From a humble identity to an identity of respect: lifetime abuse among Arab Israeli older women.

This study addresses the retrospective experiences of older Arab Israeli women after a lifetime of living in the shadow of intimate partner violence. Qualitative research was conducted, using in-depth, semi-structured interviews of 15 Arab Israeli older women. Underlying this study is a feminist perspective and a life course perspective. Two main themes emerged: (1) socially endorsed violence against Arab Israeli women. This took several forms: men's dominant position and women's dependence, sources of violence used against women before and after marriage, and the social education of women to accept their fate. (2) The construction of a multifaceted survival identity throughout Arab Israeli women's life and old age. This identity has a variety of dimensions, including: a submissive victim identity, a rehabilitative identity of respect in old age, and a form of split identity that combines both the rehabilitative social identity and the marginal identity still experienced within the home.

Elder abuse and its predictors: a cross-sectional study in a rural area of West Bengal, eastern part of India.

BACKGROUND: Elder abuse is an important public health problem hidden from public view in spite of its detrimental effect on physical and mental health. In the last three decades, there is responsiveness toward abuse of children and spouses worldwide but even today abuse and neglect of aged people seem to be the matter of least concern. This study aims to reveal the magnitude of elder abuse and its predictors. METHODS: This is a cross-sectional study carried out in a community setting among elderly people (60 years and older) from October 2015 to September 2017 in a rural area of West Bengal, eastern part of India. Elder abuse was elicited by questions adapted from the Actual Abuse Tool. Data were analysed using SPSS (version 16.0). Logistic regression analysis was performed to reveal the factors associated with elder abuse. RESULTS: The study found that 25.6% of the respondents had experienced abuse, psychological abuse being the commonest type. Disability was the most common perceived risk for abuse. Univariate logistic regression showed higher age (70 years and older), female gender, who were Scheduled caste, living in a nuclear family, having more than three children, financially and functionally dependent, who was suffering from depression and multimorbidity had increased odds of being abused. In multivariable logistic regression, people aged above 70 years, living in a nuclear family and dependent for instrumental activities of daily living remained significant predictors of abuse. CONCLUSION: Around one in four of the respondents was abused in a 1 year duration which implies the urgent need for action. Routine screening for elder abuse at ground level and abuse prevention campaigns can be an important measure to alleviate this hidden problem. Also, there is a need to explore culturally specific forms of elder abuse to provide an age-friendly environment.

A Short Form of the Lichtenberg Financial Decision Rating Scale.

Objectives: This article examines the convergent validity and clinical utility of the 34-item short form of the Lichtenberg Financial Decision Rating Scale (LFDRS-SF). A briefer scale can lead to enhanced and efficient use of a person-centered approach to the assessment of financial decision-making.Methods: Using data on 200 community-dwelling older adults from Lichtenberg and colleagues (2017a), convergent validity was examined with cognitive and financial management measures using a correlational and regression approach. Receiver operating curve analyses for predicting decision-making ability classification and suspected financial exploitation classification were used to evaluate clinical utility.Results: The LFDRS-SF total risk score was significantly correlated with both cognitive and financial management measures, and the regression analysis predicted 9% of the LFDRS-SF measure. These results demonstrate not only convergent validity, but also the conceptual and empirical uniqueness of financial decision-making.Conclusions: The LFDRS-SF is a valid tool to assess real-world financial decision-making abilities.Clinical Implications: The LFDRS-SF offers an efficient way to assess financial decision-making. Training on the tool and automatic scoring and recommendations for next steps can be found at https://olderadultnestegg.com.

Quantifying Risk of Financial Incapacity and Financial Exploitation in Community-dwelling Older Adults: Utility of a Scoring System for the Lichtenberg Financial Decision-making Rating Scale.

