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Financial Exploitation of Older Adults

A Population-Based Prevalence Study

see home page for new study findings related to financial exploitation

 

Under the Radar:
New York State Elder Abuse Prevalence Study

SELF-REPORTED PREVALENCE AND DOCUMENTED CASE SURVEYS
FINAL REPORT
EXECUTIVE SUMMARY
May 2011

Prepared by:
Lifespan of Greater Rochester, Inc.
Weill Cornell Medical Center of Cornell University
New York City Department for the Aging

The New York State Elder Abuse Prevalence Study is one of the most ambitious and comprehensive
studies to quantify the extent of elder abuse in a discrete jurisdiction ever attempted, and certainly
the largest in any single American state. With funding from the New York State William B. Hoyt
Memorial Children and Family Trust Fund, a program administered under NYS Office of Children and Family Services, three community, governmental, and academic partners (Lifespan of Greater Rochester, the New York City Department for the Aging and the Weill Cornell Medical College) formed a collaborative partnership to conduct the study.

AIMS OF THE STUDY

The study had three central aims achieved through two separate study components:

  • To estimate the prevalence and incidence of various forms of elder abuse in a large, representative,
    statewide sample of older New Yorkers over 60 years of age through direct interviews (hereafter
    referred to as the Self-Reported Prevalence Study)

  • To estimate the number of elder abuse cases coming to the attention of all agencies and programs
    responsible for serving elder abuse victims in New York State in a one-year period (the Documented Case Study), and

  • To compare rates of elder abuse in the two component studies, permitting a comparison of “known” to “hidden” cases, and thereby determining an estimate of the rate of elder abuse underreporting in New York State.

Prevalence refers to the number of older adults who have ever experienced elder mistreatment since turning 60. Incidence refers to the number of new cases of elder abuse in the year prior to the survey interview.

METHODOLOGY

At the completion of the study, 4,156 older New Yorkers or their proxies had been interviewed directly and 292 agencies reported on documented cases from all corners of the state. Through the collaborative efforts of the three research partners, the study employed “cutting edge” methodologies to accomplish the goals of the study. These included (1) improvement of existing survey instruments to make them “state of the art” using the combined field knowledge of academics and direct service providers; separate surveys were created for the Self-Reported Prevalence Survey and the Documented Case Study, (2) utilization of the Cornell Research Survey Institute in Ithaca to assemble a representative state sample of older adults and to conduct the interviews by telephone, (3) administration of a survey to all major service systems, agencies and programs in the state that receive reports of elder abuse and provide investigation and intervention to older adult victims.

Methodology - Self-Reported Prevalence Study

In the Self-Reported Prevalence Study, the research team assembled a representative sample of all residents of New York State age 60 and older representing a broad cross section of the older population in the state. The sample was created using a random digit dialing strategy derived from census tracts targeting adults over 60. The study was limited to older adults living in the community, that is, not living in licensed facilities such as nursing homes and adult care facilities. The actual surveys were conducted by telephone by trained interviewers at the Cornell Survey Research Institute. The survey instrument used for this component of the study captured elder mistreatment in four general domains: (1) Neglect by a responsible caregiver (2) Financial Exploitation (3) Emotional Abuse and (4) Physical Elder Abuse (including Sexual Abuse).

Methodology - Documented Case Study

The Documented Case Study contacted programs and agencies responsible for specifically serving victims of elder abuse and older victims of domestic violence in New York State and requested that they complete a survey about cases served in calendar year 2008. The survey included questions on elder abuse cases that mirrored the questions used for the statewide Self-Reported Prevalence Study. Programs surveyed included Adult Protective Services, law enforcement, area agencies on aging, domestic violence programs, elder abuse programs, programs funded by the Office of Victim Services (previously known as the Crime Victims Board), elder abuse coalitions, and District Attorney (DA) offices. While the amount of data supplied varied by county and organization, at least some data was collected for each of the 62 counties in New York State.

MAJOR FINDINGS

The findings of the study point to a dramatic gap between the rate of elder abuse events reported by older New Yorkers and the number of cases referred to and served in the formal elder abuse service system.

