventions measuring abuse recurrence, one small study (n = 16) reported no difference in post-test means, whilst another found higher levels of abuse reported for the intervention arms (Cox regression, combined intervention hazard ratio (HR) = 1.78, alpha level = 0.01).It is uncertain whether targeted educational interventions improve the relevant knowledge of health professionals and caregivers (very low-quality evidence), although they may improve detection of resident-to-resident abuse. The concept of measuring improvement in detection or reporting as opposed to measuring the occurrence or recurrence of abuse is complicated. An intervention of public education and support services aimed at victims may also improve rates of reporting, however it is unclear whether this was due to an increase in abuse recurrence or better reporting of abuse.The effectiveness of service planning interventions at improving the assessment and documentation of related domains is uncertain. Unintended outcomes were not reported in the studies. AUTHORS' CONCLUSIONS There is inadequate trustworthy evidence to assess the effects of elder abuse interventions on occurrence or recurrence of abuse, although there is some evidence to suggest it may change the combined measure of anxiety and depression of caregivers. There is a need for high-quality trials, including from low- or middle-income countries, with adequate statistical power and appropriate study characteristics to determine whether specific intervention programmes, and which components of these programmes, are effective in preventing or reducing abuse episodes among the elderly. It is uncertain whether the use of educational interventions improves knowledge and attitude of caregivers, and whether such programmes also reduce occurrence of abuse, thus future research is warranted. In addition, all future research should include a component of cost-effectiveness analysis, implementation assessment and equity considerations of the specific interventions under review.
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Affiliation(s)
- Philip RA Baker
- Queensland University of TechnologySchool of Public Health and Social WorkBrisbaneQueenslandAustralia4059
| | - Daniel P Francis
- Queensland University of TechnologySchool of Public Health and Social WorkBrisbaneQueenslandAustralia4059
| | - Noran N Hairi
- University of MalayaDepartment of Social & Preventive Medicine, Faculty of MedicineJalan Lembah PantaiKuala LumpurMalaysia50603
- University of MalayaJulius Centre University of MalayaKuala LumpurMalaysia50603
| | - Sajaratulnisah Othman
- Department of Primary Care Medicine, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia50603
| | - Wan Yuen Choo
- University of MalayaDepartment of Social & Preventive Medicine, Faculty of MedicineJalan Lembah PantaiKuala LumpurMalaysia50603
- University of MalayaJulius Centre University of MalayaKuala LumpurMalaysia50603
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Abstract
This article estimates the prevalence and identifies risk factors of resident aggression and abuse in assisted living facilities. We conducted multivariate analyses of resident-level data from an analytic sample of 6,848 older Americans in the 2010 National Survey of Residential Care Facilities. Nationwide, 7.6% of assisted living residents engaged in physical aggression or abuse toward other residents or staff in the past month, 9.5% of residents had exhibited verbal aggression or abuse, and 2.0% of resident engaged in sexual aggression or abuse toward other residents or staff. Dementia and severe mental illness were significant risk factors for all three types of resident aggression and abuse. Resident aggression and abuse in assisted living facilities is prevalent and warrants greater attention from policy makers, researchers, and long-term care providers. Future research is needed to support training and prevention efforts to mitigate this risk.
