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This article presents a theoretical framework for the study of social and behavioral factors associated with elder self-neglect. The model presented reflects the authors' beliefs that a risk-vulnerability model offers a useful framework from which to study all forms of elder mistreatment, as well as elder self-neglect. This model has particular utility, because it can begin to define the elements of risk and vulnerability that may be addressed using preventative measures as opposed to solely addressing intervention, which is often the case when addressing elder mistreatment and self-neglect. The authors then address a method for using the Consortium for Research in Elder Self-neglect of Texas data as currently constructed and adding to that database to effectively study risks and vulnerabilities in the elder self-neglect population. These additional data would greatly expand the scope of the study. The discussant adds his perspective to the ideas proposed by the authors.

Elder mistreatment is a serious issue that effects the lives of thousands of older adults and results in emotional difficulties, such as depression,feelings of inadequacy, self-loathing, and lowered self-esteem. It has been shown to result in family distress, impaired life functioning, and difficulties with cognition and has been linked to health problems,such as immunologic dysfunction, and increased mortality. As the population ages, and with it the numbers of persons afflicted by diseases such as Alzheimer's, understanding and recognizing elder mistreatment becomes an important factor in maintaining quality of life for older adults.

This study examined verbal aggression in a sample of community dwelling older adults with Alzheimer's Disease (AD) using the Risk and Vulnerability model as a means for identifying factors associated with verbal mistreatment in caregiver/patient dyads.Subjects were recruited in the State of Florida through their association with state-funded memory disorder clinics or with local chapters of the Alzheimer's Association. The sample for this analysis consisted of 254 caregivers who completed both a questionnaire and an in-home interview between the years 1998 and 2002. Verbal mistreatment was measured using the verbal aggression sub-scale of the Conflict Tactics Scale and logistic regression analysis was used to examine factors associated with increased risk.Verbal aggression as a conflict resolution style was self reported by 60.1% of caregivers, and was reported as a technique used against them by 74.8% of family members with AD. Logistic regression analysis suggests that factors associated with increased risk for verbal aggression by caregivers included being female, providing care to verbally aggressive elders, caregiver's diminished cognitive status, high levels of psychiatric symptoms, depression, or experiencing a high degree of caregiver hassle. Additionally, a significant interaction effect was found between levels of depression in caregivers and dementia symptoms in elders, as well as between levels of psychiatric symptoms in caregivers, feelings of caregiver hassle, and depression in care recipients and risk for verbal mistreatment.This study highlights the importance of both risks and vulnerabilities in the outcome of verbal mistreatment, and identifies that in many cases verbal mistreatment may be a reciprocal phenomenain dyads of caregivers and persons with AD.

Background. Elder neglect accounts for over 70% of all adult protective services reports in the nation annually, and il has been estimated thai there are over 70.000 new cases each year. The purpose of this study was to conduct elder neglect research in the emergency department (ED), using a dyadic vulnerahility/risk-profiling framework for elder neglect. Methods. Patients were recruited through four EDs in New York and Tampa from the beginning of February 20(11 through Ihe end of September 2003. Demographics, a Mini-Mental Status Examination score, and an initial elder assessment screen were collected. The diagnosis of neglect was then made by a Neglect Assessment Team (NAT) comprising a nurse, physician, and social worker, with extensive clinical experience in elder neglect. Results. Of the 3664 ED screens of adults 7(1 years and older. 405 (I 1%) met the inclusion criteria and agreed to participate. Neglect was diagnosed by the NAT in 86 of the 405 cases reviewed. Demographic differences between neglect versus no negleet cases were examined using Fisher's exact lest. and differences emerged between the 2 groups. Conclusion. This study documents the underreporting of cases of neglect as evidenced by differences in diagnoses hy screeners versus experts. The research assistants screened positive for neglect in 55 (N - 22) of the 405 cases. The NAT made the diagnosis of negleet in 22% (86/389) of the cases. This markedly different rate of neglect may mean that ED screns are important hut may underestimate the true number of cases. Conversely, an NAT may make the diagnosis of neglect in an older adult more often given a higher sensitivity and a more robust knowledge base of the problem.

