Elder Abuse Characteristics Based on Calls to the National Center on Elder Abuse Resource Line

Older Adults' Unmet Needs at the End of Life: A Cross-Country Comparison of the United States and England

Objectives: This study aimed to compare the end-of-life (EOL) experiences in concentration with place of death, for older adults in the U.S. and England. Methods: Weighted comparative analysis was conducted using harmonized Health and Retirement Study and English Longitudinal Study of Ageing datasets covering the period of 2006-2012. Results: At the EOL, more older adults in the U.S. (64.14%) than in England (54.09%) had unmet needs (I/ADLs). Home was the main place of death in the U.S. (47.34%), while it was the hospital in England (58.01%). Gender, marital status, income, place of death, previous hospitalization, memory-related diseases, self-rated health, and chronic diseases were linked to unmet needs in both countries. Discussion: These findings challenge the existing assumptions about EOL experiences and place of death outcomes, emphasizing the significance of developing integrated care models to bolster support for essential daily activities of older adults at the EOL.

Cognition and Wealth Changes in Mid-to-later Life: A Latent Class Trajectories Approach Using the Health and Retirement Study

ObjectivesTo assess how cognitive trajectories from mid-to-later life relate to wealth change, overall and by mid-life income. Methods: Data were from participants (51-64 years) in the 2000-2018 U.S. Health and Retirement Study who were cognitively healthy at baseline (year 2000; unweighted n = 3821). Longitudinal latent class analyses generated cognitive and wealth trajectories, independently, and multinomial logistic regressions estimated the association between cognitive trajectories and wealth profiles, overall and by median income. Results: We identified three cognitive: cognitively healthy (CH), increasing cognitive impairment (ICI), and increasing dementia (ID) and four wealth profiles: stable wealth loss (SWL), delayed gradual wealth loss (DGWL), stable wealth gain (SWG), and gradual wealth gain (GWG). The ID group had higher probability of being in the SWL group and lower probability of SWG, which was more pronounced in respondents with greater median income. Discussion: Individuals with ID may be vulnerable to wealth loss, particularly for middle-class households.

Real World Financial Mismanagement in Alzheimer's Disease, Frontotemporal Dementia, and Primary Progressive Aphasia

Background

Whereas clinical experience in dementia indicates high risk for financial mismanagement, there has been little formal study of real world financial errors in dementia.

Objective

We aimed to compare caregiver-reported financial mistakes among people with Alzheimer's disease, behavioral variant frontotemporal dementia (bvFTD), and primary progressive aphasia (PPA).

Methods

Caregivers reported whether participants with dementia had made financial mistakes within the last year; and if so, categorized these as resulting from: (a) being too trusting or gullible, (b) being wasteful or careless with money, or (c) trouble with memory. In a pre-registered analysis https://archive.org/details/osf-registrations-vupj7-v1), we examined the hypotheses that (1) financial mistakes due to impaired socioemotional function and diminished sensitivity to negative outcomes are more prevalent in bvFTD than in Alzheimer's disease, and (2) financial mistakes due to memory are more prevalent in Alzheimer's disease than in bvFTD. Exploratory analyses addressed vulnerability in PPA and brain-behavior relationships using voxel-based morphometry.

Results

Concordant with our first hypothesis, bvFTD was more strongly associated than Alzheimer's disease with mistakes due to being too trusting/gullible or wasteful/careless; contrary to our second hypothesis, both groups were similarly likely to make mistakes due to memory. No differences were found between Alzheimer's disease and PPA. Exploratory analyses indicated associations between financial errors and atrophy in right prefrontal and insular cortex.

Conclusions

Our findings cohere with documented socioemotional and valuation impairments in bvFTD, and with research indicating comparable memory impairment between bvFTD and Alzheimer's disease.

Elder Abuse and Dementia: A Comparison of Older People with and without Dementia across the Prevalence of Abuse

This paper examines the prevalence of different types of elder mistreatment, care needs, and risk factors amongst older adults living with and without dementia in any setting (community or institution). Three years (2014-2017) of anonymized reported incidents of elder mistreatment to a national UK helpline were examined in an exploratory study, using a matched sample design (N = 598) comparing adults with dementia (n = 299) to those without (n = 299) on mistreatment type, care needs, and risk factors for abuse. Financial exploitation was more common among older adults with dementia who required more daily care than those without. Risk factors for elder mistreatment among older adults without dementia were often chronic in nature (such as poor physical health) whereas risk factors for people with dementia were associated with a dementia diagnosis. Raising implications for health and social care, results show that older adults diagnosed with dementia had increased care needs and vulnerability to abuse.