Objectives: This work examines the clinical utility of the scoring system for the Lichtenberg Financial Decision-making Rating Scale (LFDRS) and its usefulness for decision making capacity and financial exploitation. Objective 1 was to examine the clinical utility of a person centered, empirically supported, financial decision making scale. Objective 2 was to determine whether the risk-scoring system created for this rating scale is sufficiently accurate for the use of cutoff scores in cases of decisional capacity and cases of suspected financial exploitation. Objective 3 was to examine whether cognitive decline and decisional impairment predicted suspected financial exploitation.Methods: Two hundred independently living, non-demented community-dwelling older adults comprised the sample. Participants completed the rating scale and other cognitive measures.Results: Receiver operating characteristic curves were in the good to excellent range for decisional capacity scoring, and in the fair to good range for financial exploitation.Conclusions: Analyses supported the conceptual link between decision making deficits and risk for exploitation, and supported the use of the risk-scoring system in a community-based population.Clinical Implications: This study adds to the empirical evidence supporting the use of the rating scale as a clinical tool assessing risk for financial decisional impairment and/or financial exploitation.

Elder Abuse in American Indian Communities: An Integrative Review.

BACKGROUND: American Indian elders have one of the lowest life expectancies in the United States. Disproportionate disease burden, socioeconomic disparities, and higher rates of violence across the lifespan are thought to contribute to higher rates of elder abuse. Elder abuse and higher rates of trauma exposure are linked with adverse outcomes. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines informed the methodology and assessment of the literature on elder abuse among American Indians. RESULTS: Of the nine studies published in the last 30 years, rates of elder abuse varied by study, location, and tribal affiliation from 4.3% to 45.9%. Large studies with comparison populations found higher rates for American Indians. There was a consensus for three risk factors: substance abuse, mental health problems, and caregiving issues. Importance of tribal norms, the notion of respect conferred to elders, and the concept of acculturation were major culturally relevant themes. Perceived tribal norms and strengths, for example, respect for elders, were at odds with abuse experiences, particularly financial exploitation and neglect. Historical trauma, shame, and fear impacted reporting. There was little consistency in study designs, most were qualitative or mixed methods, samples were small, there was no common measurement tool or time frame for abuse, and there was only one intervention study. IMPLICATIONS: High rates of abuse suggest healthcare providers should be encouraged to screen and intervene despite the lack of empirical evidence. Providers should not assume that traditional culturally ascribed strengths, such as honor and respect for elders, provide any degree of protection against elder abuse.

Sources and Variations in Social Support and Risk for Elder Mistreatment in a US Chinese Population.

OBJECTIVES: Research has examined the relationships between positive social support (PSS) and elder mistreatment (EM) but less is known regarding the negative aspect of social support (NSS), especially among minority groups in the United States. This study aimed to investigate the relationships between PSS/NSS from different sources and EM among US Chinese older adults. DESIGN: Population-based cross-sectional study. SETTING: Greater Chicago, IL, area. PARTICIPANTS: A representative sample of Chinese older adults aged 60 years or older (N = 3157) from the Population Study of ChINese Elderly in Chicago in 2011 to 2013. MEASUREMENTS: We applied a 10-item widely used instrument to assess EM. PSS and NSS from spouse/family members/friends were measured by a 12-item scale. Multivariate logistic regression analyses were conducted to examine the relationships. RESULTS: After adjusting for confounders, higher levels of overall PSS from all three sources, including spouse, family members, and friends (odds ratio [OR] = 0.88 [95% confidence interval {CI} = 0.85-0.91]), were associated with lower risk of EM. But participants with a higher level of overall NSS from all three sources (OR = 1.51 [95% CI = 1.41-1.61]) were more likely to experience EM. The results on the relationships between PSS from spouse (OR = 0.70 [95% CI = 0.64-0.76]), PSS from family members (OR = 0.73 [95% CI = 0.68-0.79]), and EM were similar to overall PSS. But PSS from friends had a nonsignificant association with EM. Greater levels of NSS from spouse (OR = 1.84 [95% CI = 1.64-2.07]), family members (OR = 2.36 [95% CI = 2.03-2.75]), and friends (OR = 1.69 [95% CI = 1.32-2.17]) were associated with increased risks of EM. CONCLUSION: Higher levels of SS were not always associated with lower risks of EM among US Chinese older adults. NSS might have counter effects. Future qualitative or longitudinal research needs to explore detailed cultural explanations and casual relationships between SS and EM. J Am Geriatr Soc 67:S499-S505, 2019.

