531617 research-article2014
JAHXXX10.1177/0898264314531617Journal of Aging and HealthDong et al.
Article
Prevalence and Correlates of Elder Mistreatment in a Community-Dwelling Population of U.S. Chinese Older Adults
Journal of Aging and Health 2014, Vol. 26(7) 1209–1224 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0898264314531617 jah.sagepub.com
XinQi Dong, MD, MPH1, Ruijia Chen, MS1, Terry Fulmer, PhD, RN, FAAN2, and Melissa A. Simon, MD, MPH3
Abstract Objective: This study aimed to examine the prevalence and correlates of elder mistreatment among U.S. Chinese older adults. Method: Data were drawn from the Population-Based Study of ChINese Elderly (PINE) study, a population-based epidemiological survey of 3,159 U.S. Chinese older adults in the Greater Chicago area. The study design was guided by a communitybased participatory research approach. Results: This study found a prevalence of 15.0% for elder mistreatment among community-dwelling Chinese older adults. In addition, higher levels of education (r = .16, p< .001), fewer children (r = .1, p< .001), lower health status (r = .11, p< .001), poorer quality of life (r = .05, p< .01), and worsening health over the past year (r = .08, p< .001) were positively correlated with any elder mistreatment. 1Rush
UniversityMedicalCenter, Chicago, IL, USA University, Boston, MA, USA 3Northwestern University, Chicago, IL, USA 2Northeastern
Corresponding Author: XinQi Dong, MD, MPH, Professor of Medicine, Nursing, and Behavioral Sciences, Rush University Medical Center; Director of Chinese Health, Aging and Policy Program; Associate Director of the Rush Institute for Health Aging, 1645 West Jackson Blvd., Suite 675, Chicago, IL 60612, USA. Email: [email protected]
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Journal of Aging and Health 26(7)
Discussion: Elder mistreatment is prevalent among U.S. Chinese older adults. The findings point to a pressing need for researchers, community service workers, health care providers, and policy makers to increase efforts on reducing elder mistreatment in U.S. Chinese communities. Keywords elder mistreatment, Chinese older adults, prevalence, population-based study
Introduction Elder mistreatment is a significant health issue across all socio-economic and cultural backgrounds. According to the World Health Organization (2002), the prevalence of elder mistreatment in developed countries ranges from 1% to 10%. The U.S. National Elder Mistreatment Study reported that 11.4% of older adults suffered from elder mistreatment in the previous year (Acierno et al., 2010). As detrimental to one’s health and well-being, elder mistreatment has been linked to increased risks of morbidity and mortality (Dong et al., 2009; Dong, Chang, Wong, Wong, & Simon, 2014; Lachs, Williams, O’Brien, Pillemer, & Charlson, 1998). In addition, elder mistreatment is likely to increase nursing home placement, emergency department utilization, and adult protective services (APS) utilization (Dong & Simon, 2013a, 2013b; Lachs et al., 1998). In view of its public health significance, the Institute of Medicine gathered experts in the field of elder mistreatment to discuss prevention programs in April 2013. Despite the growing attention, we still have rudimentary knowledge on the issue of elder mistreatment in minority populations. Cultural beliefs greatly influence the occurrence, perception, and care plans for elder mistreatment. Chinese cultural ideals highly emphasize children’s obligations of obeying, respecting, supporting, and caring for older adults, whereas disrespect may be considered as a form of mistreatment toward older adults (Ho, 1996; Tam & Neysmith, 2006). However, given the substantial social changes brought about by modernization and industrialization, younger generations, especially those who are acculturated in the United States, may be less likely to adhere to traditional cultural values and practices. The pressure from older parents to fulfill filial obligations and the growing disparity in values and interests between generations may intensify family conflicts and increase caregiver burdens that predispose older adults to elder mistreatment. In addition, influenced by the value of collectivism that encourages conformity and cohesiveness (Ho & Chiu, 1994), Chinese older adults may be less likely to disclose elder mistreatment and seek professional help. A prior
Downloaded from jah.sagepub.com at UCSF LIBRARY & CKM on December 30, 2014
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Dong et al.
