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Yoon D, Gallo H, Gassoumis ZD, Joo S. The Mediating Role of Sense of Control in the Associations Between Remote Contacts and Loneliness Among Older Adults. Res Aging 2024; 46:167-175. [PMID: 37861368 DOI: 10.1177/01640275231206484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
This study explored whether a sense of control over social life mediated the associations between using remote contact (phone calls, letters/emails, social media) and loneliness for socially isolated older adults. We used path analysis with the 2014 and 2016 Health and Retirement Study datasets (N = 3767). Results showed that more frequent phone calls and letters/emails were associated with lower levels of loneliness through sense of control. However, sense of control did not mediate the association between social media and loneliness. Findings suggest that promoting sense of control over social life by remote contact, particularly phone calls and letters/emails, may be effective in alleviating loneliness for isolated older adults.
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Affiliation(s)
- Dokyung Yoon
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Haley Gallo
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Zachary D Gassoumis
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Susanna Joo
- Human Life and Innovation Design, Yonsei University, Seoul, Republic of Korea
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Gassoumis ZD, Martinez J, Yonashiro-Cho J, Mosqueda L, Hou A, Duke Han S, Olsen B, Louis A, Connolly MT, Meyer K, Marnfeldt K, Navarro SS, Yan M, Wilber KH. Comprehensive Older Adult and Caregiver Help (COACH): A person-centered caregiver intervention prevents elder mistreatment. J Am Geriatr Soc 2024; 72:246-257. [PMID: 37791406 PMCID: PMC10842324 DOI: 10.1111/jgs.18597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 08/14/2023] [Accepted: 08/19/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Elder mistreatment (EM) harms individuals, families, communities, and society as a whole. Yet research on interventions is lagging, and no rigorous studies demonstrating effective prevention have been published. This pilot study examines whether a first-of-its-kind coaching intervention reduced the experience of EM among older adults with chronic health conditions, including dementia. METHODS We used a double-blind, randomized controlled trial to test a strengths-based person-centered caregiver support intervention, developed from evidence-based approaches used in other types of family violence. Participants (n = 80), family caregivers of older adults who were members of Kaiser Permanente, completed surveys at baseline, post-test, and 3-month follow-up. The primary outcome was caregiver-reported EM; additional proximal outcomes were caregiver burden, quality-of-life, anxiety, and depression. Nonparametric tests (Mann-Whitney U, Fisher's Exact, Wilcoxon Signed Rank, and McNemar's) were used to make comparisons between treatment and control groups and across time points. RESULTS The treatment group had no EM after intervention completion (assessed at 3-month follow-up), a significantly lower rate than the control group (treatment = 0%, control = 23.1%, p = 0.010). CONCLUSIONS In this pilot study, we found that the COACH caregiver support intervention successfully reduced EM of persons living with chronic illness, including dementia. Next steps will include: (1) testing the intervention's mechanism in a fully powered RCT and (2) scaling the intervention for testing in a variety of care delivery systems.
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Affiliation(s)
- Zachary D. Gassoumis
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Julia Martinez
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jeanine Yonashiro-Cho
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Laura Mosqueda
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Anthony Hou
- Los Angeles Medical Center, Kaiser Permanente Southern California, Los Angeles, CA, USA
| | - S. Duke Han
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Bonnie Olsen
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anat Louis
- WISE & Healthy Aging, Santa Monica, CA, USA
| | - Marie-Therese Connolly
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Kylie Meyer
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Kelly Marnfeldt
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Sheila Salinas Navarro
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Mengzhao Yan
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Kathleen H. Wilber
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
- Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
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3
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Yonashiro-Cho JMF, Gassoumis ZD, Wilber KH, Homeier DC. Improving forensics: Characterizing injuries among community-dwelling physically abused older adults. J Am Geriatr Soc 2021; 69:2252-2261. [PMID: 33945150 DOI: 10.1111/jgs.17192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Physical elder abuse affects a substantial number of older adults, leaving victims at increased risk for negative health outcomes. Improved detection of abuse-related injuries may increase victim access to professional support, but providers report difficulties distinguishing between accidental and abuse-related injuries, due in part to victims' pre-existing health conditions and medication use. OBJECTIVES To describe the spectrum and characteristics of injuries among physically abused older adults and identify injury characteristics associated with abuse. DESIGN Case-control study. SETTING Physically abused adult protective services clients were interviewed in their home; non-abused comparison group participants were interviewed in an outpatient geriatrics clinic. PARTICIPANTS Sample