The Association between Ageist Attitudes, Subjective Age, and Financial Exploitation Vulnerability Among Older Adults

Ageism, or age-based negative stereotypes, prejudice, and/or discriminatory behaviors toward older adults, has been linked with various detrimental physical and psychological consequences. The current study examined the relevance of ageist attitudes to financial exploitation vulnerability (FEV) among older adults and investigated whether feeling older than one’s chronological age (i.e., older subjective age) moderated the ageist attitudes-FEV association. 230 participants ( M age = 72.08, SD = 5.74) filled out scales assessing ageist attitudes, subjective age, and provided relevant sociodemographic information. High levels of ageist attitudes and an older subjective age were associated with increased FEV. Moreover, the ageist attitudes-FEV association was significantly stronger among participants reporting an older subjective age. The results highlight the importance of taking into account ageism and subjective age in order to gain a deeper understanding of the underlying mechanisms which render older adults vulnerable to financial exploitation. Practical and empirical implications are discussed.

Elder abuse in the COVID-19 era based on calls to the National Center on Elder Abuse resource line

BACKGROUND

The COVID-19 pandemic has exacerbated circumstances that place older adults at higher risk for abuse, neglect, and exploitation. Identifying characteristics of elder abuse during COVID-19 is critically important. This study characterized and compared elder abuse patterns across two time periods, a one-year period during the pandemic, and a corresponding one-year period prior to the start of the pandemic.

METHODS

Contacts (including social media contacts, and email; all referred to as "calls" for expediency) made to the National Center on Elder Abuse (NCEA) resource line were examined for differences in types of reported elder abuse and characteristics of alleged perpetrators prior to the pandemic (Time 1; March 16, 2018 to March 15, 2019) and during the pandemic (Time 2; March 16, 2020 to March 15, 2021). Calls were examined for whether or not abuse was reported, the types of reported elder abuse, including financial, physical, sexual, emotional, and neglect, and characteristics of callers, victims, and alleged perpetrators. Chi-square tests of independence compared frequencies of elder abuse characteristics between time periods.

RESULTS

In Time 1, 1401 calls were received, of which 795 calls (56.7%) described abuse. In Time 2, 1009 calls were received, of which 550 calls (54.5%) described abuse. The difference between time periods in frequency of abuse to non-abuse calls was not significant ([Formula: see text]). Time periods also did not significantly differ with regard to caller, victim, and perpetrator characteristics. Greater rates of physical abuse ([Formula: see text] and emotional abuse ([Formula: see text] were reported during Time 2 after adjustment for multiple comparisons. An increased frequency of multiple forms of abuse was also found in Time 2 compared to Time 1 ([Formula: see text].

CONCLUSIONS

Findings suggest differences in specific elder abuse subtypes and frequency of co-occurrence between subtypes between time periods, pointing to a potential increase in the severity of elder abuse during COVID-19.

The association between subjective age and financial exploitation vulnerability among older adults: The moderating role of social support

Financial exploitation of older adults bears detrimental physical and psychological consequences. However, risk factors of financial exploitation vulnerability (FEV) remain elusive. In line with a growing awareness of the importance of subjective perceptions of the aging process for older adults' functioning and well-being, this study examined the connection between subjective age (feeling younger/older than one's chronological age) and FEV, and the moderating effect of social support on this connection. Data were collected from a convenience sample of 137 Israeli older adults (age range 60-89, M = 69.90, SD = 6.85), who completed scales of FEV, subjective age, and social support, as well as relevant socio-demographic information. Older subjective age was associated with increased FEV when social support was low, but not when social support was high. Results are discussed in line with Socio-Emotional Selectivity Theory and provide initial information pertaining to the relevance of subjective age perceptions to FEV in older adults.

