Determining prevalence and correlates of elder abuse using promotores: low-income immigrant Latinos report high rates of abuse and neglect

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.     

Elder mistreatment in a rural area in Egypt

Aim: Mistreatment of the elderly is a hidden problem frequently cloaked under the shroud of family secrecy. The aim of the present study was to determine the extent of mistreatment of older people living at their homes in the rural area of Mansoura city, Dakahlia governorate, Egypt. Methods: The present cross‐sectional study was carried out on 1106 respondents, 518 men (mean age 67.6 ± 6.3 years) and 588 women (mean age 68.5 ± 8.4 years), who answered face‐to‐face survey questionnaires. The questionnaires used were; Questionnaire to elicit elder abuse, Actual abuse tool, Elder Assessment Instrument, Risk of abuse tool, Katz index and Geriatric depression scale 15 items. Results: Of the respondents, 43.7% reported mistreatment by family members. The predominant type of reported mistreatment was neglect (42.4%) followed by physical abuse (5.7%), psychological abuse (5.1%) and financial abuse (3.8%). Conclusions: The independent risk factors for overall mistreatment of the elderly were older age, insufficient pension and caregiver other than spouse. Although being dependent, the number of children being three or less and caregiver other than spouse were significant independent attributes for “neglect” as a form of elder mistreatment. Geriatr Gerontol Int 2012; 12: 532–537.     

Screening for Abuse and Neglect of People with Dementia

OBJECTIVE: To investigate characteristics of people with dementia and their caregivers (CGs) that are associated with mistreatment in order to inform clinicians about screening for mistreatment. DESIGN: A convenience sample of CG–care recipient (CR) dyads were assessed for literature‐supported factors associated with mistreatment, and evidence of mistreatment for the prior year was collected. An expert panel considered the evidence and decided on occurrences of psychological abuse, physical abuse, and neglect based on criteria adopted before data collection. SETTING: Participants' homes. PARTICIPANTS: One hundred twenty‐nine persons with dementia and their CGs. MEASUREMENTS: CG and CR characteristics (demographic, health, and psychosocial variables), relationship characteristics, and three elder abuse and neglect detection instruments. RESULTS: Mistreatment was detected in 47.3%. Variables associated with different kinds and combinations of mistreatment types included the CG's anxiety, depressive symptoms, social contacts, perceived burden, emotional status, and role limitations due to emotional problems and the CR's psychological aggression and physical assault behaviors. The combination of CR's physical assault and psychological aggression provided the best sensitivity (75.4%) and specificity (70.6%) for elder mistreatment as defined by the expert panel. This finding has potential to be useful as a clinical screen for detecting mistreatment. CONCLUSIONS: The findings suggest important characteristics of older adults with dementia and their CGs that have potential for use in a clinical screening tool for elder mistreatment. Potential screening questions to be asked of CGs of people with dementia are suggested.     

The Elderly in Nursing Homes

It has been argued that many elderly people are placed in nursing homes to isolate them from view, and little research has been done to investigate the effects of such isolation. Some research has focused on certain aspects of abuse and neglect of the elderly, particularly physical, material, and fiscal aspects of abuse. The purpose of this paper is to discuss psychological aspects of abuse and neglect of the elderly in the nursing home environment. Data are presented indicating that psychological aspects of neglect are subtle and not readily apparent to the observer; yet they may be very impactful in terms of their effects. Data also are presented indicating that they constitute the most common form of abuse. Psychological aspects of neglect are divided into categories including: the nature of the physical environment; nutrition and diet; physical appearance and grooming; infantilization; environmental deprivation; and benign neglect. Possible interventions are offered as alternatives to neglect, and research data are summarized as to how such interventions might benefit both the elderly and the clinical staff dealing with such a population.     

The elderly in nursing homes: psychological aspects of neglect

It has been argued that many elderly people are placed in nursing homes to isolate them from view, and little research has been done to investigate the effects of such isolation. Some research has focused on certain aspects of abuse and neglect of the elderly, particularly physical, material, and fiscal aspects of abuse. The purpose of this paper is to discuss psychological aspects of abuse and neglect of the elderly in the nursing home environment. Data are presented indicating that psychological aspects of neglect are subtle and not readily apparent to the observer; yet they may be very impactful in terms of their effects. Data also are presented indicating that they constitute the most common form of abuse. Psychological aspects of neglect are divided into categories including: the nature of the physical environment; nutrition and diet; physical appearance and grooming; infantilization; environmental deprivation; and benign neglect. Possible interventions are offered as alternatives to neglect, and research data are summarized as to how such interventions might benefit both the elderly and the clinical staff dealing with such a population.     

