Risk Factors for Community-Based Elder Abuse and Neglect Using a Population-Based Study

Background and Purpose: Elder abuse (EA) is increasingly recognized as a public health crisis and represents a major challenge facing a population with increased longevity. At the foundation of this problem, EA risk factors remain misunderstood. Previous population-based EA risk factor research has failed to use standard EA definitional/inclusion parameters or adaptations of established measurement tools to measure EA types. These methodological limitations threaten the validity and reliability of existing EA risk factor knowledge. The present paper used data from the most methodologically rigorous population-based EA study conducted to date – New York State Elder Abuse Prevalence Study (NYSEAPS) – to identify risk factors of three EA types: emotional abuse, physical abuse and neglect. We hypothesized that older adults with higher levels of physical vulnerability, co-habitation, victim-perpetrator relationship imbalance, and socio-cultural disadvantage would be at increased risk of EA.

Methods: The NYSEAPS used a random digit-dial sampling strategy to conduct direct telephone interviews with a representative sample (n = 4156) of older adults in New York State. Inclusion criteria captured adults aged 60 years or above who were living in the community, cognitively intact, and English/Spanish-speaking. In accordance with accepted EA definitions, EA was conceptualized as occurring in any relationship of trust. Elder emotional and physical abuse outcomes were assessed using a modified version of the Conflict Tactics Scale. Elder neglect was measured using a modified version of the Duke Older Americans Resources and Services scale. Potential risk factors were examined at several ecological levels of influence, including the individual victim, victim-perpetrator relationship, home living environment, and surrounding socio-cultural context. Multivariate logistic regression was used to model one-year incidence of each EA type.

Results: Older adults who were younger, functionally impaired, living in a low-income household, separated/divorced, and did not live with a spouse/partner had significantly higher odds of emotional abuse and physical abuse in the past year. Older adults who were younger, separated/divorced, living below the poverty line, non-Hispanic, and in poor health had significantly higher odds of elder neglect in the past year.

Conclusions and Implications: An identical set of risk factors predicted elder emotional and physical abuse, while elder neglect demonstrated its own set of risk factors. The literature has struggled to develop separate theoretical risk models for different EA types. With theoretical implications, findings from this study indicate that emotional and physical abuse could be represented by one risk model, while the distinct risk profile underlying neglect justifies its own theoretical representation. These EA incidence risk factor findings carry direct implications for primary and tertiary public policy and prevention/intervention initiatives aimed at preventing EA. This paper presents, arguably, the most valid and reliable elder emotional abuse, physical abuse and neglect risk factor knowledge available to date. Future EA risk factor research should implement a national, longitudinal design to keep advancing the literature.