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Cannell MB, Jetelina KK, Zavadsky M, Gonzalez JMR. Towards the development of a screening tool to enhance the detection of elder abuse and neglect by emergency medical technicians (EMTs): a qualitative study. BMC Emerg Med 2016; 16:19. [PMID: 27250247 PMCID: PMC4888496 DOI: 10.1186/s12873-016-0084-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 05/25/2016] [Indexed: 11/18/2022] Open
Abstract
Background To develop a screening tool to enhance elder abuse and neglect detection and reporting rates among emergency medical technicians (EMTs). Our primary aim was to identify the most salient indicators of elder abuse and neglect for potential inclusion on a screening tool. We also sought to identify practical elements of the tool that would optimize EMT uptake and use in the field, such as format, length and number of items, and types of response options available. Methods Qualitative data were collected from 23 EMTs and Adult Protective Services (APS) caseworkers that participated in one of five semi-structured focus groups. Focus group data were iteratively coded by two coders using inductive thematic identification and data reduction. Findings were subject to interpretation by the research team. Results EMTs and APS caseworks identified eight domains of items that might be included on a screening tool: (1) exterior home condition; (2) interior living conditions; (3) social support; (4) medical history; (5) caregiving quality; (6) physical condition of the older adult; (7) older adult’s behavior; and, (8) EMTs instincts. The screening tool should be based on observable cues in the physical or social environment, be very brief, easily integrated into electronic charting systems, and provide a decision rule for reporting guidance to optimize utility for EMTs in the field. Conclusions We described characteristics of a screening tool for EMTs to enhance detection and reporting of elder abuse and neglect to APS. Future research should narrow identified items and evaluate how these domains positively predict confirmed cases of elder abuse and neglect. Electronic supplementary material The online version of this article (doi:10.1186/s12873-016-0084-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M Brad Cannell
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA.
| | - Katelyn K Jetelina
- University of Texas School of Public Health, Dallas Regional Campus, Dallas, TX, USA
| | - Matt Zavadsky
- Department of Health Management and Policy, University of North Texas Health Science Center, Fort Worth, TX, USA.,MedStar Mobile Healthcare, Fort Worth, TX, USA
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30
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Rosen T, Bloemen EM, LoFaso VM, Clark S, Flomenbaum NE, Lachs MS. Emergency Department Presentations for Injuries in Older Adults Independently Known to be Victims of Elder Abuse. J Emerg Med 2016; 50:518-26. [PMID: 26810019 DOI: 10.1016/j.jemermed.2015.10.037] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 10/19/2015] [Accepted: 10/26/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Elder abuse is under-recognized by emergency department (ED) providers, largely due to challenges distinguishing between abuse and accidental trauma. OBJECTIVE To describe patterns and circumstances surrounding elder abuse-related and potentially abuse-related injuries in ED patients independently known to be physical elder abuse victims. METHODS ED utilization of community-dwelling victims of physical elder abuse in New Haven, CT from 1981-1994 was analyzed previously. Cases were identified using Elderly Protective Services data matched to ED records. Sixty-six ED visits were judged to have high probability of being related to elder abuse and 244 were of indeterminate probability. We re-examined these visits to assess whether they occurred due to injury. We identified and analyzed in detail 31 injury-associated ED visits from 26 patients with high probability of being related to elder abuse and 108 visits from 57 patients with intermediate probability and accidental injury. RESULTS Abuse-related injuries were most common on upper extremities (45% of visits) and lower extremities (32%), with injuries on head or neck noted in 13 visits (42%). Bruising was observed in 39% of visits, most commonly on upper extremities. Forty-two percent of purportedly accidental injuries had suspicious characteristics, with the most common suspicious circumstance being injury occurring more than 1 day prior to presentation, and the most common suspicious injury pattern being maxillofacial injuries. CONCLUSION Victims of physical elder abuse commonly have injuries on the upper extremities, head, and neck. Suspicious circumstances and injury patterns may be identified and are commonly present when victims of physical elder abuse present with purportedly accidental injuries.