Future Research: A Prospective Longitudinal Study of Elder Self‐Neglect

In almost every U.S. jurisdiction, elder self‐neglect is the most common allegation addressed by Adult Protective Service (APS) agencies. Not only is self‐neglect common, but this form of mistreatment is an independent risk factor for death. A lack of understanding of the precipitating factors and root causes and of the effect on social and medical systems persists in this field. Research in this area has been limited, because the needs of these vulnerable elderly people are complex and diverse. Moreover, these factors encompass interrelated medical, psychiatric, economic, social, and functional problems. In 2004, the National Institutes of Health Interdisciplinary Roadmap Initiative provided the means for preliminary exploration of elder self‐neglect through the formation of the Consortium for Research in Elder Self‐neglect of Texas (CREST). The goals of CREST include to conduct pilot studies, form interdisciplinary working groups, convene a national research conference, and appoint a national external advisory board. CREST orchestrated the work of 35 interdisciplinary investigators to achieve these goals. CREST researchers have begun to characterize the population of vulnerable elderly people who were reported to APS for neglecting themselves. The pilot studies provided a snapshot of 100 elderly people who had neglected themselves. A proposed next phase could involve a prospective longitudinal study of elderly people with severe self‐neglect. This study of the clinical course, the death rate, the causes of death, the occurrence of acute and chronic medical or mental illness, and the costs to the healthcare and social systems would greatly inform the field of elder mistreatment.     

Elder abuse and neglect: an overview

The dramatic growth of the American elderly population has great implications for our health care system. The "demographic imperative" that has fueled the awareness of the needs of older adults has a major impact on issues related to social welfare, justice, and economics. There are 45 million people over the age of 60 and 3 million over the age of 85. Those over age 85 represent the fastest growing segment of the elderly population. With this trend comes a segment of the population that is at risk for abuse, neglect, or self-neglect. We are challenged to be aware of the many faces of elder mistreatment and to understand it in the broader context of domestic violence. All health care professionals working with older adults need to become familiar with the recognition, treatment, and prevention of elder abuse and neglect.     

Abuse and Neglect in Older Men

Abstract

Elder abuse and mistreatment is a growing national concern. While victims and perpetrators are both men and women, much of the focus has been on women. Reports of the gender distribution of elder mistreatment conflict with some studies citing a greater prevalence in males and others showing a female predominance. The article summarizes the research on elder mistreatment, emphasizing the gender distribution. Older men are more likely to be victims of neglect, particularly abandonment. We use case vignettes to illustrate these major research findings. We also present data from a series of focus group interviews that included older men. The comments of the men about elder mistreatment were analyzed and are presented in this article. Through these findings we show that more research is needed to understand the similarities and differences between male and female victims of elder abuse and mistreatment.     

Elder Self‐Neglect: A Discussion of a Social Typology

This article presents a theoretical framework for the study of social and behavioral factors associated with elder self‐neglect. The model presented reflects the authors' beliefs that a risk–vulnerability model offers a useful framework from which to study all forms of elder mistreatment, as well as elder self‐neglect. This model has particular utility, because it can begin to define the elements of risk and vulnerability that may be addressed using preventative measures as opposed to solely addressing intervention, which is often the case when addressing elder mistreatment and self‐neglect. The authors then address a method for using the Consortium for Research in Elder Self‐neglect of Texas data as currently constructed and adding to that database to effectively study risks and vulnerabilities in the elder self‐neglect population. These additional data would greatly expand the scope of the study. The discussant adds his perspective to the ideas proposed by the authors.     

