Race and Type of Maltreatment in an Elder Abuse System

This paper examines the relationship between race and types of maltreatment experienced by elderly people. In particular, it uses logistic regression analysis to examine whether race of victim is associated with self-neglect, neglect, physical abuse, and material abuse. The findings indicate that race is related to the likelihood of self-neglect and neglect but in opposite directions; whites are more likely to be associated with self-neglect, and blacks with neglect by others. Race was not significantly related to the likelihood of being physically or materially abused. The implications of these findings are discussed.     

Is Pain a Significant Factor in Elder Self-Neglect?

ABSTRACT

Purpose. Pain is a worldwide health concern leading to cognitive impairments, depression, and decline in activities of daily living when poorly controlled. Self-neglect is also a serious public health issue being the most common allegation reported to Adult Protective Services (APS). The purpose of this analysis is to determine whether self-reported pain is associated with validated cases of self-neglect compared with matched controls.

Methods. This is a cross-sectional study of 80 (APS) validated cases of self-neglect aged 65 years and older and 80 control participants recruited from a geriatric clinic at Harris County Hospital District. Control participants were matched for age, race, gender, and zip code. Both groups were administered the Wong-Baker FACES rating scale and the Mini-Mental State Examination in their homes by a geriatric nurse practitioner and a research assistant.

Summary of Results. Self-reported pain was noted in 43% of the self-neglect group compared with only 28% in the control group (χ² = 3.85, df = 1, p = .05). This difference became non-significant after stratifying for MMSE scores of 19 or greater (χ² = 3.38, df = 1, p = .066). The self-neglecting elderly also reported significantly higher levels of pain compared with the matched controls (t = 2.5, df = 143, p = .014). This mean difference remained significant after stratifying by MMSE scores of 19 or greater (t = 2.6, df = 124, p = .009).

Conclusion. The data provide preliminary support for the relationship between self-reported pain and elder self-neglect. Research is needed to determine whether pain is a causal or associated factor in self-neglect and whether therapeutic intervention can improve the syndrome of self-neglect.     

Differentiating self-neglect as a type of elder mistreatment: how do these cases compare to traditional types of elder mistreatment?

Official estimates suggest that self-neglect is the most common type of elder mistreatment. Interestingly, very few researchers have empirically assessed self-neglect as a type of elder mistreatment. In the current study, attention is given to how self-neglect cases handled by adult protective services agencies compare to other types of elder mistreatment. Comparisons are made between the needs of self-neglect clients and other protective services clients as well as the role of stress in the different types of abuse. Findings suggest that self-neglect clients are less likely to need help with certain functional activities. In addition, those who are married and those who have completed fewer years of education are less likely to be labeled as experiencing self-neglect. City differences in rates of self-neglect were also found. Not surprisingly, self-neglect clients were more likely than other protective services clients to refuse services. Implications are provided.     

Severe self-neglect: an epidemiological and historical perspective

Older adults with severe self-neglect have multiple deficits in various social, functional and physical domains, and often live insqualor. These individuals often present with poor personal hygiene, domestic squalor and hoarding which results in a threat to their own health as well as personal and public safety. Severe self-neglect occurs along a continuum with older adults often having cognitive and affective disorders compared with younger individuals presenting with psychiatric illnesses. In cases of severe self-neglect with hoarding, evidence has shown this behavior occurs in diverse social strata and not among the wealthy and professionals alone as believed earlier. Due to the multiple conditions associated with severe self-neglect, this population will require an interdisciplinary, multidimensional approach to reduce morbidity and mortality rates including nursing home placement. Research on this group has been limited and is rarely described in the medical and nursing literature. Future research is needed to provide practitioners with effective screening instruments and interventions on cases of severe self-neglect.     

