Perceived Types, Causes, and Consequences of Financial Exploitation: Narratives From Older Adults.

OBJECTIVES: The goal of this study was to investigate the perception of financial exploitation and its causes and consequences by older adults who have firsthand experience of being exploited. METHOD: Thirty-one cognitively healthy older adult participants aged 50 or older were drawn from the Finance, Cognition, and Health in Elders Study. In-depth, one-on-one interviews were conducted. Interview transcripts were analyzed using an iterative, data-driven, thematic coding scheme and emergent themes were summarized. RESULTS: Categories of financial exploitation included (a) investment fraud, (b) wage theft/money owed, (c) consumer fraud, (d) imposter schemes, and (e) manipulation by a trusted person. Themes emerged around perceived causes: (a) element of trust, (b) promise of financial security, (c) lack of experience or awareness, (d) decision-making, and (e) interpersonal dynamics. Perceived consequences included negative and positive impacts around (a) finances, (b) financial/consumer behaviors (c) relationships and trust, (d) emotional impact, and (e) future outlook. DISCUSSION: These narratives provide important insights into perceived financial exploitation experiences.

Family dynamics and their association with elder family financial exploitation in families with appointed powers of attorney.

Powers of attorney (POA), widely used in end-of-life planning, give authority, often to relatives, to manage elders' affairs if they become incapacitated. Unfortunately, family members are frequently perpetrators of elder family financial exploitation (EFFE). To understand possible EFFE precursors, the Elder Family Financial Exploitation Survey (EFFES) collected hierarchical data (individual relatives nested within families) including respondent and elder demographics, financial exploitation details if it occurred, and family dynamics (general family functioning, fairness conflict, resource exchange patterns, entitlement attitudes, and communication/problem-solving). Multilevel logistic regression models found positive association with greater fairness conflict and entitlement attitudes, and negative association with general family function, resource exchange expectations, and communication patterns when growing up, but no association with current communication. Findings can prompt families to proactively address negative family dynamics to reduce the risk of EFFE. Results may also inform decisions about appointing other fiduciaries, e.g., trustees, and personal representatives (executors).

Effects of the COVID-19 Outbreak on Elder Mistreatment and Response in New York City: Initial Lessons.

New York City is currently experiencing an outbreak of COVID-19, a highly contagious and potentially deadly virus, which is particularly dangerous for older adults. This pandemic has led to public health policies including social distancing and stay-at-home orders. We explore here the impact of this unique crisis on victims of elder mistreatment and people at risk of victimization. The COVID-19 outbreak has also had a profound impact on the organizations from many sectors that typically respond to protect and serve victims of elder mistreatment. We examine this impact and describe creative solutions developed by these organizations and initial lessons learned in New York City to help inform other communities facing this pandemic and provide guidance for future crises.

Socioecological indicators of senior financial exploitation: an application of data science to 8,800 substantiated mistreatment cases.

Senior financial exploitation (FE) is prevalent and harmful. Its often insidious nature and co-occurrence with other forms of mistreatment make detection and substantiation challenging. A secondary data analysis of N = 8,800 Adult Protective Services substantiated senior mistreatment cases, using machine learning algorithms, was conducted to determine when pure FE versus hybrid FE was occurring. FE represented N = 2514 (29%) of the cases with 78% being pure FE. Victim suicidal ideation and threatening behaviors, injuries, drug paraphernalia, contentious relationships, caregiver stress, and burnout and victims needing assistance were most important for differentiating FE vs non-FE-related mistreatment. The inability to afford housing, medications, food, and medical care as well as victims suffering from intellectual disability disorder(s) predicted hybrid FE. This study distinguishes socioecological factors strongly associated with the presence of FE during protective service investigations. These findings support existing and new indicators of FE and could inform protective service investigation practices.

Integrating General Strain Theory and Trauma-Informed Principles into the Study of Older Adult Victimization.

Prevalence rates for late life victimization are well-documented. The literature has expanded, in part due to the identification of elder justice as a key priority for federal funding. The interdisciplinary field of criminology has begun addressing elder victimization and its consequences, informed by General Strain Theory (GST). It is challenging to connect the findings from this research to evidence-based interventions for older victims. Trauma-informed principles (TIP) - when linked with GST - offer a means for doing so. The current review contributes to the extant literature by examining connections between these perspectives, with the goal of encouraging future research, and ultimately informing treatment for older adult victims.

