Risk Factors for Elder Abuse and Neglect Megan M Doty, M-2 Linda N Meurer, MD, MPH Annie L Nguyen, MPH Medical College of Wisconsin

Co-authors/ Partners Milwaukee County Department on Aging  Linda Cieslik, PhD  Ramona Williams, MSW  Chester Kuzminski, MDiv Medical College of Wisconsin  Kevin Hamberger, PhD  Syed Ahmed, MD, DrPH Supported by: Department of Family and Community Medicine, the Cardiovascular Research Center and the Injury Research Center, Medical College of Wisconsin And the Healthier Wisconsin Partnership Program, part of the Advancing Healthier Wisconsin endowment at MCW.

Background Elder abuse: “any knowing, intended or careless act that causes harm or serious risk of harm to an older person – physically, mentally, emotionally, or financially.”  Physical, Sexual, Psychological, Financial  Self-Neglect, Neglect by others Prevalence: 2% to 10%  1 of 6 cases are reported In Wisconsin in 2006: 4,372 cases  825 were from Milwaukee County

Purpose SANE project: to improve recognition and reporting by community-based health and service providers Two-part project focusing on risk factors of elder abuse and neglect  Literature review on the risk factors  Profile of elder abuse in Milwaukee county To help identify patients at high risk of abuse To provide baseline data for the SANE project

Methods Comprehensive review of the literature to find all comparative studies that evaluate risk factors or characteristics of victims and abusers Descriptive analysis of data on elder abuse/neglect reports collected by Milwaukee County Department on Aging (MCDA) Call Center  Data provided by Wisconsin Incident Tracking System  STATA was used for statistical analysis

Socio-ecologic model of EA risk indicators Meurer & Doty, 2008

WITS Data Wisconsin Incident Tracking System  Reports of elder abuse and neglect to MCDA  Variables collected include: Incident of abuse or neglect Demographic data Medical conditions Outcome and services offered

Types of Abuse in Milwaukee County

Referral Sources in Milwaukee County

Referral source by type of abuse Category of Abuse Referred by Others (%) Referred by Medical Professionals (%) Crude odds ratio (95% CI) P-value Self-Neglect (1.01, 1.97)0.0474** Financial Exploitation (0.17, 0.48)<0.0001** Neglect by Others (1.02, 2.42)0.0435** Emotional Abuse (0.54, 1.78) Physical Abuse (0.94, 2.70)0.1033

Profile of Elder Gender: Female

Elder gender by type of abuse Category of Abuse Men (%) Women (%) Crude odds ratio (95% CI) P-value Self-Neglect (0.48, 0.85)0.0027** Financial Exploitation (0.59, 1.14) Neglect by Others (0.96, 2.26) Emotional Abuse (1.71, 6.73)0.0002** Physical Abuse (2.89, 8.28)<0.0001**

Profile of Elder Age: Older Elders (75+)

Profile of Elder Living Arrangements

Elder living arrangement by type of abuse Category of Abuse Living with Others (%) Living Alone (%) Crude odds ratio (95% CI) P-value Self-Neglect (3.45, 6.32)<0.0001** Financial Exploitation (0.61, 1.18) Neglect by Others (0.14, 0.41)<0.0001** Emotional Abuse (0.09, 0.40)<0.0001** Physical Abuse (0.17, 0.59)<0.0001**

Profile of Elder Additional Characteristics Frail: 81.3% Cognitively impaired: 15.4% Physically disabled: 7.5% Mental illness: 5.9% ADS/ EtOH Use: 4.7%

Profile of Abuser: Gender

Abuser gender by type of abuse Category of Abuse Men (%) Women (%) Crude odds ratio (95% CI) P-value Financial Exploitation (0.89, 1.81) Neglect by Others (1.39, 3.20)0.0005** Emotional Abuse (1.01, 2.50) Physical Abuse (0.32, 0.89)0.0169**

Profile of Abuser: Relationship

Profile of Abuser Additional Characteristics Lives with elder: 51.5% Caregiver: 37.5% Drug abuse: 9.0% ADS/ EtOH abuse: 5.7% $$ dependence: 5.5% Mental illness: 3.9% Cognitively impaired:1.6%

Discussion Milwaukee abuse profile: frail, older, female victims, abused by family or friends Limitations  Majority of studies are retrospective  Existing literature relies on reported cases Final conclusions  Preliminary results need further investigation  More prospective studies are needed  Improvements for MCDA database