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Affiliation(s)
- Tony Rosen
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York
| | - Elizabeth M Bloemen
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York; Division of Geriatric and Palliative Medicine, Weill Cornell Medical College, New York, New York
| | - Veronica M LoFaso
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York
| | - Sunday Clark
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York
| | - Neal E Flomenbaum
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York
| | - Mark S Lachs
- Division of Geriatric and Palliative Medicine, Weill Cornell Medical College, New York, New York
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Burnett J, Jackson SL, Sinha AK, Aschenbrenner AR, Murphy KP, Xia R, Diamond PM. Five-year all-cause mortality rates across five categories of substantiated elder abuse occurring in the community. J Elder Abuse Negl 2016; 28:59-75. [PMID: 26797389 DOI: 10.1080/08946566.2016.1142920] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Elder abuse increases the likelihood of early mortality, but little is known regarding which types of abuse may be resulting in the greatest mortality risk. This study included N = 1,670 cases of substantiated elder abuse and estimated the 5-year all-cause mortality for five types of elder abuse (caregiver neglect, physical abuse, emotional abuse, financial exploitation, and polyvictimization). Statistically significant differences in 5-year mortality risks were found between abuse types and across gender. Caregiver neglect and financial exploitation had the lowest survival rates, underscoring the value of considering the long-term consequences associated with different forms of abuse. Likewise, mortality differences between genders and abuse types indicate the need to consider this interaction in elder abuse case investigations and responses. Further mortality studies are needed in this population to better understand these patterns and implications for public health and clinical management of community-dwelling elder abuse victims.
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Affiliation(s)
- Jason Burnett
- a Medical School-Geriatric and Palliative Medicine , UTHealth Houston , Houston , Texas , USA.,b Texas Elder Abuse and Mistreatment Institute , Houston , Texas , USA.,c Department of Biostatistics, School of Public Health , UTHealth Houston , Houston , Texas , USA.,d Department of Health Promotion and Behavioral Sciences, School of Public Health , UTHealth Houston , Houston , Texas , USA.,e Consortium on Aging , UTHealth Houston , Houston , Texas , USA
| | - Shelly L Jackson
- f Institute of Law, Psychiatry and Public Policy , University of Virginia , Charlottesville , Virginia , USA
| | - Arup K Sinha
- c Department of Biostatistics, School of Public Health , UTHealth Houston , Houston , Texas , USA
| | - Andrew R Aschenbrenner
- c Department of Biostatistics, School of Public Health , UTHealth Houston , Houston , Texas , USA
| | - Kathleen Pace Murphy
- a Medical School-Geriatric and Palliative Medicine , UTHealth Houston , Houston , Texas , USA.,b Texas Elder Abuse and Mistreatment Institute , Houston , Texas , USA.,e Consortium on Aging , UTHealth Houston , Houston , Texas , USA
| | - Rui Xia
- a Medical School-Geriatric and Palliative Medicine , UTHealth Houston , Houston , Texas , USA.,b Texas Elder Abuse and Mistreatment Institute , Houston , Texas , USA
| | - Pamela M Diamond
- b Texas Elder Abuse and Mistreatment Institute , Houston , Texas , USA.,c Department of Biostatistics, School of Public Health , UTHealth Houston , Houston , Texas , USA.,d Department of Health Promotion and Behavioral Sciences, School of Public Health , UTHealth Houston , Houston , Texas , USA.,e Consortium on Aging , UTHealth Houston , Houston , Texas , USA
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Cannell MB, Weitlauf JC, Garcia L, Andresen EM, Margolis KL, Manini TM. Cross-sectional and longitudinal risk of physical impairment in a cohort of postmenopausal women who experience physical and verbal abuse. BMC Womens Health 2015; 15:98. [PMID: 26554450 PMCID: PMC4641397 DOI: 10.1186/s12905-015-0258-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 10/19/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Exposure to interpersonal violence, namely verbal and physical abuse, is a highly prevalent threat to women's health and well-being. Among older, post-menopausal women, several researchers have characterized a possible bi-directional relationship of abuse exposure and diminished physical functioning. However, studies that prospectively examine the relationship between interpersonal abuse exposure and physical functioning across multiple years of observation are lacking. To address this literature gap, we prospectively evaluate the association between abuse exposure and physical functioning in a large, national cohort of post-menopausal women across 12 years of follow-up observation. METHODS Multivariable logistic regression was used to measure the adjusted association between experiencing abuse and physical function score at baseline in 154,902 Women's Health Initiative (WHI) participants. Multilevel modeling, where the trajectories of decline in physical function were modeled as a function of time-varying abuse exposure, was