Different Definitions of Elder Mistreatment and Mortality: A Prospective Cohort Study From 2011 to 2017.

OBJECTIVES: To investigate the relationship between different definitions and subtypes of elder mistreatment (EM) and yearly mortality. DESIGN: Population-based epidemiological study. SETTING: Greater Chicago area. PARTICIPANTS: Chinese Americans aged 60 and older (N=3,157). MEASUREMENTS: Data were collected from 2011 to 2017, with mortality data collected over the subsequent 4 years. Face-to-face in-home interviews were conducted. EM was measured using a brief screening tool (10 items) and a detailed assessment (56 items) and defined using different criteria for overall and specific subtypes of EM. Mortality was ascertained during follow-up. Cox proportional hazards models were used. RESULTS: Four hundred seventy-five (15.2%) participants reported EM. Severe and moderate EM were associated with greater risk of 1-year (hazard ratio (HR)=2.51, 95% confidence interval (CI)=1.04-6.03; HR=2.55, 95% CI=1.08-6.03), 2-year (HR=1.68, 95% CI=1.01-2.78; HR=1.69, 95% CI=1.04-2.74), 3-year (HR=1.73, 95% CI=1.17-2.55; HR=1.73, 95% CI=1.19-2.51) and 4-year (HR=1.51, 95% CI=1.08-2.10; HR=1.48, 95% CI=1.08-2.04) mortality. A broad definition of EM was associated with greater risk of 3-year and 4-year mortality. With respect to subtypes of EM, psychological mistreatment and caregiver neglect were associated with greater mortality risk, whereas the relationships between psychological mistreatment, caregiver neglect and mortality risk varied according to definitional criteria. DISCUSSION: Different definitions and subtypes of EM had different associations with mortality in Chinese-American older adults. This study challenges assumptions about consequences of EM and calls for customized interventions for EM in minority populations. J Am Geriatr Soc 67:S506-S512, 2019.

Typology of Family Relationship and Elder Mistreatment in a US Chinese Population.

OBJECTIVES: To examine the associations between typology of family relationship and risk of elder mistreatment (EM). DESIGN: Population-based epidemiological cross-sectional study. SETTING: Community-dwelling older adults in the greater Chicago area. PARTICIPANTS: A total of 3157 US older Chinese immigrants. MEASUREMENTS: EM was measured by a brief screening tool. Latent class analysis was used to construct typologies of family relationship from eight indicators, evaluating the structural, associational, functional, affectual, and normative aspects of family relationship. Logistic regression models were used to test the associations between typology of family relationship and EM. RESULTS: Unobligated ambivalent type (44.77%) was the most common family type among US older Chinese immigrants. The prevalence of EM was around 15%, with 475 participants reporting experience of EM. Unobligated ambivalent (odds ratio [OR] = 1.90; 95% confidence interval [CI] = 1.54-2.34) and detached (OR = 1.78; 95% CI = 1.32-2.42) family types were associated with greater risk of EM; tight-knit (OR = .34; 95% CI = .27-.44) family type was associated with lower risk of EM. The relationship between commanding conflicted family type and EM was not significant. CONCLUSION: Unobligated ambivalent family type, featured by high emotional closeness and high family conflict, was prevalent among US Chinese families and associated with EM consequences. Culturally customized social services are suggested to reduce intergenerational ambivalence and promote family harmony for immigrant families. J Am Geriatr Soc 67:S493-S498, 2019.

Life Course Violence: Child Maltreatment, IPV, and Elder Abuse Phenotypes in a US Chinese Population.

