Longitudinal Prevalence and Correlates of Elder Mistreatment Among Older Adults Receiving Home Visiting Nursing

The objectives of this study were to identify elder mistreatment (EM) prevalence among a cohort of older adults receiving visiting nurse care in their homes, determine EM subtypes, and identify factors associated with EM. EM data were collected by nurses during monthly home visits for up to 24 months. It took the nurses a mean of 10.5 visits to discern EM. Fifty-four (7.4%) of 724 patients were identified as mistreated, of which 33 had enough information to subtype the EM. Of these 33, 27 were victims of neglect, 16 of psychological abuse, and 10 of financial exploitation, and 17 suffered more than one type. Among the entire sample, 11 variables were positively correlated with EM presence. Nurses visiting older adults in their homes should be aware that their patients are, as a group, vulnerable to EM, and that the factors identified here may be specific markers of greater risk.     

Improving medicolegal death investigative gaps of fatal elder abuse

The purpose of this brief is to present several case vignettes that illustrate omissions in the investigation of elder deaths. These vignettes demonstrate the need for a standardized approach in the conduct of medicolegal investigations of fatal elder abuse. For each of the described oversights, a recommendation is offered to address the gap in investigation processes, which in turn could improve the determination of cause and manner of elder death. Inherent limitations of resources and practical realities of death investigation are discussed and recommendations are made for future research. Viewed broadly, deficiencies in elder death investigations can lead to the underreporting of elder abuse and the reduction of legal options for victims, which may reflect a systemic pattern of social injustice.     

The feasibility of goal attainment scaling to measure case resolution in elder abuse and neglect adult protective services intervention

Objectives: This pilot study describes implementation procedures of goal attainment scaling (GAS) and examines the feasibility of using GAS to measure the multifarious intervention outcome of case resolution in elder mistreatment (EM) adult protective services (APS).

Methods: Substantiated EM victims (n = 27) were recruited prospectively from the State of Maine APS. An adapted GAS approach was implemented involving development of a pre-populated goal scale menu and web-based GAS application.

Results: The GAS menu comprised 18 goals and corresponding scales spanning several domains of case resolution: social support, service access, health/functioning, enhancing independence, and protective measures. The overall GAS process had mean length 33.8 min per case. The mean GAS summary t-score (54.3) aligned with theoretical expectations.

Discussion: Without a measure of case resolution, research cannot compare the effectiveness of different EM intervention models. Findings suggest that GAS is a feasible, client-centered strategy to measure the multifarious EM intervention case resolution outcome.     

Understanding of elder abuse and neglect among health care professionals in Malaysia: An exploratory survey

ABSTRACT

Elder abuse and neglect (EAN) is a hidden public health challenge for Malaysia. This cross-sectional survey studied the awareness of EAN among 148 doctors and nurses from two neighboring states in Malaysia using a self-administered questionnaire exploring their knowledge, perceptions, practices, and experience concerning EAN. Both doctors and nurses demonstrated poor understanding of signs of EAN and exhibited misperceptions on reporting requirements. Both groups perceived EAN as a national burden and reporting it as their responsibility; but most felt they had not been trained to diagnose it. Many were unsure of procedures and whether their own intervention could be effective. Only four (nurses) of 41 participants who suspected abuse during the past year reported the cases. Targeted education and uniform protocols are mandatory to ensure best practice with regards to EAN. Further research is crucial to extend this inquiry into the broader health care workforce.     

Exploring gender and elder abuse from the perspective of professionals

We conducted an online survey of professionals working in two Canadian provinces to learn about their knowledge of elder abuse from a gender-based perspective. A total of 169 professionals (90% women) completed a survey in either French or English. Five topic areas emerged from the analysis: the influence of gender on the risk of abuse; types of abuse detected; knowledge gaps; capacity to respond to gender-based abuse; and awareness of resources. To gain further insight into these results, we conducted three focus groups with a total of 24 professionals. Professionals held relatively little recognition of, or knowledge about, gender related to elder abuse. Our results indicate the need to develop educational and awareness raising opportunities for professionals who work with abused older adults in both French and English to identify and respond to the unique needs of older women and men.     

Mortality among elder abuse victims in rural Malaysia: A two-year population-based descriptive study

Our study aims at describing mortality among reported elder abuse experiences in rural Malaysia. This is a population-based cohort study with a multistage cluster sampling method. Older adults in Kuala Pilah (n = 1,927) were interviewed from November 2013 to May 2014. Mortality was traced after 2 years using the National Registration Department database. Overall, 139 (7.2%) respondents died. Fifteen (9.6%) abuse victims died compared to 124 (7.0%) not abused. Mortality was highest with financial abuse (13%), followed by psychological abuse (10.8%). There was a dose-response relationship between mortality and clustering of abuse: 7%, 7.7%, and 14.0% for no abuse, one type, and two types or more, respectively. Among abuse victims, 40% of deaths had ill-defined causes, 33% were respiratory-related, and 27% had cardiovascular and metabolic origin. Results suggest a link between abuse and mortality. Death proportions varied according to abuse subtypes and gender.     

