An Epidemiological Study of the Effects of Elder Abuse on Self-Reported Health and Mental Health Dr. Melba A. Hernandez-Tejada College of Nursing, Medical University of South Carolina Funding sources: National Institute of Justice Archestone Foundation

Goals of the Talk Why are we studying Elder Abuse? Outline Prevalence of Elder Mistreatment Risk Factors/Protective Factors Outline Prevalence of Self-Reported Health Status and Mental Health Problems Role of Elder Mistreatment Next steps: What We are doing in Research and Practice

Why Study Older Adults? - We are an aging country. Second Largest generation is now between 54-70. BTW, We are living longer. - Individuals 60 and over will soon represent one of the largest proportion of the population. They present a challenge to many systems, particularly our culture and our health care system. -Elder issues are increasing in relevance. - Unfortunately one of the most common issues is mistreatment of elders.

The National Elder Mistreatment Study NEMS-I (2010) and NEMS-II (2017) 5,777 COMMUNITY RESIDING adults age 60 UP 60.2% female, 39.8% male Average age 71.5 years (SD = 8.1) 85% White, 7% Black, 4.3% Hispanic The Follow-up (NEMS-II): 774 of original participants, 183 of whom were abuse victims at Wave I

Past Year Emotional Abuse (Overall and Subtypes)

Significant Risk factors & Odds Ratios (OR) for Emotional Mistreatment Lower Age (OR = 3.2) Being Employed (OR = 1.8) Poor Self-Rated Health (ns) Prior Traumatic Event (OR = 2.3) Needing ADL Assistance (OR = 1.8) Low Social Support (OR = 3.2)

Past Year Physical Abuse (Overall and Subtypes)

Significant Risk factors for Physical Mistreatment Lower Age (OR = 4.1) Non-White Racial Status Lower Income Poor Self-Rated Health Prior Traumatic Event Low Social Support (OR = 3.0)

Past Year Sexual Abuse

Sexual Mistreatment: Significant Risk factors Female Gender Low Income Poor Self-Rated Health Prior Traumatic Event Needs ADL Assistance Low Social Support (N too low for accuracy though)

One Risk Factor is common across all types of Mistreatment RISK FACTORS EMOTIONAL PHYSICAL SEXUAL Lower Age x Non-White Low Income Being Employed Poor Self-Rated Health Prior Traumatic Event Low Social Support Use Social Services Needing ADL Assistance

Vice Admiral Vivek Murthy 19th Surgeon General (2014-2017) “During my years caring for patients, the most common pathology I saw was not heart disease or diabetes; it was loneliness. The elderly man who came to our hospital every few weeks seeking relief from chronic pain was also looking for human connection: He was lonely. The middle-aged woman battling advanced HIV who had no one to call to inform that she was sick: She was lonely too. I found that loneliness was often in the background of clinical illness, contributing to disease and making it harder for patients to cope and heal.” Vice Admiral Vivek Murthy 19th Surgeon General (2014-2017) September 2017, Harvard Business Review

Social Support and Elder Mistreatment Prevalence

Rates of Emotional, Physical, and Sexual Abuse in terms of Social Support

So, that was ‘how often’ abuse happens So, that was ‘how often’ abuse happens. And how Social Support can reduce the risk of even being abused How about ’so what,’ as in: what are the effects of abuse and what can make it better or worse

First, Let’s consider effects of abuse 8 years ago on current functioning, without considering other factors (abuse makes it worse)

But now let’s see what happens if we consider high social support, as rated by the older adult today, 8 years after the abuse

Considering effects of Abuse and Social Support simultaneously in terms of outcomes

Summary: Considering Elder Abuse 1 in 10 community-residing older adults reported experiencing elder mistreatment in the past year. The majority of the cases of abuse are out there in the community and NOT in the nursing homes. Only 1 out of 23 cases gets reported. Mot providers don’t know what to do or whom to refer when the older adult is not vulnerable. Follow-up research 8 years later shows social support can protect an older adult after been abused from developing problems with health, anxiety, and depression Social support is a central protective factor, preventing virtually all forms of elder mistreatment, and its outcomes.

Social Support and our role as healthcare providers On the other hand, lack of Social Support is related to all bad things that can happen, and this extends after the abuse…people who don’t have social connections do poorly after abuse. These findings are of extreme relevance to redefine how we see our patients. Social Support is a Modifiable Construct. Visiting your doctor becomes a form of social connection, not only a preventive factor but a protective factor. Social connections prevent abuse, promote resilience, and improve quality of life, particularly after traumatic stressors.

Increasing social support by changing structure and culture Things like redesigned meeting places (benches, tables, public café permits) or easy public Transportation are very likely the most effective, useful, and efficient mental health interventions for older adults. But we also need a cultural shift backwards the “evening walk” Attack ageism: we need to change the way we speak about being old.

THANK YOU Questions? hernanma@musc.edu