PURPOSE: Neglect of older adults accounts for 60% to 70% of all elder-mistreatment reports made to adult protective services. The purpose of this article is to report data from research, using a risk-and-vulnerability model, that captures the independent contributions of both the elder and the caregiver as they relate to the outcome of neglect. METHODS: Between February 2001 and September 2003, older adults were screened and recruited through four emergency departments in New York and Tampa. The diagnosis of neglect was made by an expert neglect-assessment team. Elders and their caregivers were then scheduled for separate face-to-face interviews after discharge. RESULTS: Constructs within the risk-and-vulnerability model were examined for scale-score significance based on the outcome diagnosis of neglect. In the risk domain, caregivers' functional status, childhood trauma, and personality were statistically significant. In the vulnerability domain, the elders' cognitive status, functional status, depression, social support, childhood trauma, and personality were significant. IMPLICATIONS: Findings from this study underscore the value of interdisciplinary assessment teams in emergency departments for screening elder neglect, with attention given to risk factors related to the caregiver and elder vulnerability factors, including reports of childhood trauma. The risk-and-vulnerability model may provide a link between the caregiving and neglect research. Data should be collected independently from both members of the elder-caregiver dyad in order for clinicians to understand factors related to elders who receive the diagnosis of neglect from interdisciplinary teams. Language: en

The purpose of this paper is to describe how elder mistreatment (EM) assessment has been conducted in emergency departments in an ongoing study on elder neglect and to present profiles of older adults who are assessed as neglected by domestic caregivers. Data from 334 patients, which include 22 neglect cases, are presented in order to examine the demographic profile of the sample and the differences between the neglect and non-neglect groups. Results suggest that, although there are no differences in the basic demographic variables of the two groups, differences exist in regards to the type of caregiver, the reason for the patient's emergency department visit, and the elder's functional and dependency status.

Background: Elder mistreatment is a serious issue affecting between 300,000 and 800,000 older adults. Elder mistreatment has serious consequences for older adults and can include immunological dysfunction, increased mortality and emotional difficulties such as depression, feelings of inadequacy and self-contempt. Sub-groups such as persons with Alzheimer’s disease have heightened risk for elder mistreatment, but it is not clear whether this heightened risk represents life-long patterns of abuse between persons or whether they represent a change in conflict style over time as a result of changes associated with dementia. Methods: Data analyzed in this study were collected as part of the Aggression and Violence in Community Based Alzheimer’s Study [AV-CAD] and represents patient caregiver/dyads who received care at one of five state funded medical clinics or who belonged to one of three local chapters of the Alzheimer’s Association. Data were collected via in-person interview and mailed survey, and changes in conflict resolution style (reasoning, verbal aggression and violence) pre and post dementia were measured using the Conflict Tactic Scale (CTS) and analyzed using McNemar’s Test. Results: Reasoning was used as a conflict resolution style in 91.4% of caregivers and 89.3% of elders prior to the onset of dementia and in 66.3% of caregivers and 45.3% of elders in the past year (post dementia diagnosis). Reasoning in the post dementia period was significantly related to use of reasoning in the pre dementia period for caregivers (X2=7.47, p=.0032) and approached significance for elders (X2=6.00; p=.057). Use of verbal aggression (VA) and violence (V) as a conflict resolution style post dementia was higher for both caregivers (VA: 59.3%; V: 16.8%) and elders (VA: 68.7%; V: 24%), but was not significantly related to behaviors in the pre-dementia period for caregivers (V: X2=1.55, p=.536; VA: X2=0.67, p=.528) or elders (V: X2=0.54, p=.628; VA: X2=0.43, p=.621) Conclusions: This study lends support to the idea that elder abuse in a large number of persons with Alzheimer’s disease may be in part a result of the etiology of the disease and is susceptible over time. Implications for policy, practice and future research are discussed.

Physical mistreatment has been estimated to affect 2 million older persons each year and dramatically affects health outcomes. While researchers have attempted to examine risk factors for specific forms of abuse, many have been able to focus on only victim or perpetrator characteristics, or a limited number of psychosocial variables at any one time. Additionally, data on risk factors for subgroups such as persons with Alzheimer’s disease who may have heightened and/or unique risk profiles has also been limited. This paper examines risk for physical violence in caregiver/patient dyads who participated in the Aggression and Violence in Community-Based Alzheimer’s Families Grant. Data were collected via in-person interview and mailed survey and included demographics as well as measures of violence, physical and emotional health, and health behaviors. Logistic regression analysis indicated that caregivers providing care to elders with high levels of functional impairment or dementia symptoms, or who had alcohol problems, were more likely to use violence as a conflict resolution strategy, as were caregivers who were providing care to elders who used violence against them. By contrast, caregivers with high self-esteem were less likely to use violence as a conflict resolution strategy. Significant interaction effects were also noted.