OBJECTIVES: To examine the associations between violence experiences including phenotypes (psychological, physical/sexual abuse, financial exploitation, caregiver neglect) of child maltreatment (CM), intimate partner violence (IPV), and elder abuse (EA). DESIGN: Cross-sectional data collected during 2011-2013. SETTING: US Chinese community in Chicago, Illinois. PARTICIPANTS: A total of 3157 community-dwelling older adults (aged ≥60 y). MEASUREMENTS: Cases of CM, IPV, and EA. RESULTS: Prevalence of violence was 11.4% for CM (physical/sexual = 10.2%; psychological = 2.4%), 6.5% for IPV (psychological = 5.3%; physical/sexual = 2.8%), and 15.2% for EA (caregiver neglect = 11.2%; psychological = 9.8%; financial exploitation = 9.3%; physical/sexual = 1.2%). After adjusting for potential confounding variables, CM psychological was associated with increased risks for IPV psychological (odds ratio [OR] = 7.60; 95% confidence interval [CI] = 4.29-13.45), IPV physical/sexual (OR = 4.06; CI = 1.71-9.63), EA psychological (OR = 3.79; 95% CI = 2.20-6.51), and EA financial exploitation (OR = 2.07; 95% CI = 1.12-3.81). CM physical/sexual was associated with increased risks for IPV physical/sexual (OR = 1.86; 95% CI = 1.02-3.38), EA psychological (OR = 1.70; 95% CI = 1.20-2.42), and EA financial exploitation (OR = 2.38; 95% CI = 1.72-3.30). IPV psychological and physical/sexual were associated with 5 to 8 times increased risks for EA psychological, 6 to 9 times increased risks for EA physical/sexual, and 3 times increased risks for EA financial exploitation. CONCLUSION: Healthcare professionals working with older adults should be informed that a history of violence might further predispose a person to different types of EA. The cumulative impact of violence should also be considered when providing services or care to violence victims. J Am Geriatr Soc 67:S486-S492, 2019.

Perceptions of elder abuse and neglect by older Chinese immigrants in Canada.

This study investigates how older adults perceive elder abuse and neglect in the context of migration and ageing. Based on a qualitative study of recent Chinese older immigrants in the Greater Toronto Area in Canada, it seeks to understand how migration and ageing processes, both of which engender cultural and contextual changes, shape and reshape views of elder abuse and neglect. The study argues that culture is important in older immigrants' perceptions of elder abuse and neglect, yet individuals with the same cultural roots may differ in their conceptualizations. Further, such perceptions could change through interactions with peers and non-peers in the host society, and these, in turn, can be influenced by both cultural and structural factors.

Contextualizing mistreatment in cognitive impairment in Latin America.

Mistreatment is an important social outcome of the growing cognitive impairment epidemic, particularly in developing countries. This study aimed to bring to light what is known about mistreatment in cognitively impaired individuals in Latin American Countries. We identified a gap in the literature on this topic that opens the door for future research.

Elder abuse and its sociocultural factors from the perspectives of Kurdish rural older people: Does gender matter?

We aimed to explore the meaning of elder abuse and its sociocultural factors from the perspectives of Kurdish older people. We purposively selected the participants, 38 female and 17 male, from a rural area in Boukan country, Iran. Data were collected using semi-structured interviews and focus group discussions and were analyzed applying conventional content analysis. Researchers finally characterized viewpoints of the participants into two themes including structural changes in family interactions and changes in sociocultural values. Public education about moral norms and enactment of supportive laws for elderly people may help minimize elder abuse.

Developing a comprehensive understanding of elder abuse prevention in immigrant communities: a comparative mixed methods study protocol.

