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Clearinghouse on Elder Abuse and Neglect (CANE)
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Annual Annotated Bibliography of Elder Abuse and Neglect Publications
July 2004 - June 2005


41. P5912-17
Jogerst, G. et al.
APS Investigative Systems Associated with County Reported Domestic Elder Abuse
Journal of Elder Abuse & Neglect; Vol. 16 (3), 1-17; 2004.
This research was designed "to evaluate the association between state-defined elder abuse
investigation systems and rates of reported, investigated and substantiated domestic elder
abuse..." Responses to a mailed survey were received from 1,409 adult protective services (APS)
investigators from 44 states and the District of Columbia. Of the findings, reports made to county APS ranged from 0 to 191.7 per 1,000 elder population; investigations rates ranged from 0 to 150 per 1,000; and substantiation rates ranged from 0 to 116.7 per 1,000. Investigation rates were higher among APS programs that charged investigators with evaluating only elder abuse cases and where most investigators had social work education backgrounds. Higher investigation and substantiation rates were associated with investigators who believed that elders were typically benefited by the investigation. Higher substantiation rates appear associated with systems that used longer training programs for investigators.

42. P5952-22
Kietzman, K., Scharlach, A. & Dal Santo, T.
Local Needs Assessment and Planning Efforts for Family Caregivers: Findings and Recommendations
Journal of Gerontological Social Work; Vol. 42 (3/4), 39-60; 2004.
The reauthorized Older Americans Act (OAA, 2000) requires state and local Area Agencies on Aging (AAAs) to identify and meet the needs of family caregivers. This study examines the needs assessment techniques of California AAAs' Title III-E Area Plans and their responses to a follow-up survey. The most direct methods for defining the caregiver population appeared to be used very infrequently; few AAAs conducted population surveys and caregiver-specific focus groups. Agency representatives reported much greater success in identifying the needs of White/non-Hispanic caregivers than of other ethnic and racial groups. In addition to difficulties in defining the caregiver population, barriers to determining caregiver needs also included difficulty in determining current service usage, in prioritizing needs, and in translating this information into viable service plans. As a result of this project, researchers recognized the following tasks as essential to completing the needs assessment process: describing the current caregiver population; determining the needs of the population; inventorying current caregiver resources; prioritizing identified needs; and devising a service delivery plan that reduces barriers to access, supplements current resources and creates additional supports. (Note: This entry is also included in the CANE bibliography entitled Informal Caregiving for Dependent Elders: The Association with Elder Abuse, Neglect, and the Well-Being of Older Individuals, 2000-2005, posted on the NCEA Web site at: http://www.elderabusecenter.org/default.cfm?p=cane_informal.cfm .)

43. P5845-4
Klaus, P., for the U.S. Department of Justice, Office of Justice Programs
Crimes against Persons Age 65 or Older, 1993-2002 (Bureau of Justice Statistics Special Report)
Bureau of Justice Statistics; Washington, D.C.; January 2005.
This publication reports characteristics and trends involving crimes against individuals aged 65 and over from 1993 through 2002, and offers comparisons to victimization of individuals in other age groups. Data was drawn from the National Crime Victimization Survey (NCVS) and the Uniform Crime Reports. Of the findings, elders experienced much lower rates of victimization than younger groups. Nonfatal violent crime rates were 4 per 1,000 for this age group; elder head of households experienced property crimes at a rate of 93 per 1,000; and personal larceny (such as purse snatching) was the only category of crime experienced at rates similar to other age groups. Homicide rates declined slightly for the elderly from 1993 through 1998 and have remained constant since that time. (Note: This report is available online at: http://www.ojp.usdoj.gov/bjs/pub/pdf/cpa6502.pdf .)

44. P5826-5
Kumamoto, K. & Arai, Y
Validation of 'Personal Strain' and 'Role Strain': Subscales of the Short Version of the Japanese Version of the Zarit Burden Interview (J-ZBI_8)
Psychiatry and Clinical Neurosciences; Vol. 58 (6), 606-610; 2004.
The Zarit Burden Interview is the assessment tool most widely used in North America and Europe to assess caregiver burden experienced by family members caring for impaired elders. This research was designed to confirm the construct validity of two subscales (personal strain and role strain) of the eight-item Japanese version of the Zarit Burden Interview (J-ZBI_8). Personal strain is described as the personally stressful component of the caregiving experience, while role strain is described as the stress related to role conflict or overload. The study sample consisted of 51 dyads of impaired elders (living in the community, and registered with a nursing clinic in Kyoto City) and their primary caregivers. Caregivers provided information regarding the extent and duration of their caregiving experience and the nature of the impaired elders' disabilities, and also completed the J-ZBI_8. Elders' ability to perform activities of daily living (ADLs) was assessed using the Barthel Index (BI); cognitive impairment was assessed using the Short-Memory Questionnaire (SMQ); and behavioral disturbances were assessed using the Troublesome Behavior Scale (TBS). Findings confirm the validity of both subscales. Behavioral disturbances were associated with personal strain, while ADL deficits were associated with role strain. (Japan) (Note: This entry has been included in the CANE bibliography entitled Identifying Elder Abuse: Tools, Techniques and Guidelines for Screening and Assessment, which is posted on the NCEA Web site at http://www.elderabusecenter.org/default.cfm?p=cane_ea_assessment.cfm . It has also been included in the CANE bibliography entitled Informal Caregiving for Dependent Elders: The Association with Elder Abuse, Neglect, and the Well-Being of Older Individuals, 2000-2005, posted on the NCEA Web site at: http://www.elderabusecenter.org/default.cfm?p=cane_informal.cfm .)