used to evaluate the contribution of abuse to trajectories of physical function scores over time. RESULT Abuse was prevalent among WHI participants, with 11 % of our study population reporting baseline exposure. Verbal abuse was the most commonly reported abuse type (10 %), followed by combined physical and verbal abuse (1 %), followed by physical abuse in the absence of verbal abuse (0.2 %). Abuse exposure (all types) was associated with diminished physical functioning, with women exposed to combined physical and verbal abuse presenting baseline physical functioning scores consistent with non-abused women 20 years senior. Results did not reveal a differential rate of decline over time in physical functioning based on abuse exposure. CONCLUSIONS Taken together, our findings suggest a need for increased awareness of the prevalence of abuse exposure among postmenopausal women; they also underscore the importance of clinician's vigilance in their efforts toward the prevention, early detection and effective intervention with abuse exposure, including verbal abuse exposure, in post-menopausal women. Given our findings related to abuse exposure and women's diminished physical functioning at WHI baseline, our work illuminates a need for further study, particularly the investigation of this association in younger, pre-menopausal women so that the temporal ordering if this relationship may be better understood.
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Affiliation(s)
- M Brad Cannell
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA.
| | - Julie C Weitlauf
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
| | - Lorena Garcia
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA.
| | - Elena M Andresen
- School of Public Health, Oregon Health & Science University, Portland State University, Portland, OR, USA.
| | - Karen L Margolis
- HealthPartners Institute for Education and Research, Minneapolis, MN, USA.
| | - Todd M Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA.
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Sirey JA, Halkett A, Chambers S, Salamone A, Bruce ML, Raue PJ, Berman J. PROTECT: A Pilot Program to Integrate Mental Health Treatment Into Elder Abuse Services for Older Women. J Elder Abuse Negl 2015; 27:438-53. [PMID: 26331553 DOI: 10.1080/08946566.2015.1088422] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The goal of this pilot program was to test the usefulness of adapted Problem-Solving Therapy (PST) and anxiety management, called PROTECT, integrated into elder abuse services to reduce depression and improve self-efficacy. Depressed women victims were randomized to receive elder abuse resolution services combined with either PROTECT or a mental health referral. At follow-up, the PROTECT group showed greater reduction in depressive symptoms and endorsed greater improved self-efficacy in problem-solving when compared to those in the Referral condition. These preliminary findings support the potential usefulness of PROTECT to alleviate depressive symptoms and enhance personal resources among abused older women.
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Affiliation(s)
- Jo Anne Sirey
- a Department of Psychiatry , Weill Cornell Medical College , White Plains , New York , USA
| | - Ashley Halkett
- a Department of Psychiatry , Weill Cornell Medical College , White Plains , New York , USA
| | - Stephanie Chambers
- a Department of Psychiatry , Weill Cornell Medical College , White Plains , New York , USA
| | - Aurora Salamone
- b New York City Department for the Aging , New York , New York , USA
| | - Martha L Bruce
- a Department of Psychiatry , Weill Cornell Medical College , White Plains , New York , USA
| | - Patrick J Raue
- a Department of Psychiatry , Weill Cornell Medical College , White Plains , New York , USA
| | - Jacquelin Berman
- b New York City Department for the Aging , New York , New York , USA
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Sirey JA, Berman J, Salamone A, DePasquale A, Halkett A, Raeifar E, Banerjee S, Bruce ML, Raue PJ. Feasibility of integrating mental health screening and services into routine elder abuse practice to improve client outcomes. J Elder Abuse Negl 2015; 27:254-69. [PMID: 25611116 DOI: 10.1080/08946566.2015.1008086] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The goal of this pilot program was to test the feasibility of mental health screening among elder abuse victims and of offering those victims a brief psychotherapy for depression and anxiety. Elder abuse victims who sought assistance from a large, urban elder abuse service were screened for depression and anxiety using standardized measures. Clients with clinically significant depression (PHQ-9) or anxiety (GAD-7) were randomized to receive one of three different interventions concurrent with abuse resolution services. Staff were able to screen 315 individuals, with 34% of clients scoring positive for depression or anxiety. Of those with mental health needs, only 15% refused all services. The mental health intervention (PROTECT) was successfully implemented in two different formats with collaboration between staff workers. These findings support both the need for mental health care among elder abuse victims and the feasibility of integrating mental health screening and treatment into routine elder abuse practice.
