The high rates of abuse, neglect, and financial exploitation in this sample (40.4% total; 22.7% severe) exceed those reported in previous community-based studies. There are several explanations for these striking findings. First, our sample may represent a particularly high-risk subset of the Latino population that has been under-represented in elder abuse research. Challenges faced by this community—limited English proficiency, economic insecurity, neighborhood seclusion, fear of crime and mistrust of authorities—may present barriers to survey research and suppress abuse reporting. The approach of going door-to-door within the target neighborhoods may have recruited Latinos who do not typically participate in studies of elder mistreatment.
Second, it is possible that we did not capture a hidden population, but rather our interview method uncovered abuse that is often concealed. Respondents may have felt more comfortable discussing mistreatment with promotores who represent their culture and community. Furthermore, promotores did not collect identifying information and were not mandated to report abuse, potentially increasing willingness to disclose. To our knowledge, no new reports of abuse were filed as a result of our survey, despite offers from promotores to assist respondents.
Third, our instrument may have been more sensitive and/or our threshold may have been lower than other studies. Comparing the USC-OACS
to the telephone survey used by Acierno revealed that both instruments assess similar abusive behaviors, although the telephone survey combines them into a single item, e.g., “Has anyone ever hit you with their hand or object, slapped you, or threatened you with a weapon?”12
asks about each behavior separately, potentially capturing a wider range of harmful experiences. Further validation and psychometric testing with other populations is needed to determine whether the USC-OACS
is more sensitive to mistreatment.
Few studies have examined the prevalence of elder abuse in Latin America; among them, the only studies we are aware of that used large community-based samples took place in Mexico. In 2007, a study of 1,078 rural Mexican elders reported an overall abuse prevalence of 8.1%.27
A second study reported a past-year abuse prevalence of 16% among urban-dwelling Mexican elders.28
As with our study’s findings, psychological mistreatment was the most commonly reported abuse-type, yet our overall frequency was much higher. Higher rates of abuse from smaller studies have been reported in other Latin American countries29
; however, prevalence findings in Mexico are more consistent with nationally representative surveys conducted in the U.S.1
Based on population statistics from the 2010 U.S. Census30
and our analysis of data obtained from Los Angeles County, approximately 2.0% of the residents within the target community of SPA 6 made a report to APS in the year prior to our final survey being administered (July 2009-June 2010). This number is very close to the 1.5% of our respondents who indicated reporting abuse of any kind to APS in the year prior to taking our survey, but is significantly lower than abuse rates detected by the USC-OACS
instrument. This comparison suggests that Latino immigrants considerably underreport mistreatment; perhaps stemming from a cultural tendency to resolve conflict within the family or from fear that contacting authorities constitutes a greater risk to the victim and the family.
Correlates of Abuse
Consistent with existing research,1
we found that the risk of conflict abuse decreases with age. Our finding that conflict abuse is higher among those with more education contradicts earlier research.2
We also found that respondents who have lived longer in the U.S. face a higher risk of financial exploitation. Although the underlying reasons are not apparent from this study, these associations suggest that Latinos who are more acculturated to the U.S. and more educated are more likely to acknowledge abuse.
Experiencing physical and/or sexual abuse before age 65 was a considerable risk factor for mistreatment in our sample. This finding informs the debate that some elder abuse is domestic abuse that persists into old age.21
Our findings support previous research that suggests that other types of elder abuse, particularly financial exploitation and neglect, are associated with different vulnerabilities, including functional and cognitive impairment.31,32
Limitations and Future Research
Several caveats should be noted when considering these findings. First, the study focused on a specific population within a specific geographic region of Los Angeles County. As such, the goal was to provide greater detail about a group that may be underrepresented in national studies, however, results may not generalize to all Latinos. Second, although there are trade-offs with any survey approach, we believe that because of their cultural knowledge, promotores likely obtained a higher response rate and perhaps more valid results. This should be tested by comparing promotores with other survey methods. Because promotores worked off-site in a community-based agency, it was important to ensure that they were well trained and acquainted with the goals of the study.
Our instrument had good internal consistency with the exception of financial exploitation. In analyzing responses, it appears that some items were less relevant in this population (e.g., forced to change will/power of attorney), and some were less likely to be perceived as harmful. Cultural differences in the perception of what constitutes a misuse of funds9
suggest that normative assumptions of proper/improper resource exchange may not be sufficiently culturally-nuanced to identify financial exploitation in our population.
Finally, we did not include respondents with moderate or severe cognitive impairment and chose not to interview proxy respondents. Previous research has found that proxies may report different levels of mistreatment than victims.12,21
Measuring neglect using self-report also presents a challenge, and we may have missed elders who were highly dependent and unable to be surveyed. We believe, however, that our approach of identifying need for caregiver support as a criterion for neglect is important to the conceptual framework of this abuse type.
Health practitioners that serve older Latinos should recognize that elder abuse is considerably underreported in these populations. With this in mind, practitioners should be aware of the reporting requirements in their community and actively seek to identify abuse in their older patients. Strategies such as a brief screening for abuse coupled with careful attention to physical and emotional warning signs of mistreatment should be considered (e.g., bruising, malnutrition, depression).33
In addition, from a public health perspective, using promotores
to educate and advocate on behalf of older adults in their communities may bring greater awareness to the problem and normalize the practice of reporting. The last several years have seen groundbreaking national studies measuring the incidence of elder abuse among community-residing older adults in the U.S.1,11
To continue to improve our understanding of how elder abuse affects older adults and communities, more efforts are needed to include minorities into our current models of abuse prevalence and vulnerability.