  • Overall the study found an elder abuse incidence rate in New York State that was nearly 24 times
    greater than the number of cases referred to social service, law enforcement or legal authorities who have the capacity as well as the responsibility to assist older adult victims.

  • Psychological abuse was the most common form of mistreatment reported by agencies providing data on elder abuse victims in the Documented Case Study. This finding stands in contrast to the results of the Self-Reported Study in which financial exploitation was the most prevalent form of mistreatment reported by respondents as having taken place in the year preceding the survey.

  • Applying the incidence rate estimated by the study to the general population of older New Yorkers, an estimated 260,000 older adults in the state had been victims of at least one form of elder abuse in the preceding year (a span of 12 months between 2008-2009).

Caution must be exercised in interpreting the large gap between prevalence reported directly by older
adults and the number of cases served. The adequacy of some documentation systems to provide elder abuse case data may have played a role in the results. The inability of some service systems and individual programs to report on their involvement in elder abuse cases may have affected the final tally of documented cases. As a result, an undetermined number of cases may not be accounted for from agencies and programs that could not access some data about elder abuse victims served. However, the study received comprehensive data from the largest programs serving elder abuse victims: Adult Protective Services, law enforcement and community-based elder abuse programs.

 

Table A
Rates of Elder Abuse in New York State:
Comparison of Self-Reported One-Year Incidence and Documented Case Data
 

Documented
Rate per 1,000

Self-reported
Rate per 1,000

Ratio of
Self-Reported to Documented

New York State -
All forms of abuse
3.24
76.0
23.5
Financial
.96
42.1
43.9
Physical and Sexual
1.13*
22.4*
19.8
Neglect
.32
18.3
57.2
Emotional
1.37
16.4
12.0
 
*The Documented Case rate includes physical abuse cases only. Physical and sexual abuse data were combined in the Self-Reported Study. The sexual abuse rate for the Documented Case Study was 0.03 per 1,000.

 

It should be noted that the sum of the rates exceeds the total rates in both the Documented Case and Self-Reported Studies because some victims experienced more than one type of abuse.

SELF-REPORTED PREVALENCE STUDY

Major findings of the Self-Reported Study include:

  • A total one-year incidence rate of 76 per 1,000 older residents of New York State for any form of elder abuse was found.

  • The cumulative prevalence of any form of non-financial elder mistreatment was 46.2 per thousand subjects studied in the year preceding the survey.

  • The highest rate of mistreatment occurred for major financial exploitation (theft of money or
    property, using items without permission, impersonation to get access, forcing or misleading to get items such as money, bank cards, accounts, power of attorney) with a rate of 41 per 1,000 surveyed. This rate reflects respondent reports of financial abuse that occured in the year preceding the survey. (The rate for moderate financial exploitation, i.e. discontinuing contributions to household finances in spite of agreement to do so, constituted another 1 per 1,000 surveyed.)

  • The study also found that 141 out of 1,000 older New Yorkers have experienced an elder abuse event since turning age 60.

DOCUMENTED CASE STUDY

Major findings of the Documented Case Study include:

  • Adjusting for possible duplication of victims served by more than one program, the study determined that in a one-year period 11,432 victims were served throughout New York State, yielding a rate of 3.24 elder abuse victims served per 1,000 older adults.

  • Rates of documented elder abuse varied by region. The highest rate was in New York City (3.79 reported cases per 1,000 older adult residents) compared to the region with the lowest rate of documented cases, Central New York /Southern Tier (2.30 cases per 1,000).

  • Variability in data collection across service systems contributed to the large gap uncovered between the number of cases reported through the Documented Case Study and the prevalence rates found in the Self-Reported Study. The extent to which the gap can be attributed to data collection issues among service systems has not been established.

  • While there was little difference among urban, suburban and rural counties in types of abuse reported in the Documented Case Survey (for all regions, emotional abuse is the most common abuse category reported), urban areas tend to have higher documented case rates than rural counties.

