2014 Theses Doctoral

Risk Factors for Elder Abuse Incidence and Severity Among Cognitively Intact Older Adults

Burnes, David

Background: Elder abuse is increasingly recognized as a public health crisis and is associated with significant morbidity and premature mortality. At the foundation of this problem, elder abuse risk factors remain misunderstood. Previous elder abuse risk factor research contains methodological limitations that threaten the validity and reliability of existing knowledge. Further population-based research using standard elder abuse definitional/inclusion parameters and adaptations of established measurement tools is required to advance the literature. A major gap in the elder abuse risk factor literature is consideration of problem severity. Previous studies have focused on dichotomous prevalence/incidence outcomes, yet substantial variation exists in the extent, frequency, and self-perceived seriousness of the problem. Using data from the most methodologically rigorous population-based elder abuse study conducted to date - New York State Elder Abuse Prevalence Study (NYSEAPS) - this dissertation identified candidate risk factors of one-year incidence, objective severity, and subjective severity for elder emotional abuse, physical abuse, and neglect among cognitively intact, community-dwelling older adults.
Methods: The NYSEAPS used a random digit-dial sampling strategy to conduct direct telephone interviews with a representative sample (n = 4156) of older adults in New York State. Inclusion criteria captured older adults aged 60 years or above living in the community, cognitively intact, and English/Spanish-speaking. Elder emotional and physical abuse types were assessed using a modified version of the Conflict Tactics Scale. Elder neglect was measured using a modified version of the Duke Older Americans Resources and Services scale. Potential risk factors were examined at several ecological levels of influence, including the individual victim, victim-perpetrator relationship, home living environment, and surrounding socio-cultural context. Multivariate regression modelling was used to identify factors associated with one-year elder abuse incidence in the general population, as well as factors associated with objective and subjective elder abuse severity among mistreated older adults.
Results - Incidence: Older adults who were younger, functionally impaired, living in a low-income household, and separated/divorced had significantly higher odds of emotional abuse and physical abuse in the past year. Older adults who were younger, separated/divorced, living below the poverty line, non-Hispanic, and in poor health had significantly higher odds of elder neglect in the past year.
Results - Objective Severity: Increasingly severe emotional abuse was predicted by younger age, functional impairment, shared living, Hispanic ethnicity, a spousal/partner perpetrator, and living alone with the perpetrator. Higher levels of physical abuse severity were associated with younger age, a grandchild perpetrator, and living alone with the perpetrator. Increasingly severe neglect was predicted by younger age, functional impairment, and low household income.
Results - Subjective Severity: Victims of emotional abuse were more likely to perceive the problem as serious if they were functionally impaired, highly educated, or endured more objectively severe mistreatment; victims were less likely to perceive the emotional abuse as serious if they lived with family or lived with their perpetrator. Physical abuse victims had higher odds of viewing their abuse with greater seriousness if they were a widow, single or experienced more objectively severe mistreatment; victims were less likely to perceive physical abuse as serious if they lived with the perpetrator. Neglect victims reported higher perceptions of problems seriousness if they were functionally impaired, male, had a paid attendant perpetrator, or endured more objectively severe mistreatment; neglect victims had lower perceptions of problem seriousness if their perpetrator was an adult child or when they lived with the perpetrator
Implications: Using NYSEAPS data, this dissertation contributes the most valid and reliable elder emotional abuse, physical abuse and neglect risk factor knowledge available to date. It also extends existing risk factor research as the first known study to examine factors predicting elder abuse operationalized along a continuum of severity. Incidence-related risk factor information carries direct implications for policy and interventions aimed at preventing new elder abuse cases. Objective severity risk factor findings inform the development of targeted interventions to alleviate the magnitude of existing elder abuse cases and protect victims from heightened risks of mortality and morbidity. A focus on subjective severity carries indirect implications towards understanding victim help-seeking intentions and protective service utilization.