Relevance of Perpetrator Identity to Reporting Elder Financial and Emotional Mistreatment.

Objective: The National Elder Mistreatment Study (NEMS) found that 5.2% of community older adults experienced financial abuse, and 4.6% experienced emotional mistreatment in the past year. Unfortunately, the majority of abuse was not reported to the authorities. This study investigated reasons for non-reporting. Method: In all, 774 NEMS participants were surveyed 8 years later via telephone to assess past-year financial and emotional mistreatment, perpetrator status, and whether any of these episodes were reported to authorities. Results: In total, 87.5% of financial abuse by family, friends, or acquaintances was not reported versus 33% of that perpetrated by strangers; for emotional mistreatment, 89.9% of that perpetrated by family, friends, and acquaintances was not reported, compared with 83.3% by strangers. Reasons for non-reporting of emotional abuse centered largely around with "not wanting publicity" and "not wanting to get the perpetrator in trouble," while no consistent reason emerged for failure to report stranger-perpetrated mistreatment.

A Short Form of the Lichtenberg Financial Decision Rating Scale.

Objectives: This article examines the convergent validity and clinical utility of the 34-item short form of the Lichtenberg Financial Decision Rating Scale (LFDRS-SF). A briefer scale can lead to enhanced and efficient use of a person-centered approach to the assessment of financial decision-making.Methods: Using data on 200 community-dwelling older adults from Lichtenberg and colleagues (2017a), convergent validity was examined with cognitive and financial management measures using a correlational and regression approach. Receiver operating curve analyses for predicting decision-making ability classification and suspected financial exploitation classification were used to evaluate clinical utility.Results: The LFDRS-SF total risk score was significantly correlated with both cognitive and financial management measures, and the regression analysis predicted 9% of the LFDRS-SF measure. These results demonstrate not only convergent validity, but also the conceptual and empirical uniqueness of financial decision-making.Conclusions: The LFDRS-SF is a valid tool to assess real-world financial decision-making abilities.Clinical Implications: The LFDRS-SF offers an efficient way to assess financial decision-making. Training on the tool and automatic scoring and recommendations for next steps can be found at https://olderadultnestegg.com.

Financial Fraud Among Older Americans: Evidence and Implications.

OBJECTIVES: The consequences of poor financial capability at older ages are serious and include making mistakes with credit, spending retirement assets too quickly, and being defrauded by financial predators. Because older persons are at or past the peak of their wealth accumulation, they are often the targets of fraud. METHODS: Our project analyzes a module we developed and fielded on people aged 50 an older years in the 2016 Health and Retirement Study (HRS). Using this data set, we evaluated the incidence and prospective risk factors (measured in 2010) for investment fraud and prize/lottery fraud using logistic regression (N = 1,220). RESULTS: Relatively few HRS respondents mentioned any single form of fraud over the prior 5 years, but 5.0% reported at least one form of investment fraud and 4.4% recounted prize/lottery fraud. Greater wealth (nonhousing) was associated with investment fraud, whereas lower housing wealth and symptoms of depression were associated with prize/lottery fraud. Hispanics were significantly less likely to report either type of fraud. Other suspected risk factors-low social integration and financial literacy-were not significant. DISCUSSION: Fraud is a complex phenomenon and no single factor uniquely predicts victimization across different types, even within the category of investment fraud. Prevention programs should educate consumers about various types of fraud and increase awareness among financial services professionals.

Quantifying Risk of Financial Incapacity and Financial Exploitation in Community-dwelling Older Adults: Utility of a Scoring System for the Lichtenberg Financial Decision-making Rating Scale.

Objectives: This work examines the clinical utility of the scoring system for the Lichtenberg Financial Decision-making Rating Scale (LFDRS) and its usefulness for decision making capacity and financial exploitation. Objective 1 was to examine the clinical utility of a person centered, empirically supported, financial decision making scale. Objective 2 was to determine whether the risk-scoring system created for this rating scale is sufficiently accurate for the use of cutoff scores in cases of decisional capacity and cases of suspected financial exploitation. Objective 3 was to examine whether cognitive decline and decisional impairment predicted suspected financial exploitation.Methods: Two hundred independently living, non-demented community-dwelling older adults comprised the sample. Participants completed the rating scale and other cognitive measures.Results: Receiver operating characteristic curves were in the good to excellent range for decisional capacity scoring, and in the fair to good range for financial exploitation.Conclusions: Analyses supported the conceptual link between decision making deficits and risk for exploitation, and supported the use of the risk-scoring system in a community-based population.Clinical Implications: This study adds to the empirical evidence supporting the use of the rating scale as a clinical tool assessing risk for financial decisional impairment and/or financial exploitation.