study on Chinese older adults’ perceptions of elder mistreatment suggested that there was a tendency for older adults to tolerate elder mistreatment so as to protect family reputation (Dong, Chang, Wong, Wong, & Simon, 2011). Another study among Asian American older adults further suggested that such tolerance for elder mistreatment may be associated with not favoring reporting and outside intervention (Moon, Tomita, & Jung-Kamei, 2001). Consequently, the scope of elder mistreatment among Chinese older adults is very likely to be under-reported (Chan, Chun, & Chung, 2008). There is a growing body of literature that has helped improve the understanding of elder mistreatment in the Chinese communities. Prior studies suggested that elder mistreatment was common among Chinese older adults in Mainland China, with overall prevalence rates ranging from 20% to 40% (Dong, Simon, & Gorbien, 2007; Wu et al., 2012). Empirical evidence further demonstrated that elder mistreatment resulted in psychological distress among Chinese older adults (Yan & Tang, 2001). However, the majority of studies on elder mistreatment focused on Chinese older adults in Mainland China or Hong Kong, and very few studies have investigated elder mistreatment in U.S. Chinese older populations. The Chinese community is the largest and the fastest growing Asian American subgroup population in the United States, numbering approximately 4 million (American Community Survey, 2011). The population of U.S. Chinese adults aged 65 and above has increased by 55% in the past decade, far exceeding the population growth rate of 15% among U.S. older adults (U.S. Census Bureau, 2010). Compared with the general population, the Chinese population is older in average age and less acculturated among U.S. immigrant groups (Shinagawa, 2008). A lack of language competency, coupled with cultural barriers and social isolation, may exacerbate frailty and dependency, and further dispose U.S. Chinese older adults to higher risk of elder mistreatment. Despite the vulnerability of U.S. Chinese older adults, there is a dearth of investigations examining elder mistreatment in the U.S. Chinese communities. The purposes of this study were to (a) investigate the prevalence of elder mistreatment in U.S. Chinese older adults and (b) examine socio-demographic and health-related correlates of elder mistreatment in U.S. Chinese older adults.
Method Population and Settings The Population-Based Study of ChINese Elderly (PINE) is a communityengaged, population-based epidemiological study of U.S. Chinese older
Downloaded from jah.sagepub.com at UCSF LIBRARY & CKM on December 30, 2014
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Journal of Aging and Health 26(7)
adults aged 60 years and above conducted in the Greater Chicago area. Briefly, the purpose of the PINE study is to collect community-level data of U.S. Chinese older adults to examine the key cultural determinants of health and well-being. The project was initiated by a synergistic community–academic collaboration between the Rush Institute for Healthy Aging, Northwestern University, and many community-based social services agencies and organizations throughout the Greater Chicago area (Dong, Wong, & Simon, 2014). To ensure study relevance to the well-being of the Chinese community and increase community participation, the PINE study implemented extensive culturally and linguistically appropriate community recruitment strategies strictly guided by a community-based participatory research (CBPR) approach. The formation of this community–academic partnership allowed us to develop appropriate research methodology in accordance with the local Chinese cultural context, in which a community advisory board (CAB) played a pivotal role in providing insights and strategies for conducting research. Board members were community stakeholders and residents enlisted through more than 20 civic, health, social and advocacy groups, community centers, and clinics in the city and suburbs of Chicago. The board worked extensively with investigative team to develop and examine study instrument to ensure cultural sensitivity and appropriateness. More than 20 social service agencies, community centers, health advocacy agencies, faith-based organizations, senior apartments, and social clubs served as the basis of study recruitment sites, where eligible participants were approached through routine social services and outreach efforts serving Chinese American families in the Chicago city and suburban areas. Out of 3,542 eligible participants who were approached, 3,159 agreed to participate in the study, yielding a response rate of 91.9%. Based on the available census data drawn from U.S. Census 2010 and a random block census project conducted in the Chinese community in Chicago, the PINE study is representative of the Chinese aging population in the Greater Chicago area with respect to key demographic attributes, including age, sex, income, education, number of children, and country of origin (Simon, Chang, Rajan, Welch, & Dong, 2014). The study was approved by the Institutional Review Board of the Rush University Medical Center.
