Marguerite DeLiema

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.

Multicultural voices: attitudes of older adults in the United States about elder mistreatment

ABSTRACT Despite international growth in policies to increase the identification and response to elder abuse and neglect, there remain considerable barriers to treating the problem. Some of these barriers may be attributed to how older adults from different racial/ethnic backgrounds define, experience and seek to remedy elder mistreatment. Using focus group discussions based on case vignettes, this paper examines how older adults from different racial and ethnic backgrounds in the United States of America perceive elder mistreatment. Five focus groups were conducted with African Americans, English-speaking Latinos, Spanish-speaking Latinos, non-Latino Whites and African American care-givers for older adults. While similar definitions and meanings of elder abuse were expressed across the different racial/ethnic groups, Latino participants introduced additional themes of machismo, respect, love and early intervention to stop abuse, suggesting that perceptions/beliefs about elder mistreatment are determined by culture and degree of acculturation in addition to race/ethnicity. Most differences in attitudes occurred within groups, demonstrating that perceptions vary by individual as well as by culture. In identifying scenarios that constitute elder mistreatment, some participants felt that certain cases of abuse are actually the persistence of intimate partner violence into old age. Participants also indicated that victims may prefer to tolerate mistreatment in exchange for other perceived benefits (e.g. companionship, security); and out of fear that they could be placed in an institution if mistreatment is reported. Findings suggest the need for person-centred intervention and prevention models that integrate the cultural background, care needs and individual preferences of older adults.

The Forensic Lens: Bringing Elder Neglect Into Focus in the Emergency Department

We present 2 case studies of older patients who were brought to the emergency department (ED) in severely debilitated states. Both presented with severe malnutrition, contractures, and decubitus ulcers, and were nonverbal, with histories of dementia and end-stage disease. Their primary caregivers, adult children, were uncooperative with Adult Protective Services and disregarded treatment recommendations. Although both elders had signs suspicious for neglect, a comprehensive review revealed many layers of complexity. We use these cases to illustrate an approach to the assessment of possible elder neglect in ED settings and how to intervene to ensure patient safety. We begin with a discussion of the differences between willful, unintentional, and unsubstantiated neglect by a caregiver and then describe when to suspect neglect by evaluating the elder, interviewing the caregiver and first responders, assessing the caregivers ability to meet the elders needs, and, if possible, obtaining medical history and information about the home care environment. These cases illustrate the importance of careful documentation in cases of suspected neglect to assist investigative agencies, reduce the risk of further harm, and improve patient outcomes.

Beware of Data Gaps in Home Care Research: The Streetlight Effect and Its Implications for Policy Making on Long-Term Services and Supports

Policy initiatives increasingly seek greater use of home- and community-based services for older persons and those with chronic care needs, yet large gaps persist in our knowledge of home care, an indispensable component of long-term services and supports. Unrecognized data gaps, including the scope of home care provided by private hire and nonmedical providers, can distort knowledge and poorly inform long-term services and supports policy. The purpose of this article is to examine these gaps by describing the universe of formal home care services and provider types in relationship to major national sources. Findings reveal four distinct home care sectors and that the majority of formal home care is provided in the sectors that are understudied. We discuss the policy implications of data gaps and conclude with recommendations on where to expand and refine home care research.

Financial exploitation of older adults

Surveys have repeatedly found that financial exploitation is the most common type of elder mistreatment [1, 58], and the loss of financial resources can be devastating for older adults. Despite this, there has been very little theory development in elder financial exploitation. Part of the problem is that it encompasses a wide range of crimes—theft, scams, abuse of powers of attorney, unauthorized joint tenancies, etc.—each involving perpetrators with varying relationships to their victims. In this chapter, we review several currents of thought on financial exploitation, describe and test a plausible theoretical model based on current understandings, and discuss practical actions that may prevent exploitation and help investigate it when it has been reported or is suspected. We close by suggesting directions for future research to test pressing theoretical propositions and intervention approaches.

Development of short-form measures to assess four types of elder mistreatment: Findings from an evidence-based study of APS elder abuse substantiation decisions

ABSTRACT Improving the standardization and efficiency of adult protective services (APS) investigations is a top priority in APS practice. Using data from the Elder Abuse Decision Support System (EADSS), we developed short-form measures of four types of elder abuse: financial, emotional/psychological, physical, and neglect. The EADSS data set contains 948 elder abuse cases (age 60+) with yes/no abuse substantiation decisions for each abuse type following a 30-day investigation. Item sensitivity/specificity analyses were conducted on long-form items with the substantiation decision for each abuse type as the criterion. Validity was further tested using receiver–operator characteristic (ROC) curve analysis, correlation with long forms and internal consistency. The four resulting short-form measures, containing 36 of the 82 original items, have validity similar to the original long forms. These short forms can be used to standardize and increase efficiency of APS investigations, and may also offer researchers new options for brief elder abuse assessments.

Emotional arousal may increase susceptibility to fraud in older and younger adults.

Financial fraud is a societal problem for adults of all ages, but financial losses are especially damaging to older adults who typically live on fixed incomes and have less time to recoup losses. Persuasion tactics used by fraud perpetrators often elicit high levels of emotional arousal; thus, studying emotional arousal may help to identify the conditions under which individuals are particularly susceptible to fraud. We examined whether inducing high-arousal positive (HAP) and high-arousal negative (HAN) emotions increased susceptibility to fraud. Older (ages 65 to 85) and younger (ages 30 to 40) adults were randomly assigned to 1 of 3 emotional arousal conditions in a laboratory task: HAP, HAN, or low arousal (LA). Fraud susceptibility was assessed through participants’ responses to misleading advertisements. Both HAP and HAN emotions were successfully induced in older and younger participants. For participants who exhibited the intended induced emotional arousal, both the HAP and HAN conditions, relative to the LA condition, significantly increased participants’ reported intention to purchase falsely advertised items. These effects did not differ significantly between older and younger adults and were mitigated in participants who did not exhibit the intended emotional arousal. However, irrespective of the emotional arousal condition to which older adults were assigned (HAP, HAN, or LA), they reported greater purchase intention than did younger adults. These results inform the literature on fraud susceptibility and aging. Educating consumers to postpone financial decisions until they are in calm emotional states may protect against this common persuasion tactic.