Abstract:
Introduction: The overall aim of this project was to conduct a national epidemiological study to determine prevalence and risk factors for elder mistreatment in community residing older adults, defined generally as physical, sexual, emotional, neglectful, or financial mistreatment of a person age 60 years or above. A second goal was to determine whether proxy reports of mistreatment would yield prevalence estimates similar to those of older adult respondents themselves, thereby demonstrating the validity of an alternate method of assessing elder mistreatment. Method: Random Digit Dialing methodology was used to derive a nationally representative sample (based on age, race, and gender) of 5,777 older adults (target goal 4,000) and 813 proxy respondents (target goal 500) for this study. Participants were interviewed via telephone in English or Spanish about a variety of mistreatment types and mistreatment risk factors, in addition to questions regarding health, social support, and demographics. Specific elder mistreatment categories included emotional, physical, sexual, financial, and neglect. Results: The cooperation rate was 69% for the sample. 60.2% of the older adults were women and 39.8% were men. The average age of respondents was 71.5 years (SD = 8.1) with a range of 60 to 97 years. Of the 5,777, about 57% were married or cohabitating, 12% were separated or divorced, 25% were widowed, and 5% were never married. Considering race in order of magnitude, about 85% indicated that they were White, 7% Black, 2% American Indian or Alaskan Native, 1% Asian, 0.2% Pacific Islander, and the remainder chose not to identify. Considering Ethnicity, 4.3% indicated that they were of Hispanic or Latino origin. In addition to factors such as race and gender, the study sample was also characterized in terms of important contextual risk factors that might serve to increase or decrease risk of elder mistreatment, yielding the following risk factor information: low household income (i.e., less than $35,000 per year combined for all members of the household) was reported by 45.7% (2,262); being unemployed or retired was noted by 80.9% (5,174); poor health was self reported by 22.3% (1,279), a prior traumatic event (defined below) was reported by 62.0% (3,566) . Another 43.6% (1,379) indicated that they currently felt that they had very low levels of social support. Fully 40.8% (2,329) used social services of some form, and 37. 8% (2,176) reported that they needed some assistance with activities of daily living (ADL). In order to simplify analyses, we also dichotomously grouped participants into two age groups: ‘younger old’ age 60 to 69 (49.9% of the sample), and ‘older old’ age 70+ (50.1%, of the sample). Past-year prevalences were as follows: emotional mistreatment: 4.6%; physical mistreatment: 1.6%; sexual mistreatment: 0.6%; current potential neglect: 5.1%; current financial exploitation by family: 5.2%. Lifetime financial exploitation by a stranger was also obtained: 6.5%. Considering only emotional, physical, sexual, and potential neglect (i.e., excluding financial mistreatment), 11% reported at least one form of past year mistreatment, 1.2% reported 2 or more forms of past year mistreatment, and 0.2% reported 3 forms of mistreatment. In contrast to expectations, proxy reports were not useful in identifying mistreatment, with the exception of family-member perpetrated financial exploitation. Thus, alternative methods of mistreatment prevalence estimation will need to be developed for community residing, cognitively impaired older adults. Overall, the elder mistreatment assessment strategy used in this study proved extremely effective in detecting all forms of abusive behaviors. (Author Abstract)