Elder Abuse: Systematic Review and Implications for Practice

This article is based on the lecture for the 2014 American Geriatrics Society Outstanding Scientific Achievement for Clinical Investigation Award. Elder abuse is a global public health and human rights problem. Evidence suggests that elder abuse is prevalent, predictable, costly, and sometimes fatal. This review will highlight the global epidemiology of elder abuse in terms of its prevalence, risk factors, and consequences in community populations. The global literature in PubMed, MEDLINE, PsycINFO, BIOSIS, Science Direct, and Cochrane Central was searched. Search terms included elder abuse, elder mistreatment, elder maltreatment, prevalence, incidence, risk factors, protective factors, outcomes, and consequences. Studies that existed only as abstracts, case series, or case reports or recruited individuals younger than 60; qualitative studies; and non‐English publications were excluded. Tables and figures were created to highlight the findings: the most‐detailed analyses to date of the prevalence of elder abuse according to continent, risk and protective factors, graphic presentation of odds ratios and confidence intervals for major risk factors, consequences, and practical suggestions for health professionals in addressing elder abuse. Elder abuse is common in community‐dwelling older adults, especially minority older adults. This review identifies important knowledge gaps, such as a lack of consistency in definitions of elder abuse; insufficient research with regard to screening; and etiological, intervention, and prevention research. Concerted efforts from researchers, community organizations, healthcare and legal professionals, social service providers, and policy‐makers should be promoted to address the global problem of elder abuse.     

Professional Preparedness to Address Abuse and Neglect among Elders Living in the Rural South: Identifying Resiliency Where Stress Prevails

A growing social problem in the U.S. is the increase of elder abuse and neglect. With the increase of the population of older adults over the age of 65 it is expected that there will be an increased need for professionals skilled in working with older adults and with elder victims of abuse and neglect. While this need is present and growing, there is an absence of literature assessing the preparedness of professionals in working with abused and neglected older adults. The purpose of this research is to assess professionals?? perceptions of their preparedness in working with elderly people who are victims of abuse and neglect. Results indicate that professionals struggle with numerous challenges in their pursuit to provide professional service. However, through their narratives, it also becomes clear that factors such as individual and community resiliency are not to be ignored. This study highlights how in spite of the stress imposed by limited resources, lack of funding to obtain training, differing definitions of abuse, and the challenge of working with rural population, assets such as workers?? compassion, dedication, hard work, creativity, a pro-active approach to problem solving, and doing more with less are the assistive factors in helping a vulnerable population. Implications for future research and policy practice are discussed.     

Defining elder mistreatment in four ethnic groups across two generations

Ethnic and generational variation in elder mistreatment has only recently been explored. This research builds upon pioneer work in the field by examining perceptions of elder mistreatment across four ethnic groups (European-American, African-American, Puerto Rican, and Japanese-American) and two generations (elder and baby boom caregiver). Focus group discussions revealed differences in defining elder mistreatment and responding to it. They also suggested that psychological abuse and neglect may be more important mistreatment forms than previously acknowledged. Policy and practice implications of study results are considered. jg]Key words gw]Elder mistreatment gw]Elder abuse gw]Ethnic groups gw]Generations     

Recognition and perception of elder abuse by prehospital and hospital-based care providers

The purposes of this study were to evaluate the extent of exposure, knowledge and attitudes of prehospital care providers (PCPs) and hospital care providers (HCPs) to elder abuse and neglect. A 20-question survey was designed to determine the providers' perception, knowledge and ability to identify patients that were potential victims of elder abuse and/or neglect. The surveys were distributed at four Maryland statewide conferences during 2006. A total of 645 surveys were distributed at the start of the individual conferences and 400 completed surveys were returned. Of the respondents, 272 (68.2%) were PCP (emergency medical services=EMSs) and 127 (31.8%) were HCP. During the past 12 months, 51.3% of those surveyed did not have reason to suspect any patients were exposed to abuse or neglect, although 60.5% admitted little or no contact with the elderly. In an attempt to determine respondent's ability to recognize potential abuse and neglect patients, scenario-type questions were used. Respondents believed a decubital ulcer (bedsore) was a positive indicator (83.5%) of abuse/neglect and 92.8% indicated that the elderly could suffer from injuries similar to "shaken-baby syndrome". When questioned about skin bruises as a possible indicator of abuse, only 69.3% of the respondents identified it as a possible sign of abuse. Seventy-one percent of respondents indicated that burns are not common in the elderly and could be another sign of elder abuse. One-in-three providers indicated they would suspect other reasons (dementia, depression, etc.) for the report of a sexual assault in an elderly patient. Eighty-nine percent of providers were aware that healthcare providers in the State of Maryland are required to report suspected elder and vulnerable patient abuse and/or neglect to law enforcement or social services' agencies. When asked to define elder abuse as a medical or social problem, 25.0% of providers stated that it was a social problem. Over 95% of the providers suspected the existence of abuse, neglect and domestic violence among the elderly were not rare events. In Maryland, there are a limited number of specific educational programs dealing with abuse and neglect of the elderly. A statewide training program is needed to ensure PCP and HCP can recognize the signs and symptoms of elder abuse and neglect, and to ensure that the providers are aware of their legal requirements for reporting the abuse to the proper state or local agencies.     

