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1.  Verbal Mistreatment in the Elderly 
Journal of elder abuse & neglect  2014;26(4):351-364.
Elder mistreatment is expected to rise with the aging of the American population. To date, the association between specific forms of mistreatment and decreased quality of life is poorly understood. The aim of the present study was to explore the association between verbal mistreatment among elderly individuals and depression and quality of life. A sample of 142 older adults (40% male) aged 65 or over was enrolled from a large medical practice and academic dental practice, mean (SD) = 74.88 (6.98) years. Thirty-eight percent of the sample reported verbal mistreatment. Controlling for socio-demographic characteristics and depression, verbal mistreatment was a significant predictor of social functioning (β = −.28, p<.001), mental health (β = −.25, p<.001), and role limitations OR = 3.02, 95% CI [1.34 – 6.77]. The present findings highlight the prevalence of verbal mistreatment in elderly individuals.
PMCID: PMC4051298  PMID: 24910894
elderly; verbal mistreatment; depression; quality of life
2.  Correlates of Susceptibility to Scams in Older Adults Without Dementia 
Journal of elder abuse & neglect  2014;26(2):107-122.
This study examined correlates of susceptibility to scams in 639 community-dwelling older adults without dementia from a cohort study of aging. Regression models adjusted for age, sex, education, and income were used to examine associations between susceptibility to scams, measured by 5-item self-report measure, and a number of potential correlates. Susceptibility was positively associated with age and negatively associated with income, cognition, psychological well being, social support, and literacy. Fully adjusted models indicated that older age and lower levels of cognitive function, decreased psychological well-being, and lower literacy in particular may be markers of susceptibility to financial victimization in old age.
PMCID: PMC3916958  PMID: 24499279
Fraud; scam; financial exploitation; elder abuse; risk factors
3.  Elder Mistreatment among Chinese and Korean Immigrants: The Roles of Sociocultural Contexts on Perceptions and Help-Seeking Behaviors 
Journal of elder abuse & neglect  2014;26(3):244-269.
The purpose of this study was to identify dimensions of elder mistreatment in Chinese and Korean immigrant communities and to increase sociocultural understanding of such mistreatment by elucidating the complexities of abuse embedded in unique social and cultural contexts. In-depth interviews were conducted with 20 local professionals working primarily in Asian elderly advocacy, and six focus group discussions were conducted involving 60 community members in the San Francisco Bay area. Five dimensions of elder mistreatment were identified: psychological abuse, neglect by a trusted person, financial exploitation, physical abuse, and sexual abuse. In general, fewer Korean community member participants reported having observed physical or financial abuse than Chinese groups, but they reported greater knowledge of situations involving psychological abuse, neglect by a trusted person, and sexual abuse. The contexts of cultural influences and immigration and acculturation were salient themes that shaped participants’ subjective perceptions and beliefs about elder abuse and hence help-seeking behaviors.
PMCID: PMC4167010  PMID: 24779539
cultural issues; elder mistreatment; intervention; prevention; race; ethnicity
4.  Do Incident and Perpetrator Characteristics of Elder Mistreatment Differ by Gender of the Victim? Results from the National Elder Mistreatment Study 
Perpetrator and incident characteristics were studied in regard to incidents of emotional, physical, and sexual mistreatment of older adults (age 60 +) in national sample of older men and women. Random Digit Dialing (RDD) across geographic strata was used to compile a nationally representative sample; Computer Assisted Telephone Interviewing (CATI) was used to standardize collection of demographic, mistreatment, and perpetrator and incident characteristics data. The final sample size consisted of 5,777 older adults. Approximately one in ten adults reported at least one form of mistreatment, and the majority of incidents were not reported to authorities. Perpetrators of physical mistreatment against men had more “pathological” characteristics compared to perpetrators of physical mistreatment against women. Perpetrators of physical mistreatment (compared to emotional and sexual mistreatment) also evidenced increased likelihood of legal problems, psychological treatment, substance use during incident, living with victim, and being related to the victim. Implications for future research and social policy are discussed.
PMCID: PMC4017657  PMID: 21253929
5.  Urban and Rural Variations in the Characteristics Associated with Elder Mistreatment in a Community-Dwelling Chinese Population 
Journal of elder abuse & neglect  2013;25(2):97-125.
