David V. Flores

Medical Implications of Elder Abuse: Self-Neglect

Self-neglect, the most common form of elder mistreatment seen by Adult Protective Service Agencies across the United States, is an often unrecognized geriatric syndrome characterized by squalor and unsafe living circumstances. It is a result of medical, neurologic, or psychiatric disorders coupled with lack of capacity for self-care and self-protection in the absence of necessary services or medical care, and leads to increased morbidity and mortality. Clinicians should evaluate self-neglecters and plan interventions based on comprehensive geriatric assessment and capacity assessment. State and federal policies are needed to address the pressing needs of this vulnerable population of seniors.

From "Kickeando las malias" (Kicking the Withdrawals) to "Staying clean": The Impact of Cultural Values on Cessation of Injection Drug Use in Aging Mexican-American Men

Drug use among older adults is a growing concern, particularly for the burgeoning Hispanic population. Older adults seeking drug treatment will double over the next decade to almost 6 million. Cultural factors influence drug use, and more specifically, Hispanic cultural values influence heroin use. This study explored Mexican-American injection drug users’ adherence to traditional Hispanic cultural values and their impact on cessation. Ethnographic interviews endorsed contextualized influences of values on heroin use. Cultural values functioned dichotomously, influencing both initiation and cessation. Understanding the impact of cultural values on substance abuse is critical given the changing demographics in American society.

“El Lado Oscuro”: “The Dark Side” of Social Capital in Mexican American Heroin Using Men

This article describes social capital in a cohort of 227 Mexican American men who are long-term injection heroin users. Social capital scores for current and former users were similar, suggesting equal absolute values of capital, but associated with illicit activities in current users and with cessation efforts in former users. Stable drug-using relationships provided high negative capital, whereas conventional relationships provided positive capital. Thus, social capital functions dichotomously in positive and negative contextualized roles. This study provides an alternative understanding of the dynamic interactions between individuals, environment, and drug abuse and can inform prevention and treatment interventions for an important demographic group.

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.

Community-Based Risk Assessment of Elder Mistreatment and Self-Neglect: Evidence of Construct Validity and Measurement Invariance Across Gender and Ethnicity

Mistreatment and self-neglect among older adults are linked to significantly high mortality rates, but research in this area is hindered by a lack of standardized assessments to identify these circumstances. No available assessment has been tested for construct validity (CV) or measurement invariance (MI) across gender or race/ethnicities. This study presents the CV and MI properties of a comprehensive assessment of elder mistreatment (EM) and self-neglect (SN). The 57-item Texas Adult Protective Services Client Assessment and Risk Evaluation (CARE) tool was completed on 7,580 substantiated cases of EM and SN. Confirmatory factor analysis (CFA) and cross-validation techniques were used to assess CV, and MI techniques were used to assess item and domain bias across genders and race/ethnicities. Model fit was estimated using robust estimators. A 43-item CARE tool with 5 domains reached good fit and cross-validated (X2 DIFF TEST, p = 0.69). Overall, the construct reliability ranged from 0.78 (physical/medical) to 0.93 (living conditions).The same model was measurement invariant across gender (X2 DIFFTEST, p = 0.02). The financial status domain could not be used for the Hispanic population, but a 4-factor CARE tool model was measurement invariant across African Americans, Caucasians, and Hispanics (X2 DIFFTEST, p = 0.05). The constructs of the CARE tool appear to be valid and reliable assessments of EM and SN. Overall, the use of this assessment to identify EM and SN does not result in health or social service disparities among older adults. Further research on this topic is needed.