Measurements Socio-demographics. Basic demographic information included age (in years), sex (female and male), education (years of education completed), annual personal income ($0-$4,999 per year; $5,000-$9,999 per year; $10,000-$14,999
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Dong et al.
per year; or more than $15,000 per year), marital status (married, separated, divorced, or widowed), number of children, and living arrangement (living alone, living with 1 person, living with 2-3 persons, or living with 4 or more persons). Overall health status, quality of life, and health changes over the last year. Overall health status was measured by “in general, how would you rate your health?” on a 4-point scale (1 = poor, 2 = fair, 3 = good, 4 = very good). Quality of life was assessed by asking “in general, how would you rate your quality of life?” on a 4-point scale ranging from 1 = poor to 4 = very good. Health changes over the last year was measured by “compared to one year ago, how would you rate your health now?” on a 3-point scale (1 = worsened, 2 = same, 3 = improved). Elder mistreatment. Elder mistreatment was measured using a 10-item selfreported instrument, derived from the Hwalek–Sengstok Elder Abuse Screening Test (H-S/EAST) and the Vulnerability to Abuse Screening Scale (VASS; Hwalek & Sengstock, 1986; Schofield & Mishra, 2003). Participants were asked whether they had (a) family conflicts at home, (b) felt uncomfortable with someone in the family, (c) felt that nobody wanted them around, (d) been told by someone that they gave too much trouble, (e) been afraid of someone in the family, (f) felt that someone close tried to hurt or harm them, (g) been neglected or confined, (h) been called names or put down, (i) been forced by someone to do things, or (j) had belongings taken without permission. Each question elicited a yes or no answer. A “yes” response to any questions defined a participant as having experienced elder mistreatment. Modified VASS has been administered in Chinese elderly populations both in Mainland China and the United States (Dong, Beck, & Simon, 2009; Dong et al., 2007). The scale demonstrated good reliability in this study sample, with Cronbach’s alpha of .80.
Data Analysis We used descriptive statistics to summarize demographic information of the participants. Chi-square statistics were used to compare the socio-demographic and health-related characteristics between groups with and without any elder mistreatment. Pearson correlation coefficients were calculated to determine the relationships of socio-demographic and health-related variables with elder mistreatment. All statistical analyses were undertaken using SAS, Version 9.2 (SAS Institute Inc., Cary, NC).
Downloaded from jah.sagepub.com at UCSF LIBRARY & CKM on December 30, 2014
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Journal of Aging and Health 26(7)
Results Sample Characteristics Of the 3,159 participants, 58.9% were female. Characteristics of the study participants by the presence of any elder mistreatment are presented in Table 1. Elder mistreatment was found in 15.0% of the participants. Compared with the group without any elder mistreatment, the group with any elder mistreatment had a greater proportion of older adults who aged less than 80 years (83.6% vs. 78.1%, p< .01), had an educational level of more than 13 years (35.3% vs. 18.6%, p< .001), were separated or divorced (8.1% vs. 3.5%, p< .001), had zero to one child (21.8% vs. 13.6%, p< .001), had poor overall health status (29.3% vs. 17.1%, p< .001), reported poor quality of life (5.9% vs. 2.6%, p< .001), and perceived worsened health status in the past year (53.7% vs. 40.4%, p< .001).
Prevalence of Elder Mistreatment The prevalence of elder mistreatment is shown in Table 2. Feeling uncomfortable with someone in the family was the most common form of elder mistreatment (9.1%), followed by having family conflicts at home (6.7%) and being called names or put down (5.5%). In addition, 4.7% of the study participants felt that nobody wanted them to be around, and 3.3% of the participants had been told that they gave too much trouble.
