Health status, living arrangement, race/ethnicity factors in risk for elder mistreatment

Health care visits may serve as important opportunities for detecting older adults at risk for mistreatment, according to results of a longitudinal, population-based cohort study published in JAMA Network Open.

“To date, population-based [elder mistreatment] studies have focused on problem prevalence, typically over a 1-year period,” David Burnes, PhD, of the Factor-Inwentash Faculty of Social Work at the University of Toronto in Canada, and colleagues wrote. “However, prevalence alone does not provide information about the rate of new cases entering the population over time and does not allow identification of factors associated with increased risk of new [elder mistreatment] cases among older adults.”

In the current study, the researchers sought to advance prior research on elder mistreatment incidence by implementing a longitudinal, population-based design to estimate incidence rate and pinpoint factors linked to the risk for occurrence of elder mistreatment over time. Specifically, they analyzed the incidence of elder mistreatment in New York households between 2009, the first wave, and 2019, the second wave.

For the first wave, the researchers used random digit-dial to recruit English- and/or Spanish-speaking, cognitively intact, community-dwelling adults aged 60 years or older across New York. Further, they used computer-assisted telephone interviews with wave one participants who gave permission to be contacted again for interviews during wave two, with a response rate of 60.7%.

Exposures included physical factors, such as health status, functional capacity and age; living arrangement; and sociocultural characteristics, such as sex, race/ethnicity, geocultural context and household income. As main outcomes and measures, the researchers assessed 10-year incidence for overall elder mistreatment and subtypes, including financial abuse, emotional or psychological abuse, physical abuse and neglect, using adapted versions of the Conflict Tactics Scale, the Duke Older Americans Resources and Services scale and the New York State Elder Mistreatment Prevalence Study financial abuse tool.

Burnes and colleagues included 628 participants in the analytical sample. Participants had a mean age of 69.2 years at wave one and 79.4 years at wave two. A total of 80.9% were non-Hispanic white individuals, and 64.6% were women.

Results showed 10-year incidence rates of 11.4% (95% CI, 8.8-14.3) for overall elder mistreatment, 8.5% (95% CI, 6.3-10.9) for financial abuse, 4.1% (95% CI, 2.6-5.7) for emotional abuse, 2.3% (95% CI, 1.2-3.6) for physical abuse and 1% (95% CI, 0.3-1.8) for neglect. The researchers noted an association between poor self-rated health at wave one and increased risk at wave two for new overall mistreatment (OR = 2.86; 95% CI, 1.35-5.84), emotional abuse (OR = 3.67; 95% CI, 1.15-11.15), physical abuse (OR = 4.21; 95% CI, 1.14-13.7) and financial abuse (OR = 2.8; 95% CI, 1.16-6.38).

Black participants had increased risk for overall mistreatment (OR = 2.61; 95% CI, 1.16-5.7) and financial abuse (OR = 2.8; 95% CI, 1.09-6.91) compared with non-Hispanic white participants. Participants who changed from co-residence to living alone had increased risk for financial abuse (OR = 2.74; 95% CI, 1.01-7.21).

“Our findings confirm what researchers, policy makers and advocates have increasingly argued: [elder mistreatment] is pervasive, and only a small minority of cases are observed in service systems,” Burnes and colleagues wrote. “The development and evaluation of [elder mistreatment] prevention programs is critically needed to address risk of [elder mistreatment] associated with health status, living arrangement and race/ethnicity.”

In a related editorial, Mengting Li, PhD, and XinQi Dong, MD, MPH, both of the Institute for Health, Health Care Policy and Aging Research, at Rutgers University in New Jersey, highlighted the importance of using health care visits as an opportunity for detecting elder mistreatment.

“Older adults are more likely than young adults to visit a health care professional, which creates a unique opportunity to screen and detect [elder mistreatment] in health care settings,” Li and Dong wrote. “Evidence-based and culturally appropriate screening, treatment and prevention strategies should be developed to protect these at-risk populations.”