This study compared the urban and rural differences in the sociodemographic, socioeconomic, health-related, and psychosocial factors associated with elder mistreatment (EM) in a Chinese population. Cross-sectional study of 269 urban and 135 rural participants aged 60 years or greater was performed. For urban participants, those with EM were more likely to be younger, have lower levels of education and income, and have lower levels of psychosocial well-being. For rural participants, those with EM were more likely to be older, have lower levels of education, have higher numbers of medical conditions and lower levels of health status, and have lower levels of psychosocial well-being. Among those with EM, rural participants were more likely to be women, have lower levels of education and income, have lower levels of health status and quality of life, have worse change in recent health, and have lower levels of psychosocial well-being. Both higher levels of depressive symptoms and lower levels of social support were associated with increased risk of EM. Future intervention studies are needed to examine the effect of improving psychosocial well-being on the risk of EM among Chinese populations.
PMCID: PMC3605746  PMID: 23473295
elder mistreatment; health and aging; Chinese population; rural health; quality of life
6.  Intimate Partner Violence in Late Life: An Analysis of National News Reports 
Journal of elder abuse & neglect  2013;25(3):230-241.
Intimate partner violence (IPV) in late life takes various forms including physical harm, sexual assault, and murder. Using national newspaper reports of IPV among elders, we identified the types of violence reported most frequently in media and examined how the abuse was conceptualized by reporters. We found that most cases of IPV reported involved murder, with men as perpetrators and women as victims. Caregiving stress and health problems were frequently cited as contributing factors in the cases. Interpreting these findings from a feminist perspective, we suggest implications for practitioners working with older adults.
PMCID: PMC3641680  PMID: 23627429
domestic violence; elder mistreatment; intimate partner violence; media reports; older women; public perceptions
7.  The National Elder Mistreatment Study: Race and Ethnicity Findings 
Journal of elder abuse & neglect  2013;25(4):281-293.
The prevalence of elder mistreatment with respect to race and ethnicity was examined in an unweighted sample of 5,777 participants (5,776 participants in weighted sample). Random Digit Dialing methodology was used to select a representative sample of community-dwelling older adults, and the survey was available in English and Spanish. Mistreatment types included emotional, physical, and sexual abuse. Race and ethnicity based differences were largely absent, and the only observed increase was for physical mistreatment among Non-White older adults; however this association was not sustained in multivariate analyses controlling for income, health status, and social support. Findings are in contrast to prior reports of increased risk of mistreatment in minority populations, and point to correlated and modifiable factors of social support and poor health as targets for preventive intervention.
PMCID: PMC3694735  PMID: 23768412
elder mistreatment; race; ethnicity; sexual abuse; physical abuse
8.  Screening for Elder Mistreatment in a Dental Clinic Population 
Journal of elder abuse & neglect  2012;24(4):326-339.
The purpose of this study was to establish the feasibility and utility of screening for elder mistreatment in a dental clinic population. We approached older adults in a busy dental clinic, and enrolled 139 persons over the age of 65 who completed an Audio Computer Assisted Self Interview (ACASI), which included the Hwalek-Sengstock Elder Abuse Screening Test (HS-EAST). Overall, 48.4% of the participants scored 3 or greater on the HS-EAST, and 28.3% scored 4 or greater. Our study suggests that there is an opportunity to screen in busy dental clinics and to facilitate early detection for those patients who screen positive for elder mistreatment.
PMCID: PMC3462354  PMID: 23016728
dental clinics; elder mistreatment; screening; ACASI
9.  Mistreatment and Self-Reported Emotional Symptoms: Results from the National Elder Mistreatment Study 
Journal of elder abuse & neglect  2012;24(3):216-230.
Significant numbers of community-residing older adults in the United States report some form of past year mistreatment; however, little is known about mental health correlates of elder abuse. The present study represents an initial investigation of whether a recent history of emotional, physical, or sexual abuse is associated with self-reported emotional symptoms (e.g., anxiety and depression) among a nationally representative sample of 5,777 older adults residing in the continental United States. Results demonstrated that each abuse type independently increased likelihood of reporting emotional symptoms; however, when other known correlates (social support, physical health, traumatic event exposure) were controlled only emotional abuse remained a significant predictor. These results indicate a need for additional study of mistreatment-related correlates of depression and anxiety, with a particular focus on the often overlooked category of emotional mistreatment.