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Affiliation(s)
- Jo Anne Sirey
- a Department of Psychiatry , Weill Cornell Medical College , White Plains , New York , USA
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Abstract
Elder abuse and neglect are highly prevalent but woefully underdetected and underreported. The presentation is rarely clear and requires the piecing together of clues that create a mosaic of the full picture. More research needed to better characterize findings that, when identified, can contribute to certainty in cases of suspected abuse. Medical and laboratory data can be helpful in the successful determination of abuse and neglect.
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Affiliation(s)
- Veronica M LoFaso
- New York Presbyterian Hospital, Weill Cornell Medical College, Box 39, 525 East 68th Street, New York, NY 10065, USA.
| | - Tony Rosen
- New York Presbyterian Hospital, Weill Cornell Medical College, Box 39, 525 East 68th Street, New York, NY 10065, USA
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Leddy MA, Farrow VA, Schulkin J. Obstetrician-Gynecologists' Knowledge, Attitudes, and Practice Regarding Elder Abuse Screening. Womens Health Issues 2014; 24:e455-64. [DOI: 10.1016/j.whi.2014.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 04/03/2014] [Accepted: 04/21/2014] [Indexed: 11/27/2022]
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Montero I, Martín-Baena D, Escribà-Agüir V, Ruiz-Pérez I, Vives-Cases C, Talavera M. Intimate partner violence in older women in Spain: prevalence, health consequences, and service utilization. J Women Aging 2014; 25:358-71. [PMID: 24116995 DOI: 10.1080/08952841.2013.838854] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The purpose of this study is to estimate the prevalence of lifetime intimate partner violence (IPV) in older women and to analyze its effect on women's health and Healthcare Services utilization. Women aged 55 years and over (1,676) randomly sampled from Primary Healthcare Services around Spain were included. Lifetime IPV prevalence, types, and duration were calculated. Descriptive and multivariate procedures using logistic and multiple lineal regression models were used. Of the women studied, 29.4% experienced IPV with an average duration of 21 years. Regardless of the type of IPV experienced, abused women showed significantly poorer health and higher healthcare services utilization compared to women who had never been abused. The high prevalence detected long standing duration, negative health impact, and high healthcare services utilization, calling attention to a need for increased efforts aimed at addressing IPV in older women.
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Affiliation(s)
- Isabel Montero
- a Department of Medicine , University of Valencia , Valencia , Spain
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Garcia L, Qi L, Rasor M, Clark CJ, Bromberger J, Gold EB. The relationship of violence and traumatic stress to changes in weight and waist circumference: longitudinal analyses from the study of women's health across the nation. JOURNAL OF INTERPERSONAL VIOLENCE 2014; 29:1459-76. [PMID: 24212978 PMCID: PMC3969450 DOI: 10.1177/0886260513507132] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
This article investigates the associations of violence and traumatic stress with changes in weight and waist circumference, hypothesizing that violence in midlife would be associated with increases or decreases in weight and waist circumference. The longitudinal cohort of the Study of Women's Health Across the Nation comprised the study sample, which included an ethnically/racially and socially diverse group of 2,870 women between the ages of 42 and 52 years at baseline. Women were followed annually for 10 years, and assessments included weight and waist circumference measures and data on violence, health outcomes, and confounders. At baseline, 8.6% Caucasian, 10.8% African American, 9.2% Chinese, and 5.0% Japanese women reported violence and traumatic stress. Reporting violence and traumatic stress during follow-up was significantly associated with weight gain (odds ratio [OR] = 2.39, 95% confidence interval [CI] = [1.28-4.47]), weight loss (OR = 3.54, 95% CI = [1.73-7.22]), and gain (OR = 2.44, 95% CI = [1.37-4.37]) or loss (OR = 2.66, 95% CI = [1.23-5.77]) in waist circumference, adjusting for age, race/ethnicity, education, marital status, and smoking. Violence and traumatic stress against midlife women were associated with gains or losses in weight and waist circumference.
