Risk Factors for Elder Abuse and Neglect Megan

Risk Factors for Elder Abuse and Neglect Megan M Doty, M-2 Linda N Meurer, MD, MPH Annie L Nguyen, MPH Medical College of Wisconsin

Co-authors/ Partners n Milwaukee County Department on Aging ¨ Linda Cieslik, Ph. D ¨ Ramona Williams, MSW ¨ Chester Kuzminski, MDiv n Medical College of Wisconsin ¨ Kevin Hamberger, Ph. D ¨ Syed Ahmed, MD, Dr. PH Supported by: Department of Family and Community Medicine, the Cardiovascular Research Center and the Injury Research Center, Medical College of Wisconsin And the Healthier Wisconsin Partnership Program, part of the Advancing Healthier Wisconsin endowment at MCW.

Background n Elder abuse: “any knowing, intended or careless act that causes harm or serious risk of harm to an older person – physically, mentally, emotionally, or financially. ” ¨ Physical, Sexual, Psychological, Financial ¨ Self-Neglect, Neglect by others n Prevalence: 2% to 10% ¨ 1 n of 6 cases are reported In Wisconsin in 2006: 4, 372 cases ¨ 825 were from Milwaukee County

Purpose SANE project: to improve recognition and reporting by community-based health and service providers n Two-part project focusing on risk factors of elder abuse and neglect n ¨ Literature review on the risk factors ¨ Profile of elder abuse in Milwaukee county To help identify patients at high risk of abuse n To provide baseline data for the SANE project n

Methods n Comprehensive review of the literature to find all comparative studies that evaluate risk factors or characteristics of victims and abusers n Descriptive analysis of data on elder abuse/neglect reports collected by Milwaukee County Department on Aging (MCDA) Call Center ¨ Data provided by Wisconsin Incident Tracking ¨ STATA was used for statistical analysis System

Socio-ecologic model of EA risk indicators Meurer & Doty, 2008

WITS Data n Wisconsin Incident Tracking System ¨ Reports of elder abuse and neglect to MCDA ¨ Variables collected include: Incident of abuse or neglect n Demographic data n Medical conditions n Outcome and services offered n

Types of Abuse in Milwaukee County 45% 40. 85% 40% 35% 30% 25. 45% 20% 14. 91% 15% 8. 61% 10% 9. 09% 5% 0. 73% 0% Self-Neglect Financial Exploitation Neglect by Other(s) Emotional Abuse Physical Abuse 0. 12% Sexual Abuse Unreasonable Confinement 0. 24% Other

Referral Sources in Milwaukee County

Referral source by type of abuse Category of Abuse Referred by Others (%) Referred by Medical Professionals (%) Crude odds ratio (95% CI) Self-Neglect 39. 04 47. 46 1. 41 (1. 01, 1. 97) 0. 0474** Financial Exploitation 29. 48 10. 73 0. 29 (0. 17, 0. 48) <0. 0001** Neglect by Others 13. 58 19. 77 1. 57 (1. 02, 2. 42) 0. 0435** Emotional Abuse 8. 64 8. 47 0. 98 (0. 54, 1. 78) 1. 0000 12. 43 1. 59 (0. 94, 2. 70) 0. 1033 Physical Abuse 8. 18 P-value

600 Profile of Elder Gender: Female 545 Female Male 500 400 300 279 202 200 134 132 78 100 90 61 33 54 10 21 6 0 Total Self-Neglect Financial Neglect by Exploitation Other(s) Emotional Abuse Physical Abuse Sexual Abuse

Elder gender by type of abuse Category of Abuse Men (%) Women (%) Crude odds ratio (95% CI) P-value Self-Neglect 48. 03 37. 06 0. 64 (0. 48, 0. 85) 0. 0027** Financial Exploitation 27. 96 24. 22 0. 82 (0. 59, 1. 14) 0. 2722 Neglect by Others 11. 83 16. 51 1. 47 (0. 96, 2. 26) 0. 0741 Emotional Abuse 3. 58 11. 19 3. 39 (1. 71, 6. 73) 0. 0002** Physical Abuse 4. 10 17. 31 4. 89 (2. 89, 8. 28) <0. 0001**

Profile of Elder Age: Older Elders (75+) 45% 42. 1% 40% 35. 8% 35% 30% 27. 4% 24. 7% 25. 2% 23. 9% 20% 15% 10% 12. 2% 8. 8% 5% 0% 60 to 64 years % 65 to. WITS 74 years Census 75% to 84 years 85 years and over

Profile of Elder Living Arrangements 70% 63. 8% Living Alone Living with Others 60% 50% 40% 30% 27. 5% 26. 9% 23. 6% 20% 12. 6% 10% 5. 8% 2. 6% 0% Self-Neglect Financial Exploitation Neglect by Others 12. 4% 4. 2% Emotional Abuse Physical Abuse

Elder living arrangement by type of abuse Category of Abuse Living with Others (%) Living Alone (%) Crude odds ratio (95% CI) P-value Self-Neglect 27. 18 63. 55 4. 67 (3. 45, 6. 32) <0. 0001** Financial Exploitation 26. 60 23. 55 0. 85 (0. 61, 1. 18) 0. 3642 Neglect by Others 20. 39 5. 81 0. 24 (0. 14, 0. 41) <0. 0001** Emotional Abuse 12. 23 2. 58 0. 19 (0. 09, 0. 40) <0. 0001** Physical Abuse 12. 04 17. 33 0. 32 (0. 17, 0. 59) <0. 0001**

Profile of Elder Additional Characteristics n n n Frail: Cognitively impaired: Physically disabled: Mental illness: ADS/ Et. OH Use: 81. 3% 15. 4% 7. 5% 5. 9% 4. 7%

Profile of Abuser: Gender 110 104 103 Male 100 Female 90 80 73 70 60 48 50 50 46 40 30 25 25 20 16 10 5 5 1 0 Financial Exploitation Neglect by Other(s) Emotional Abuse Physical Abuse Self-Neglect Sexual Abuse

Abuser gender by type of abuse Category of Abuse Men (%) Women (%) Crude odds ratio (95% CI) P-value Financial Exploitation 38. 52 44. 21 1. 26 (0. 89, 1. 81) 0. 2044 Neglect by Others 17. 78 31. 33 2. 11 (1. 39, 3. 20) 0. 0005** Emotional Abuse 17. 04 10. 73 1. 59 (1. 01, 2. 50) 0. 0536 Physical Abuse 18. 52 10. 73 0. 53 (0. 32, 0. 89) 0. 0169**

Profile of Abuser: Relationship

Profile of Abuser Additional Characteristics n n n n Lives with elder: Caregiver: Drug abuse: ADS/ Et. OH abuse: $$ dependence: Mental illness: Cognitively impaired: 51. 5% 37. 5% 9. 0% 5. 7% 5. 5% 3. 9% 1. 6%

Discussion n n Milwaukee abuse profile: frail, older, female victims, abused by family or friends Limitations ¨ Majority of studies are retrospective ¨ Existing literature relies on reported cases n Final conclusions ¨ Preliminary results need further investigation ¨ More prospective studies are needed ¨ Improvements for MCDA database