45. P5910-7
Lauder, W., Anderson, I. & Barclay, A.
A Framework for Good Practice in Interagency Interventions with Cases of Self-Neglect
Journal of Psychiatric and Mental Health Nursing; Vol. 12 (2), 192-198; 2005.
Observing that there are very few evidence-based practice guidelines for dealing with self-
neglecters, this paper (written for nurses) briefly outlines the framework for developing an
interagency approach to working with this population. The development of the framework involved a review of the literature, an empirical study of interdisciplinary responses to self-neglect; and the establishment of a structure that incorporated stakeholder input from professionals and volunteers in the health, housing, environmental health and social work fields and related research fields. The framework recommendations include the following: the development of public advocacy services which would encourage a coordinated, multidisciplinary response to client needs; the early identification of potential and actual self-neglect (which would require an accepted definition for the phenomenon as well as standard assessment strategies); an understanding of the self-neglecting client's perceptions and coping skills; established protocols for working across agencies, and a shared understanding of the possible roles and resources of various stakeholders. Interdisciplinary research is also warranted to develop a best practice model. While the authors emphasize the need for an accurate mental health diagnosis for each client in order to open potential resource avenues currently available, they recommend that the absence of a psychiatric diagnosis should not prevent self-neglecting individuals from attaining services. (U.K.) (Note: This entry has also been included in the CANE bibliography entitled Self-Neglect: An Update of the Literature, 2000-2005, posted on the NCEA Web site at:
http://www.elderabusecenter.org/default.cfm?p=cane_selfneglectupdate.cfm .)

46. P6007-10
Litwin, H. & Zoabi, S.
A Multivariate Examination of Explanations for the Occurrence of Elder Abuse
Social Work Research; Vol. 28 (3), 133-142; September 2004.
In this matched case-control study, variables were analyzed to evaluate four explanations for the rise in elder abuse in a once traditional culture now in transition. Predictors related to
sociodemographic status, dependency, modernization, and social integration were examined and
compared among abused (n=120) and nonabused (n=120) Arab Israeli elders living in Northern
Israel in 1998. Lower income, increased dependency, increased modernization, and poor social
integration were positively associated with elder abuse. Findings suggest that there are multiple explanations for the increase in elder mistreatment. However, increased modernization,
compounded by poor social integration, were most significantly associated with elder abuse and
neglect; this suggests that these are the dominant factors contributing to this trend. (Israel)

47. R6088-4
Livingston, G. et al.
The Caregivers for Alzheimer's Disease Problems Scale (CAPS): Development of a New Scale Within the Laser-AD Study
Age and Ageing; Vol. 34 (3), 287-290; March 2005.
The Caregivers for Alzheimer's Disease Problems Scale (CAPS), was developed by the authors to identify caregivers at high risk for anxiety and depression. The CAPS (which is comprised of recognized risk factors for caregiver psychological morbidity) screens characteristics of the caregiver, care recipient and their relationship. This study was designed to evaluate the sensitivity and specificity of the instrument. One-hundred fifty-three family caregivers from the London and the South-East Region of England Alzheimer's Disease study (LASER-AD) were interviewed and screened for anxiety and depression using the Hospital Anxiety and Depression Scale, and each caregiver-care recipient dyad was administered the CAPS. Results indicate that the five-item instrument is effective at detecting caregivers at high risk for these mental health problems, and the researchers recommend the use of the tool for routine assessment. (U.K.) (Note: This entry is also included in the CANE bibliography entitled Informal Caregiving for Dependent Elders: The Association with Elder Abuse, Neglect, and the Well-Being of Older Individuals, 2000-2005, posted on the NCEA Web site at: http://www.elderabusecenter.org/default.cfm?p=cane_informal.cfm .)

48. R6028-18
Lundy, M. & Grossman, S.
Elder Abuse: Spouse/Intimate Partner Abuse and Family Violence Among Elders
Journal of Elder Abuse & Neglect; Vol. 16 (1), 85-102; 2004.
This descriptive research analyzes the characteristics of 1,057 victims of domestic violence (DV), aged 65 and over, who sought or utilized support through DV services throughout the state of Illinois from 1990 through 1995. Data was collected by the Illinois Coalition Against Domestic Violence (ICADV). Older service users were predominantly female (90 percent), White (75 percent), and nearly half were currently married (47 percent). Although nearly 40 percent were abused by either a current or former spouse or male friend, 46.6 percent of the abusers identified were nonspousal relatives. Almost all reported psychological abuse, 71 percent reported physical abuse, and nearly five percent reported sexual abuse. Most referrals were made by police (34 percent), followed by legal sources, social services professionals, and self. Service users most frequently needed support followed by legal assistance. Eleven percent required emergency shelter while six percent required assistance finding housing. Compared with younger victims, older women are more likely to need legal assistance regarding interdependent financial issues (such as retirement benefits), but were less likely to need assistance regarding education, employment and child care.

49. R6084-4
Magsi, H. & Malloy, T.
Underrecognition of Cognitive Impairment in Assisted Living Facilities
Journal of the American Geriatrics Society/JAGS; Vol. 53 (2), 295-298; 2005.
This study was designed to examine the underrecognitiion of cognitive impairment among
residents in assisted living facilities (ALFs). Two-hundred and thirty residents (of 407 solicited) from seven ALFs in Omaha, Nebraska participated in the research. Participants were administered the Mini-Mental State Examination (MMSE) and their medical charts were reviewed for evidence of diagnosis of and treatment for dementia. Results of the MMSE indicate that 58 percent of the ALF residents experienced symptoms of cognitive impairment. However, examination of the medical record indicates that 63 percent of these residents were not diagnosed or treated for dementia. Among other potential hazards noted for these residents was the fact that one-fifth self-administered between three and six medications daily, and only eleven percent had surrogate decision makers named.

50. R6086-11
McConaghy, R. & Caltabiano, M.
Caring for a Person with Dementia: Exploring Relationships Between Perceived Burden,
Depression, Coping and Well-Being

Nursing & Health Sciences; Vol. 7 (2), 81-91; 2005.
This study was designed to assess the relationship between such variables as gender, length of
time caregiving, coping style, depression, and perception of caregiver burden with the physical and psychological well-being of caregivers of individuals with dementia. Forty-two caregivers known to home care service agencies in Queensland, Australia, participated in the survey. Participants completed the Satisfaction with Life Scale, the Center for Epidemiologic Studies Depression Scale, The COPE Short Form (SF) - 12, and the Zarit Caregiver Burden Scale. Among the findings, high levels of caregiver burden were associated with poorer psychological health and lower levels of satisfaction with life. Caregivers who practiced practical forms of coping (such as taking a "one step at a time" approach) experienced less burden, but there was no association between coping style and physical well-being. There were no significant gender differences noted, and no significant correlation was found between length of time caregiving and caregiver physical health status. (Australia) (Note: This entry is also included in the CANE bibliography entitled Informal Caregiving for Dependent Elders: The Association with Elder Abuse, Neglect, and the Well-Being of Older Individuals, 2000-2005, posted on the NCEA Web site at: http://www.elderabusecenter.org/default.cfm?p=cane_informal.cfm .)