Background This study compared the occurrence of psychiatric symptoms in a large group of community-residing participants enrolled in an Alzheimer's disease patient registry who met clinical diagnostic criteria for Alzheimer's disease or multi-infarct dementia, as well as mixed Alzheimer's disease and multi-infarct dementia. Methods Psychiatric morbidity observed from a psychiatric examination of 514 patients with Alzheimer's disease, 135 patients with multi-infarct dementia, and 86 cases with mixed dementia was analyzed using analysis of variance comparing symptoms across groups and chi-square test for differences in frequency of occurrence. Associations between pairs of symptoms were also reported. Results The frequency of occurrence and patterns of psychiatric problems were similar in patients with Alzheimer's disease and multi-infarct dementia. Agitation was the most frequent symptom, followed by depression, apathy, and behavioral disorders. Patients with mixed dementia had significantly more psychopathology. Conclusion This study demonstrated that significant psychopathology occurs in individuals with Alzheimer's disease or multi-infarct dementia. The high levels of symptoms in mixed dementia suggest that the two conditions have a synergistic effect on behavioral problems. The prevalence of multiple symptoms is higher than previously reported.

This study describes the prevalence of violence and the putative risk factors for violence in 184 Alzheimer patients and their primary caregivers living in the community. Analysis of the severe violence subscale of the Conflict Tactics Scale indicated that 15.8% of patients had been violent in the year since diagnosis. A total of 5.4% of caregivers reported being violent toward the patient. The overall prevalence of violence was 17.4%. The variables most associated with violence were caregiver depression and living arrangement. Language: en

Context Both elder self-neglect and abuse have become increasingly prominent public health issues. The association of either elder self-neglect or abuse with mortality remains unclear. Objective To examine the relationship of elder self-neglect or abuse reported to social services agencies with all-cause mortality among a community-dwelling elderly population. Design, Setting, and Participants Prospective, population-based cohort study (conducted from 1993 to 2005) of residents living in a geographically defined community of 3 adjacent neighborhoods in Chicago, Illinois, who were participating in the Chicago Health and Aging Project (CHAP; a longitudinal, population-based, epidemiological study of residents aged ≥65 years). A subset of these participants had suspected elder self-neglect or abuse reported to social services agencies. Main Outcome Measures Mortality ascertained during follow-up and by use of the National Death Index. Cox proportional hazard models were used to assess independent associations of self-neglect or elder abuse reporting with the risk of all-cause mortality using time-varying covariate analyses. Results Of 9318 CHAP participants, 1544 participants were reported for elder self-neglect and 113 participants were reported for elder abuse from 1993 to 2005. All CHAP participants were followed up for a median of 6.9 years (interquartile range, 7.4 years), during which 4306 deaths occurred. In multivariable analyses, reported elder self-neglect was associated with a significantly increased risk of 1-year mortality (hazard ratio [HR], 5.82; 95% confidence interval [CI], 5.20-6.51). Mortality risk was lower but still elevated after 1 year (HR, 1.88; 95% CI, 1.67-2.14). Reported elder abuse also was associated with significantly increased risk of overall mortality (HR, 1.39; 95% CI, 1.07-1.84). Confirmed elder self-neglect or abuse also was associated with mortality. Increased mortality risks associated with either elder self-neglect or abuse were not restricted to those with the lowest levels of cognitive or physical function. Conclusion Both elder self-neglect and abuse reported to social services agencies were associated with increased risk of mortality.

This chapter describes both the concept of comprehensive geriatric assessment and its components. Beginning with a definition of the process, the article then describes the history of the development of the comprehensive geriatric assessment, including its origins in the geriatric assessment units in Europe. The article then moves from this historical overview to a discussion of the basic components of the comprehensive geriatric assessment as envisioned by the author. The article then discusses in detail each of these component elements, including instruments that might be used in conducting each element of the assessment and some of the pertinent issues that need to be considered when using these instruments. The article then discusses the relationship of the assessment process to the development of the care plan for the client and the presentation of that care plan. The article concludes with a discussion of the research on the effectiveness of comprehensive assessment. Keywords: elderly; geriatric assessment; mental status; functional assessment; older adults

Advances in handheld computer technology are making data collection faster, easier, and more accurate. In this article, the use of personal digital assistants (PDAs) to collect data for a study on elder neglect is described and evaluated. Methods for integrating this technology into a research study are discussed as are suggestions for increasing the performance of data collectors using these devices. The authors offer some practical solutions for researchers and clinicians planning to use PDAs in their research.

