David Burnes

Elder Abuse: Global Situation, Risk Factors, and Prevention Strategies

PURPOSE Elder mistreatment is now recognized internationally as a pervasive and growing problem, urgently requiring the attention of health care systems, social welfare agencies, policymakers, and the general public. In this article, we provide an overview of global issues in the field of elder abuse, with a focus on prevention. DESIGN AND METHODS This article provides a scoping review of key issues in the field from an international perspective. RESULTS By drawing primarily on population-based studies, this scoping review provided a more valid and reliable synthesis of current knowledge about prevalence and risk factors than has been available. Despite the lack of scientifically rigorous intervention research on elder abuse, the review also identified 5 promising strategies for prevention. IMPLICATIONS The findings highlight a growing consensus across studies regarding the extent and causes of elder mistreatment, as well as the urgent need for efforts to make elder mistreatment prevention programs more effective and evidence based.

Prevalence of and Risk Factors for Elder Abuse and Neglect in the Community: A Population-Based Study.

To estimate past‐year prevalence and identify risk and protective factors of elder emotional abuse, physical abuse, and neglect.

A Systematic Evaluation of a Multidisciplinary Social Work–Lawyer Elder Mistreatment Intervention Model

This study introduces a conceptually based, systematic evaluation process employing multivariate techniques to evaluate a multidisciplinary social work–lawyer intervention model (JASA-LEAP). Logistic regression analyses were used with a random sample of case records (n = 250) from three intervention sites. Client retention, program fidelity, and exposure to multidisciplinary services were significantly related to reduction in mistreatment risk at case closure. Female gender, married status, and living with perpetrator significantly predicted unfavorable outcomes. This study extends the elder mistreatment program evaluation literature beyond descriptive/bivariate evaluation strategies. Findings suggest that a multidisciplinary social work–lawyer elder mistreatment intervention model is a successful approach.

Elder Abuse Severity: A Critical but Understudied Dimension of Victimization for Clinicians and Researchers

Purpose of the Study To describe the variation in severity of elder emotional abuse, physical abuse, and neglect and identify factors associated with more severe forms of elder mistreatment (EM). Design and Methods Population-based study using random digit-dial sampling and telephone interviews with a representative sample (n = 4,156) of community-dwelling, cognitively intact older adults in New York State. The Conflict Tactics Scale and DUKE Older Americans Resources and Services scales were adapted to assess EM subtypes. For each EM subtype, severity was operationalized by summing the number of different mistreatment behaviors and the frequency of each behavior. Among older adults reporting some degree of mistreatment, ordinal or multinomial regression predicted severity of elder emotional abuse, physical abuse, and neglect. Results Distribution of EM severity was characterized by a negative/right skew. More severe emotional abuse was predicted by younger age, living with the perpetrator only, Hispanic background, and higher education. Increasing physical abuse severity was associated with younger age and living only with the perpetrator. Higher neglect severity was associated with functional impairment, younger age, living only with the perpetrator, lower income, and lower education. The presence of nonperpetrator others living in the home served a protective function against escalating mistreatment severity. Implications Extends existing EM risk factor research by operationalizing mistreatment phenomena along a continuum of severity. Findings enhance capacity to screen and report particularly vulnerable EM victims and inform targeted interventions to ameliorate the problem. Incorporation of severity into EM research/measurement reflects the clinical and phenomenological reality of the problem.

Developing a Research Agenda on Resident-to-Resident Aggression: Recommendations From a Consensus Conference

This article provides an overview of the development of a research agenda on resident-to-resident aggression (RRA) in long-term care facilities by an expert panel of researchers and practitioners. A 1-day consensus-building workshop using a modified Delphi approach was held to gain consensus on nomenclature and an operational definition for RRA, to identify RRA research priorities, and to develop a roadmap for future research on these priorities. Among the six identified terms in the literature, RRA was selected. The top five priorities were: (a) developing/assessing RRA environmental interventions; (b) identification of the environmental factors triggering RRA; (c) incidence/prevalence of RRA; (d) developing/assessing staff RRA education interventions; and (e) identification of RRA perpetrator and victim characteristics. Given the significant harm RRA poses for long-term care residents, this meeting is an important milestone, as it is the first organized effort to mobilize knowledge on this under-studied topic at the research, clinical, and policy levels.