51. P5706-10
Moos, R., Schutte, K., Brennan, P. & Moos, B.
Ten-year Patterns of Alcohol Consumption and Drinking Problems among Older Women and Men
Addiction; Vol. 99 (7), 829-838; 2004.
This study analyzes changes in patterns of alcohol consumption among older women and men,
and considers late-life and life history predictors of alcohol related problems. A sample of 1,291 community residents aged 55 to 65 who had consumed alcohol within the preceding year were assessed at baseline, then at one, four and ten year intervals. Frequency, greatest daily amount consumed, and drinking problems experienced within the past year were measured. In addition, medical conditions, psychoactive medication use, negative life events and avoidance coping were also assessed. Over time, the proportion of individuals (male and female) who consumed alcohol declined along with amount consumed. Predictors identified for greater risk of late-life drinking included history of heavy drinking, history of drinking problems, smoking, avoidance coping, and friends' approval of drinking.

52. P5750-6
Mosqueda, L., Burnight, K., Liao, S. & Kemp, B.
Advancing the Field of Elder Mistreatment: A New Model for Integration of Social and Medical Services
The Gerontologist; Vol. 44 (5), 703-708; 2004.
This article reviews the development and function of a new model program for the integrated
delivery of medical and social services to vulnerable adults. The Vulnerable Adult Specialist Team (VAST) was introduced in Orange County, California, in 2000, with the purpose of providing the county's APS, law enforcement and district attorney's offices access to trained medical expertise when addressing cases of elder mistreatment. The multidisciplinary team is comprised of two geriatricians, a psychologist, a gerontologist and a project coordinator. The authors analyzed the data concerning cases referred to VAST during the first two years of its existence. Ninety-eight referrals were made during the first year, increasing to 171 during the second year. The most common reason for referrals was mental status evaluation (35 percent), followed by medical evaluation (22 percent), a combination of mental status and medical evaluation (27 percent), medical information or referral (10 percent), review of records and/or photos (5 percent), and vague needs (6 percent). According to follow-up evaluation, the team's services were considered most helpful in confirming abuse, in documenting impaired capacity, and in reviewing medications and clarifying medical problems.

53. P5708-6
Mukamal, K. et al.
Self-Reported Alcohol Consumption and Falls in Older Adults: Cross-Sectional and Longitudinal Analyses of the Cardiovascular Health Study
Journal of the American Geriatrics Society (JAGS); Vol. 52 (7), 1174-1179; July 2004.
This research, drawing upon data from the Cardiovascular Health Study, provides a cross-sectional and longitudinal analysis of associations between alcohol consumption and risk of falls in the elderly. The sample consisted of 5,841 participants who, at the baseline assessment, were physically examined, had gait speed and maximal grip strength measured, reported upon alcohol consumption (including frequency and changes in patterns), and reported upon falls. Follow-up occurred at six month intervals for four years, alternating between clinical visits and telephone contact. Among the results, while a cross-sectional analysis suggests an apparent inverse association between consumption and falls, the longitudinal analysis suggests that older individuals who consume 14 or more drinks per week are at greater risk for experiencing falls.

54. P5749-16
Office of Program Policy Analysis and Government Accountability (an office of the Florida
Legislature)
Most Adult Protection Working Agreements Signed, But Have Had Limited Effectiveness
October 2004.
This report examines the effectiveness of the working agreements required by the Florida legislature in 2000, between the Department of Children and Families' Adult Protective Services Program and local law enforcement agencies. Although working agreements have been signed with 342 of 346 law enforcement agencies, the OPPAGA evaluation finds that the agreements "...have had limited effectiveness in improving cooperation..." Focus groups and interviews with APS and law enforcement professionals indicate that most local alliances were not effected by the agreements; either the relationships between the two sectors were positive and cooperative prior to the agreements, or the relationships were negative prior to the agreement, and had not improved as a result. The following areas were identified as problematic: delayed emergency entrance into a vulnerable adult's home by law enforcement; transportation of vulnerable adults by law enforcement; timely notification of possible criminal cases by APS professionals to law enforcement officials; APS interviews with alleged perpetrators without consent of law enforcement. The report provides recommendations to enhance the efficacy of the interagency agreements, including the need for increased training, written local protocols, periodic meetings, and the designation of a contact person at each local law enforcement and APS agency. (Note: This report is accessible online at: http://www.oppaga.state.fl.us/reports/pdf/0473rpt.pdf .)

55. R6081-12
Oktay, J. & Tompkins, C.
Personal Assistance Providers' Mistreatment of Disabled Adults
Health & Social Work; Vol. 29 (3), 177-188; August 2004.
This study assessed the prevalence and nature of personal assistance (PA) provider's
mistreatment of 84 adults with disabilities. Participants were solicited through a local advocacy organization for adults with disabilities and through a local chapter of an organization for adults with spinal cord injuries. Researchers interviewed the respondents, either by telephone or in their homes and not in the presence of the PA, using the Attendant Mistreatment Interview Schedule (AMIS, adapted from the Conflict Tactics Scale, in order to measure mistreatment by the primary and other PAs. PAs included agency employees, family members, and others. Among the findings, 30 percent reported mistreatment from their primary PA and 61 percent reported mistreatment by another care provider. Mistreatment by the primary PA most commonly consisted of verbal abuse, physical abuse, and theft or extortion. Others were most likely to be verbally abusive, neglectful and likely to steal. Among the victim characteristics, lower income was associated with higher rates of mistreatment. Among perpetrator characteristics, males, those with less experience, and those who provided more that 50 hours of care per week were most likely to mistreat. (Note: This article is not specific to elders.)