 

Table B
Victim Demographic Information
Comparison of Documented Case Data and Self Reported Data
Information about victims

Documented Case Study
Percent of Victims

Self-Reported
Study
Percent of Victims
Age Groups
   60-64
17.0
20.3
   65-74
41.9
38.0
   75-84
28.1
29.1
   85+
13.0
12.7
   (Missing)
14.9
0.0
Gender    
   Male
32.8
35.8
   Female
67.2
64.2
   (Missing)
13.8
0.0
Race/Ethnicity
   African American
27.9
26.3
   Asian/Pacific Islander
3.0
1.6
   Caucasian
69.3
65.5
   Hispanic/Latino
16.4
7.6
   Native American/Aleut Eskimo
0.8
1.9
   Race, other
10.5
2.9
   (Missing)
50.8
1.9

 

Under Race/Ethnicity, it should be noted that in the Documented Case Study, some agencies permitted
elder abuse victims to declare more than one ethnic category; as a result the sum of percentages exceeds 100. In the Self-Reported Study column, respondents who self identified as Hispanic/Latino in addition to another category are reported in a separate statistic (7.6%). As a result, the sum of all categories again exceeds 100 percent.

Note that in Table B, “Missing” in the Documented Case Study column indicates the percentage of cases
in which responding organizations were unable to supply the data requested. In the Self-Reported Study
column, “Missing” indicates the percentage of telephone survey respondents who declined to supply the
requested information.

The comparison of demographic data in Table B reveals similar trends in both the Self-Reported and
Documented Case data except in the area of Race/Ethnicity. The percentage of Hispanic/Latino and
Asian/Pacific Islander victims served by Documented Case Study respondent organizations was approximately twice the percentage of Self-Reported Study respondents who self-identified as Hispanic/Latino or Asian/Pacific Islander. On the other hand, Native Americans/Aleut Eskimos were represented in the Documented Case findings at less than half the rate they were found in the Self-Reported Study. It should also be noted, however, that responding organizations in the Documented Case Study were as a whole unable to provide racial/ethnic data in half of the cases.

CONCLUSIONS

While the Prevalence Study did not attempt to analyze the reasons for the disparity in self-reported versus documented elder abuse, some possible explanations can be offered. Considerable variability in documentation systems may play a role in the results. The Documented Case Study found a great deal of variability in the way service systems and individual organizations collect data in elder abuse cases. Some service systems and some regions may lack the resources to integrate elder abuse elements in data collection systems or may simply not have an adequate elder abuse focus in their data collection. Population density, the visibility of older adults in the community and, conversely, social isolation in rural areas may contribute to differences in referral rate trends based on geography. Greater awareness by individuals, both lay and professional, who have contact with older adults and might observe the signs and symptoms of elder abuse, may also explain higher referral rates in some areas.

The New York State Elder Abuse Prevalence Study uncovered a large number of older adults for whom elder abuse is a reality but who remain “under the radar” of the community response system set up to assist them.

The findings of the New York State Elder Abuse Prevalence Study suggest that attention should be paid to the following issues in elder abuse services:

  • Consistency and adequacy in the collection of data regarding elder abuse cases across service systems. Sound and complete data sets regarding elder abuse cases are essential for case planning and program planning, reliable program evaluation and resource allocation.

  • Emphasis on cross-system collaboration to ensure that limited resources are used wisely to identify and serve elder abuse victims.

  • Greater focus on prevention and intervention in those forms of elder abuse reported by elders to be most prevalent, in particular, financial exploitation.

  • Promotion of public and professional awareness through education campaigns and training concerning the signs of elder abuse and the resources available to assist older adults who are being mistreated by trusted individuals.

IMPLICATIONS FOR FOLLOW UP AND FURTHER STUDY

For the first time, a scientifically rigorous estimate of the prevalence of elder abuse in New York State has been established. The study also provides an estimate of the number of cases that receive intervention in a one-year period throughout the state. The study raises many questions about differences in rates of abuse in various regions, about referral rates by region and about how elder abuse data is recorded. Further exploration of these issues in future research studies is warranted.

The findings also serve as a platform for more informed decision making about policy, use of limited
resources and models of service provision for the thousands of older New Yorkers whose safety, quality of life and dignity are compromised each year by elder mistreatment.

 

Download full NYS Prevalence and Incidence Study (pdf)

Download 2010 Summit Report (pdf)

Download 2004 Summit Report (pdf)

 
   
         
 

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The New York State Coalition on Elder Abuse is administered by Lifespan of Greater Rochester, Inc.
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