Introduction: Emergency departments are often the first point of contact for elder neglect victims. The purpose of this article is to describe a pilot study pertaining to the screening of patients and detection of elder neglect conducted in a large metropolitan medical center emergency department. The research question to be answered was, "Is it feasible for ED nurses to conduct accurate screening protocols for elder neglect in the context of their busy practice?" Methods: During a 3-week period, 180 patients older than age 70 years (90% of all possible elderly patients during the screening hours) were screened to determine if they met the study criteria and could be enrolled into the protocol. Results: Thirty-six patients met the eligibility criteria to enroll in the study, and 7 patients screened positive for neglect by a home caregiver. The nurses were able to screen and detect elder neglect with more than 70% accuracy, confirming the research question. The true-positive rate was 71%, and the false-positive rate was 7%. Discussion: Elder neglect protocols are feasible in busy emergency departments, and neglect can be accurately detected in the emergency department when screening procedures are in place. (J Emerg Nurs 2000;26: 436-43)

Objective: To describe drug use patterns by persons with Alzheimer's disease, multi-infarct dementia, and mixed Alzheimer's disease and multi-infarct dementia. Design: Multicenter, patient registry. Setting: Community-living persons evaluated in primary care, geriatric, and Alzheimer ambulatory settings. Participants: Of the 930 persons in three diagnostic categories, there were 671 with probable or possible Alzheimer's disease by NINCDS/ADRDA criteria or Alzheimer's disease by DSM-III-R criteria, 162 multi-infarct cases by DSM-III-R criteria, and 97 mixed cases by DSM-III-R criteria. In each diagnostic category, 65% were women, and the majority were 70 years or older. Measurements: The average number of all prescription and non-prescription drugs and selected therapeutic categories by age, sex, diagnosis, and mini-mental status score at the time of diagnosis or evaluation. Results: Alzheimer patients average 2.3 drugs compared with multi-infarct (4.3; P < 0.0001) and mixed (3.7; P = 0.002) patients, and their pattern of drug use was different when stratified by therapeutic categories and drug classes. Drug use increased with age, and women used significantly more drugs than men in all three diagnostic categories. Women with Alzheimer's disease used significantly more cardiovascular drugs than men with Alzheimer's disease (P < 0.05). The lower the mini-mental status score in patients with any dementia, the greater the mean number of central nervous system agents used. The higher the mini-mental status score in a patient with multi-infarct or mixed dementia, the greater the use of cardiovascular drugs. Conclusion: Drug use by Alzheimer patients was lower than in multi-infarct and mixed patients, primarily due to a lower prevalence of cardiovascular drugs.

We analyzed the association of clinical findings with impaired functional status, i.e., activities of daily living (ADLs), in a sample of 240 patients diagnosed with Alzheimer's disease by NINCDS/ADRDA or DSM-III-R criteria. Logistic regression models were used to determine independent predictors of both the number of ADL impairments and number of ADL impairments characterized as moderate to severe. Two psychiatric problems, behavioral disorders and apathy, as well as a history of hypertension were significantly associated with ADL impairment independent of age, sex, race, and cognitive impairment. Behavioral disorders and apathy were also significantly associated with moderate to severe ADL impairment, but hypertension was not significant at this level.

Child sexual abuse continues to be a problem within the United States with both the numbers of reported cases, and quite probably the number of actual cases continuing to grow. Of particular interest are the cases of father/daughter-stepfather/stepdaughter sexual abuse. The current literature has discussed at length many of the risk factors associated with this form of sexual assault. Unfortunately, much of the literature is either based on clinical studies or on surveys of adults. The current study described in this article uses an epidemiologic case-control approach to study the problem. In total, 34 current case families and 68 controls responded to a self-administered questionnaire. The data provided by these subjects were analyzed using the multivariate technique of logistic regression. Four variables are indicated as having a strong relationship to risk for this form of sexual assault. These four variables are income, marital satisfaction, closeness of the mother-daughter relationship, and violence between the abuser and the spouse. The results of this analysis are discussed in terms of interrelational theory and current treatment practices and recommendations are made concerning future research endeavors.