included 156 community-dwelling adults aged 65 and older, including 57 physically abused and 99 non-abused individuals. Self-reported abuse history was confirmed through independent case assessment by a LEAD (Longitudinal, Expert All-Data) panel of clinicians with family violence expertise. MEASUREMENTS Full-body assessments were conducted, documenting injury incidence, diagnosis, and location. We also collected sociodemographic characteristics, level of social support, functional ability, medical history, and medication use. RESULTS Physically abused older adults were more likely to be injured upon assessment (79.0% vs 63.6%; p < 0.05) and have a greater number of injuries ( x ¯ = 2.9 vs x ¯ = 2.0 , p < 0.05). Injuries seen more often among abused individuals included: upper extremity ecchymoses (42.1% vs 26.3%; p < 0.05), abrasions (31.6% vs 11.1%; p < 0.01), and areas of tenderness (8.8% vs 0.0%; p < 0.01); and head/neck/maxillofacial ecchymoses (15.8% vs 2.0%; p < 0.01) and tenderness (15.8% vs 0.0%; p < 0.001). Lower extremity abrasions (12.3%) were common but unrelated to abuse status. CONCLUSION While physical abuse does not always result in physical injury, victims more commonly display head/neck/maxillofacial ecchymoses or tenderness and upper extremity abrasions, ecchymoses, or tenderness. Detection of these injuries among older adults warrants further interview and examination.
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Affiliation(s)
| | - Zachary D Gassoumis
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA.,Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Kathleen H Wilber
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Diana C Homeier
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
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Rowan JM, Yonashiro-Cho J, Wilber KH, Gassoumis ZD. Who is in the revolving door? Policy and practice implications of recurrent reports to adult protective services. J Elder Abuse Negl 2020; 32:489-508. [PMID: 33308080 DOI: 10.1080/08946566.2020.1852142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Repeat referral to adult protective services APS (recurrence) is a much-discussed topic among APS agencies as it may indicate ongoing harm, yet there is limited research examining prevalence or causes. This paper provides a foundational investigation of recurrence within a California APS county program. Drawing from thirty-three months of de-identified reports, we used logistic regression to examine the impact of intake report characteristics on repeat referral within one year after baseline case closure. One-fifth of the sample was recurrent (19.9%, n=987/4,958), with self-neglect being the most common type of report to recur (14.3%, n=307/2,141). Overall recurrence was predicted by female gender, older age, living alone, and multiple elder abuse, neglect, and exploitation (ANE) types reported at baseline, and report placed by social service provider, friends, family, landlords, and victim self-reports. Reporters personally related to the victim and social service providers are potential partners in identifying ANE, and alternate intervention approaches may be necessary.
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Affiliation(s)
- Julia M Rowan
- Leonard Davis School of Gerontology, University of Southern California , Los Angeles, California, USA
| | - Jeanine Yonashiro-Cho
- Keck School of Medicine, University of Southern California , Los Angeles, California, USA
| | - Kathleen H Wilber
- Leonard Davis School of Gerontology, University of Southern California , Los Angeles, California, USA
| | - Zachary D Gassoumis
- Keck School of Medicine, University of Southern California , Los Angeles, California, USA
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Yonashiro-Cho J, Rowan JM, Gassoumis ZD, Gironda MW, Wilber KH. Toward a better understanding of the elder abuse forensic center model: comparing and contrasting four programs in California. J Elder Abuse Negl 2019; 31:402-423. [DOI: 10.1080/08946566.2019.1647326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jeanine Yonashiro-Cho
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Julia M. Rowan
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Zachary D. Gassoumis
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Melanie W. Gironda
- Department of Care Management, WISE and Healthy Aging, Santa Monica, CA, USA
| | - Kathleen H. Wilber
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
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6
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Weissberger GH, Goodman MC, Mosqueda L, Schoen J, Nguyen AL, Wilber KH, Gassoumis ZD, Nguyen CP, Han SD. Elder Abuse Characteristics Based on Calls to the National Center on Elder Abuse Resource Line. J Appl Gerontol 2019; 39:1078-1087. [PMID: 31364442 DOI: 10.1177/0733464819865685] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Characterizing the types of elder abuse and identifying the characteristics of perpetrators are critically important. This study examined the types of elder abuse reported to the National Center on Elder Abuse (NCEA) resource line. Calls were coded with regard to whether abuse was reported, types of abuse alleged, whether multiple abuse subtypes occurred, and who perpetrated the alleged abuse. Of the 1,939 calls, 818 (42.2%) alleged abuse, with financial abuse being the most commonly reported (449 calls, 54.9%). A subset of calls identified multiple abuse types (188, 23.0%) and multiple abusers (149, 18.2%). Physical abuse was most likely to co-occur with another abuse type (61/93 calls, 65.6%). Family members were the most commonly identified perpetrators (309 calls, 46.8%). This study reports the characteristics of elder abuse from a unique source of frontline data, the NCEA resource line. Findings point to the importance of supportive resources for elder abuse victims and loved ones.
