The Importance of Investigating Abuser Characteristics in Elder Emotional/Psychological Abuse: Results from Adult Protective Services Data

Adult Maltreatment Risk Factors: Adding Community-Level Factors to an Individual-Level Field

Adult maltreatment is a pervasive problem in the United States and has serious individual and societal consequences. Adult protective services (APS) agencies are the social services programs responsible for serving older adults and adults with disabilities who may be experiencing adult maltreatment. The adult maltreatment literature differentiates elder maltreatment from the maltreatment of adults with disabilities, yet APS agencies serve both groups. Understanding the etiology of adult maltreatment as well as the associated risk and protective factors is crucial for APS workers, clinical practitioners, researchers, and policymakers. To advance the evidence in this area, we undertook a scoping review to examine recent evidence on risk and protective factors associated with adult maltreatment. Searches of nine electronic databases were conducted in 2020 to identify studies published in peer-reviewed journals since 2010. A total of 29 studies were included in the final review. The findings identified several categories of risk factors associated with the individual: demographic traits, socioeconomic characteristics, physical and mental health, interpersonal issues, and historical events. Several studies identified caregiver and alleged perpetrator risk factors. However, the current body of research lacks community and contextual risk and protective factors. Therefore, we present several potential data sources that may be leveraged to examine the links between social-contextual characteristics and adult maltreatment. These data may be combined with APS data to advance the field's understanding of risk and protective factors through advanced analytic techniques.

Relationship between emotional elder abuse and developmental function of the family

AIM

This study aimed to assess the relationship between emotional elder abuse and the developmental function of the family.

DESIGN

Community-based correlational cross-sectional study was conducted.

METHODS

Data were collected on 265 older adults from July to October 2019 in Tehran-Iran. The samples were selected by simple random sampling and they completed self-report tools: demographic information, emotional elder abuse developmental function in the family. Data analysis was performed using descriptive and inferential statistics and SPSS software v.16.

RESULTS

Mean score of the developmental function in the family was 67.38 (SD = 3.22, range = 0-129). There was a significant negative correlation between the total score of developmental function in the families and emotional elder abuse. Moreover, there was a relationship between the subscale of care and regulation, being attracted to human relationships, purposeful exchange, and creating representatives and ideas with emotional elder abuse.

Prevention of Older Adult Infantilization by Nursing Home Professionals: An Intervention Program

This study analyzes the efficacy of a brief psychoeducational program aimed at preventing older adult infantilization by nursing home professionals. We examined whether an experimental group of professionals reported less infantilization than those of a control group. Changes in stereotypes and humanization were regarded as sub-targets. The sample comprised 154 staff members. Infantilization, humanization, and negative stereotypes toward older adults were assessed before and after the intervention, and repeated measures of ANOVA and one-way ANCOVAs were conducted. Infantilization and negative stereotypes decreased in the experimental group. Significant post-intervention differences were found between the experimental and control groups both in infantilization and negative stereotypes but not in humanization. Results reflect the relevance of developing specific interventions focused on preventing infantilization as well as the need for professionals' training and education to generate a culture of change.

A qualitative evaluation of the "RISE" elder abuse intervention from the perspective of adult protective services caseworkers: addressing a service system gap

Our understanding of effective elder abuse (EA) response interventions is limited. Adult Protective Services (APS), the primary agency responsible for responding to EA, lacks a coherent, conceptually driven, prolonged intervention phase. Informed by an ecological-systems perspective and adapting evidence-based modalities from other fields, the RISE EA intervention addresses this APS systems gap. Based on a three-year pilot project involving a partnership between RISE and Maine APS, the current study conducted a qualitative evaluation of RISE, from the perspective of APS caseworkers (n = 14) who worked with RISE, to understand RISE strengths and areas for improvement. Findings suggest APS workers perceive that RISE complements the scope and nature of APS, enhances APS caseworker well-being, and reduces repeat APS cases, while further APS/RISE collaboration and clarification on RISE role responsibilities and referral eligibilities are areas of growth. This study provides preliminary evidence for RISE as a community-based EA intervention in partnership with APS.

Broken Toughness: Iranian Older Adults’ Perceptions of Abuse

Background

Older people abuse includes intentional or unintentional conduct or omission of a specific behavior by a trusted person that causes injury or distress to older people. This study described older peoples’ perceptions of abuse in Iranian society.

Methods

This qualitative study applied a conventional content analysis method to understand the perceptions of abuse among older Iranian people. Twenty older residents were selected by purposeful sampling. Data were collected through in-depth, semi-structured, and face-to-face interviews. The six-step Graneheim and Lundman content analysis method guided data analysis. MAXQDA software version 10 was used to manage the data.

Results

The data analysis led to the identification of three main themes: broken toughness, hidden abuse, and exploitation. The first theme had two sub-themes: domination and disturbed peace and tranquility.

Conclusion

Abuse resulted from a combination of causes and factors. Abuse was hidden in many cases and was not limited to physical abuse. The other examples of abuse included disrespect, deprivation of authority, disturbed tranquility, and financial exploitation of older adults.

RISE: A Conceptual Model of Integrated and Restorative Elder Abuse Intervention

Despite a growing number of elder abuse cases nationwide, response programs such as Adult Protective Services (APS) lack a defined, prolonged intervention phase to address these complex situations. This paper presents RISE, a model of elder abuse intervention that works alongside APS or other systems that interact with at-risk older adults. Informed by an ecological-systems perspective and adapting evidence-based modalities from other fields (including motivational interviewing, teaming, restorative justice, goal attainment scaling), the RISE model intervenes at levels of the individual older adult victim, individual harmer, their relationship, and community to address elder abuse risk and strengthen systems of support surrounding the victim-harmer dyad. The RISE model addresses an intervention gap in existing systems to better meet the needs of elder abuse victims and others in their lives, leading to more sustainable outcomes.

