1. 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

2. 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.

3. 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

4. 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

5. 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

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

7. 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

8. Types of Abuse in Milwaukee County

9. Referral Sources in Milwaukee County

10. Referral source by type of abuse Category of Abuse Referred by Others (%) Referred by Medical Professionals (%) Crude odds ratio (95% CI) P-value Self-Neglect39.0447.461.41 (1.01, 1.97)0.0474** Financial Exploitation 29.4810.730.29 (0.17, 0.48)<0.0001** Neglect by Others 13.5819.771.57 (1.02, 2.42)0.0435** Emotional Abuse 8.648.470.98 (0.54, 1.78)1.0000 Physical Abuse8.1812.431.59 (0.94, 2.70)0.1033

11. Profile of Elder Gender: Female

12. Elder gender by type of abuse Category of Abuse Men (%) Women (%) Crude odds ratio (95% CI) P-value Self-Neglect48.0337.060.64 (0.48, 0.85)0.0027** Financial Exploitation 27.9624.220.82 (0.59, 1.14)0.2722 Neglect by Others11.8316.511.47 (0.96, 2.26)0.0741 Emotional Abuse3.5811.193.39 (1.71, 6.73)0.0002** Physical Abuse4.1017.314.89 (2.89, 8.28)<0.0001**

13. Profile of Elder Age: Older Elders (75+)

14. Profile of Elder Living Arrangements

15. Elder living arrangement by type of abuse Category of Abuse Living with Others (%) Living Alone (%) Crude odds ratio (95% CI) P-value Self-Neglect27.1863.554.67 (3.45, 6.32)<0.0001** Financial Exploitation 26.6023.550.85 (0.61, 1.18)0.3642 Neglect by Others 20.395.810.24 (0.14, 0.41)<0.0001** Emotional Abuse12.232.580.19 (0.09, 0.40)<0.0001** Physical Abuse12.0417.330.32 (0.17, 0.59)<0.0001**

16. 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%

17. Profile of Abuser: Gender

18. Abuser gender by type of abuse Category of Abuse Men (%) Women (%) Crude odds ratio (95% CI) P-value Financial Exploitation 38.5244.211.26 (0.89, 1.81)0.2044 Neglect by Others17.7831.332.11 (1.39, 3.20)0.0005** Emotional Abuse17.0410.731.59 (1.01, 2.50)0.0536 Physical Abuse18.5210.730.53 (0.32, 0.89)0.0169**

19. Profile of Abuser: Relationship

20. 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%

21. 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