Characterizing Elder Abuse in the UK: A Description of Cases Reported to a National Helpline

The abuse of older adults by someone in a position of trust-also known as elder abuse (EA)-has a severe impact on victims and society. However, knowledge about EA in the UK is limited in comparison to other types of interpersonal violence and international knowledge. The present study utilized secondary data from a UK national EA helpline to investigate the characteristics of reported cases. Over a one-year period between 2017 and 2018, 1,623 records met inclusion criteria. Descriptive statistics are provided to describe this sample. Most cases reported to the helpline pertained to female victims, suffering from financial or psychological abuse. Co-occurrence of different abuse types was common. Findings provide updated knowledge about the phenomenology of EA cases in the UK. Recommendations are provided for advancing research in this area, including the need for examining cases across longer periods of time with a view to informing practice and policy.

Increased Financial Altruism is Associated with Alzheimer's Disease Neurocognitive Profile in Older Adults

BACKGROUND

Older age is associated with an increase in altruistic behaviors such as charitable giving. However, few studies have investigated the cognitive correlates of financial altruism in older adults.

OBJECTIVE

This study investigated the cognitive correlates of financial altruism measured using an altruistic choice paradigm in a community-based sample of older adults.

METHODS

In the present study, a sample of older adults (N = 67; M age = 69.21, SD = 11.23; M education years = 15.97, SD = 2.51; 58.2% female; 71.6% Non-Hispanic White) completed a comprehensive neuropsychological assessment and an altruistic choice paradigm in which they made decisions about allocating money between themselves and an anonymous person.

RESULTS

In multiple linear regression analyses that controlled for age, education, and sex, financial altruism was negatively associated with performance on cognitive measures typically sensitive to early Alzheimer's disease (including word list learning and recall, delayed story recall, and animal fluency).

CONCLUSION

Findings of this study point to a negative relationship between financial altruism and cognitive functioning in older adults on measures known to be sensitive to Alzheimer's disease. Findings also point to a potential link between financial exploitation risk and Alzheimer's disease in older age.

Anxiety and Depressive Symptoms are Associated with Perceived Financial Exploitation in Israeli Older Adults

OBJECTIVES

There are no studies that have investigated mental health correlates of financial exploitation (FE) in Israel. Israel has diverse cultural traditions that emphasize strong family ties and social embeddedness, factors which may impact FE correlates. This study aimed to examine mental health correlates of perceived FE in Israel.

METHODS

Israeli older adults (N = 137; mean age = 67.86, SD = 6.86, 51.5% female) were surveyed for history of FE, demographic measures, and depressive (CES-D) and anxiety symptoms (GAD-7).

RESULTS

Twenty-one participants self-reported a FE history (perceived FE group), and 115 denied a history (non-FE group). After controlling for age, sex, and education, the perceived FE group reported significantly more anxiety (F(1, 108) = 7.16, p = .009) and depressive symptoms (F(1, 103) = 13.90, p < .001) than the non-FE group. A greater frequency of perceived FE participants surpassed clinical cutoffs of anxiety and depression.

CONCLUSIONS

Perceived FE was associated with anxiety and depressive symptoms, and in some cases at clinically significant levels. Future studies aimed at understanding mechanisms of these relationships are needed.

CLINICAL IMPLICATIONS

Findings support the need for clinical evaluations for those who have experienced FE in order to provide mental health services when appropriate.

Abuse and Discrimination Experienced by Older Women in the Era of COVID-19: A Two-Wave Representative Community Survey in Hong Kong

Although there is a growing volume of research on violence against women, violence against older women has received little attention to date. Little is known about the experience of elder abuse, discrimination, loneliness, and health among older women, in particular in the era of COVID-19 when our lives have been changed drastically. Using two waves of survey data (N = 1,498), this study compared the estimates of elder abuse and age discrimination before and during the COVID-19 pandemic, examined their associations with physical and mental health, and explored the mediating effects of loneliness on the associations in two independent samples of older women in Hong Kong. Reductions in some forms of abuse and discrimination against older women during the pandemic were observed. Findings from regression analyses show that elder abuse and age discrimination were associated with poorer health, and these associations were mediated by loneliness.