Exploring an Emerging Measurement Issue in Older Adult Maltreatment: Exploitation of Older Adults' Residences.

Despite nationwide housing challenges that might lead to the exploitation of older adults' housing resources, exploitation of older adults' residences has not been a focus of measurement in the rapidly developing field of elder abuse and neglect. Rather, measures of older adult abuse and exploitation used in the research literature emphasize specific property, money, or resources being taken. Two composites are used to illustrate exploitation of older adults' residences by trusted others on whom the older adults depended with potentially serious implications for environmental safety and ultimately the older adults' housing stability. As part of a larger study on older adult maltreatment, police reports were coded for abuse and financial exploitation as well as misuse of the older adult's residence that threatened the older adult's housing security and/or exerted control over the older adult. Nearly one in ten (9.2%) police reports involving older adult victims and known/trusted perpetrators described exploitation of residences. Residence exploitation was separable from financial exploitation and less likely to co-occur with neglect. Considering the importance of housing stability to older adult well-being, consequences of maltreatment by a known/trusted other, and a national housing crisis, we propose that exploitation of older adults' residences warrants further measurement and practice attention. Findings are relevant to advancing theory in older adult maltreatment (e.g., application of white-collar crime versus betrayal trauma and family violence theories).

Financial-patrimonial elder abuse: an integrative review.

OBJECTIVE: to analyze the available evidence in the nursing literature about financial-patrimonial elder abuse. METHOD: integrative review of articles indexed in the databases CINAHL, Scopus, Web of Science, LILACS and MEDLINE, from 2007 to 2017. The combination of controlled and uncontrolled descriptors was used in Portuguese, English and Spanish. RESULTS: 15 studies developed in seven countries were included. In the thematic analysis, three categories emerged: epidemiological data, risk factors and institutions providing services to the elderly. The occurrence of this type of violence concomitantly to the other subtypes was highlighted among the most frequent. FINAL CONSIDERATIONS: the literature points to important epidemiological data, risk factors and characteristics of this type of violence, including within institutions providing services to the elderly, in different countries, essential aspects for structuring and rethinking public policies for protection and appreciation of the elderly.

Providing Assistance for Older Adult Financial Exploitation Victims: Implications for Clinical Gerontologists.

Background and Objective: Despite the growth of financial exploitation research in the past decade, almost none has focused on older urban adults, and especially urban African Americans. The Success After Financial Exploitation (SAFE) program provides individual financial coaching to older urban adults. Methods: We use community education, delivered separately to older adults and to the professionals who serve them, to raise awareness about financial exploitation (FE) and to motivate referrals for financial coaching. This paper describes the program and methodology, and uses case examples and preliminary research to investigate the intersection of FE and physical and mental health functioning. Results: SAFE participants were able to repair their credit scores, reduce new financial burdens, and even recover monies they had lost due to FE. Case examples illustrate how financial scams and identity theft impacts urban older adults. Participants were assessed prior to the provision of services, and SAFE participants performed poorer on executive functioning tasks than participants in the control group. They also reported more physical health problems and anxiety and depressive symptoms. SAFE participants also had significantly higher risk scores on a financial decision-making scale. Conclusion: Study findings advance our understanding of the impacts of FE on cognitive functioning, mental health, and financial decision-making. Clinical Implications: Clinicians need to be more attuned to the financial health of their older clients, who, if they are struggling with financial exploitation, may also be suffering from problems with cognitive functioning and physical and mental health.

Economic-financial and patrimonial elder abuse: a documentary study.