The lifetime economic and social costs of child maltreatment in Australia

A cost of illness (COI) study was undertaken to estimate the magnitude and range of lifetime effects associated with child maltreatment in Australia, using an incidence-based approach. Costs were primarily estimated through calculation of population attributable fractions (PAFs) to determine the marginal effects of child maltreatment on a range of outcomes. PAFs were then applied to estimates of expenditure, inflated to 2014–15 Australian dollars, projected over the life course, according to a baseline age of incident cases for child maltreatment in 2012–13, and discounted at 7% per annum. Sensitivity analysis was conducted using a best and lower bound estimate of incidence of child abuse. The best estimate of the total estimated lifetime financial costs for incident cases of child maltreatment in 2012–13 was $9.3 billion (a cost per child maltreated of $176,437), with a lower bound of $5.8 billion. The best estimate of lifetime costs associated with reduced quality of life and premature mortality (non-financial costs) for all incident cases of child maltreatment in 2012–13 was $17.4 billion, or $328,757 per child maltreated. The considerable lifetime costs associated with child maltreatment warrants an expansion of existing investment in primary and secondary prevention and targeted support services for children and families at risk.     

The role of social isolation of elders in recidivism of self-neglect cases at San Francisco Adult Protective Services

This study examined the relationship between social isolation of elders and recidivism of self-neglect cases at San Francisco Adult Protective Services. Of secondary interest was an examination of other risk factors: mental health concerns, cognitive deficits, and substance/alcohol abuse. A secondary chart review was conducted on 704 elder clients with confirmed cases of self-neglect in 2004. Bivariate and multivariate analyses showed a positive relationship between substance/ alcohol abuse and recidivism, and a negative relationship between cognitive decline and recidivism. No significant relationships were found for social isolation or mental health concerns and recidivism. This study supports previous research suggesting significant relationships between substance abuse and self-neglect, further demonstrating a need for more substance/alcohol abuse programs for elders.     

Assessing Capacity in the Setting of Self-Neglect: Development of a Novel Screening Tool for Decision-Making Capacity

ABSTRACT

Compared with older adults with disabilities and those who autonomously choose to live in squalor, self-neglect syndrome arises from a predicate state of vulnerability in frail older adults. This state of vulnerability is characteristically associated with a decline in decision-making capacity regarding the ability to care for and protect oneself. We developed the COMP Screen to evaluate vulnerable older adults to identify potential gaps in decision-making capacity using a screening tool. A total of 182 older adults were evaluated and consistent declines in cognitive ability and decision-making processes were present in this population. However, there were no significant differences between elders referred for self-neglect and matched older adults. These findings suggest that declines in decision-making processes are not uncommon in vulnerable older adults but traditional conceptualizations of decision-making capacity may be inadequate for differentiating the capacity for self-care and protection in elders who self-neglect.     

Elder Abuse and Neglect Substantiations:

This study set out to measure rates of substantiation of initial abuse and neglect reports and to identify case related factors that are associated with substantiation. Toward this end, analysis was performed on 2,849 cases reported to the Wisconsin Elder Abuse Reporting System in 1988 and 1989. Over 57% of all initial reports were substantiated by the investigating agencies with higher rates for cases of self-neglect only. Among cases involving other abusers, physicial and emotional abuse had the highest substantiation rates. Results also indicate that substantiation rates for all types of abuse and neglect are higher in urban settings. Cases referred by professionals usually have higher substantiation rates than those referred by relatives and neighbors. Higher rates were found for elders living alone and those with several high risk characteristics such as mental illness and Alzheimer's disease. The abusers in substantiated cases were more likely to be spouses, sons, and other relatives. These abusers were also likely to be in one or more risk categories. The amount of services that were offered to and accepted by the victims was associated with substantiation only for alternative placements but not for community based services. Clients in substantiated cases were in fact more likely to refuse services than their peers in unsubstantiated ones.     