Using administrative data from adult protective services: opportunities and considerations

As federal agencies support the development of data systems for adult protective services (APS), researchers and practitioners are increasingly using administrative data to study types of adult maltreatment, including self-neglect, and the systems that respond to them. To date, however, APS has worked with little guidance about how best to use these data. This situation has contributed to inconsistent findings and uneven quality of research. Based on the authors' experience in multiple states and using examples from research and practice, this paper reviews practical considerations related to organizing and analyzing APS administrative data. We address concerns related to time-limited, erroneous, and missing data, as well as defining metrics and accounting for the multilevel structure of data with repeated observations. Reviewing these methodological details can help APS practitioners strengthen quality assurance processes and improve research in this important area.

OUP accepted manuscript

Background and Objectives

Adult Protective Services (APS) are the frontline agencies investigating elder mistreatment and providing/coordinating postinvestigation services. Yet, their effectiveness in reducing different types of mistreatment in relation to services is unknown. This study aimed to address the knowledge gap by identifying services provided by mistreatment type, and examining the associations of services with mistreatment reduction.

Research Design and Methods

A pretest–post-test design was implemented using the Identification, Services, and Outcomes (ISO) Matrix to assess mistreatment levels during case investigation and at case closure after services were provided. San Francisco and Napa APS participated in a 6-month data collection.

Results

The 4 most prevalent types of mistreatment were examined: emotional, physical, financial abuse, and neglect by others. On average, level of mistreatment decreased across mistreatment types after APS intervention. Care/case management, mental health, and other services were most common, while specific services differed depending on type of mistreatment. Care/case management services were associated with physical and emotional abuse reduction, legal services further correlated with emotional abuse reduction; financial planning services were associated with financial abuse reduction; care/case management and other services were associated with neglect reduction.

Discussion and Implications

This is the first study to address APS services by mistreatment type and the outcomes of services. Adoption of the ISO Matrix by APS programs opens the possibility of research and practice collaboration in APS outcomes research using a standardized approach.

Elder Abuse Vulnerability and Risk Factors: Is Financial Abuse Different From Other Subtypes?

Elder abuse (EA) affects one in six older adults, and financial EA, a common subtype, severely impacts victims and society. Understanding victim vulnerability and perpetrator risk factors is essential to EA prevention and management. The limited existing evidence about these factors in relation to EA types suggests that financial EA is different. In a cross-sectional quantitative analysis of secondary data (N = 1,238), we investigated EA vulnerability and risk factors, and victim-perpetrator family relationship, with respect to different EA types (financial only, financial co-occurring with other types, and nonfinancial abuse). Financial abuse-only cases had the lowest prevalence of vulnerability and risk factors. Most of these factors, and a familial relationship, were significantly more common in cases involving other EA types. Findings indicate that financial abuse, occurring in isolation, is distinct from other EA types. Risk assessment and future research should consider financial abuse separately to other EA forms.

Impact of structural ageism on greater violence against older persons: a cross-national study of 56 countries

OBJECTIVE

To determine the association between country-level structural ageism and prevalence of violence against older persons.

DESIGN

Country-level ecological study.

SETTING

Structural ageism data were drawn from the nationally representative World Values Survey 2010-2014 (WVS), global databases from the WHO, United Nations and the World Bank. Violence data were based on the Global Burden of Diseases (GBD) study 2017.

PARTICIPANTS

Analysis of 56 countries that represented 63.1% of the world's ageing population aged 60 and over across all six of WHO regions.

EXPOSURE

Structural ageism, following established structural stigma measures, consisted of two components: (1) discriminatory national policies related to older persons' economic, social, civil and political rights, based on the four core components of human rights protection in Madrid International Plan of Action on Aging and (2) prejudicial social norms against older persons, measured by negative attitudes toward older persons in 56 national polls in WVS aggregated to country-level. These components were z scored and combined such that higher score indicated greater structural ageism.

MAIN OUTCOMES AND MEASURES

Prevalence rates of violence per 100 000 persons aged 70 and over in each country was based on extensive epidemiological surveillance data, survey, clinical data and insurance claims in GBD and compiled by the Institute of Health Metrics and Evaluation, University of Washington.

RESULTS

There was a wide variation in levels of structural ageism across countries. As predicted, structural ageism was significantly associated with the prevalence rates of violence in multivariate models (β=205.7, SE=96.3, p=0.03), after adjusting for relevant covariates. Sensitivity analyses supported the robustness of our findings. That is, structural ageism did not predict other types of violence and other types of prejudice did not predict violence against older persons.

CONCLUSIONS

This study provides the first evidence of the association between higher structural ageism and greater violence against older persons across countries.

The Role of Social Support in Elder Financial Exploitation Using a Community Sample

BACKGROUND AND OBJECTIVE

Social support is known to be an important protective factor against elder financial exploitation (FE), yet few empirical studies have examined the relationship between FE and distinct components of social support. Perceived social support, social network size, and interactions with close network members (positive and negative) were measured separately and tested as potential predictors of FE.

RESEARCH DESIGN AND METHODS

Three hundred and ninety-five community-dwelling adults aged 60 and older were recruited to complete a 90-minute survey and interview. We used OLS regression to examine the role of social support in FE. Other risk factors associated with FE including dependency, poor physical health, depression, cognition, and demographic characteristics were included as potential predictors.

RESULTS

Negative interactions with close network members predicted FE, and remained predictive when all other variables and social support factors were included in the model. Other social support factors were not unique predictors of FE.

DISCUSSION AND IMPLICATIONS

Negative social interactions with close network members are important to assess and consider in FE prevention and intervention programs; relationships between social interactions and other risk factors warrant further attention.