Research That Matters (January 17 - 20, 2008)

Purpose: Based on data from a statewide adult protective services (APS) program, the purpose of this study was to examine the association between poverty indicators and elder neglect/self-neglect and elder abuse (physical, psychological, and financial). Despite its serious health and mental health consequences to the victim, empirical studies of etiologies of elder mistreatment are limited. The existing literature on elder mistreatment tends to focus on individual or intrafamily level vulnerability and risk factors, to the neglect of systemic and economic barriers to older adults' ability to provide necessary self-care or family members' capacity to provide adequate caregiving.

Methods: We used the APS assessment data of a representative sample of 579 persons age 60 and older in a southwestern state. The assessment was done in 2005 with a 57-item comprehensive, standardized instrument covering each case's circumstances and service delivery needs in five domains: living conditions; financial status; physical/medical status; mental status; and social interaction/support. We examined the prevalence of each type of mistreatment—medical neglect/self neglect only (e.g., medication outage and not receiving healthcare), other types of neglect/self-neglect, abuse/exploitation. Then, we used multinomial logistic regression to analyze the association between the poverty indicator and the types of mistreatment. Standardized odds ratios were calculated based on partially standardized logistic regression coefficients (using Stata 9) to examine relative contributions of the predictors. We also analyzed caseworkers' detailed narratives about each case.

Results: The individual economic status was assessed by data in the financial and living conditions domains in the assessment instrument, and 35.1% of the study sample were categorized as “poor.” According to the assessment data, 36% were found to have been mistreated, and 34% out of 36% consisted of those with signs of neglect/self-neglect. Medical neglect/self-neglect was the most prevalent problem (23%), and the absolute majority of the medical neglect/self-neglect cases involved not receiving treatment for health problems and not getting medical supplies and medications. Most case notes contained specific statements that the inability to buy medication and medical supplies was “not because of mismanagement of funds but because of lack of funds.” Bivariate analysis showed that there were significantly (p < .001) higher rates of poverty among the mistreated sample than among those without any assessed mistreatment. In multivariate analysis, controlling for functional and cognitive impairments and demographics, poverty was still a significant correlate of all three types of mistreatment. Standardized odds ratios showed that poverty was the most significant of all risk factors.

Implications: A large portion of elder mistreatment was the consequence of the victims' poverty and deficits in safety net programs, especially Medicaid. This failure in public policy, rather than individual and intrafamily risk factors per se, should be considered as a significant cause of suffering among many older adult victims of misreatment and their family caregivers. Social service providers need to rally behind the Elder Justice Act (S. 2010). Social service providers also need to advocate for both federal- and state-level expansion of Medicaid coverage, Medicare provisions, and other long-term care services for vulnerable older adults.