56. R6029-14
Oswald, R., Jogerst, G., Daly, J. & Bentler, S.
Iowa Family Physician's Reporting of Elder Abuse
Journal of Elder Abuse & Neglect; Vol. 16 (2), 75-88; 2004.
This study was designed to analyze family practitioner's knowledge of elder abuse and reporting
laws in the state of Iowa, to identify perceived barriers to reporting suspected mistreatment, and to examine factors associated with reporting suspected abuse in this clinical setting. Of the 1,030 members of the Iowa Academy of Family Practice Physicians solicited for the survey, 378 completed a mailed questionnaire regarding their general knowledge concerning elder abuse, and their experiences with suspected elder abuse cases during the past year. Overall, the participants appeared knowledgeable about elder abuse. Over three-fourths of the respondents knew where to report suspected domestic elder abuse; 63 percent knew where to report suspected institutional elder abuse; twelve percent routinely asked direct questions about elder abuse during physical assessments. Nearly half had observed at least one case of elder abuse during the past year, and 54 percent of those had made a report to the Iowa Department of Human Services. Neglect and self-neglect were the most commonly observed types of mistreatment. Respondents indicated that victims' denials, reporting by other officials, unrecognized signs of mistreatment at the time of examination, and the victim not being a dependent adult were the most common reasons for not reporting. Less than two-thirds of those who had attended required training regarding mandatory reporting found the information helpful. The practice of routinely screening for elder abuse by asking direct questions and the presence of a reporting protocol were significantly associated with observing at least one case of elder mistreatment. Direct questioning and knowledge regarding elder abuse were also significantly associated with reporting suspected mistreatment.

57. P5920-8
Payne, B. & Fletcher, L.
Elder Abuse in Nursing Homes: Prevention and Resolution Strategies and Barriers
Journal of Criminal Justice; Vol. 33 (2), 119-125; 2005.
After providing an overview of the existing literature on elder abuse occurring in nursing homes, the authors describe the current study which considers prevention and resolution strategies by using the routine activities theory as a guide. Seventy-six (of 400) nursing home professionals completed a mailed survey regarding their facility's protocols for addressing allegations of elder abuse, and the preventative strategies that were in place. Responses were categorized into prevention strategies, resolution strategies, and barriers. Underlying themes of prevention strategies were classified as: facility-based (such as an expectation that employees would follow protocols to protect residents, reporting procedures, etc.); education for residents, their families and staff, regarding residents' rights; community outreach and resources, such as liaisons with local police departments and senior citizens' groups; and facility security, such as the use of closed circuit cameras in hallways, locked doors, visitors sign-in sheets, etc. Internal or "in-house" investigations, reports to external agencies (such as law enforcement, ombudsmen, and adult protective services), suspension and termination of offending employees, etc. were identified as strategies to address abuse. Participants did not describe the protocol for referrals for external investigations. Barriers to resolution included lack of evidence, difficulty in obtaining witness' statements, prohibitive court costs, inconsistent or inappropriate penalties, slow agency response time, and a lack of clear definitions of elder abuse. The development of policies that incorporate consistent guidelines, multidisciplinary approaches and coalition building with responding agencies, and zero tolerance of violence and mistreatment are among the recommendations made.

58. R6010-26
Podnieks, E. & Wilson, S.
An Exploratory Study of Responses to Elder Abuse in Faith Communities
Journal of Elder Abuse & Neglect; Vol. 15 (3), 137-162; 2003.*
In this exploratory study, conducted jointly by Ryerson University, the Ontario Network for the Prevention of Elder Abuse, the Older Women's Network, and the Centre for Applied Family Research, faith leaders were surveyed regarding their perceptions of elder abuse. Forty-nine clergy members throughout the province of Ontario participated. Of the findings, two-thirds of the respondents were aware of (or suspected) at least one case of elder abuse among their followers. Lack of training and education regarding elder mistreatment, along with confidentiality issues were viewed as significant barriers to appropriate responses. (The survey instrument is included.) (Canada)

59. R6024-22
Rabiner, D., Brown, D. & O'Keefe, J.
Financial Exploitation of Older Persons: Policy Issues and Recommendations for Addressing Them
Journal of Elder Abuse & Neglect; Vol. 16 (1), 65-84; 2004.
Under the reauthorization of the Older Americans Act (2000), the Secretary of the Department of
Health and Human Services (DHHS), in consultation with the Departments of Treasury and Justice, conducted a study of financial exploitation of older persons. This article reports upon the findings of that research, which involved a literature review, consultation with nationally recognized experts in the area of elder financial abuse, the development of a technical advisory group (TAG), and analysis of promising practices. The following needs were identified: to understand risk factors associated with victimization (including a more specific cognitive screening that focuses on executive control functioning); to understand perpetrators of financial exploitation (particularly distinguishing between opportunists and predators); to obtain accurate prevalence and incidence data; to understand the full impact of financial exploitation (in terms of not only the health and psychological well-being of the victim, but also the sociological and economic costs); to evaluate the effectiveness of money management programs and other preventative initiatives; to reduce misuse of legal protections (such as Powers of Attorney) and to provide effective monitoring mechanisms; to identify key elements of prosecution; to establish restitution programs; and to develop multidisciplinary training and education. (Note: This article includes an essay linking it to a companion piece by the same authors, "A Conceptual Framework of Financial Exploitation of Older Persons," JEAN, Vol. 16 (2), 2004. See CANE file #R6025-23 for additional details.)

60. R6020-23
Reynolds, S. & Schonfeld, L.
Using Florida's Adult Protective Services Data in Research: Opportunities and Challenges
Journal of Elder Abuse & Neglect; Vol. 16 (1), 1-22; 2004.
This article draws upon data from Florida's Adult Protective Services (APS) system to analyze
victim characteristics and to observe trends regarding reported abuse from 1993 through 1998. In addition, the challenges in using state APS data to research elder abuse and neglect are examined. A total of 146,913 cases involving elders and vulnerable adults were recorded during this time frame. Among the findings, 74.7 percent of the cases involved adults aged 60 and over, nearly two-thirds of the victims were female, and 83 percent were white. Most referrals were made by social services personnel (31.5 percent), followed by health care professionals (14.7) family members (13.5) and anonymous informants (10.8). Neglect was the most frequently reported type of mistreatment (44.8 percent of all cases), followed by physical abuse, self-neglect, and financial exploitation. The abuse reports were unfounded in 55.8 percent of the cases, and over a third of the cases were closed without classification, due to a lack of evidence to either substantiate or discount the report. Only 1.2 percent of cases reported were actually confirmed. Age group, gender and racial differences are also analyzed. Among the trends observed, the rates of reported abuse and financial exploitation increased by 4.5 percent, while neglect decreased and self-neglect increased. The authors note that when data is analyzed on elder victims only, different trends are observed. Differences in trends are also observed when these findings are compared with similar data from Texas and Illinois, and when compared to the National Elder Abuse Incidence Study (NEAIS). Researchers suggest that data supplied through state APS systems may need to be supplemented, as they were in the NEAIS, with data from sentinel agencies in order to gain a more accurate profile of the victims and perpetrators as well as the circumstances of abuse.