Prevalence of Elder Mistreatment by Health Status We further examined the prevalence of elder mistreatment by health status (Table 3). Elder mistreatment was most prevalent among older adults with poor overall health status (23.4%, p< .001). Likewise, the prevalence of elder mistreatment was highest among older adults with poor quality of life (28.6%, p< .001). In addition, the proportion of elder mistreatment victims in older adults with a worsened health status over the last year (19.1%) was similar to those with an improved health status over the last year (19.6%). Both proportions were much higher than that in older adults with a same health status over the last year (10.8%).
Correlation of Socio-Demographic and Health-Related Factors With Elder Mistreatment Higher levels of education (r = .16, p< .001), fewer children (r = .1, p< .001), lower overall health status (r = .11, p< .001), poorer quality of life (r = .05,
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Dong et al. Table 1. Characteristics of PINE Study Participants by Presence of Elder Mistreatment. Any No mistreatment mistreatment (n = 475) (n = 2,665) Age group, number (%) 60-64 90 (19.0) 65-69 108 (22.7) 70-74 106 (22.3) 75-79 93 (19.6) 80-84 53 (11.2) 25 (5.3) 85 and over Sex, number (%) Male 183 (38.5) Female 292 (61.5) Education level, number (%) 0 year 14 (3.0) 1-6 years 120 (25.4) 7-12 years 172 (36.4) 13-16 years 142 (30.0) 17 and over 25 (5.3) Income in US$, number (%) $0-$4,999 $5,000-$9,999 48 (10.2) $10,000-$14,999 35 (7.5) $15,000 and over Marital status, number (%) Married 336 (71.2) Separated 22 (4.7) Divorced 16 (3.4) Widowed 98 (20.8) Number of children (%) 23 (4.9) 0 1 80 (16.9) 276 (58.2) 2-3 4 or more 95 (20.0) Living arrangement, number (%) Living alone 108 (22.7) With 1 person 204 (43.0) With 2-3 persons 73 (15.4) With 4 or more 90 (19.0)
χ2
df
p value
588 (22.1) 532 (20.0) 495 (18.6) 463 (17.4) 336 (12.6) 251 (9.4)
16.0
5
.007
1,107 (41.5) 1,558 (58.5)
1.5
1
.22
4
JAHXXX10.1177/0898264314531617Journal of Aging and HealthDong et al.
Article
Prevalence and Correlates of Elder Mistreatment in a Community-Dwelling Population of U.S. Chinese Older Adults
Journal of Aging and Health 2014, Vol. 26(7) 1209–1224 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0898264314531617 jah.sagepub.com
XinQi Dong, MD, MPH1, Ruijia Chen, MS1, Terry Fulmer, PhD, RN, FAAN2, and Melissa A. Simon, MD, MPH3
Abstract Objective: This study aimed to examine the prevalence and correlates of elder mistreatment among U.S. Chinese older adults. Method: Data were drawn from the Population-Based Study of ChINese Elderly (PINE) study, a population-based epidemiological survey of 3,159 U.S. Chinese older adults in the Greater Chicago area. The study design was guided by a communitybased participatory research approach. Results: This study found a prevalence of 15.0% for elder mistreatment among community-dwelling Chinese older adults. In addition, higher levels of education (r = .16, p< .001), fewer children (r = .1, p< .001), lower health status (r = .11, p< .001), poorer quality of life (r = .05, p< .01), and worsening health over the past year (r = .08, p< .001) were positively correlated with any elder mistreatment. 1Rush
UniversityMedicalCenter, Chicago, IL, USA University, Boston, MA, USA 3Northwestern University, Chicago, IL, USA 2Northeastern
Corresponding Author: XinQi Dong, MD, MPH, Professor of Medicine, Nursing, and Behavioral Sciences, Rush University Medical Center; Director of Chinese Health, Aging and Policy Program; Associate Director of the Rush Institute for Health Aging, 1645 West Jackson Blvd., Suite 675, Chicago, IL 60612, USA. Email: [email protected]
Downloaded from jah.sagepub.com at UCSF LIBRARY & CKM on December 30, 2014
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Journal of Aging and Health 26(7)
Discussion: Elder mistreatment is prevalent among U.S. Chinese older adults. The findings point to a pressing need for researchers, community service workers, health care providers, and policy makers to increase efforts on reducing elder mistreatment in U.S. Chinese communities. Keywords elder mistreatment, Chinese older adults, prevalence, population-based study