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Affiliation(s)
| | | | - Laura Mosqueda
- Keck School of Medicine of USC, Los Angeles, USA.,National Center on Elder Abuse, Alhambra, CA, USA
| | - Julie Schoen
- Keck School of Medicine of USC, Alhambra, USA.,National Center on Elder Abuse, Alhambra, CA, USA
| | | | | | | | | | - S Duke Han
- Keck School of Medicine of USC, Alhambra, USA.,Keck School of Medicine of USC, Los Angeles, USA.,USC Leonard Davis School of Gerontology, Los Angeles, USA.,Rush University Medical Center, Chicago, IL, USA.,USC Dornsife College of Letters, Arts and Sciences, Los Angeles, USA
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7
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Abstract
Background and Objectives Online service delivery options have the potential to increase access to informational resources among caregivers to older adults. However, it is unknown which caregivers will use online-delivered services over usual service delivery modes (e.g., by phone) when both options are available in social service settings. This is important for service providers to know when making decisions that best serve their communities. Research Design and Methods Guided by Andersen's model of health service utilization, we used step-wise logistic regression models to compare the characteristics of caregivers who used an online information service called FCA CareJourney (FCA CJ) with those who accessed the same services using the usual mode of service delivery (N = 540). Online and usual-care services were available through two social service organizations in California. Results In all, 13.7% of clients used FCA CJ to receive services online. Enabling characteristics were the main predictors of using online-delivered services. Caregivers employed part-time had 3.82 times the odds of using online-delivered services compared to those employed full-time (odds ratio [OR] = 3.82; 95% confidence interval [CI]: 1.58-9.22). Caregivers who learned about services from health care providers had 2.91 times the odds of using FCA CJ as those who learned about services through social services (OR = 2.91; 95% CI: 1.28-6.62). Even among those who learned about services online, 62.2% still accessed services using usual delivery modes. Discussion and Implications Based on differences in the characteristics of caregivers using different service delivery modes and the low uptake of online-delivered services, we suggest online service delivery should supplement, not replace, usual delivery modes in social service settings. At the same time, user rates of online service delivery are likely modifiable. Given the potential for online-delivered programming to expand access to information services for caregivers, we recommend further examination into the effects of marketing online service delivery options to caregivers in novel ways.
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Affiliation(s)
- Kylie Meyer
- School of Nursing, University of Texas Health Science Center at San Antonio
| | - Zachary D Gassoumis
- University of Southern California Leonard Davis School of Gerontology, Los Angeles, California
| | | | - Donna Benton
- University of Southern California Leonard Davis School of Gerontology, Los Angeles, California
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8
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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9
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Yonashiro-Cho J, Gassoumis ZD, Wilber KH. STRENGTHENING INDIVIDUAL AND COMMUNITY CAPACITIES TO COMBAT AGE-RELATED VULNERABILITY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Yonashiro-Cho
- University of Southern California, Los Angeles, California, United States
| | - Z D Gassoumis
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - K H Wilber
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
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10
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Galdamez G, Avent E, Rowan J, Wilber KH, Mosqueda L, Olsen B, Gassoumis ZD. ELDER ABUSE MULTIDISCIPLINARY TEAMS AND NETWORKS: UNDERSTANDING NATIONAL INTERVENTION APPROACHES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- G Galdamez
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States
| | - E Avent
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA USA
| | - J Rowan
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - K H Wilber
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - L Mosqueda
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | - B Olsen
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Z D Gassoumis
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
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11
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Meyer K, Yonashiro-Cho J, Gassoumis ZD, Mosqueda L, Han SD, Wilber KH. What Can Elder Mistreatment Researchers Learn About Primary Prevention From Family Violence Intervention Models? The Gerontologist 2017; 59:601-609. [DOI: 10.1093/geront/gnx179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 10/20/2017] [Indexed: 11/14/2022] Open
Abstract
Abstract
Elder mistreatment (EM) is a public health problem that harms millions of older Americans each year. Despite growing recognition of its occurrence, there are no evidence-based primary prevention programs. Although EM is distinct from other areas of family violence, including child maltreatment and intimate partner violence, common risk factors and theoretical underpinnings point to opportunities for prevention strategies. Drawing on evidence-based best practices found in other fields of family violence, we identify approaches that could be tested to prevent EM at the hands of family caregivers, who are among the most likely to commit mistreatment. Specifically, we examine home visiting approaches primarily used in the child maltreatment field and identify components that have potential to inform EM interventions, including prevention. We conclude that there is enough information to begin testing a prevention intervention for EM that targets caregivers.
