Behind Closed Doors: Ethnicity, Culture, and Substance Use As Risk Factors for Elder Mistreatment

Background:By 2030, the U.S. will undergo a significant demographic transformation. The cultural composition of the older population will be more ethnically diverse than any other older generation in U.S history. Further, these changes will result in a shift of cultural norms and perceptions towards certain phenomena, thus, emphasizing the need for research. Elder mistreatment (EM), also known as “elder abuse”, is defined as “any knowing, intentional, or negligent act by a person that causes harm or a serious risk of harm to a vulnerable adult” and encompasses “physical, psychological, sexual, financial abuse, and neglect.” EM increases mortality in victims 3-6 times. Some common risk factors for victims include: frailty, dementia, depression, psychosis, loss of executive function, alcohol/substance abuse, reduced physical abilities, socially isolation, and being dependent on a caregiver (formal or informal). Perpetrator risk-factors include: “adult child” of the victim, Caucasian, history of substance abuse, and dependency on the victim’s resources. Research has found that perceptions and reporting behaviors vary greatly across ethnicities and the World Health Organization has designated culture as a risk factor for EM. Also of great concern is the increased substance use (SU) among older adults specifically due to the aging of the “baby-boomer” generation. The Institute of Medicine reports that older adults in need of substance use treatment will almost double to 6 million by 2020 and we as a society are ill prepared. True prevalence and incident rates of SU related EM remains unknown due to underreporting and cultural perceptions of EM. Further study is needed to determine the true scope of the problem.

Methods:An exploratory quantitative secondary analysis of Texas Adult Protective Services archived data of substantiated EM cases (N= 7580) between 2004-2008 was performed. Demographic, EM type and SU data were assessed.

Results: Mean age of the sample was 70 (SD=5.3). SU associated EM occurred in n=465 (6.1%) of the cases. SU victims represented 32% of cases, 63% were caregivers, and 5% were a combination. Most common types of abuse among SU victims were physical neglect (n=139), medical neglect (n=64), and mental health neglect (n=35). Among SU caregivers, physical neglect (n=158), emotional/verbal abuse (n=148), and physical abuse (n=148) were most common. Further exploratory results revealed that medical (OR=4.2, 95%CI: 2.6-6.5), physical (OR=13.0, 95%CI: 6.4-26.5) and mental health neglect (OR=8.7, 95%CI: 4.2-18.1) was statistically reliably associated with victim SU compared to caregiver SU. However, when caregivers were using substances, emotional/verbal abuse (OR=75.6, 95%CI: 18.4-310.7) and physical abuse (OR=12.8, 95%CI: 3.9-41.6) were most common. Ethnically, the most frequent type of abuses reported were: Physical neglect Blacks (n=2299), Whites (n=2172), Other (n=948), and Hispanics (n=737); Medical neglect Blacks (n=589), Whites (n=561), Other (n=214), and Hispanics (n=189); Emotional/verbal abuse Whites (n=273), Blacks (n=191), and Hispanics (n=134); and Financial exploitation Whites (n=160), Blacks, (n=117), and Hispanics (n=40).

Conclusions: This study found that SU, culture, and ethnicity were significant risk factors for EM and that types and intensity of EM varied across ethnicities. More studies are needed to inform identification, prevention, and intervention efforts.