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Health-related quality of life in older age and a risk of being a victim of domestic violence. Arch Gerontol Geriatr 2014; 58:388-98. [PMID: 24560719 DOI: 10.1016/j.archger.2013.11.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 11/28/2013] [Accepted: 11/30/2013] [Indexed: 11/23/2022]
Abstract
Violence against older people remains a taboo topic in Poland, and is still an under-recognized phenomenon. The aim of this study was to examine the risk of different types of domestic violence in older people in relation to their health-related quality of life as measured by chronic conditions, functional limitations, psychological well-being, depressive symptoms and feelings of social isolation. A cross-sectional study using a standardized questionnaire in a simple random sample of 518 older citizens of Krakow was carried out. A multidimensional logistic regression of data showed that such factors as poor assessment of psychological health, number of chronic conditions, suffering from emotional and social loneliness and lack of social support in everyday life significantly increased the risk of being a victim of domestic violence in older citizens of Krakow.
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Roberto KA, McPherson MC, Brossoie N. Intimate Partner Violence in Late Life. Violence Against Women 2014; 19:1538-58. [DOI: 10.1177/1077801213517564] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This integrated review of the empirical literature synthesizes a decade of scientific research across scholarly and professional publications addressing intimate partner violence (IPV) in late life. Deriving insights through a qualitative coding scheme and detailed analysis of 57 empirical sources, we discuss the theoretical frameworks, conceptual themes, and methodological approaches that cut across the literature. Based on these findings, we identify future research directions for improved understanding of late-life IPV as well as implications for policy development and refined community interventions.
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Affiliation(s)
| | - Marya C. McPherson
- Mental Health Association of the New River Valley, Inc., Blacksburg, USA
| | - Nancy Brossoie
- Center for Gerontology at Virginia Tech, Blacksburg, USA
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Roberto KA, McCann BR, Brossoie N. Intimate partner violence in late life: an analysis of national news reports. J Elder Abuse Negl 2013; 25:230-41. [PMID: 23627429 DOI: 10.1080/08946566.2012.751825] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Intimate partner violence (IPV) in late life takes various forms including physical harm, sexual assault, and murder. Using national newspaper reports of IPV among elders, we identified the types of violence reported most frequently in media and examined how the abuse was conceptualized by reporters. We found that most cases of IPV reported involved murder, with men as perpetrators and women as victims. Caregiving stress and health problems were frequently cited as contributing factors in the cases. Interpreting these findings from a feminist perspective, we suggest implications for practitioners working with older adults.
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Affiliation(s)
- Karen A Roberto
- Center for Gerontology, Virginia Tech, Blacksburg, Virginia 24061, USA.