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Affiliation(s)
- Kylie Meyer
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles
| | | | - Zachary D Gassoumis
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles
| | - Laura Mosqueda
- Department of Family Medicine, Keck School of Medicine of the University of Southern California, Alhambra
| | - S Duke Han
- Department of Family Medicine, Keck School of Medicine of the University of Southern California, Alhambra
| | - Kathleen H Wilber
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles
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12
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Yon Y, Mikton CR, Gassoumis ZD, Wilber KH. Elder abuse prevalence in community settings: a systematic review and meta-analysis. The Lancet Global Health 2017; 5:e147-e156. [DOI: 10.1016/s2214-109x(17)30006-2] [Citation(s) in RCA: 370] [Impact Index Per Article: 52.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 10/25/2016] [Accepted: 11/16/2016] [Indexed: 01/12/2023]
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13
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Gassoumis ZD, Navarro AE, Wilber KH. Protecting victims of elder financial exploitation: the role of an Elder Abuse Forensic Center in referring victims for conservatorship. Aging Ment Health 2016; 19:790-8. [PMID: 25269384 DOI: 10.1080/13607863.2014.962011] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The aim of this study was to examine the extent to which an Elder Abuse Forensic Center protects financial exploitation (FE) victims through referral to the Office of the Public Guardian (PG) for investigation and possible conservatorship (called 'guardianship' in many states). METHOD Los Angeles County Elder Abuse Forensic Center cases involving adults aged 65 and older (April 2007-December 2009) were matched using one-to-one propensity-score matching to 33,650 usual care Adult Protective Services (APS) cases. The final analysis sample consisted of 472 FE cases. RESULTS Compared to usual care, Forensic Center cases were more likely to be referred to the PG for investigation (30.6%, n = 72 vs. 5.9%, n = 14, p < .001). The strongest predictors of PG referral were suspected cognitive impairment, as identified by APS (odds ratio [OR] = 11.69, confidence intervals [CI]: 3.50-39.03), and Forensic Center review (OR = 7.85, CI: 3.86-15.95). Among referred cases, the court approved conservatorship at higher rates - though not statistically significant - for Forensic Center cases than usual care (52.9%, n = 36/68 vs. 41.7%, n = 5/12). CONCLUSION Conservatorship may be a necessary last resort to improve safety for some FE victims, and the Forensic Center appears to provide a pathway to this service. These findings suggest modification to the Elder Abuse Forensic Center conceptual model and contribute to an emerging body of evidence on the role of the Forensic Center in addressing elder abuse.
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Affiliation(s)
- Zachary D Gassoumis
- a Davis School of Gerontology , University of Southern California , Los Angeles , CA , USA
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14
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Abstract
OBJECTIVE Using a socio-ecological model, this study examines the influence of facility characteristics on the transition of nursing home residents to the community after a short stay (within 90 days of admission) or long stay (365 days of admission) across states with different long-term services and supports systems. DATA SOURCE Data were drawn from the Minimum Data Set, the federal Online Survey, Certification, and Reporting (OSCAR) database, the Area Health Resource File, and the LTCFocUs.org database for all free-standing, certified nursing homes in California (n = 1,127) and Florida (n = 657) from July 2007 to June 2008. STUDY DESIGN Hierarchical generalized linear models were used to examine the impact of facility characteristics on the probability of transitioning to the community. PRINCIPAL FINDINGS Facility characteristics, including size, occupancy, ownership, average length of stay, proportion of Medicare and Medicaid residents, and the proportion of residents admitted from acute care facilities are associated with discharge but differed by state and whether the discharge occurred after a short or long stay. CONCLUSION Short- and long-stay nursing home discharge to the community is affected by resident, facility, and sometimes market characteristics, with Medicaid consistently influencing discharge in both states.