Risk factors associated with elder abuse: the importance of differentiating by type of elder maltreatment

Elder abuse research rarely differentiates by the type of elder maltreatment involved when identifying risk factors. The purpose of this study was to compare risk factors across four predominant types of elder maltreatment (financial exploitation, physical abuse, neglect by others, and hybrid financial exploitation [HFE]). Data were collected from two sources: interviews with victims of substantiated elder abuse, responding adult protective services (APS) caseworkers (N = 71), and third-party informants; and a statewide database that contained all substantiated cases over a corresponding 2-year period (N = 2,142). Using chi-square (interview data) and logistic regressions (Adult Services/Adult Protective Services [ASAPS] data), significant differences across the four types of elder maltreatment were found. These two datasets provide converging evidence for the importance of differentiating by type of maltreatment when identifying risk factors for elder maltreatment and for the importance of considering both the elderly victim and the abusive individual when predicting type of elder maltreatment.     

Adult protective services clients confirmed for self-neglect: characteristics and service use

Self-neglect is a complex and inadequately understood phenomenon that accounts for the majority of Adult Protective Services cases. This retrospective, record-based study of the characteristics of 210 older adults who were reported to Adult Protective Services and confirmed for self-neglect revealed that common health problems included nutritional frailty, arthritis, and incontinence. Comparisons based upon length of service showed differences in worker-rated social environment risk, client capacity, and activities of daily living performance. Comparisons of findings with those of other studies of self-neglect underscore the need for systematic research on this population.     

Assessing capacity in the setting of self-neglect: development of a novel screening tool for decision-making capacity

Compared with older adults with disabilities and those who autonomously choose to live in squalor, self-neglect syndrome arises from a predicate state of vulnerability in frail older adults. This state of vulnerability is characteristically associated with a decline in decision-making capacity regarding the ability to care for and protect oneself. We developed the COMP Screen to evaluate vulnerable older adults to identify potential gaps in decision-making capacity using a screening tool. A total of 182 older adults were evaluated and consistent declines in cognitive ability and decision-making processes were present in this population. However, there were no significant differences between elders referred for self-neglect and matched older adults. These findings suggest that declines in decision-making processes are not uncommon in vulnerable older adults but traditional conceptualizations of decision-making capacity may be inadequate for differentiating the capacity for self-care and protection in elders who self-neglect.     

Factors predicting prosecution of child maltreatment cases

ObjectivesThe purpose of the current study was to examine what case characteristics increased the likelihood of a child maltreatment case being prosecuted, and upon prosecution, of being convicted.MethodsData came from 406 criminal court case files from nine judicial districts in North Carolina. Using logistic regression, we examined how county-level and individual characteristics of arrests predicted the probability of prosecution, and for arrests that result in prosecution, the probability of conviction.ResultsNearly two-fifths (39%) of individuals arrested for child maltreatment were also charged with a concurrent offense. Of those with a concurrent offense, 11% had a felony charge. Of those arrested, 40% were prosecuted on at least one charge. Two case characteristics, the presence of any concurrent non-child maltreatment charge or a concurrent felony non-child maltreatment charge, were positively associated being prosecuted on at least one charge. Prosecution for child maltreatment was less likely when there was a concurrent felony charge, when the defendant was the father or a non-parent (relative to the mother), and if the youngest child named was between ages 2–5, or 6–12 (relative to children < 2). Only 18% of cases had physical evidence available. Conviction on at least one charge was more likely when there was a concurrent felony non-child maltreatment charge. Conviction for a child maltreatment was less likely when: there was a concurrent non-child maltreatment felony charge, the defendant was not the parent or caregiver, and there was a CPS investigation or assessment for neglect within a 30 day window of the arrest relative to no investigation.ConclusionsProsecutors in child maltreatment cases weigh not only the admissibility of evidence in deciding whether to pursue prosecution, but also other case characteristics such as the age of the child victim, whether there is available evidence outside of victim testimony, and other concurrent crimes. The prosecutor may have a stronger case for concurrent non-child maltreatment crimes, and these will thus be more likely to result in conviction. This may also play a role in prosecutor decisions.     