Addressing the measurement challenge in elder abuse interventions: need for a severity framework

ABSTRACT

The field of elder abuse is evolving toward an emphasis on intervention research. However, researchers currently rely on binary approaches to measure elder abuse phenomena, which fail to capture changes in problem status over the course of intervention. This commentary develops a case for severity as a framework to operationalize and measure elder abuse in intervention research and practice. A severity framework provides enhanced elder abuse measurement responsiveness and aligns with the dominant client-centered, harm-reduction clinical approach to intervening with elder abuse cases.     

A new role for imaging in the diagnosis of physical elder abuse: results of a qualitative study with radiologists and frontline providers

Pediatric radiologists play a key role in the detection of child abuse through the identification of characteristic injury patterns. Emergency radiologists have the potential to play an equally important role in the detection of elder physical abuse; however, they currently play little to no part in this effort. We examine the reasons behind this limited role, and potential strategies to expand it, by interviewing attending faculty from Emergency Radiology, Geriatrics, Emergency Medicine, Pediatric Radiology, and Pediatrics. Our interviews revealed that radiologists’ contribution to elder abuse detection is currently limited by gaps in training, gaps in knowledge about imaging correlates, and gaps in inter-team clinical communication. Specifically, radiographic interpretation of elder trauma is severely restricted by lack of communication between frontline providers and radiologists about patients’ injury mechanism and functional status. Improving this communication and re-conceptualizing ED workflow is critical to expanding and optimizing radiologists’ role in elder abuse detection.     

The prevalence of elder abuse and neglect in Iran: a systematic review and meta-analysis

ABSTRACT

Objective: The aim of this study was to estimate the prevalence of elder abuse and neglect in Iran.

Methods: We searched PubMed, Embase, Scopus, and PsycINFO by the end of 2017. The prevalence was calculated based on the percentage or the amount reported in the studies. Heterogeneity was assessed by the I² statistic, and the data were combined using random effects model. The results were reported as the pooled estimates and the 95% confidence intervals (CIs). The review protocol was registered in PROSPERO (CRD42017070744).

Results: A total of 16 studies involving 6,461 participants aged 60 years and over were included. The pooled prevalence for overall elder abuse was 45.7% (95% CI: 27.3–64.1, p < .001).

Discussion: The prevalence of elder abuse and neglect is substantial in the Iranian population aged 60 years and over. More research is needed to investigate the actual prevalence of elder abuse at the national level.     

Cognitive,social, and neural determinants of diminished decision-making and financial exploitation risk in aging and dementia: A review and new model

ABSTRACT

In this article we will briefly review how changes in brain and in cognitive and social functioning, across the spectrum from normal to pathological aging, can lead to decision-making impairments that increase abuse risk in many life domains (e.g., health care, social engagement, financial management). The review will specifically focus on emerging research identifying neural, cognitive, and social markers of declining financial decision-making capacity in older adults. We will highlight how these findings are opening avenues for early detection and new interventions to reduce exploitation risk.     

Correlates of Susceptibility to Scams in Older Adults Without Dementia

This study examined correlates of susceptibility to scams in 639 community-dwelling older adults without dementia from a cohort study of aging. Regression models adjusted for age, sex, education, and income were used to examine associations between susceptibility to scams, measured by a five-item self-report measure, and a number of potential correlates. Susceptibility was positively associated with age and negatively associated with income, cognition, psychological well-being, social support, and literacy. Fully adjusted models indicated that older age and lower levels of cognitive function, decreased psychological well-being, and lower literacy in particular may be markers of susceptibility to financial victimization in old age.     

Multiple approaches to understanding and preventing elder abuse: Introduction to the cross-disciplinary National Institutes of Health workshop

ABSTRACT

On October 30, 2015, the National Institutes of Health (NIH) convened a workshop, “Multiple Approaches to Understanding and Preventing Elder Abuse,” in Bethesda, Maryland. The workshop brought together experts from across disciplines to discuss research challenges, opportunities, and lessons learned from other fields. Participants included experts in elder abuse, child abuse, intimate partner violence (IPV), emergency medicine, and neuroscience. In this special issue of the Journal of Elder Abuse and Neglect, participants address topics explored before, during, and after the day-long workshop.     

State of the science on prevention of elder abuse and lessons learned from child abuse and domestic violence prevention: Toward a conceptual framework for research

ABSTRACT

The goal of this review is to discuss the state of the science in elder abuse prevention. Findings from evidence-based programs to reduce elder abuse are discussed, drawing from findings and insights from evidence-based programs for child maltreatment and domestic/intimate partner violence. A conceptual measurement model for the study of elder abuse is presented and linked to possible measures of risk factors and outcomes. Advances in neuroscience in child maltreatment and novel measurement strategies for outcome assessment are presented.     