61. P5915-32
Roberto, K. A. & Teaster, P. B.
Sexual Abuse of Vulnerable Young and Old Women
Violence Against Women; Vol. 11 (4), 473-504; April 2005.
After a discussion of the existing (though scant) literature on elder sexual abuse and the sexual abuse of women with disabilities, the authors present an analysis of the nature of sexual abuse cases substantiated by the adult protective services (APS) throughout Virginia from July 1996 through June 2001. The immediate context of the abusive situation (including the victim's functional abilities), the relationship between victim and abuser, the impact of external systems (such as APS) and the broader, cultural context (including institutional norms and values) are considered. Of those addressed by APS professionals throughout the state, 125 substantiated cases, involving women aged 18 and older, were submitted to researchers for analysis. Among the findings, 63 percent of the women victimized were over 59, and the most common type of abuse (regardless of age) involved sexualized kissing or fondling, or unwelcome sexual interest. Younger women victimized were more likely to live in the community, were more likely to be oriented and ambulatory, their abusers were more likely to be family members, and they were more likely to be raped than older victims. Older women victimized were more likely to be disoriented and to have mobility limitations. In contrast to previous research regarding sexual abuse occurring in nursing homes, abusers of older women were more likely to be male residents aged 60 and over (as opposed to facility staff). Findings regarding case outcomes are also presented.

62. R6078-5
Rosen, D.
Factors Associated with Illegal Drug Use among Older Methadone Clients
The Gerontologist; Vol. 44 (4), 543-547; 2004.
Given that substance abuse is a risk factor for self-neglect and mistreatment, and that one-tenth of all clients in methadone treatment centers in the U.S. are aged 50 and over, research regarding this treatment population is warranted. In this study, 143 older clients involved in methadone treatment were screened for use of illegal drugs during the preceding month. Logistic regression was used to test the relationship between life stressors, exposure to illegal substance use, and the participant's ability to remain abstinent. Results indicate that older individuals exposed to illegal drug use through their social networks and within their neighborhoods were significantly more likely to relapse.

63. P5713-3
Talbot, N. et al.
Preliminary Report on Childhood Sexual Abuse, Suicidal Ideation, and Suicide Attempts Among Middle-Aged and Older Depressed Women
American Journal of Geriatric Psychiatry; Vol. 12 (5), 536-538; September-October 2004.
Depression and other mental health issues are risk factors for self-neglect and elder mistreatment. In this study, researchers examined the association between childhood sexual abuse history and suicidal ideation and suicide attempts among older, female, psychiatric inpatients. The sample was comprised of 127 women, aged 50 and over, who met the criteria for major depression. Each woman was assessed by use of the Clinical Interview for DSM-III-R, and asked about sexual abuse occurring before age 18. By using the Scale of Suicidal Ideation (SSI) and exploring the patient's history of suicidal behaviors, researchers evaluated the outcomes of death ideation, suicidal ideation, and suicide attempt status. Eighteen of the participants reported a history of childhood sexual abuse. Among the findings, women who reported histories of childhood sexual abuse were more likely to have an additional Axis I psychiatric diagnosis (including dysthymia, phobias, panic disorders, and substance abuse), and were more likely to experience suicidal ideation, suicidal behaviors, and multiple suicide attempts.

64. P5885-3
Staff, NSDUH Report (Office of Applied Studies, Substance Abuse and Mental Health Services
Administration/SAMHSA)
Substance Use among Older Adults: 2002 and 2003 Update
The NSDUH Report (The National Survey on Drug Use and Health); April 22 2005.
This report contains information on the substance use of older adults, drawing upon data from 2002 and 2003. Highlights of the findings include the following: 17.1 percent of the U.S. population aged 50 and over used cigarettes; 45.1 percent consumed alcohol; 1.8 percent had used an illicit drug during the previous month. However, older adults were less likely to have used cigarettes, alcohol or illicit drugs during the preceding month than younger adults. Older males were more likely to be alcohol users, binge drinkers, and illicit drug users than were older females. (Note: This report is accessible online at: http://www.oas.samhsa.gov/2k5/olderadults/olderadults.pdf .)

65. R6016-17
Teaster, P. B., Nerenberg, L. & Stansbury, K.
A National Look at Elder Abuse Multidisciplinary Teams
Journal of Elder Abuse & Neglect; Vol. 15 (3), 91-107; 2003.*
This research provides insight regarding elder abuse multidisciplinary teams (MDTs) throughout the U.S. An email survey yielded responses from 31 MDT coordinators representing specialized teams such as fatality review teams, financial abuse specialist teams (FAST), medically oriented teams, as well as more traditional teams. The most prevalent functions of the teams were the provision of expert consultation to service providers, and the identification of service gaps. Additionally, teams served to update all members regarding new services in the field. The survey gathered information on average attendance and policies, categories of membership, level of team formality, administration, leadership, funding, sources of technical assistance, challenges, and tangible products (such as training materials, etc.). One interesting finding is that, counter to anecdotal evidence, there did not appear to be significant concern regarding confidentiality issues. Researchers suspect that this may be due to effective confidentiality agreements (in place among nearly two-thirds of the sampled teams) and other safeguards taken.

