Childhood Adversities, Midlife Health, and Elder Abuse: Use of Cumulative Disadvantage Theory to Understand Late Life Victimization

Objectives: Victimization of adults in late life is increasingly recognized as a pressing public health concern. Prevalence studies suggest that nearly one in ten adults over age 65 will experience at least one form of elder abuse (i.e., physical, psychological, and sexual abuse; neglect; financial exploitation) in the past year, often with devastating consequences (e.g., hospitalizations, chronic diseases, mental health problems, health care costs). Pioneering research has recently linked childhood adversities to elder abuse. However, little is known about mechanisms through which early trauma may increase the risk of being victimized in late life. Guided by cumulative disadvantage theory, the current study examined whether compromised health in middle adulthood mediates the association between child abuse and elder abuse.

Methods: This secondary, longitudinal analysis was based on data from the Wisconsin Longitudinal Study, a population-based, multi-wave dataset that followed lives of high school graduates from 1957 to present. We analyzed responses from 5,968 participants (mean age = 71 years; 54% female) on adapted versions of standardized measures. The outcome variable was elder victimization (Abusive Behaviors Inventory). The independent variable, childhood adversities, was a count measure of seven items which corresponded to Adverse Childhood Experiences. Mediator variables included three domains of health: physical (self-rating), psychological (Center for Epidemiologic Studies Depression scale), and cognitive (Weschler Adult Intelligence Scale). Retention rates were high for the six-decade study: 76.2%, after adjusting for mortality and non-response bias. Missing data were addressed through the Full Information Maximum Likelihood approach. After univariate and bivariate analyses, serial multiple mediation models were conducted using data from three of the waves, controlling for background characteristics (e.g., gender, marital status, family background).

Results: Rates for elder abuse and child adversities were, respectively, 16.3% and 47.9%. Multivariate analyses supported the cumulative disadvantage hypothesis. Childhood adversities (0.11, p < .001) and midlife health (physical, -0.09, p < .05; psychological distress, 0.09, p < .001; cognitive, 0.03, p < .01) had significant direct effects on elder victimization. Childhood adversities also had an indirect effect on elder abuse through two domains of health in middle adulthood, both in serial: physical health (0.002, p < .05) and psychological distress (0.01, p < .001).

Discussion: This innovative study provides empirical evidence that early childhood trauma can increase vulnerability to subsequent abuse, more than fifty years later in older adulthood. As important, results represent a breakthrough in gerontological scholarship around cumulative disadvantage theory, as they identify mechanisms in midlife (i.e., compromised physical and psychological health) that help explain the association between childhood adversities and elder abuse. National, cross-disciplinary efforts to reduce elder abuse, as well as clinical assessment and treatment resources, should adopt a broader, more comprehensive approach to life course trauma. Public health programs aimed at preventing child abuse or boosting health in middle adulthood represent two levels to reduce risks of elder abuse, a compelling example of how social work science can affect social change. Future research should explore factors that can mitigate long-term health effects of early trauma.