Elder Abuse: A Global Challenge and Canada's Response

Elder abuse is a global call to action. Nurses have a primary role to play in its detection and prevention. Globally, demographic change is creating an increasing number of older adults. Consequently, this increased number of people will be affected by age discrimination and ageism, both of which contribute to elder abuse. Despite the existence of the Universal Declaration of Human Rights, older adults are not recognized explicitly under the international human rights laws that legally oblige governments to address the rights of all people. Drawing initially on global conversations specific to elder abuse and the role of nurses, the current article explores the challenges of recognizing and combating elder abuse. To provide specific gerontological nursing strategies, recognition is given to actions implemented in Canada to address this major health challenge. The desired outcome is an advocacy framework for gerontological nurses to use in working toward the recognition and prevention of elder abuse. [Journal of Gerontological Nursing, 48(4), 21-25.].

The Connection Between Deception Detection and Financial Exploitation of Older (vs. Young) Adults

Although poor deception detection accuracy is thought to be an important risk factor for fraud among older adults, this link has not been explicitly studied. Using a cross-sectional design, older and young adults viewed and made judgments of real, high-stakes truths and lies with financial consequences. Older (vs. young) adults exhibited a greater truth bias when evaluating individuals pleading for help in finding a missing relative, which was associated with greater donations to deceptive pleaders. However, all participants were highly vulnerable to fraud. Future research should consider both risk and protective factors affecting financial fraud across the lifespan.

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.

Diagnostic Coding of Elder Mistreatment: Results From a National Database of Medicare Advantage and Private Insurance Patients, 2011-2017

Health care providers may play an important role in detection of elder mistreatment, which is common but underrecognized. We used the Health Care Cost Institute insurance claims database to describe elder mistreatment diagnosis among Medicare Advantage (MA) and private insurance patients in the United States from 2011 to 2017. We used International Classification of Diseases (ICD) coding to identify cases, examining the impact of transition from ICD-9 (Ninth Revision) to ICD-10 (Tenth Revision), which occurred in October 2015 and added 14 new codes for "suspected" mistreatment. 8,127 patients (0.051% of all aged ≥ 65), including 6,304 with MA (0.058%) and 1,823 with private insurance (0.026%) received elder mistreatment diagnosis. Transition from ICD-9 to ICD-10 was associated with a small increase in diagnosis rate, with "suspected" codes used in 45.3% of ICD-10 versus 9.7% of ICD-9 cases. Overall rates remained low. Rates, settings, and types of diagnosis differed between MA and private insurance patients.

Unrepresented Adults Face Adverse Healthcare Consequences: The Role of Guardians, Public Guardianship Reform, and Alternative Policy Solutions

Persons without family or friends to serve as healthcare agents may become "unrepresented" in healthcare, with no one to serve as healthcare agents when decisional support is needed. Surveys of clinicians (N = 81) and attorneys/guardians (N = 23) in Massachusetts reveal that unrepresented adults experience prolonged hospital stays (66%), delays in receiving palliative care (52%), delays in treatment (49%), and other negative consequences. Clinicians say guardianship is most helpful in resolving issues related to care transitions, medical treatment, quality of life, housing, finances, and safety. However, experiences with guardianship are varied, with delays often/always in court appointments (43%) and actions after appointments (24%). Policy solutions include legal reform, education, and alternate models.

From Need to Policy: Community Supported Development and Implementation of the South Carolina Vulnerable Adult Guardian Ad Litem (SC VAGAL) Program

Adult guardian ad litem programs are a necessary public service to protect adults from abuse and neglect. This article describes the development and implementation of an adult guardian ad litem program. We discuss the program's impetus, pilot testing, evaluation, and implementation of the program. Our experience highlights the vital role of diverse inter-sectoral stakeholders. Furthermore, the development process highlights the need for flexibility in program development, tension negotiation among stakeholders, and engagement of aging stakeholders in nontraditional arenas.

Elder Mediation Services Among Diverse Older Adult Communities in Australia: Practitioner Perspectives on Accessibility

BACKGROUND AND OBJECTIVES

Elder abuse is a complex problem, and barriers to reporting and help-seeking include shame and fear of loss of relationships with key family members. Elder-mediation has been identified as one promising method of alternative dispute resolution. This study aimed to investigate the accessibility of elder-mediation services among diverse groups of older adults, from the perspective of practitioners in a large Australian jurisdiction.