66. P5768-9
Teaster, P. B. & Roberto, K. A.
Sexual Abuse of Older Adults: APS Cases and Outcomes
The Gerontologist; Vol. 44 (6), 788-796; 2004.
This article provides a profile of elder sexual abuse cases being addressed by the adult protective services (APS) units in Virginia. Of the incidents addressed by APS professionals throughout the state from July 1996 through June 2001, in both domestic and institutional settings, 82 substantiated cases were submitted to researchers for analysis. Data analyzed included victim characteristics (such as age, orientation, self-care ability), perpetrator characteristics, type of sexual abuse, resolution of the case, and outcomes for the victim (such as treatment, relocation, and risk for future victimization). Researchers used a multivariate analysis to examine relationships between victim characteristics and types of victimization. Of the results, 95 percent of the victims were women, approximately half were aged 60 to 79, 72 percent resided in nursing homes or other institutional care facilities, and 17 percent lived with a family member. Most victims required help with orientation to time and place (86 and 81 percent, respectively), and half could not ambulate without assistance. The most common types of abuse were sexualized kissing and fondling (73 percent) and unwelcome sexual interest (43 percent). Victims also experienced exposure to unwelcome discussion regarding sexual activity, sexual jokes and comments, oral genital contact, penetration, and vaginal rape. Nearly half of the cases involved multiple types of sexual abuse. Results indicate that the younger women who were more disoriented more often experienced sexualized touching, while older women more often experienced sexualized interest. Perpetrators, identified in 95 percent of the cases, were male in all but one instance, and typically aged 60 and over (88 percent). In 69 percent of the cases in residential facilities, the perpetrator was another resident; in 5 percent the perpetrator was a staff member. Approximately 28 percent were identified as having untreated psychiatric illness, 16 percent were substance abusers, and 14 percent were financially dependent upon the victim. Only four of the perpetrators were prosecuted (three were convicted). Insufficient evidence was the most common reason for not prosecuting. Relocation was the most common outcome for both victims (16 percent) and perpetrators (29 percent), with relatively few victims receiving physical or psychological treatment (11 percent) and even fewer of the perpetrators receiving psychiatric treatment (10 percent). (Note: This entry has also been included in the CANE bibliography, entitled The Scope of Elder Abuse, posted on the NCEA Web site at: http://www.elderabusecenter.org/default.cfm?p=cane_EAScope.cfm .)

67. P5898-244
Teaster, P. B., Wood, E., Karp, N., Lawrence, S., Schmidt, W. & Mendiondo, M. (for the University of Kentucky and the American Bar Association Commission on Law and Aging)
Wards of the State: A National Study of Public Guardianship
Funded by a grant from the Retirement Research Foundation; April 2005.
As stated in the executive summary, this study was designed to "advance public understanding about the operation and effect of public guardianship programs, and to compare the state of public guardianship today with the findings of the 1981 Schmidt study..." (see CANE file #A37-9). Researchers began by conducting a literature review on public guardianship and a review of state statutes and court cases involving guardianship of the "unbefriended." They conducted a national survey with representatives from public guardianship programs from all 51 jurisdictions throughout the nation, and followed up with telephone interviews of program staff from the states of Florida, Illinois, Indiana, Iowa, Kentucky, Missouri, and Wisconsin. Site visits, which included personal interviews and focus groups, were conducted in Florida, Illinois and Kentucky. Among the findings, state statute analysis reveals that states have shifted towards an enactment of "explicit" public guardianship schemes, with great diversity among programs. Four public guardianship models were identified, including programs within the court system, independent agencies within the executive branch, agencies providing direct services to wards (the most common), and county agencies. A number of states have high ward to guardian ratios, and most indicated that they were chronically understaffed. The greatest strengths perceived were those of the staff, while the most significant weakness was a lack of funding. Although it appears that fewer wards are institutionalized now than in 1981, in most states, a majority of wards continue to be institutionalized. Recommendations generated include the establishment of minimum standards for public guardianship programs, the establishment of staff to ward ratios, and increased oversight to insure due process protections. Funding issues are also examined. (Note: This report is accessible online at: http://www.mc.uky.edu/gerontology/Research%20Reports/
Wards%20of%20State%20Public%20Guardianship%20final%20copy.pdf
. This entry has also been included in the CANE bibliography entitled Guardianship and other Legal Protections of Vulnerable Adults, which is posted on the NCEA Web site at: http://www.elderabusecenter.org/default.cfm?p=cane_guardianship.cfm .)

68. P5918-3
Templeton, D.
Sexual Assault of a Postmenopausal Woman
Journal of Clinical Forensic Medicine; Vol. 12 (2), 98-100; 2005.
In this brief article, a case report of a sexually assaulted 63 year old female is presented. The author reviews earlier research that describes characteristics that are more prevalent in the sexual assault of older women versus younger women, including the greater likelihood and severity of genital trauma.

69. P5732-7
Tierney, M. et al.
Risk Factors for Harm in Cognitively Impaired Seniors Who Live Alone: A Prospective Study
Journal of the American Geriatrics Society/JAGS; Vol. 52 (9), 1435-1441; 2004.
This study was designed to identify risk factors for harm caused by self-neglect or behaviors
attributed to disorientation related to cognitive impairment. The sample included 139 participants, aged 65 and over, who were identified as cognitively impaired and were referred by health care and/or community service agency representatives. At baseline, participants were assessed for dementia, social resources, medical diagnosis, and medication use. The sample was monitored for 18 months for incidence of harm. Incident of harm was described as a physical injury to self or other (or property loss or damage) related to issues of self-neglect due to disorientation, and resulted in emergency intervention. The three factors that appeared to most significantly predict incidence of harm were fewer social resources, poor performance on the Mini-Mental Status Exam (MMSE), and the presence of chronic obstructive pulmonary disease (COPD). Such predictors can be identified in the primary care setting, and therefore could be used by physicians to identify patients at greatest risk. (Note: This entry is also included in the CANE bibliography entitled Self-Neglect: An Update of the Literature - 2000-2005, which is posted on the NCEA Web site at: http://www.elderabusecenter.org/default.cfm?p=cane_selfneglectupdate.cfm .)

70. R6075-11
Touza, C., Segura, M. & Prado, C.
Initial Conclusions on the Design and Validation of the 'Inadequate Treatment Detection Scale' for Elders
Journal of Adult Protection; Vol. 6 (1), 4-14; November 2004.
This article reports upon the findings of the Ciudad Lineal District Elder Abuse Detection Project of Madrid, Spain, particularly focusing on the development and testing of the "Inadequate Treatment Detection Scale (SIT)". The tool was designed to assist health and social services professionals in determining whether further assessment of potential abuse, neglect or self-neglect is warranted. The SIT is a 76 item scale designed to be completed based upon the professional's perception of the elder's situation versus self-report by the elder. The instrument was pilot tested using information from 34 elder social service cases in order to evaluate the response format, content validity, consistency, sensitivity and ease of administration. Item-by-item analysis suggests that there are elements of the scale effective in differentiating cases in which inadequate treatment is suspected. Indicators of neglect, physical abuse, sexual abuse, and conflictive family environments were identified, along with perpetrator risk factors. Although the tool requires further testing and certain items are likely to be deleted, results suggest that this tool will also be useful in developing treatment interventions based upon the individual's needs and circumstances. (Spain)

