Face-Saving and Help-Seeking Among U.S. Chinese Older Adults With Elder Mistreatment

Chinese culture places a high value on saving face and not bringing shame to the family. This study aimed to examine the associations between face-saving and help-seeking among U.S. Chinese older adults who experienced elder mistreatment (EM). Data were retrieved from the PINE study. Regression analyses were performed. Most EM victims sought help from informal sources only (48.21%), followed by no help (26.79%), informal plus formal help (19.64%), and formal help only (5.36%). For EM screening, face-saving was associated with informal help-seeking intentions (p < .05). For EM subtypes, face-saving was associated with overall help-seeking intentions for financial exploitation (p < .05), but not on physical mistreatment, psychological mistreatment, and caregiver neglect. Face-saving was not associated with help-seeking behaviors. Study findings underscore the significance of a unique cultural value in understanding EM help-seeking intentions among Chinese older adults. Cultural constructs should be considered in future EM research in diverse populations.

Incidence and Risk Factors of Elder Mistreatment in the Community: A Longitudinal Population-Based Study

Prior population-based elder mistreatment (EM) risk factor research has focused on problem prevalence using cross-sectional designs, which cannot make causal inferences between proposed risk factors and EM or discern existing cases from new cases entering the population. This study sought to estimate the incidence of EM and identify risk factors for new cases. It is a ten-year prospective, population-based cohort study with data collected between 2009 (Wave 1) and 2019 (Wave 2). Based on Wave 1 random, stratified sampling to recruit English/Spanish-speaking, cognitively intact, community-dwelling older adults (age ≥ 60) across New York State, this study conducted computer assisted telephone interviews (CATI) with 628 respondents participating in both Wave 1 and Wave 2 interviews (response rate=60.7%). Ten-year EM incidence was regressed on factors related to physical vulnerability, living arrangement, and socio-cultural characteristics using logistic regression. Ten-year incidence rates included overall EM (11.4%), financial abuse (8.5%), emotional abuse (4.1%), physical abuse (2.3%), and neglect (1.0%). Poor self-rated health at Wave 1 significantly predicted increased risk of new Wave 2 overall EM (odds ratio [OR]=2.8), emotional abuse (OR=3.67), physical abuse (OR=4.21), and financial abuse (OR=2.8). Black older adults were at significantly heightened risk of overall EM (OR=2.61), specifically financial abuse (OR=2.8). Change from co-residence (Wave 1) toward living alone (Wave 2) significantly predicted financial abuse (OR=2.74). Healthcare visits represent important opportunities to detect at-risk older adults. Race is highlighted as an important social determinant for EM requiring urgent attention. This study represents the first longitudinal, population-based EM incidence study.

Multi-method Examination of Elder Mistreatment in the Age of COVID-19

A multi-method study exposed COVID-19 influence on the pre-existing epidemic of elder mistreatment in Utah. We found changes in 1) abuse types, 2) service responses, 3) firearm access and 4) policy implications. Gun sales were tracked by news surveillance and FBI National Instant Criminal Background Check System (NICS) for pre-pandemic (2018/2019) and pandemic years (2020/2021). New requests for permits skyrocketed during the pandemic. The 2021 Utah State Legislature loosened restrictions on concealed permits. Domestic violence (DV) Fatality Tracker Data in pre-covid years were compared to 2020-2021. A figure illustrates the prevalence of DV fatalities, ages of victims by year and methods used. We conducted 15 in-depth interviews of stake holders who serve DV victims (shelters, police, etc.). DV shelters had a relative lack of children during the pandemic, but increased use by older persons 60+. Susceptibility to chronic respiratory distress syndrome, required social distance for older persons. DV shelters obtained CARES Act funds to adapt solutions, like placing victims in hotel rooms. Most victims stayed at home, confined with abuser(s), some without technology, so isolation decreased their safety. Evidence suggests some fatalities among elder adults. A case study during the pandemic described a 73-year-old mother’s suspicious bank account activity. Bank employees sent police to her home. She was missing, but her co-resident adult son was in possession of her bank cards. She was later found in a shallow grave. Utah households have increased risks of DV fatalities in the wake of the pandemic and for years to come.

Recognizing and Responding to Elder Mistreatment: Developing and Testing an Online Training for EMS Practitioners

Elder mistreatment is an urgent and under recognized public health concern with devastating consequences for older adults, families, and health systems. Risk for elder mistreatment has increased during the COVID-19 pandemic, further highlighting the urgency to address it. Prehospital emergency medical service (EMS) practitioners have unique opportunities to recognize signs of elder mistreatment but often lack the training and tools required to facilitate consistent identification and intervention. To address this gap, Education Development Center collaborated with a team of expert advisors and EMS practitioners to develop and pilot test Recognizing and Responding to Elder Mistreatment: An Online Training for EMS Practitioners with funding from the RRF Foundation for Aging. This training aims to prepare EMS practitioners to recognize potential mistreatment and report suspected elder mistreatment in line with state laws and their professional code of ethics. In this presentation, we will describe the iterative development process, present results from a pilot test conducted with EMS practitioners in Massachusetts and share strategies and progress for disseminating the training nationally. The pilot study utilized a pre-post design to assess changes in knowledge, attitudes, and practices at baseline, immediately after and two months following participation in the training. Results indicate statistically significant improvements in knowledge related to elder mistreatment identification and response from pre- to post-training and maintenance of these improvements two months later. Participants reported feeling more prepared to address elder mistreatment in their work as EMS practitioners and applying their new knowledge and skills during the two months following the training.