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Cianelli R, Villegas N, Lawson S, Ferrer L, Kaelber L, Peragallo N, Yaya A. Unique factors that place older Hispanic women at risk for HIV: intimate partner violence, machismo, and marianismo. J Assoc Nurses AIDS Care 2013; 24:341-54. [PMID: 23790277 DOI: 10.1016/j.jana.2013.01.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 01/15/2013] [Indexed: 11/25/2022]
Abstract
Hispanic women who are 50 years of age and older have been shown to be at increased risk of acquiring HIV infection due to age and culturally related issues. The purpose of our study was to investigate factors that increase HIV risk among older Hispanic women (OHW) as a basis for development or adaptation of an age and culturally tailored intervention designed to prevent HIV-related risk behaviors. We used a qualitative descriptive approach. Five focus groups were conducted in Miami, Florida, with 50 participants. Focus group discussions centered around eight major themes: intimate partner violence (IPV), perimenopausal-postmenopausal-related biological changes, cultural factors that interfere with HIV prevention, emotional and psychological changes, HIV knowledge, HIV risk perception, HIV risk behaviors, and HIV testing. Findings from our study stressed the importance of nurses' roles in educating OHW regarding IPV and HIV prevention.
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Affiliation(s)
- Rosina Cianelli
- School of Nursing and Health Studies, University of Miami, Florida, USA
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Choo WY, Hairi NN, Othman S, Francis DP, Baker PRA. Interventions for preventing abuse in the elderly. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010321] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Tredal I, Soares JJF, Sundin Ö, Viitasara E, Melchiorre MG, Torres-Gonzales F, Stankunas M, Lindert J, Ioannidi-Kapolou E, Barros H. Alcohol use among abused and non-abused older persons aged 60–84 years: An European study. DRUGS-EDUCATION PREVENTION AND POLICY 2013. [DOI: 10.3109/09687637.2012.751087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Liles S, Usita P, Irvin VL, Hofstetter CR, Beeston T, Hovell MF. Prevalence and Correlates of Intimate Partner Violence Among Young, Middle, and Older Women of Korean Descent in California. JOURNAL OF FAMILY VIOLENCE 2012; 27:801-811. [PMID: 23645971 PMCID: PMC3640577 DOI: 10.1007/s10896-012-9471-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This research examined the prevalence and correlates of intimate partner violence (IPV) among younger, middle-aged, and older Korean American women. Data were drawn from telephone interviews of a population-based, representative probability sample (N = 592) of female adults of Korean descent residing in California, with a completion rate of 70%. Data were grouped by age. In each group, psychological aggression was the most common type of IPV in the past year, followed by a moderate form of sexual coercion, while physical assault and injury were infrequent. Immigration stress was associated with psychological aggression in all three groups, and partner alcohol use was associated in none. Other predictors varied by group. Results suggest that psychological abuse is a serious issue, and that women's life stage is an important consideration in IPV among Korean Americans. Findings, which sometimes diverged from those of prior studies of this population, merit further investigation.
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Affiliation(s)
- Sandy Liles
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California
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Crowne SS, Juon HS, Ensminger M, Bair-Merritt MH, Duggan A. Risk factors for intimate partner violence initiation and persistence among high psychosocial risk Asian and Pacific Islander women in intact relationships. Womens Health Issues 2011; 22:e181-8. [PMID: 22001632 DOI: 10.1016/j.whi.2011.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 08/06/2011] [Accepted: 08/08/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE The present study identifies risk factors for intimate partner violence (IPV) initiation and persistence over three years in a high psychosocial risk Asian American and Pacific Islander (AAPI) sample of women with children living in Hawaii. METHODS We included 378 women in a 3-year relationship with the same partner who reported IPV experiences at baseline and 3 years later. Baseline risk factors included characteristics of each woman, her partner, and their relationship. Bivariate and multivariate regression models were conducted to assess the influence of risk factors on the likelihood of experiencing IPV initiation and persistence. FINDINGS Of women who experienced no physical violence at baseline, 43% reported IPV initiation. Of women who did experience physical violence at baseline, 57% reported IPV persistence. Being unemployed and reporting poor mental health at baseline are important risk factors for experiencing IPV initiation. Reporting frequent physical violence at baseline increases the likelihood of experiencing IPV persistence. Asian women were significantly less likely to report IPV persistence than other groups of women. CONCLUSIONS Our study indicates that among a high psychosocial risk sample of AAPI women there are different risk factors for IPV initiation and persistence. Future prevention and screening efforts may need to focus on these risk factors.