The impact of repeated maltreatment on behavioral trajectories from early childhood to early adolescence

Using multilevel model for change, this study examined the trajectories of both internalizing and externalizing behavioral problems from early childhood to early adolescence among a cohort of 685 children with early alleged maltreatment from age 4 through age 12. These children were recruited from five study sites using the LONGSCAN archive data. Repeated allegation of maltreatment for each child was treated as a time-varying variable and was tracked continuously and assessed at each measurement of the child behavioral problems. Child behavioral problems were measured at ages 4, 6, 8, 10, and 12 using the Child Behavior Checklist. Findings indicated that repeated maltreatment significantly predicted subsequent trajectories of both internalizing and externalizing problems. In both cases, the effect of repeated maltreatment was on the slope, rather than on the intercept which was reflected in the trajectories. Repeated maltreatment was associated with significantly steeper increases in both internalizing and externalizing problems over time. Although there were no differences in early behavioral assessments (e.g., age 4 and age 6), both internalizing and externalizing behaviors emerged later and became more pronounced over time among those with repeated maltreatment (e.g., since age 8) compared to those without. Although behavioral problems may not be seen in younger children who experience multiple maltreatment, it is prudent to be aware that the impact may likely emerge in later ages of the child. Thus, ongoing monitoring and assessment of treatment needs for children who have had multiple occurrence of maltreatment becomes imperative.     

Dosage matters: The relationship between participation in the Nurturing Parenting Program for infants, toddlers, and preschoolers and subsequent child maltreatment

This article uses statewide data on caregivers of young children referred to the Nurturing Parenting Program (NPP) for allegations of abuse and neglect to examine the relationship between program dosage and subsequent maltreatment. At six months after participating in the program, caregivers who attended more sessions were significantly less likely to be reported for child maltreatment, holding other factors constant. At two years after participating, caregivers attending more sessions were significantly less likely to have a substantiated maltreatment incidence, controlling for other characteristics of families associated with maltreatment. These findings demonstrate the program is associated with preventing short-term allegations and longer-term substantiated incidences of maltreatment for a child welfare population. By demonstrating the importance of participation in the NPP, we increase the evidence about effective parent education programs for this population.     

Children placed in out-of-home care: risk factors for involvement with the juvenile justice system

In previous research, child maltreatment has been associated with several negative outcomes, including delinquency. This study uses administrative data to examine risk factors, including the severity and chronicity of maltreatment, for juvenile justice involvement among children, ages 7 to 17, who were placed in out-of-home care in Florida (N = 13,212). The results of multivariate Cox regression analysis indicated that among specific types of maltreatment, sexual abuse was associated with the risk of faster placement only in a detention center. Additionally, findings from this study suggest that maltreatment chronicity but not maltreatment severity increases the chances of earlier involvement with the juvenile justice system among children who were placed in an out-of-home care. Implications of these findings are discussed.     

Maltreatment prevention through early childhood intervention: A confirmatory evaluation of the Chicago Child-Parent Center preschool program

Increased recognition of the consequences associated with child maltreatment has led to greater emphasis on its prevention. Promising maltreatment prevention strategies have been identified, but research continues to suffer from methodological limitations and a narrow focus on select prevention models. This investigation uses data from the Chicago Longitudinal Study to examine mediating mechanisms that link the Chicago Child-Parent Center preschool program to a reduction in overall child maltreatment and, more specifically, child neglect. We use structural equation modeling to test child, family, and school measures hypothesized to mediate the effects of CPC participation on maltreatment and neglect. Results indicate that a substantial proportion of the program's impacts can be accounted for by family support processes, including increased parent involvement in school and maternal educational attainment as well as decreased family problems. The CPC program's association with reduced school mobility and increased attendance in higher-quality schools also significantly mediated its effects on maltreatment and neglect. Further, a decrease in troublemaking behavior contributed modestly to mediating the program's association with maltreatment but not neglect. We discuss the implications of these results for the field of maltreatment prevention.     

