Elder Abuse, Sleep Disturbance, and Anxiety: The Role of a Close Friend

Background/Purpose

Elder abuse (hereafter EA) is a global public health concern and human rights violation. About 11% of U.S. older adults each year report having experienced EA (Yoon, 2024); however, the extent has been underestimated due to underreporting and misunderstandings (Dong, 2015). Among the many devastating health consequences of EA, poor sleep deserves more research attention (Yunus et al., 2017). Previous research shows that EA is associated with sleep disturbances and adverse mental health outcomes such as anxiety (Babar et al., 2000; Ford & Kamerow, 1989; Yoon & Mahapatra, 2024). Another even more understudied area for investigation is protective factors against adverse mental health outcomes caused by EA victimization. (Yoon, 2024; Yoon & Cummings, 2019). Support from close friends has been reported as a protective factor against adverse mental health outcomes resulting from EA (Yoon, 2024). This study investigated the direct association between EA and anxiety, the indirect association between EA and anxiety through sleep disturbance, and the moderating effect of having a close friend (hereafter, a friend) on the association between EA and anxiety.

Methods

Data came from in-person and telephone interviews with 5,928 participants in the Wisconsin Longitudinal Study, Graduate Wave 3 (ages 70-73). A Maximum Likelihood estimation was employed for missing values (Enders, 2022). Analysis was conducted via a conditional process model using PROCESS macro (Hayes, 2022). One independent variable, EA, was measured using an item derived from Shepard & Cambell’s (1992) Abusive Behavior Inventory (Shepard & Campbell, 1992). Individual reports of at least one EA experience in the past 12 months were coded as EA (yes=1, no=0). The dependent variable, anxiety (α = .875), was measured with a seven-item version of the Spielberger State-Trait Anxiety Inventory (Kvaal et al., 2005). Analysis was conducted using the sum of square root values. The mediator, sleep disturbance, was measured by asking, “On how many days during the past week did you sleep restlessly?” (0= none, 7= every day in the past week). The moderator, a friend, was measured by asking, “Is there a friend outside your family with whom you really can share your very private feelings and concerns?” (yes=1, no=0). The mean-centered values of the continuous variable were employed for the interaction term between EA and a friend. Covariates were income, gender, physical health, education, and marital status. A 95% confidence interval was estimated using 5,000 bootstrap samples for indirect effects.

Results

EA was positively associated with sleep disturbance and anxiety. Sleep disturbance was positively associated with anxiety. In addition, EA was associated with anxiety through sleep disturbance. A friend was not significantly associated with anxiety. However, the interaction between EA and a friend was significant. Although EA was significantly associated with anxiety, older adults with a friend showed significantly lower anxiety than older adults without a friend.

Conclusions and Implications

EA may result in poor sleep and anxiety. However, a friend may reduce the adverse mental health outcomes. Screening for EA and assessing sleep quality while promoting reliable social connectedness is crucial for effective and timely interventions.