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Affiliation(s)
- Sarah Shea Crowne
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Cook JM, Dinnen S, O'Donnell C. Older women survivors of physical and sexual violence: a systematic review of the quantitative literature. J Womens Health (Larchmt) 2011; 20:1075-81. [PMID: 21668378 PMCID: PMC3130511 DOI: 10.1089/jwh.2010.2279] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This systematic review synthesizes the quantitative empirical literature concerning older women survivors of physical and sexual assault. METHODS A literature search was conducted using a range of scholarly databases. Information is presented here on the prevalence, correlates, and consequences of these types of interpersonal violence in older women. Additionally, age-related differences in prevalence, psychiatric distress, and characteristics of violence, including information on perpetrators, are reviewed. RESULTS Overall, older women report lower lifetime and past year rates of physical and sexual assault and associated negative psychologic consequences compared to younger and middle-aged women. Additionally, older women who experienced interpersonal violence report greater psychiatric distress, including posttraumatic stress disorder (PTSD), than older women who have not experienced such events. CONCLUSIONS Some women who have been physically or sexually assaulted decades earlier in life continue to report significant levels of PTSD well into older adulthood. Gaps in the literature, including lack of information on ethnicity and culture, are presented, and future research directions are proposed.
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Affiliation(s)
- Joan M Cook
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06516, USA.
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Walsh CA, Olson JL, Ploeg J, Lohfeld L, MacMillan HL. Elder abuse and oppression: voices of marginalized elders. J Elder Abuse Negl 2011; 23:17-42. [PMID: 21253928 DOI: 10.1080/08946566.2011.534705] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The voices of elderly people from marginalized groups are rarely solicited, and the relationship between elder maltreatment and belonging to an oppressed group has not been adequately investigated. This article reviews the literature on oppression and elder abuse and describes findings from the secondary analysis of data from focus group discussions on elder abuse held with marginalized older adults and (quasi)professionals caring for them in two Canadian cities. Participants identified that increased vulnerability to elder abuse was related to oppression experienced as a consequence of ageism, sexism, ableism/disability, racism, heterosexism/homophobia, classism, and various intersecting types of oppression.
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Affiliation(s)
- Christine A Walsh
- Faculty of Social Work, University of Calgary, 2500 University Drive NW, Calgary, Alberta, Canada.
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Sawin EM, Parker B. “If Looks Would Kill Then I Would Be Dead”: Intimate Partner Abuse and Breast Cancer in Older Women. J Gerontol Nurs 2011. [DOI: 10.3928/00989134-20110601-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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50
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Sawin EM, Parker B. "If looks would kill then I would be dead": intimate partner abuse and breast cancer in older women. J Gerontol Nurs 2011; 37:26-35; quiz 36-7. [PMID: 21446640 DOI: 10.3928/00989134-20110307-01] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 11/12/2010] [Indexed: 11/20/2022]
Abstract
The objective of this study was to describe the experiences of older women diagnosed with breast cancer while experiencing intimate partner abuse (IPA), determined by scores on the Women's Experience With Battering (WEB) Scale. Semi-structured qualitative interviews were conducted with a convenience sample of 11 women ages 51 to 84 (mean age = 64.8). Data were analyzed using hermeneutic phenomenological analysis. Themes that emerged were Cancer and Control, Negative Relationship Changes, Changes in Intimacy, and Moving On. Older women simultaneously experiencing IPA and breast cancer have unique needs due to the complex interplay among three factors: age, IPA, and breast cancer. Gerontological nurses should be aware of issues surrounding older women with breast cancer and older women experiencing IPA. Assessment of older breast cancer patients should take into consideration patients' social support network and quality of intimate partner support.
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Affiliation(s)
- Erika Metzler Sawin
- James Madison University, Department of Nursing, Harrisonburg, VA 22807, USA.
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