Elder Abuse and Neglect Risk Alleviation in Protective Services

Little is known about conditions associated with favorable elder mistreatment (EM) case outcomes. The fundamental goal of EM protective service programs is to alleviate risk associated with substantiated cases of elder abuse and neglect. Using the EM socio-cultural model, this study examined victim, perpetrator, victim–perpetrator relationship, social embeddedness, and socio-cultural factors predicting risk alleviation of EM cases. Data from a random sample of EM protective social service cases (n = 250) at a large community agency in New York City were collected and coded by multiple, independent raters. Multinomial and binary logistic regression were used to examine undifferentiated risk alleviation for the entire sample of EM cases as well as differentiated financial, emotional, and physical abuse sub-types. Undifferentiated EM risk alleviation was associated with male victim gender, older victim age, previous community help-seeking, and victim–perpetrator dyads characterized by a separate living arrangement and shorter term abuse longevity. Financial abuse cases with younger perpetrators were less likely to have risk reduction. Physical abuse risk reduction was less likely when the perpetrator was male and the victim–perpetrator dyad included different genders. Distinct findings across EM sub-types suggest a need to develop targeted practice strategies with clients experiencing different forms of EM. Findings highlight a need to develop EM protective service infrastructure around perpetrator rehabilitation.

Understanding Service Utilization in Cases of Elder Abuse to Inform Best Practices

Elder abuse (EA) case resolution is contingent upon victims accepting and pursuing protective service interventions. Refusal/underutilization of services is a major problem. This study explored factors associated with extent of EA victim service utilization (SU). Data were collected from a random sample of EA cases (n = 250) at a protective service program in New York City. In cases involving financial abuse, higher SU was associated with females, poor health, perceived danger, previous help-seeking, and self or family referral. In physical abuse cases, higher SU was associated with family referral and previous help-seeking; lower SU was related to Hispanic race/ethnicity, being married, and child/grandchild perpetrator. In emotional abuse cases, higher SU was associated with self or family referral, victim–perpetrator gender differential, perceived danger, and previous help-seeking; lower SU was related to child/grandchild perpetrator. Findings carry implications for best practices to retain and promote service use among elder victims of abuse.

The Case for Individualized Goal Attainment Scaling Measurement in Elder Abuse Interventions

Research available to inform the development of effective community-based elder abuse protective response interventions is severely limited. Elder abuse intervention research is constrained by a lack of research capacity, including sensitive and responsive outcome measures that can assess change in case status over the course of intervention. Given the heterogeneous nature of elder abuse, standard scales can lack the flexibility necessary to capture the diverse range of individually relevant issues across cases. In this paper, we seek to address this gap by proposing the adaptation and use of an innovative measurement strategy—goal attainment scaling—in the context of elder protection. Goal attainment scaling is an individualized, client-centered outcome measurement approach that has the potential to address existing measurement challenges constraining progress in elder abuse intervention research.

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

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

Varying appraisals of elder mistreatment among victims: findings from a population-based study

OBJECTIVES Prior elder mistreatment (EM) research has not examined subjective assessments of problem seriousness from the perspective of victims. This study sought to describe the variation in appraisals of perceived EM seriousness among victims of emotional abuse, physical abuse, and neglect and to examine factors that influence varying appraisals using neutralization theory. METHODS Data came from a subsample of EM victims (n = 191) drawn from a representative, population-based study (n = 4,156) of community-dwelling, cognitively intact older adults in New York State. The Conflict Tactics Scale and Duke Older Americans Resources and Services scales were adapted to assess EM. Subjective appraisal of abuse/neglect was measured according to ordinal levels of victim-perceived seriousness and predicted using ordinal regression. RESULTS Emotional abuse was appraised less seriously among victims who were both functionally impaired and dependent upon the perpetrator, lived with the perpetrator, and of increasing age. Emotional abuse was perceived with greater seriousness among victims enduring more frequent/varied abuse and when the perpetrator was distally-related. Neglect was appraised with lower seriousness among female victims and greater seriousness if perpetrated by a paid homecare attendant or in scenarios involving more frequent/varied unmet needs. DISCUSSION Findings carry implications for understanding victim help-seeking behavior and informing EM measurement.