71. P5878-97
U. S. Government Accountability Office (GAO)
Guardianships: Collaboration Needed to Protect Incapacitated Elderly People (GAO-04-655)
U. S. Government Accountability Office (GAO); Washington, D.C.; July 2004.
In this report, the researchers analyze "...(1) what state courts do to ensure that guardians fulfill their responsibilities, (2) what guardianship programs recognized as exemplary do to ensure that guardians fulfill their responsibilities, and (3) how state courts and federal agencies work together to protect incapacitated elderly..." State statutes were analyzed and guardianship courts of Florida, California, and New York (states with the largest elderly population) were surveyed. In addition, four courts that were identified as exemplary by the National Guardianship Network were studied: Broward County, Florida; Rockingham County, New Hampshire; San Francisco County, California; and Tarrant County, Texas, Probate Court #2. Among the findings, although all states have courts to oversee guardianship, the court implementation varies. While many states require the filing of periodic reports, court review of reports is not specified. Judicial issues arise when one state does not recognize a guardianship originating in another state. Most states do not track the number of active guardianships or the number of incapacitated elders. Coordination among state courts and the representative payee programs of federal agencies (such as the Social Security Administration, the Department of Veterans Affairs, and the Office of Personnel Management) is inconsistent, and often leaves incapacitated elders vulnerable to financial abuse and exploitation. Exemplary courts focused on the training of guardians (beyond state requirements), and monitoring through computerized case management, court visitor programs, in depth review of reports filed, and oversight by court employees. A primary recommendation is that federal agencies create a study group to enhance information sharing among themselves and the state guardianship systems. Appendices address the scope and methodology of the study, include the survey and results, as well as comments from the Social Security Administration (SSA), the Department of Veterans Affairs (VA), the Office of Personnel Management (OPM), and the Department of Health and Human Services (HHS). (Note: The entire report can be accessed online at: http://www.gao.gov/new.items/d04655.pdf . This entry has also been included in the CANE bibliography entitled Guardianship and other Legal Protections of Vulnerable Adults, which is posted on the NCEA Web site at: http://www.elderabusecenter.org/default.cfm?p=cane_guardianship.cfm .)

72. P5649-60
U. S. Government Accountability Office (GAO)
Nursing Home Fire Safety - Recent Fires Highlight Weaknesses in Federal Standards and Oversight
U. S. Government Accountability Office (GAO); Washington, D.C.; July 2004.
According to this agency report, approximately 2,300 of the 16,300 U.S. nursing homes reported
having had a structural fire each year from 1993 through 1999, with an average of five deaths resulting annually. However, in 2003, 31 residents died in two nursing home fires in Connecticut and Tennessee. Like 20 to 30 percent of all U.S. institutional care facilities, neither home was required to have a sprinkler system. Through investigation of these two facility fires, and a review of the compliance history of each facility with existing federal safety standards, the GAO developed the following recommendations: the need for improved oversight of federal fire safety standards, including a review of the appropriateness of exemptions of such standards; and the need for coordination between CMS and the National Fire Prevention Association (NFPA) to reevaluate and strengthen standards, particularly regarding facilities without sprinkler systems. (Note: This report is accessible online at http://www.gao.gov/new.items/d04660.pdf .)

73. P5755-4
Walters, N. for the AARP Public Policy Institute (PPI)
Identity Theft: An Update on the Experience of Older Complainants
AARP Public Policy Institute; October 2004.
Using 2003 data from Federal Trade Commission's Identity Theft Data Clearinghouse, this publication updates the AARP Public Policy Institute's report issued in 2001. Overall, complainants aged 50 and over were 1.75 times more likely than all aged complainants to report identity theft, including existing and new credit card account fraud and attempted identity theft. The highest rates of complaints among this age group were found in the District of Columbia, Nevada, California, Arizona, Texas, New York, Colorado, Oregon, Florida, and Michigan. (Note: This report is accessible online at:     http://research.aarp.org/consume/dd102_id_theft.html .)

74. P5752-70
Waters, H. et al., for the Department of Injuries and Violence Prevention, World Health Organization (WHO)
The Economic Dimensions of Interpersonal Violence
World Health Organization (WHO), Geneva, Switzerland; 2004.
This study examines the costs associated with interpersonal violence, and the research that
supports the cost effectiveness of preventive efforts. The study considers the individual,
relationship, community and societal risk factors of interpersonal violence within an ecological framework. Existing research is presented describing the costs of child abuse and neglect, intimate partner violence, sexual violence, workplace violence, youth violence and other violent crimes (the costs of elder abuse are largely undocumented). Direct costs include such expenses as legal and medical services, policing, controlling and incarceration of perpetrators, security, foster care and economic benefits to perpetrators. Indirect costs include losses in earning, time and investment in human capital, indirect protection, insurance costs and psychological costs. (Note: This report is accessible online at: http://www.who.int/violence_injury_prevention/publications/
violence/economic_dimensions/en/
.)

75. P5934-15
Weeks, L. et al.
A Gendered Analysis of the Abuse of Older Adults: Evidence from Professionals
Journal of Elder Abuse & Neglect; Vol. 16 (2), 1-15; 2004.
Employing an ecological framework, researchers analyzed the gendered nature of elder abuse
through the experiences of medical and non-medical professionals working with seniors. One-
hundred and twenty-one professionals (representing a 46.9 percent response rate) throughout
Prince Edward Island, Canada, were surveyed regarding their exposure to elder abuse cases. Of the 51,893 seniors that these respondents had collectively worked with, 260 had been identified as abused (0.5 percent), and 40 of the participants had encountered at least one case of elder abuse. Of the 75 abuse cases described, 50 victims were female, 17 were male, four were of unknown gender, and two cases involved couples. Dementia was identified among eleven percent of the victims; five cases involved other mental health problems; five cases involved alcohol abuse; and five cases involved women with other health conditions. In 40 percent of the cases, victims were abused by males; in 22 .4 percent there were multiple abusers; 14.9 percent of the perpetrators were female; 14.9 percent of the cases involved self-abuse. Power and control issues, prevalent in domestic violence, were identified in the twelve cases involving abusive husbands. Researchers suggest that the gender may also be a factor in the professional's likelihood of identifying elder abuse cases; female participants in this study were disproportionately more likely to identify abuse cases. (Canada)

