Prevalence and Correlates of Emotional, Physical, Sexual, and Financial Abuse and Potential Neglect in the United States: The National Elder Mistreatment Study

摘要

Objectives. We estimated prevalence and assessed correlates of emotional, physical, sexual, and financial mistreatment and potential neglect (defined as an identified need for assistance that no one was actively addressing) of adults aged 60 years or older in a randomly selected national sample. Methods. We compiled a representative sample by random digit dialing across geographic strata. We used computer-assisted telephone interviewing to standardize collection of demographic, risk factor, and mistreatment data. We subjected prevalence estimates and mistreatment correlates to logistic regression. Results. We analyzed data from 5777 respondents. One-year prevalence was 4.6% for emotional abuse, 1.6% for physical abuse, 0.6% for sexual abuse, 5.1% for potential neglect, and 5.2% for current financial abuse by a family member. One in 10 respondents reported emotional, physical, or sexual mistreatment or potential neglect in the past year. The most consistent correlates of mistreatment across abuse types were low social support and previous traumatic event exposure. Conclusions. Our data showed that abuse of the elderly is prevalent. Addressing low social support with preventive interventions could have significant public health implications. The National Elder Abuse Incidence Study, 1 conducted more than a decade ago, was the first major investigation of mistreatment of the elderly in the United States. It found that 449 924 persons aged 60 years or older had been physically abused, neglected, or in some way mistreated in 1996. However, the study did not solicit data directly from older adults; rather, it assessed Adult Protective Service records and sentinel (e.g., community professionals) reports. Thus, it is very likely that the results greatly underestimated the true scope of the problem of abuse of older Americans, because a large majority of cases are unreported and are undetected by monitoring agents. In another, earlier investigation, more than 2000 older adults in the Boston area were directly questioned about their experiences. 2 Extrapolated data indicated that approximately 1 000 000 US adults had experienced abuse since reaching age 60 years, with 2% reporting physical abuse and 1.1% verbal abuse. Only approximately 1 in 14 cases was reported to authorities. Other investigators have conducted preliminary assessments of abuse prevalence among the elderly, but most were completed 2 to 3 decades ago. A telephone survey of 2000 randomly selected elderly Canadians found that 0.5% suffered physical abuse and 1.4% emotional abuse since they reached age 60 years. 3 In a random sample of older adults in New Jersey, researchers found an abuse rate of approximately 1%. 4 In a sample of elderly persons in Maryland, the rate was 4.1%. 5 A study of respite care workers in Great Britain found that 45% admitted committing either verbal (41%) or physical (14%) abuse since they began working with the elderly. 6 Interestingly, frequency of patient reports of abuse was less than that of caregivers. Finally, a record review of 404 patients in a chronic illness center identified abuse symptoms in 9.6% of participants. 7 Most recently, Laumann et al. appended mistreatment questions to the National Social Life, Health, and Aging Project, a study of a nationally representative sample of older Americans. 8 The survey asked 3005 individuals aged 57 to 85 years about past-year physical, verbal, and financial abuse. Two thirds were interviewed in person, and the remainder completed a booklet of questions that was left for participants to read and answer independently (i.e., with no interviewer present). Past-year prevalence was 9.0% for verbal, 0.2% for physical, and 3.5% for financial mistreatment. Respondents toward the younger end of this age range were more likely to experience verbal and financial mistreatment. Women and physically frail elderly persons were more likely to experience verbal mistreatment, African Americans and those in poor health were more likely to report financial exploitation, and Latinos were less likely than respondents from other ethnic groups to report either form of victimization. This study, although it improved on previous investigations of the problem, had significant limitations. It did not query about some forms of abuse (e.g., sexual assault and neglect were not studied). Moreover, each type of abuse was assessed with only 1 short question. The literature on the epidemiology of interpersonal violence against younger and middle-aged adults demonstrates that to identify abuse and assault events adequately, assessments need to use comprehensive, behaviorally defined descriptions of interpersonal violence events in closed-ended questions. 9 To build on existing research and address the limitations of previous studies, we designed a study of mistreatment among the elderly in the United S