Indicators of Elder Mistreatment: Correlates among Veterans Receiving Care in the Veterans Health Administration

Among community-dwelling adults ages 65 and older, approximately 11% have experienced elder mistreatment (EM), including physical, emotional or sexual abuse, neglect, or financial exploitation. EM research typically focuses on this age group; however, Veterans receiving Veterans Health Administration (VHA) care have increased earlier morbidity, which may accelerate the impacts of EM. Using a cohort of all VHA Veterans 50 years and older with VHA use in 2018-2020, we examined correlates of EM. ICD-10 codes from clinical encounters identified Veterans with indications of EM (n=4,427). A 10% sample of Veterans without indications of EM was selected for comparison (n=530,535). Logistic regression compared EM+ Veterans to the comparison sample and assessed overall demographic and clinical differences as well as differences by age, i.e. 50-64 versus 65 and older. Overall, female gender (OR=5.3, 95% CI=4.3-6.5), non-white race/ethnicity (OR=1.7, CI=1.5-1.9), dementia (OR=3.0, CI=2.6-3.5), PTSD (OR=2.0, CI=1.6-2.5), anxiety (OR=1.3, CI=1.0-1.5), military service connected disability status (OR=1.3, CI=1.1-1.5), and higher Elixhauser medical morbidity scores (OR=1.1, CI=1.1-1.1) were associated with EM. Prior year ER visits (OR=28.0, CI=23.6-33.4), inpatient stays (OR=14.0, CI=11.5-17.0), and mental health visits (OR=26.1, CI=22.2-30.6) also predicted EM+ status. Forty-six percent of VHA Veterans with indicators of EM were aged 50-64. For these Veterans, female gender, PTSD, service connection, and mental health visits were associated with increased risk of EM compared to Veterans 65+. Findings highlight clinical correlates of EMs among Veterans in VHA care. Increased awareness of EM risk factors is warranted and may inform VHA efforts for EM prevention, detection and intervention.

Changes in Elder Mistreatment Risk Factors Reported by Caregivers of Older Adults During the COVID-19 Pandemic

This study aimed to assess how the COVID-19 pandemic has impacted caregiver (CG)-related risk factors for elder mistreatment (EM) in a community sample of CGs. A non-probability sample of 433 CGs caring for care recipients (CRs) age ≥60 years completed a survey on COVID-19 impacts in April-May 2020. Compared to before COVID-19, over 40% of caregivers reported doing worse financially, 16% were experiencing new financial hardship, 19.4% were a lot more worried about their financial situation, 15% reported drinking more alcohol, and 64% had somewhat or greatly increased feelings of social isolation and loneliness. CGs reported that COVID-19 had made caregiving more physically (18.7%), emotionally (48.5%) and financially (14.5%) difficult and interfered with their own healthcare (19%). Differences found between younger and older caregivers will be presented and implications of these increased CG-related EM risk factors for healthcare and social service providers discussed.

Measuring Utility of VASS Elder Mistreatment Screener Within Community Dwelling U.S. Chinese Older Adults

Elder mistreatment (EM) is often underreported, making potential screening a valuable tool. There is limited literature on the screening utility, especially for minority populations. This abstract aims to study sensitivity and specificity of a commonly used 10-point EM screener compared to a detailed EM questionnaire among Chinese older adults. This study used data from a representative sample of 3,157 community-dwelling U.S. Chinese older adults 60+. Chi-squared test was conducted between VASS 10-questionare screener and EM measured by 56 items on psychological, physical and sexual mistreatment, caregiver neglect and financial exploitation subtypes. Sensitivity and specificity was calculated using the Bayes Theorem. In this sample, average age was 72 and 59% female. 637 (20.30%) reported any EM while 475 (15.14%) older adults screened positive for EM. Of participants reporting any EM, 365 (57.30%) did not screen positive for EM. The screener had a sensitivity of 42.70% and specificity of 91.88% for all EM subtypes. Gaps between reported EM and negative EM screener is smaller in psychological (sensitivity 72.85%, specificity 91.07%) and physical (sensitivity 63.64%, specificity 86.66%) EM subtypes, but much larger in financial exploitation (sensitivity 34.60%, specificity 86.85%) and neglect (sensitivity 14.11%, specificity 84.75%). The VASS screener demonstrates poor sensitivity but acceptable specificity rate for any EM. The screener showed better sensitivity and specificity for physical and psychological mistreatment, but performed worse for more common forms of mistreatment like financial exploitation and neglect. Modifying this screener may improve sensitivity and specificity in identifying EM.

Recognizing and Intervening on Elder Abuse, Neglect, and Exploitation in the Age of COVID-19

The rapid outbreak of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to a global pandemic. Public health measures to prevent the spread of COVID-19, such as social distancing and self-quarantine, have drastically altered people’s lives and led to social isolation, financial instability, and disrupted access to healthcare and social services. Older adults have not only borne the brunt of the highest COVID-19 mortality rates, but recent studies also describe growing reports of elder mistreatment. It is necessary to attend to these age-related disparities during the remainder of the COVID-19 pandemic and future health crises. This symposium includes four presentations on researchers’ findings in elder mistreatment during the COVID-19 pandemic. Dr. E-Shien Chang will compare prevalence of elder mistreatment before and since the pandemic, and highlight associated risk and protective factors during the pandemic. Dr. Lena Makaroun will examine changes in elder mistreatment risk factors among caregivers during the pandemic. Dr. Pamela Teaster will present Adult Protective Services’ (APS) policy and practice changes in response to the pandemic to demonstrate the pandemic’s impact on service providers. Lastly, Dr. Pi-Ju (Marian) Liu will appraise elder mistreatment victims’ awareness of COVID-19 and their unmet needs during the pandemic. Following the four presentations, Dr. Pamela Teaster will moderate a discussion on how elder mistreatment is a growing concern, especially during the pandemic, and what service providers are doing to protect older adults.