INTRODUCTION: Older adults are the fastest growing age group in Canada. Elder abuse has significant individual and societal implications, so it is critical to address. While interest in this topic is increasing, little is known about the risk factors for elder abuse in immigrant communities in Canada, or about culturally relevant strategies to address these risk factors. METHODS AND ANALYSIS: This mixed-methods study is guided by the intersectionality and ecological frameworks. We will include two long-term (ie, established) and two recent immigrant communities from East Asian and South Asian communities in the Greater Toronto Area: Chinese, Korean, Punjabi and Tamil. Through structured group interviews, we will first identify factors that contribute to elder abuse within and across each of the immigrant communities and then explore culturally relevant strategies to address those risk factors. Group interviews will be conducted separately with five stakeholder groups in each of the four languages: older women, older men, family members, community leaders and service providers. Quantitative and qualitative data will be analysed at the level of the particular interview groups, subgroups and communities, and will be integrated across communities to identify common and unique risk factors and strategies to address elder abuse. ETHICS AND DISSEMINATION: The study protocol has received ethics approval from the two universities associated with the research team. Given the comprehensive approach to incorporate local knowledge and expert contributions from multi-level stakeholders, the empirical and theoretical findings will facilitate practice change and improve the well-being of older men and women in immigrant communities.

The elder abuse and neglect phenomenon in the ultra-Orthodox Jewish society: social workers' perspectives.

ABSTRACTBackground:In the last 30 years, elder abuse and neglect has been recognized as a social and health-related problem. The aim of this paper is to describe the phenomenon of elder abuse and neglect in a separatist faith-based society (ultra-Orthodox Jewish society-UOJS). METHODS: A qualitative-phenomenological study with 28 social workers who underwent in-depth semi-structured interviews based on an interview guide consisting of the following items: visibility of the elder abuse and neglect phenomenon in the ultra-Orthodox society, and dilemmas and sensitive issues that arise when working with this population. RESULTS: Three main themes emerged: (1) Between the commandment to honor one's parents and concealment patterns: Cultural barriers to exposing the abuse and neglect phenomenon; (2) "Life is demanding:" The unique expression of abusive and neglectful behavior in the UOJS; (3) Culturally related dilemmas when intervening with cases of elder abuse and neglect. CONCLUSIONS: Ultra-Orthodox Jewish cultural belief is a differentiating component in the context of elder abuse and neglect. Social workers need to develop a deep understanding of the unique characteristics of the phenomenon and cultural sensitivity to cope with it to address the well-being of older ultra-Orthodox Jews.

Cultural and ethical considerations in late-life polyvictimization.

This article examines the cultural and ethical considerations for professionals working with older adults who experience polyvictimization. Drawing from the Department of Justice training program, Polyvictimization in Later Life (OVC/TTAC, 2017), topics include cultural competencies, ethical standards, personal and professional ethics, and ethical considerations when working in teams. Also described are specific suggestions and recommendations to ensure sensitive and ethical responses when working with cases involving polyvictimization.

Elder Abuse in the African Diaspora: A Review.

BACKGROUND: As with many other populations, abuse of older adults is a growing problem across the Africa Diaspora. Modernization and urbanization are eroding the traditional values of respect for older adults. Also, older adults living in environments with limited social and economic resources, and having no means of economic support create a recipe for elder abuse and neglect. METHODS: This article reviews the current literature on the epidemiology, risk factors, and interventions used for elder abuse across the African Diaspora. RESULTS: Reports of elder abuse range from 24.9% to 81.1% across the Diaspora. Risk factors include cognitive and physical impairment, social isolation, lack of resources and widowhood. CONCLUSION: Community-based programs using the unique social networks of older populations of African descent can provide a venue to improve caregiver training and support, reinforce traditional filial and informal caregiving practices, increase the utilization of available governmental and institutional.

The Association Between Childhood Abuse and Elder Abuse Among Chinese Adult Children in the United States.

BACKGROUND: The previous researchers have postulated that an abused child may abuse his or her abuser parent when the parent is getting old, also known as the intergenerational transmission of violence. However, few studies use data to support this model, and it has yet to be examined in the U.S. Chinese community. This study aims to examine the association between childhood abuse and elder abuse reported by Chinese adult children in the United States. METHODS: Guided by a community-based participatory research approach, 548 Chinese adult children aged 21 years and older participated in this study. Childhood abuse was assessed by four-item Hurt-Insult-Threaten-Scream (HITS) scale. Elder abuse was assessed by a 10-item instrument derived from the Caregiver Abuse Screen (CASE). Logistic regression analysis was performed. RESULTS: Childhood abuse was associated with caregiver abuse screen results (odds ratio = 1.92, 95% confidence interval = 1.24-2.95). Being physically hurt (r = .13, p < .01), insulted (r = .15, p < .001), threatened (r = .12, p < .01), and screamed at (r = .18, p < .001) as a child were significantly correlated with caregiver abuse screen results. CONCLUSION: This study suggests that childhood abuse is associated with increased risk of elder abuse among Chinese adult children in the United States. Longitudinal research should be conducted to explore the mechanisms through which childhood abuse and its subtypes links with elder abuse.

