Mental Health Correlates and Service Utilization Among Older Adults at Risk for Elder Maltreatment

Background and Purpose: Despite recent research pointing to the serious criminal and social justice problem of abuse, neglect, and financial exploitation of older adults, the field knows relatively little about the mental health consequences and service needs of older adults who experience maltreatment. National estimates suggest that more than 10% of older adults have experienced maltreatment and that financial exploitation costs billions of dollars annually. Research is urgently needed to guide how legal, health, and social service providers respond to maltreatment, especially given the increasing support provided by the federal Elder Justice Act of 2010. This paper describes the collaboration between researchers and an interdisciplinary coalition of legal, adult protective services, intimate partner violence, and senior service agencies to identify (1) mental health correlates for abuse, neglect, and financial exploitation, and (2) patterns of service utilization and service gaps in a diverse sample of older adults. 

Methods:  In 2013, we conducted 99 structured, in-person interviews with a sample of older adults at risk for abuse, neglect and exploitation for this descriptive, cross-sectional study.  Participants were invited to contact researchers by the agencies involved in the interdisciplinary coalition.  Trained research assistants conducted the two-hour long interviews that included standardized measures for assessing experience of abuse, neglect, and exploitation; mental health symptoms (Patient Health Questionnaire-9, Post-Traumatic Diagnostic Scale, and the Short-Form-12 for quality of life); and health, legal, and social service use in the past six months. Current rates for abuse, neglect, and exploitation, mental health symptoms, and service use are described.  Multiple regression analysis tested the hypothesis that maltreatment is directly associated with mental health symptoms.  

Results: Participants were above age 60, majority female (89%), mostly widowed (39%) or divorced (30%), about half living alone, and mostly minority older adults (59% African American; 10% Latino/a).  Within the last year, the percent of participants reporting some form of emotional abuse (i.e., saying mean things to you, being humiliated, harassed, ignored) was 23%, physical abuse was less than 1%, and financial exploitation was 11%. Services most frequently used in the last six months included: doctor visits (95%), activity programs (44%), senior center (32%), religious leader (31%), self-help or support groups (23%), caseworker (22%), and hospital stay overnight (20%).  About 10% of participants reported using specialty mental health services or legal services. While rates of depression and PTSD are on par with national estimates, they were not signicantly associated with experience of maltreatment.

Conclusions and Implications: Findings indicate a need for responding to elder maltreatment, particularly in terms of emotional abuse and financial exploitation. The need for interdisciplinary response to maltreatment is evident, given that health and social service providers are more likely to come in contact with at-risk older adults, yet these older adults may have unmet needs in legal, financial, and mental health services.  Additionally, with the link between current mental health needs and maltreatment, future longitudinal research should include evaluation of mental health symptoms to clarify their role as risk factors, consequences, and modifiable outcomes of interventions.