Community approaches to elder abuse

Collaboration of professionals from diverse disciplines is required to address the multiple, complex issues and needs of community-dwelling elders who are abused or neglected. Reporting suspected elder abuse or neglect cases to Adult Protective Service (APS) agencies provides access to services that address the social, medical, and legal needs of elderly persons. A geriatric interdisciplinary team can provide a comprehensive medical, functional, and social assessment. Based on the findings from the assessment and in collaboration with the APS team, the intervention plan can be formulated. Some cases of elder abuse or neglect may require intervention from the criminal justice or the civil justice system for serious legal issues such as sexual assault, financial exploitation, or guardianship. Other resources, such as Area Agencies on Aging, local women's shelters, and The National Center for Elder Abuse, are available to help manage elder abuse and neglect cases in the community.     

New publications

Barbara Stucki is currently a research analyst in the Public Policy Institute at the American Association of Retired Persons. She deals with policy issues concerning long-term care needs of older persons, with special emphasis on the family support network. She has also conducted research on the lives of rural elderly in Ghana. Barbara maintains her focus on international development and aging as a member of the African Gerontological Society, the Society for International Development, and the Society for Cross-Cultural Research.     

A case-comparison analysis of elder abuse and neglect

This study examines factors which contribute to elderly abuse and neglect by caregivers in a domestic setting. Methodological and conceptual variations and problems in previous studies have led to considerable confusion as to the determinants of this important social problem. A more rigorous research design was used in this study than has been previously employed. Fifty-nine abused elders from a model project site for the study of elderly abuse were compared with forty-nine non-abused clients from a home care program in the same agency. Using a research instrument designed by the authors, data related to the following aspects of the lives of the elders and their caregivers were collected: psychological status, stressful life events, social networks, mutual dependency, and the nature of their relationships. The study indicates that members of abusive families are more likely to have emotional problems which contribute to interpersonal difficulties. Abused elders are not more dependent on caregivers for many of their daily needs. However, the abused elderly and their caregivers have become increasingly interdependent prior to the onset of abuse because of the loss of other family members, increased social isolation, and the increased financial dependency of the perpetrator on the elderly person.     

Psychological distress in victims of elder mistreatment: the effects of social support and coping

The objective of the study was to examine psychological distress in victims of elder mistreatment and to determine whether social support, coping style, mastery, and perceived self-efficacy favorably influence the psychological health of these victims. The study sample consisted of 77 subjects who reported recent chronic verbal aggression, physical aggression, or financial mistreatment, and a control group of 147 subjects who had not been mistreated. All participants were elderly persons who were over 65 years of age and living independently in the community. Social support, coping style, mastery, and perceived self-efficacy were measured by means of a standardized home interview. Psychological distress was measured by means of the General Health Questionnaire (GHQ-12). Victims of elder mistreatment had significantly higher levels of psychological distress than nonvictims. Social support showed a favorable effect on the level of psychological distress in victims, but not in nonvictims; victims who received more social support showed less psychological distress. A lower sense of mastery, a negative perception of self-efficacy, and a passive reaction pattern were associated with higher levels of psychological distress in victims as well as in nonvictims. The beneficial role of social support, locus of control, and perceived self-efficacy on the level of psychological distress could be of importance in the development of future intervention programs.     

Theoretical Development and Elder Mistreatment: Spreading Awareness and Conceptual Complexity in Examining the Management of Socio-Emotional Boundaries

This paper critically examines the spread of awareness of elder abuse and neglect (mistreatment) and asks how this has occurred without an accompanying growth in theoretical understanding. Three areas of conceptual development are identified that acknowledge the special qualities of elder mistreatment. These include a focus at the level of interpersonal relationships, a recognition that situations are negotiated between adults and that age, either intergenerationally or between age peers is a significant factor in the form mistreatment takes. Rather than allowing definitional inflation, it is argued that theoretical boundaries are needed to allow the complex nature of mistreatment to become visible. Reactions to emotional ambivalence are proposed as an important area that helps explain the phenomenon, both conceptually and practically. Understanding the role of emotional ambivalence it is argued, would lead to sustainable solutions to the mistreatment of older people.