RESEARCH DESIGN AND METHODS

The study employed a sequential mixed-methods approach, comprising a thematic analysis of semi-structured interviews (N=17) and an online survey of practitioners (N=49) involved in referral to, or provision of, elder-mediation services. Accessibility was conceptualized using existing theoretical frameworks, spanning practical (logistics-related) and normative (justice and culture-related) dimensions.

RESULTS

Factors limiting accessibility of elder-mediation services included lack of community and practitioner awareness of elder abuse and elder-mediation, discomfort with the mediation process, financial costs, lack of services in regional and remote areas and complex service systems for older people. Within the mediation process, difficulties in assessing and accommodating cognitive and other impairments, managing power imbalances and determining the appropriateness of the dispute for mediation were influential.

DISCUSSION AND IMPLICATIONS

This study showed that mediation can be a promising and effective approach to resolving disputes involving older people. The emergent perceptive dimension (community and practitioner awareness) emphasizes the importance of awareness raising efforts surrounding both elder abuse and the potential of mediation as a viable pathway, the training of elder-mediators as well as resourcing elder-mediation services, especially in rural and remote locations.

Prevalence and associated factors of elder psychological abuse- a cross- sectional screening study, based on a hospitalized community from Poland

OBJECTIVE

The aim of the present work was to exploring the prevalence, perpetrators and predictors of elder psychological abuse.

METHOD

We conducted the cross- sectional study, based on a hospitalized community. The sample consisted of 200 respondents aged ≥60. The Chi-square test and logistic regression models were used.

RESULTS

A total of 29 % respondents experienced at least one type of psychological abuse in the last 12 months. The percentage of women who statistically more often than men experienced arrogance, isolating, insulting and mocking was 71-77 %. It has been shown that the lower the monthly income, the higher the risk of psychological violence. Statistically, the highest percentage of violence in the form of arrogance, vulgarity and blackmail, threats was recorded in people aged 60-65 (48.9 % and 56.3 %, respectively). On the other hand, logistic regression analysis showed that the oldest respondents aged >70 more than three times more often than people from the youngest age category are victims of violence. The rate of arrogance, vulgarity (odd ratio (OR) 2.90;p < 0.01) and mocking (OR 3.56; p < 0.01) is statistically significantly higher, respectively, in people living in towns than in villages. People with chronic diseases are statistically more likely to experience violence in the form of isolation (OR 4.74; p = 0.04). Cohabitants, spouses or sons are the most frequent perpetrators of elder abuse and neglect.

CONCLUSION

This study reveals that statistically more often, psychological abuse is experienced by women, older adults living in urban areas and people with a low socioeconomic status and chronic disease.

Elder abuse and associated factors in eastern romania

BACKGROUND

This article explores elder abuse in a hospitalised population. We wanted to identify details related to psychological and emotional abuse in the older population in our region and to determine the importance of the Elderly Abuse Suspicion Index (EASI^© ) in comprehensive geriatric assessments.

METHODS

This cross-sectional study conducted between March 2015 and May 2016 included 386 consecutive hospitalised patients over 65 years of age. All patients underwent a geriatric assessment, data were collected about their medical history, and the EASI^© was administered to each. The main outcome was identifying the presence, the type of abuse and the factors associated with abuse.

RESULTS

There were 21.5% of patients who suffered any form of abuse. Women were more frequently abused than men. Emotional abuse was the most common (60.2%) followed by neglect (53%) and physical abuse (22.91%); sexual abuse was absent in our study group. The abused patients had an impaired cognitive function (P = 0.034). They were also malnourished (P ≤ 0.001) and depressed (P = 0.001). The presence of peripheral artery disease, stroke, pneumonia, chronic kidney disease, musculoskeletal diseases and anxiety correlated with the presence of abuse. No statistically significant correlation was found between the degree of independence in instrumental activities of daily living and the presence of abuse (r = 0.105, P = 0.051).

CONCLUSIONS

EASI is a tool for detecting elder abuse and should be included in the standard geriatric assessment to prevent ageism. The number of abused elderly patients is significant, and the multiple factors associated with abuse are diverse.