Introduction Elder mistreatment is a significant health issue across all socio-economic and cultural backgrounds. According to the World Health Organization (2002), the prevalence of elder mistreatment in developed countries ranges from 1% to 10%. The U.S. National Elder Mistreatment Study reported that 11.4% of older adults suffered from elder mistreatment in the previous year (Acierno et al., 2010). As detrimental to one’s health and well-being, elder mistreatment has been linked to increased risks of morbidity and mortality (Dong et al., 2009; Dong, Chang, Wong, Wong, & Simon, 2014; Lachs, Williams, O’Brien, Pillemer, & Charlson, 1998). In addition, elder mistreatment is likely to increase nursing home placement, emergency department utilization, and adult protective services (APS) utilization (Dong & Simon, 2013a, 2013b; Lachs et al., 1998). In view of its public health significance, the Institute of Medicine gathered experts in the field of elder mistreatment to discuss prevention programs in April 2013. Despite the growing attention, we still have rudimentary knowledge on the issue of elder mistreatment in minority populations. Cultural beliefs greatly influence the occurrence, perception, and care plans for elder mistreatment. Chinese cultural ideals highly emphasize children’s obligations of obeying, respecting, supporting, and caring for older adults, whereas disrespect may be considered as a form of mistreatment toward older adults (Ho, 1996; Tam & Neysmith, 2006). However, given the substantial social changes brought about by modernization and industrialization, younger generations, especially those who are acculturated in the United States, may be less likely to adhere to traditional cultural values and practices. The pressure from older parents to fulfill filial obligations and the growing disparity in values and interests between generations may intensify family conflicts and increase caregiver burdens that predispose older adults to elder mistreatment. In addition, influenced by the value of collectivism that encourages conformity and cohesiveness (Ho & Chiu, 1994), Chinese older adults may be less likely to disclose elder mistreatment and seek professional help. A prior
Downloaded from jah.sagepub.com at UCSF LIBRARY & CKM on December 30, 2014
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Dong et al.
study on Chinese older adults’ perceptions of elder mistreatment suggested that there was a tendency for older adults to tolerate elder mistreatment so as to protect family reputation (Dong, Chang, Wong, Wong, & Simon, 2011). Another study among Asian American older adults further suggested that such tolerance for elder mistreatment may be associated with not favoring reporting and outside intervention (Moon, Tomita, & Jung-Kamei, 2001). Consequently, the scope of elder mistreatment among Chinese older adults is very likely to be under-reported (Chan, Chun, & Chung, 2008). There is a growing body of literature that has helped improve the understanding of elder mistreatment in the Chinese communities. Prior studies suggested that elder mistreatment was common among Chinese older adults in Mainland China, with overall prevalence rates ranging from 20% to 40% (Dong, Simon, & Gorbien, 2007; Wu et al., 2012). Empirical evidence further demonstrated that elder mistreatment resulted in psychological distress among Chinese older adults (Yan & Tang, 2001). However, the majority of studies on elder mistreatment focused on Chinese older adults in Mainland China or Hong Kong, and very few studies have investigated elder mistreatment in U.S. Chinese older populations. The Chinese community is the largest and the fastest growing Asian American subgroup population in the United States, numbering approximately 4 million (American Community Survey, 2011). The population of U.S. Chinese adults aged 65 and above has increased by 55% in the past decade, far exceeding the population growth rate of 15% among U.S. older adults (U.S. Census Bureau, 2010). Compared with the general population, the Chinese population is older in average age and less acculturated among U.S. immigrant groups (Shinagawa, 2008). A lack of language competency, coupled with cultural barriers and social isolation, may exacerbate frailty and dependency, and further dispose U.S. Chinese older adults to higher risk of elder mistreatment. Despite the vulnerability of U.S. Chinese older adults, there is a dearth of investigations examining elder mistreatment in the U.S. Chinese communities. The purposes of this study were to (a) investigate the prevalence of elder mistreatment in U.S. Chinese older adults and (b) examine socio-demographic and health-related correlates of elder mistreatment in U.S. Chinese older adults.