Poly-victimization and resilience portfolios: Trends in violence research that can enhance the understanding and prevention of elder abuse

ABSTRACT

This literature review assesses the current state of knowledge about elder abuse and mistreatment, focusing on the lack of incorporation of all forms of elder victimization and the benefits of a poly-victimization framework. This review also includes existing knowledge on risk factors and calls for a greater focus on protective factors and a greater inclusion on family and community factors. Future research, prevention, and intervention would benefit from considering the true burden of elder victimization and a greater implementation of strengths-based approaches to programs.     

Financial Exploitation of Older Adults in Rural Settings: A Family Perspective

Federal agencies responsible for funding protective services to older adults are increasingly concerned with the growing incidence of financial exploitation in rural areas. The Wall Street Journal recently has reported an increasing trend of unemployed adult children migrating from urban centers to smaller rural towns and countrysides to live with their parents since 2008. This current study explores the attitudes of family caregivers regarding management of financial matters for their elderly care recipients. The major findings of the study include that adult children often (1) overestimate their parents' ability to manage their finances; (2) prefer to manage their parents' finances informally, as opposed to using legal options like power of attorney; and (3) tend to think of their parents' assets as “almost theirs.” The study concludes with recommendations on the critical need for information to help families make important decisions about helping elderly parents with their finances. This information would not only promote the use of safeguards against abuse, but could potentially provide caregivers with greater confidence and protection.     

Elder Mistreatment in U.S. Residential Care Facilities: The Scope of the Problem

Many in the United States believe elder mistreatment in long-term care is serious and widespread, but until recently few studies focused on the problem. This study was designed to describe the scope of mistreatment in assisted living facilities (ALFs) in Arizona during a 3-year period. Findings showed that receiving citations for elder mistreatment was relatively rare. However, analysis of narrative reports from only 7% of facilities showed 598 allegations of mistreatment in complaint investigations, of which 372 (62.2%) were substantiated and given citations for something other than mistreatment. Results show that elder mistreatment in ALFs is seriously underidentified, even by state inspectors.     

Assessing Knowledge of Elder Financial Abuse: A First Step in Enhancing Prosecutions

Financial exploitation by a family member is the most common form of elder mistreatment; yet, it is a difficult crime to detect and prosecute. Psychologists have traditionally assisted prosecutors by assessing decisional capacity and opining in court whether an alleged victim was able to consent to the contested transactions. This article proposes and evaluates a novel form of psychological expertise in financial abuse trials—social framework testimony to reeducate jurors who are misinformed about aspects of this largely hidden crime. Findings suggest that, as in cases of child and spousal abuse, social framework testimony on the general dispositional and situational factors inherent in elder financial abuse may enhance prosecutions.     

Mistreatment of Older People in the United Kingdom: Findings from the First National Prevalence Study

There have been few national studies of the prevalence of elder mistreatment (abuse and neglect) in private households. This article provides an overview of the UK National Prevalence Study of Elder Mistreatment that took place in 2006. It addressed 2,111 respondents in four countries who answered a face-to-face survey questionnaire. The achieved sample was weighted to be representative of the UK older population. Of respondents, 2.6% reported mistreatment by family members, close friends, or care workers. The predominant type of reported mistreatment was neglect (1.1%) followed by financial abuse (0.6%), with 0.4% of respondents reporting psychological abuse, 0.4% physical abuse, and 0.2% sexual abuse. Women were significantly more likely to have experienced mistreatment than men, but there were gender differences according to type of abuse and perpetrator characteristics. Divergent patterns were found for neglect, financial, and interpersonal abuse. Further analysis of the data indicated that the likelihood of mistreatment varied with socioeconomic position and health status.     

Prevalence estimates and correlates of elder abuse in the United States: The National Intimate Partner and Sexual Violence Survey

This study examines the prevalence and correlates of psychological abuse and physical abuse against women and men aged 70 or older. Self-report data from 2,185 respondents in the 2010 National Intimate Partner and Sexual Violence Survey (NISVS) were used to create weighted estimates for past-year experiences of abuse. Correlates were then examined using survey logistic regression models. More than 1 in 10 adults who are 70 years of age or older (14.0%) have experienced some form of abuse in the past year, with 12.1% experiencing psychological abuse and 1.7% experiencing physical abuse. One in five victims (20.8%) were abused by both intimate and nonintimate partners. Health care insecurity was the strongest correlate of past-year abuse. The odds of experiencing abuse were 4.53 times greater for those who experienced health care insecurity than for those who did not. This presents a significant challenge for identifying and helping victims of abuse.     

Disclosure among victims of elder abuse in healthcare settings: a missing piece in the overall effort toward detection

Elder abuse remains a largely hidden problem in our society and only a small minority of victims are connected to formal support/protective services. Healthcare settings have been identified as a critical milieu to uncover cases of elder abuse; however, under-detection in these settings is a major issue. Victimization disclosure is an important component within the overall detection effort, yet it has received little attention in the elder abuse literature. Drawing on relevant literature from other domains of family/interpersonal violence, this article highlights the disclosure process, as well as disclosure barriers, facilitators, and competencies to consider when working with older adults.