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Affiliation(s)
- Amanda A Holup
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, FL
| | - Zachary D Gassoumis
- Davis School of Gerontology, University of Southern California, Los Angeles, CA
| | - Kathleen H Wilber
- Davis School of Gerontology, University of Southern California, Los Angeles, CA
| | - Kathryn Hyer
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, FL
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15
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Rahman AN, Bressette M, Gassoumis ZD, Enguidanos S. Nursing Home Residents' Preferences on Physician Orders for Life Sustaining Treatment. Gerontologist 2015; 56:714-22. [PMID: 26035903 DOI: 10.1093/geront/gnv019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 01/13/2015] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY Previous studies examining preferences documented in Physician Orders for Life Sustaining Treatment (POLST) have found that most sampled POLSTs show a preference to limit care. These studies were conducted in states that are relatively ethnically homogeneous. This study investigated the POLST preferences of nursing home residents in an ethnically diverse state-California-that requires nursing homes to document whether residents execute POLST. DESIGN AND METHODS Data were collected from POLST forms executed by 941 residents in a convenience sample of 13 nursing homes in Southern California. The study analyzed data from 4 POLST form items: signatory (resident vs. surrogate decision-maker) and care preferences related to: (a) resuscitation; (b) medical intervention; and (c) artificially administered nutrition. Descriptive, comparative, and regression analyses are reported at both individual and facility levels. RESULTS Of reviewed POLSTs, 46.8% documented a preference for "do not resuscitate" (DNR); 47.3% documented limits on medical intervention; and 52% documented limits on artificially administered nutrition. Residents in nursing homes serving comparatively larger populations of older residents and White residents had lower odds of electing the full care option for each of the POLST's 3 care items; those in nursing homes serving comparatively larger populations of Hispanic residents had higher odds of electing long-term artificially administered nutrition. IMPLICATIONS This study found lower rates of POLST choices limiting care than previous studies, possibly because the sampled nursing homes served a more ethnically- and age-diverse population. California's requirement that nursing homes document whether residents execute POLST also may have indirectly influenced choice patterns.
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Affiliation(s)
- Anna N Rahman
- Gerontology Research Consultant, Santa Monica, California.
| | | | - Zachary D Gassoumis
- Davis School of Gerontology, University of Southern California, Los Angeles, CA
| | - Susan Enguidanos
- Davis School of Gerontology, University of Southern California, Los Angeles, CA
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Gassoumis ZD, Fike KT, Rahman AN, Enguidanos SM, Wilber KH. Who transitions to the community from nursing homes? Comparing patterns and predictors for short-stay and long-stay residents. Home Health Care Serv Q 2014; 32:75-91. [PMID: 23679659 DOI: 10.1080/01621424.2013.779353] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Little is known about characteristics of those who transition to the community after long stays in nursing facilities. Yet this information is highly relevant to efforts to reduce preventable nursing facility use. This study identifies and compares community transition among short-stay (1-90 days) and long-stay residents (91-365 days) aged 65 + using Kaplan-Meier survival estimates and logistic regression to analyze 3,762 episodes of care in Southern California. Over 90% of community discharges occurred in the first 90 days, and few characteristics predicted discharge after 90 days. The findings inform transition programs' efforts to identify and effectively target residents after 90-day stays.
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Affiliation(s)
- Zachary D Gassoumis
- Davis School of Gerontology, University of Southern California, Los Angeles, California 90089-0191, USA.