Method Population and Settings The Population-Based Study of ChINese Elderly (PINE) is a communityengaged, population-based epidemiological study of U.S. Chinese older
Downloaded from jah.sagepub.com at UCSF LIBRARY & CKM on December 30, 2014
1212
Journal of Aging and Health 26(7)
adults aged 60 years and above conducted in the Greater Chicago area. Briefly, the purpose of the PINE study is to collect community-level data of U.S. Chinese older adults to examine the key cultural determinants of health and well-being. The project was initiated by a synergistic community–academic collaboration between the Rush Institute for Healthy Aging, Northwestern University, and many community-based social services agencies and organizations throughout the Greater Chicago area (Dong, Wong, & Simon, 2014). To ensure study relevance to the well-being of the Chinese community and increase community participation, the PINE study implemented extensive culturally and linguistically appropriate community recruitment strategies strictly guided by a community-based participatory research (CBPR) approach. The formation of this community–academic partnership allowed us to develop appropriate research methodology in accordance with the local Chinese cultural context, in which a community advisory board (CAB) played a pivotal role in providing insights and strategies for conducting research. Board members were community stakeholders and residents enlisted through more than 20 civic, health, social and advocacy groups, community centers, and clinics in the city and suburbs of Chicago. The board worked extensively with investigative team to develop and examine study instrument to ensure cultural sensitivity and appropriateness. More than 20 social service agencies, community centers, health advocacy agencies, faith-based organizations, senior apartments, and social clubs served as the basis of study recruitment sites, where eligible participants were approached through routine social services and outreach efforts serving Chinese American families in the Chicago city and suburban areas. Out of 3,542 eligible participants who were approached, 3,159 agreed to participate in the study, yielding a response rate of 91.9%. Based on the available census data drawn from U.S. Census 2010 and a random block census project conducted in the Chinese community in Chicago, the PINE study is representative of the Chinese aging population in the Greater Chicago area with respect to key demographic attributes, including age, sex, income, education, number of children, and country of origin (Simon, Chang, Rajan, Welch, & Dong, 2014). The study was approved by the Institutional Review Board of the Rush University Medical Center.
Measurements Socio-demographics. Basic demographic information included age (in years), sex (female and male), education (years of education completed), annual personal income ($0-$4,999 per year; $5,000-$9,999 per year; $10,000-$14,999
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per year; or more than $15,000 per year), marital status (married, separated, divorced, or widowed), number of children, and living arrangement (living alone, living with 1 person, living with 2-3 persons, or living with 4 or more persons). Overall health status, quality of life, and health changes over the last year. Overall health status was measured by “in general, how would you rate your health?” on a 4-point scale (1 = poor, 2 = fair, 3 = good, 4 = very good). Quality of life was assessed by asking “in general, how would you rate your quality of life?” on a 4-point scale ranging from 1 = poor to 4 = very good. Health changes over the last year was measured by “compared to one year ago, how would you rate your health now?” on a 3-point scale (1 = worsened, 2 = same, 3 = improved). Elder mistreatment. Elder mistreatment was measured using a 10-item selfreported instrument, derived from the Hwalek–Sengstok Elder Abuse Screening Test (H-S/EAST) and the Vulnerability to Abuse Screening Scale (VASS; Hwalek & Sengstock, 1986; Schofield & Mishra, 2003). Participants were asked whether they had (a) family conflicts at home, (b) felt uncomfortable with someone in the family, (c) felt that nobody wanted them around, (d) been told by someone that they gave too much trouble, (e) been afraid of someone in the family, (f) felt that someone close tried to hurt or harm them, (g) been neglected or confined, (h) been called names or put down, (i) been forced by someone to do things, or (j) had belongings taken without permission. Each question elicited a yes or no answer. A “yes” response to any questions defined a participant as having experienced elder mistreatment. Modified VASS has been administered in Chinese elderly populations both in Mainland China and the United States (Dong, Beck, & Simon, 2009; Dong et al., 2007). The scale demonstrated good reliability in this study sample, with Cronbach’s alpha of .80.