The Association Between Physical Function and Elder Mistreatment Among Community-Dwelling Chinese Older Adults in the Greater Chicago Area.

BACKGROUND: Physical function (PF) impairment and elder mistreatment (EM) are alarming public health issues facing by many older adults. Prior studies have not generated uniform findings on the associations between PF and EM. This study aimed to address the research gap of this association among U.S. Chinese aging population. METHODS: Three thousand one hundred fifty-eight community-dwelling Chinese older adults in the Greater Chicago Area were surveyed. Independent variables included both self-reported and performance-based PF measurements. Dependent variable was EM, assessed by a 10-item instrument that has been widely used in social studies. RESULTS: The mean age of study participants was 76.3 years (SD ± 8.4) and 58.0% were female. After adjusting for potential covariates, higher scores of activities of daily living (odds ratio [OR] = 0.85, 95% confidence interval [CI] = 0.73-0.98), instrumental activities of daily living (OR = 0.87, 0.82-0.92), and Rosow-Breslau reversely coded (OR = 0.85, 0.75-0.96) were associated with lower risk of EM. Also, lower scores of observed PF performance measurements, including tandem stand (OR = 0.78, 0.70-0.88), measured walk (OR = 0.84, 0.77-0.91), and the overall measurement (OR = 0.93, 0.89-0.97) have significant associations with lower risk of EM. CONCLUSIONS: Findings from this study suggested that greater levels of PF impairment were associated with lower risk of EM among U.S. Chinese older adults in the Greater Chicago Area. Longitudinal studies are needed to obtain a more comprehensive understanding of the pathways between PF and EM and its subtypes among Chinese aging populations.

Incidence of Elder Abuse in a U.S. Chinese Population: Findings From the Longitudinal Cohort PINE Study.

BACKGROUND: Elder abuse (EA) is a global public health issue. However, no prior longitudinal research has quantified the incidence of EA, which is critical to understand risk factors and future prevention strategies. METHODS: The study is based on a longitudinal cohort design. We followed 2,713 U.S. Chinese older adults who agreed to participate in the study within 2011 to 2015. A structured questionnaire was used to collect data regarding the 2-year incidence of EA and its subtypes. We employed multiple logistic regression analyses to examine the associations between the sociodemographic characteristics and incident EA. RESULTS: The incidence of overall EA was 8.8% with 4.8% for psychological, 2.9% for financial, 0.5% for physical, 0.1% for sexual abuse, and 1.1% for caregiver neglect. Age, gender, duration of residence, language preference and health status change were associated with incident EA. Self-perceived worsened health was positively associated with overall EA (odds ratio [OR] 1.28 (1.01, 1.62). Women (OR 2.98 [1.10, 8.11]) and older individuals (OR 1.06 [1.00, 1.13]) had an increased risk of caregiver neglect. Older adults who have lived in the U.S. longer had a higher risk of financial exploitation (OR 1.02 [1.00, 1.05]). Individuals who prefer to speak Mandarin or English were more likely to experience EA (OR 2.08 [1.21, 3.58]) and sexual or physical abuse (OR 3.91 [1.01, 15.17]). No significant association was observed between education, income, marital status, number of children, country of origin, overall health, life quality, and incident EA. CONCLUSION: This study presents the first illustration of EA incidence in a longitudinal cohort study, the findings of which verify and challenge prior fundamental assumptions of risk factors associated with EA, and are relevant to future prevention strategies.