Prevalence and Correlates of Elder Abuse and Neglect in a Geriatric Psychiatry Service

Abstract

Objective: To determine the prevalence and correlates of 4 types of elder abuse and neglect in a geriatric psychiatry service. Method:We conducted a cross-sectional retrospective chart review of new in-and outpatients seen by the Montreal General Hospital Division of Geriatric Psychiatry in one calendar year.Results: Abuse or neglect was suspected or confirmed in 20 (16%) of 126 patients, comprising financial abuse in 16 (13%), neglect in 7 (6%), emotional abuse in 5 (4%), physical abuse in 3 (2%), and multiple abuse in 7 (6%). On bivariate analysis, patients living with nonspouse family, friends, or other persons were significantly more likely to have suffered abuse than were those living with their spouse or in a supervised setting (OR 10.5; 95%CI, 2.3 to 47.8); widowed, divorced, or separated patients were significantly more likely to have suffered abuse than were married patients (OR 4.7; 95%CI, 1.02 to 22.0). Nonsignificant trends included female sex (OR 4.1; 95%CI, 0.89 to 18.6); alcohol abuse (OR 2.1; 95%CI, 0.71 to 6.2); behaviour problems (OR 1.9; 95%CI, 0.71 to 5.2); and chronic cognitive impairment (OR 1.4; 95%CI, 0.55 to 3.8). Although living situation with nonspouse family, friends, or others and marital status of widowed, divorced, or separated were significantly associated with abuse when examined in separate logistic regression models, both were nonsignificant when examined together, suggesting collinearity. Both were retained in the model because they probably represent different aspects of vulnerability. The final model included living situation with nonspouse family, friends, or others (OR 6.1; 95%CI, 0.75 to 49.5) and widowed, divorced, or separated marital status (OR 2.4; 95%CI, 0.21 to 26.8). Nonsignificant trends included female sex (OR 2.6; 95%CI, 0.45 to 14.4); alcohol abuse (OR 2.2; 95%CI, 0.59 to 7.9); and lowest quartile on the Global Assessment of Functioning (GAF) scale (GAF < 35; OR 2.0; 95%CI, 0.64 to 6.0). Conclusions:The practical implications of our study are that elder abuse and neglect are common among patients referred to geriatric psychiatry services, that such services should have access to multidisciplinary expertise and resources to deal with abuse, and that certain situations may signal higher risk. In our setting, the situation of living with nonspouse family, friends, or other persons in a nonsupervised setting and a history of family disruption by widowhood, divorce, or separation were significant correlates of abuse. Suggestive but nonsignificant trends of potential importance (OR ³ 2.0) included female sex, alcohol abuse, and lowest quartile of functional status. Study limitations include a cross-sectional retrospective chart review design, a clinically derived sample, a small sample size, and a lack of structured instruments for several variables. (Can J Psychiatry 2002; 47;459-467)

Abuse and Neglect Experienced by Aging Chinese in Canada

“…The correlates or factors identified were similar to the ones of abuse and neglect of older people in the general population (MacLean, 1995;Quinn & Tomita, 1986;Vida, Monks, & Des Rosiers, 2002) except for the fact that abuser dependency on the victim as a correlate (Pillemer, 1986;Wolf & Pillemer, 1989) has not emerged in the findings on the older Chinese. A probable reason for this is that within Chinese culture, as the children, particularly the sons, have grown up, there is a strong sense of expectation that they should be responsible for providing care to their aging parents (Cheng & Chan, 2006;Sung, 2001;Yu, 1983) instead of relying on their parents.…”

Developing an Empirical Profile for Elder Abuse Research in Canada

“…Conclusions with respect to determinants of elder abuse are precluded by methodological limitations including inconsistent definitions of elder abuse, nonrandom research designs, a lack of appropriate control groups, the use of assessment tools demonstrating limited reliability and validity, and a reliance on retrospective reports (Vida, Monks, & DesRosiers, 2002). For example, in a study of screening instruments, 90 articles in the English literature that discussed risk factors were identified; of these, 18 included a screening tool but only 6 provided information regarding the reliability and validity of the instrument (Shott, Ploeg, & Hutchinson, 1999).…”

Mandatory Reporting of Elder Abuse: Between a Rock and a Hard Place

“…4,[7][8][9][10][11][12] Risk factors include a shared living environment, cognitive or functional impairment, depression, and alcohol abuse. [12][13][14][15][16][17][18] The American Medical Association (AMA) has advocated for health care professionals to assume a greater responsibility in addressing elder abuse. 19 Based partially on the Older Americans Act of 1975, 33 states currently have some form of mandatory reporting of elder abuse.…”