PMCID: PMC3386791  PMID: 22737973
elder abuse; depression; anxiety; interpersonal violence
10.  Healthcare Professionals’ Perspectives on Barriers to Elder Abuse Detection and Reporting in Primary Care Settings 
The purpose of this study was to explore through interviews of healthcare professionals their perspectives on elder abuse to achieve a better understanding of the problems of reporting and generate ideas for improving the process. Through a mailed survey, nurses, physicians, and social workers were invited to participate in an interview. Nine nurses, 8 physicians, and 6 social workers were interviewed and thematic analysis was used to identify the following core themes: professional orientation, assessment, interpretation, systems, and knowledge and education. The impact by healthcare professionals in recognizing and reporting elder abuse and obtaining resources for those mistreated can be profound. Nurses tended to perceive elder abuse as uncommon and generally did not feel it was their role nor did they have time to assess patients for potential abuse. Physicians felt that other patient care issues, time limitations and maintaining trust in the clinician-patient relationship outweighed the importance of detecting and pursuing suspected cases of elder abuse. Social workers, although having the most knowledge and experience related to elder abuse, relied on nurses and physicians to detect potential abusive situations and to work with them in making appropriate referrals. The three disciplines acknowledged the need for more and better education about elder abuse detection and reporting. Participants suggested a reorganization of the external reporting system. More frequent and pragmatic education is necessary to strengthen practical knowledge about elder abuse.
PMCID: PMC3298114  PMID: 22206510
elder abuse; elder mistreatment; primary care; reporting
11.  Practitioners’ Views on Elder Mistreatment Research Priorities: Recommendations from a Research-to-Practice Consensus Conference 
Journal of elder abuse & neglect  2011;23(2):115-126.
This article presents recommendations from expert practitioners and researchers regarding future directions for research on elder abuse prevention. Using the Research-to-Practice Consensus Workshop model, participants critiqued academic research on the prevention of elder mistreatment and identified practice-based suggestions for a research agenda on this topic. The practitioners’ critique resulted in 10 key recommendations for future research that include the following priority areas: defining elder abuse, providing researchers with access to victims and abusers, determining the best approaches in treating abusers, exploiting existing data sets, identifying risk factors, understanding the impact of cultural factors, improving program evaluation, establishing how cognitive impairment affects legal investigations, promoting studies of financial and medical forensics, and improving professional reporting and training. It is hoped that these recommendations will help guide future research in such a way as to make it more applicable to community practice.
PMCID: PMC3076805  PMID: 21462046
elder mistreatment research; consensus workshop; research-practice collaboration
12.  Assessing Capacity in the Setting of Self-Neglect 
Compared to older adults with disabilities and those who autonomously choose to live in squalor; self-neglect syndrome arises from a predicate state of vulnerability in frail older adults. This state of vulnerability is characteristically associated with a decline in decision-making capacity regarding the ability to care for and protect oneself. We developed the COMP Screen to evaluate vulnerable older adults to identify potential gaps in decision-making capacity using a screening tool. A total of 182 older adults were evaluated and consistent declines in cognitive ability and decision-making processes were present in this population. However, there were no significant differences between elders referred for self-neglect and matched older adults. These findings suggest that declines in decision-making processes are not uncommon in vulnerable older adults but traditional conceptualizations of decision-making capacity may be inadequate for differentiating the capacity for self care and protection in elders who self-neglect.
PMCID: PMC2855536  PMID: 17972661
Self-Neglect; Capacity; Decision-making; Self Care and Protection
13.  Multidimensional Measurement Within Adult Protective Services: Design and Initial Testing of the Tool for Risk, Interventions, and Outcomes 
Journal of Elder Abuse & Neglect  2014;26(5):495-522.
This study describes the development, field utility, reliability, and validity of the multidimensional Tool for Risk, Interventions, and Outcomes (TRIO) for use in Adult Protective Services (APS). The TRIO is designed to facilitate consistent APS practice and collect data related to multiple dimensions of typical interactions with APS clients, including the investigation and assessment of risks, the provision of APS interventions, and associated health and safety outcomes. Initial tests of the TRIO indicated high field utility, social worker “relevance and buy-in,” and inter-rater reliability. TRIO concurrent validity was demonstrated via appropriate patterns of TRIO item differentiation based on the type of observed confirmed abuse or neglect; and predictive validity was demonstrated by prediction of the risk of actual APS recurrence. The TRIO is a promising new tool that can help meet the challenges of providing and documenting effective APS practices and identifying those at high risk for future APS recurrence.
PMCID: PMC4226422  PMID: 24848994
elder abuse and neglect; Adult Protective Services (APS); risk assessment; APS recurrence; measure development; reliability; validity

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