Data Analysis We used descriptive statistics to summarize demographic information of the participants. Chi-square statistics were used to compare the socio-demographic and health-related characteristics between groups with and without any elder mistreatment. Pearson correlation coefficients were calculated to determine the relationships of socio-demographic and health-related variables with elder mistreatment. All statistical analyses were undertaken using SAS, Version 9.2 (SAS Institute Inc., Cary, NC).
Downloaded from jah.sagepub.com at UCSF LIBRARY & CKM on December 30, 2014
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Journal of Aging and Health 26(7)
Results Sample Characteristics Of the 3,159 participants, 58.9% were female. Characteristics of the study participants by the presence of any elder mistreatment are presented in Table 1. Elder mistreatment was found in 15.0% of the participants. Compared with the group without any elder mistreatment, the group with any elder mistreatment had a greater proportion of older adults who aged less than 80 years (83.6% vs. 78.1%, p< .01), had an educational level of more than 13 years (35.3% vs. 18.6%, p< .001), were separated or divorced (8.1% vs. 3.5%, p< .001), had zero to one child (21.8% vs. 13.6%, p< .001), had poor overall health status (29.3% vs. 17.1%, p< .001), reported poor quality of life (5.9% vs. 2.6%, p< .001), and perceived worsened health status in the past year (53.7% vs. 40.4%, p< .001).
Prevalence of Elder Mistreatment The prevalence of elder mistreatment is shown in Table 2. Feeling uncomfortable with someone in the family was the most common form of elder mistreatment (9.1%), followed by having family conflicts at home (6.7%) and being called names or put down (5.5%). In addition, 4.7% of the study participants felt that nobody wanted them to be around, and 3.3% of the participants had been told that they gave too much trouble.
Prevalence of Elder Mistreatment by Health Status We further examined the prevalence of elder mistreatment by health status (Table 3). Elder mistreatment was most prevalent among older adults with poor overall health status (23.4%, p< .001). Likewise, the prevalence of elder mistreatment was highest among older adults with poor quality of life (28.6%, p< .001). In addition, the proportion of elder mistreatment victims in older adults with a worsened health status over the last year (19.1%) was similar to those with an improved health status over the last year (19.6%). Both proportions were much higher than that in older adults with a same health status over the last year (10.8%).
Correlation of Socio-Demographic and Health-Related Factors With Elder Mistreatment Higher levels of education (r = .16, p< .001), fewer children (r = .1, p< .001), lower overall health status (r = .11, p< .001), poorer quality of life (r = .05,
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Dong et al. Table 1. Characteristics of PINE Study Participants by Presence of Elder Mistreatment. Any No mistreatment mistreatment (n = 475) (n = 2,665) Age group, number (%) 60-64 90 (19.0) 65-69 108 (22.7) 70-74 106 (22.3) 75-79 93 (19.6) 80-84 53 (11.2) 25 (5.3) 85 and over Sex, number (%) Male 183 (38.5) Female 292 (61.5) Education level, number (%) 0 year 14 (3.0) 1-6 years 120 (25.4) 7-12 years 172 (36.4) 13-16 years 142 (30.0) 17 and over 25 (5.3) Income in US$, number (%) $0-$4,999 $5,000-$9,999 48 (10.2) $10,000-$14,999 35 (7.5) $15,000 and over Marital status, number (%) Married 336 (71.2) Separated 22 (4.7) Divorced 16 (3.4) Widowed 98 (20.8) Number of children (%) 23 (4.9) 0 1 80 (16.9) 276 (58.2) 2-3 4 or more 95 (20.0) Living arrangement, number (%) Living alone 108 (22.7) With 1 person 204 (43.0) With 2-3 persons 73 (15.4) With 4 or more 90 (19.0)
χ2
df
p value
588 (22.1) 532 (20.0) 495 (18.6) 463 (17.4) 336 (12.6) 251 (9.4)
16.0
5
.007
1,107 (41.5) 1,558 (58.5)
1.5
1
.22
4