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DeLiema M, Gassoumis ZD, Homeier DC, Wilber KH. Determining prevalence and correlates of elder abuse using promotores: low-income immigrant Latinos report high rates of abuse and neglect. J Am Geriatr Soc 2012; 60:1333-9. [PMID: 22697790 PMCID: PMC3396729 DOI: 10.1111/j.1532-5415.2012.04025.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Low-income Latino immigrants are understudied in elder abuse research. Limited English proficiency, economic insecurity, neighborhood seclusion, a tradition of resolving conflicts within the family, and mistrust of authorities may impede survey research and suppress abuse reporting. To overcome these barriers, promotores, local Spanish-speaking Latinos, were recruited and trained to interview a sample of Latino adults aged 66 and older residing in low-income communities. The promotores conducted door-to-door interviews in randomly selected census tracts in Los Angeles to assess the frequency of psychological, physical, and sexual abuse; financial exploitation; and caregiver neglect. Overall, 40.4% of elderly Latino adults had experienced some form of abuse or neglect within the previous year. Nearly 25% reported psychological abuse, 10.7% physical assault, 9% sexual abuse, and 16.7% financial exploitation, and 11.7% were neglected by their caregivers. Younger age, higher education, and experiencing sexual or physical abuse before age 65 were significant risk factors for psychological, physical, and sexual abuse. Years lived in the United States, younger age, and prior abuse were associated with greater risk of financial exploitation. Years spent living in the United States was a significant risk factor for caregiver neglect. Abuse prevalence was much higher in all mistreatment domains than findings from previous research on community-dwelling elderly adults, suggesting that low-income Latino immigrants are highly vulnerable to elder mistreatment or that respondents are more willing to disclose abuse to promotores who represent their culture and community.
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Affiliation(s)
- Marguerite DeLiema
- Davis School of Gerontology, University of Southern California, Los Angeles, California 90089, USA.
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Navarro AE, Gassoumis ZD, Wilber KH. Holding abusers accountable: an elder abuse forensic center increases criminal prosecution of financial exploitation. Gerontologist 2012; 53:303-12. [PMID: 22589024 DOI: 10.1093/geront/gns075] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Despite growing awareness of elder abuse, cases are rarely prosecuted. The aim of this study was to examine the effectiveness of an elder abuse forensic center compared with usual care to increase prosecution of elder financial abuse. DESIGN AND METHODS Using one-to-one propensity score matching, cases referred to the Los Angeles County Elder Abuse Forensic Center (the Forensic Center) between April 2007 and December 2009 for financial exploitation of adults aged 65 and older (n = 237) were matched to a population of 33,650 cases that received usual care from Adult Protective Services (APS). RESULTS 1 Significantly, more Forensic Center cases were submitted to the District Attorney's office (DA) for review (22%, n = 51 vs. 3%, n = 7 usual care, p < .001). Among the cases submitted, charges were filed by the DA at similar rates, as was the proportion of resultant pleas and convictions. Using logistic regression, the strongest predictor of case review and ultimate filing and conviction was whether the case was presented at the Forensic Center, with 10 times greater odds of submission to the DA (Odds ratio = 11.00, confidence interval = 4.66-25.98). IMPLICATIONS Previous studies have not demonstrated that elder abuse interventions impact outcomes; this study breaks new ground by showing that an elder abuse multidisciplinary team increases rates of prosecution for financial exploitation. The elder abuse forensic center model facilitates cooperation and group problem solving among key professionals, including APS, law enforcement, and the DA and provides additional resources such as neuropsychological testing, medical record review, and direct access to the Office of the Public Guardian.
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Affiliation(s)
- Adria E Navarro
- Department of Graduate Social Work, School of Behavioral and Applied Sciences, Azusa Pacific University, 901 East Alosta Avenue, Azusa, CA 91702-7000, USA.
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Gassoumis ZD, Wilber KH, Baker LA, Torres-Gil FM. Who are the Latino baby boomers? Demographic and economic characteristics of a hidden population. J Aging Soc Policy 2010; 22:53-68. [PMID: 20390712 DOI: 10.1080/08959420903408452] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The United States is confronting two simultaneous demographic shifts with profound implications for public policy: population aging and increasing diversity. These changes are accelerating during a dramatic economic downturn, placing entitlement reform prominently on the national policy agenda. Using decennial census data from 2000, this paper examines the nexus of these trends by examining characteristics of Latino baby boomers. In the census data, Latinos constituted 10% of the 80 million boomers; roughly one-third of Latino boomers (37%) were born in the United States or abroad to a U.S. parent; 6% were born in a U.S. territory; 21% were naturalized citizens; and 36% were noncitizens. Compared to non-Latinos, Latino baby boomers had lower levels of education, home ownership, and investment income and higher rates of material hardship and poverty; however, there was considerable variation based on citizenship status. A better understanding of Latino baby boomers will help policy makers anticipate the retirement needs of baby boomers as the United States prepares for the aging of a racially and ethnically diverse population.
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Affiliation(s)
- Zachary D Gassoumis
- Davis School of Gerontology, University of Southern California, Los Angeles, California 90089-0191, USA.
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