76. P5769-9
Yan, E. & Tang, C.
Elder Abuse by Caregivers: A Study of Prevalence and Risk Factors in Hong Kong Chinese Families
Journal of Family Violence; Vol. 19 (5), 269-277; October 2004.
After providing a review of the international literature on prevalence and incidence studies of elder abuse, this article reports upon research designed to study prevalence rates and associated risk factors (age, gender, living arrangements, visual and memory abilities, chronic illness and dependence upon caregivers) of abuse among Hong Kong Chinese individuals aged 60 and over. Participants were referred from five community elder centers, with the final sample consisting of 90 males and 186 females, ranging in age from 60 to 91. Ninety-one percent of the participants were living with family members at the time of the study. Researchers administered oral questionnaires regarding their experiences of verbal and physical abuse and violation of personal rights occurring within the previous 12 months. Of the findings, 27.5 percent of the elders experienced some form of abuse. Verbal abuse was the most prevalent mistreatment experienced (by 26.8 percent of the participants); violation of personal rights was experienced by 5.1 percent; and physical abuse was experienced by 2.5 percent. Eighty-eight percent of the abusers were adult children. Of those victimized, over one-fourth was victimized by multiple abusers. Strongest predictors for all types of mistreatment were victim's poor visual ability, dependence on caregivers, and memory impairment, and caregivers' nondependence on victims. Physical abuse was also predicted by caregivers' nondependence on elders and elders' dependence on caregivers. Advanced age was the only significant predictor of violation of personal rights. (Hong Kong) (Note: This entry is included in the CANE bibliography entitled The Scope of Elder Abuse, which is posted on the NCEA Web site at http://www.elderabusecenter.org/default.cfm?p=cane_EAScope.cfm . It is also included in the CANE bibliography entitled Informal Caregiving for Dependent Elders:
The Association with Elder Abuse, Neglect, and the Well-Being of Older Individuals
2000-2005.)

III. Scholarship

The following publications do not rely upon a scientific method to obtain results. However, they do present new ideas or information that contributes to our overall knowledge in the field of elder abuse and neglect.

77. P5726-00
Aging & Independence Services, County of San Diego Health and Human Services Agency
Elder Abuse: Mandated Reporters: Audio Training Segments (online)
Aging & Independence Services, County of San Diego Health and Human Services Agency; San
Diego, CA; 2004.
This audio training, available online only, was designed for use in San Diego County, California, but is adaptable for use in other regions. Training segments address general issues related to reporting elder abuse, along with specific information for law enforcement, employees of financial institutions, and clergy. (To access audio training, visit
http://sandiego.networkofcare.org/aging/elder_abuse.cfm .)

78. P5923-18
Anetzberger, G.
Elder Abuse: Case Studies for Clinical Management
The Clinical Gerontologist; Vol. 28 (1/2), 43-53; 2005.
This article is part of an issue dedicated to the topic of elder abuse. It describes the three case studies presented to analyze elder mistreatment from the perspectives of clinicians, physicians, nurses, social workers and attorneys as they address clinical management using a multidisciplinary/interdisciplinary approach. In the first case scenario, a woman lives a relatively isolated existence and displays some risk signs for self-neglect. In the second, the caregiver of an abusive spouse now appears to be neglectful in providing for his needs. The third focuses on a verbally and emotionally abusive adult daughter who appears overburdened both at work as a nurses' aide and in taking care of her mother who suffers from Alzheimer's disease. (Note: This issue was co-published simultaneously as a book entitled The Clinical Management of Elder Abuse, Anetzberger, G., ed.; The Haworth Press, Inc., Binghamton, NY; 2004. The book is not available through CANE; for further information, visit the Haworth Press, Inc. Web site at: www.haworthpress.com or telephone 1-800-429-6784 in the US/Canada or 607-722-5857 outside US/Canada.)

79. P5859-13
Anetzberger, G.
The Reality of Elder Abuse
The Clinical Gerontologist; Vol. 28 (1/2), 1-25; 2005.
The first part of this overview on elder abuse provides a summary of empirical research conducted in the areas of definitions, types of abuse, prevalence and incidence, identification, and risk factors. The latter part of the article examines the experience of elder abuse from the perspectives of the clinician as well as the victim. The author acknowledges not only the ethical and practical difficulties of clinical decision-making, but also describes some of the emotional and sensorial challenges of addressing elder abuse and neglect, self-neglect and exploitation. The inherent conflict in the role of protective service, which seeks to recognize clients as self-determining adults who also need interventions and assistance, is highlighted. The cultural and ethnic influences on the elder's response to abuse are considered, along with four possible dimensions of response to mistreatment: the physical (including physical pain and injury, sleeping and eating disturbances), behavioral (ranging from anger to suicidal behaviors), psychological (including denial, anxiety and depression), and social (which could include increased dependence and isolation). (Note: This issue was co-published simultaneously as a book entitled The Clinical Management of Elder Abuse, Anetzberger, G., ed.; The Haworth Press, Inc., Binghamton, NY; 2004. The book is not available through CANE; for further information, visit the Haworth Press, Inc. Web site at: www.haworthpress.com or telephone 1-800-429-6784 in the US/Canada or 607-722-5857 outside US/Canada.)

80. P5926-20
Anetzberger, G. et al.
Multidisciplinary Teams in the Clinical Management of Elder Abuse        
The Clinical Gerontologist; Vol. 28 (1/2), 157-171; 2005.        
This article is part of an issue that utilizes three case studies to analyze elder mistreatment from the perspectives of various clinicians as they collaborate to address clinical management. This entry describes the function of multidisciplinary teams (M-teams) in the assessment and intervention of elder abuse and neglect cases. After presenting an overview of the M-team, the authors present highlights of the team review of the case studies previously analyzed from individual clinical perspectives. (Note: This issue was co-published simultaneously as a book entitled The Clinical Management of Elder Abuse, Anetzberger, G., ed.; The Haworth Press, Inc., Binghamton, NY; 2004. The book is not available through CANE; for further information, visit the Haworth Press, Inc. Web site at: www.haworthpress.com or telephone 1-800-429-6784 in the US/Canada or 607-722-5857 outside US/Canada.)

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