Correlates of depression in self-neglecting older adults: A cross-sectional study examining the role of alcohol abuse and pain in increasing vulnerability

ABSTRACT

Self-neglect among older adults results in increased morbidity and mortality rates. Depression is strongly linked to self-neglect and when untreated, severely complicates management of health and functional outcomes. The study aims to identify factors correlated with depression to inform approaches to service recruitment and retention that improve long-term outcomes. The sample included urban community-dwelling older adults (n = 96) 65 years of age and older with Adult Protective Services-substantiated self-neglect. All participants completed a range of validated cognitive, functional, and self-report demographic and clinical measures around health and mental health functioning. A secondary data analysis using multivariable logistic regression revealed that a positive screen for alcohol abuse, low self-rated health, and higher self-reported pain were associated with significantly higher odds of self-reported depression. Further research is needed to understand the temporality between these correlates and depression and to inform prevention and intervention practices for self-neglecting older adults.     

Didn't we just see you? Time to recurrence among frequently encountered families in CPS

In child protection services, multiple maltreatment recurrences, or chronic maltreatment, has been a concern drawing increased attention because of its persistent harm to the children and the need to consider more effective intervention strategies to meet its unique needs. Timing has been an important issue in understanding the pattern of chronic maltreatment. No existing research has examined the influence of the interval between previous maltreatment incidents on future recurrences. The current study uses state administrative data to conduct longitudinal analyses to examine how the interval between previous maltreatment incidents is associated with the likelihood of future maltreatment occurrence among children who encountered multiple maltreatment recurrences. The findings suggest that short intervals are associated with increased likelihood of encountering a future recurrence, while controlling various covariates. The findings suggest the possibility of including the interval between previous maltreatment incidents as an indicator for child maltreatment risk assessment, and the need for developing responsive intervention strategies to stop the trend of chronic maltreatment.     

Multi‐type maltreatment and the long‐term adjustment of adults

Multi‐type maltreatment refers to the experience of more than one form of child maltreatment (sexual abuse, physical abuse, psychological maltreatment, neglect and witnessing family violence). Researchers have largely ignored the presence of other types of child abuse and neglect when examining the adjustment problems associated with a particular form of maltreatment. The association between ‘multi‐type maltreatment’ and adjustment was explored in the current study. Retrospective data were obtained on (a) the degree to which maltreatment types co‐occurred, (b) childhood family characteristics and (c) adjustment problems in adulthood in an Australian self‐selected community sample (N=175). As hypothesized, a large degree of overlap was reported in the experience of the five types of maltreatment. Family characteristics—particularly family cohesion and adaptability—discriminated between respondents reporting single‐type and multi‐type maltreatment. Greater adjustment problems were associated with reports of a larger number of different maltreatment types. Multi‐type maltreatment should be recognized as a crucial aspect of the nature and impact of child maltreatment and considered in the development of programmes for the prevention and treatment of child abuse and neglect. Copyright © 2000 John Wiley & Sons, Ltd.     

Animal Hoarding: Slipping Into the Darkness of Comorbid Animal and Self-Neglect

Substantial research and literature indicate how people and companion animals form relationships that are, for the most part, mutually beneficial. Yet there are highly dysfunctional human–animal relationships that do occur, meriting attention and remediation. One of the most perplexing and problematic human–animal relationships is encountered in cases of animal hoarding—a deviant behavior associated with extremely deleterious conditions of comorbid animal and self-neglect. Adult Protective Services workers often encounter theoretical and methodological dilemmas with these complex cases. To intervene most effectively, it becomes critical to elucidate some of the developmental factors of animal hoarding behavior and its correlation with self-neglecting behaviors in general. This article presents an in-depth diagnostic perspective as derived from the author's research and clinical experience. An analysis of the complex dynamics of the relationship between animal hoarders and their pets is presented in conjunction with accepted theories of self-neglect. With enhanced knowledge and understanding of animal hoarding, human service professionals will be better prepared to respond to these clients, evoke greater rapport and cooperation, and engage in the interdisciplinary efforts that are essential for optimal resolution.