OBJECTIVE: To analyze economic-financial and patrimonial cases of elder abuse, recorded in the specialized police station for security and protection of the elderly of a capital city in the northeast region of Brazil. METHOD: A cross-sectional study was carried out with data extracted from police reports and inquiries recorded in the abovementioned police station. Descriptive and inferential statistics were carried out by means of Pearson's chi-square test or Fisher's exact test, and multivariate logistic regression. RESULTS: The sample was made up of 555 police reports. The data showed that financial abuse presented a prevalence of 58.9%, and that older elderly people (67.9%), men (70.4%), and single (75.0%) presented a higher percentage of financial abuse compared with other types of violence, often occurring in public places, with 3.1 more chances of occurrence than at the elderly's home. Regarding aggressors, women (73.5%), without suspicion of alcohol use (66.4%), and non-family members committed more financial abuse, evidencing 2.97 more chances of practicing it. CONCLUSION: In the period studied, financial abuse increased in its magnitude when compared with other types of violence, a fact that justifies researching the theme in order to prevent it.

Mental Health Correlates of Financial Mistreatment in the National Elder Mistreatment Study Wave II.

Objective: Whereas prevalence of elder financial mistreatment has received increased attention over the past decade, health and mental health correlates are rarely studied. Thus, the potential relevance of financial abuse to mental health and perceived health is relatively unknown, and the objective of this article is to illustrate this relationship. Method: The second wave of the National Elder Mistreatment Study used random digit dialing telephone survey methodology to assess both recent financial mistreatment and its potential mental health correlates (i.e., diagnoses of depression, posttraumatic stress disorder [PTSD], generalized anxiety disorder [GAD], and self-ratings of physical health) in 774 older adults. Results: The study indicated that past-year Wave II financial mistreatment was associated with significantly increased likelihood of depression, PTSD, GAD, and poor self-rated health; and financial mistreatment perpetrated by family members was associated with particularly increased risk of depression. Discussion: Assessment of mental health is relevant and important in cases of financial abuse.

Financial-patrimonial elder abuse: an integrative review / Violencia financiera-patrimonial contra la persona mayor: revisión integrativa / Violência financeiro-patrimonial contra idosos: revisão integrativa

ABSTRACT Objective: to analyze the available evidence in the nursing literature about financial-patrimonial elder abuse. Method: integrative review of articles indexed in the databases CINAHL, Scopus, Web of Science, LILACS and MEDLINE, from 2007 to 2017. The combination of controlled and uncontrolled descriptors was used in Portuguese, English and Spanish. Results: 15 studies developed in seven countries were included. In the thematic analysis, three categories emerged: epidemiological data, risk factors and institutions providing services to the elderly. The occurrence of this type of violence concomitantly to the other subtypes was highlighted among the most frequent. Final considerations: the literature points to important epidemiological data, risk factors and characteristics of this type of violence, including within institutions providing services to the elderly, in different countries, essential aspects for structuring and rethinking public policies for protection and appreciation of the elderly.

RESUMEN Objetivo: analizar las evidencias disponibles en la literatura de enfermería acerca de la violencia financiero-patrimonial contra ancianos. Método: revisión integradora de los artículos indexados en las bases de datos CINAHL, Scopus, Web of Science, LILACS y MEDLINE desde 2007 a 2017. Se utilizó una combinación de descriptores controlados y no controlados, en portugués, Inglés y Español. Resultados: se incluyeron 15 estudios, desarrollados en siete países. En el análisis temático, surgieron tres categorías: datos epidemiológicos, factores de riesgo e instituciones proveedoras de servicios a los ancianos. Se verificó la ocurrencia de este tipo de violencia de forma concomitante a los otros subtipos, que se destacó entre las más frecuentes. Consideraciones finales: la literatura apunta importantes datos epidemiológicos, factores de riesgo y características de ese tipo de violencia, incluso dentro de las instituciones prestadoras de servicio a ancianos, en diferentes países, aspectos esenciales para estructurar y repensar políticas públicas de protección y valorización de la persona anciana.

RESUMO Objetivo: analisar as evidências disponíveis na literatura de enfermagem acerca da violência financeiro-patrimonial contra idosos. Método: revisão integrativa de artigos indexados nas bases de dados CINAHL, Scopus, Web of Science, LILACS e MEDLINE, no período de 2007 a 2017. Utilizou-se a combinação de descritores controlados e não controlados, nos idiomas português, inglês e espanhol. Resultados: foram incluídos 15 estudos, desenvolvidos em sete países. Na análise temática, emergiram três categorias: dados epidemiológicos, fatores de risco e instituições provedoras de serviços aos idosos. Verificou-se a ocorrência deste tipo de violência de forma concomitante aos outros subtipos, que se destacou entre as mais frequentes. Considerações finais: a literatura aponta importantes dados epidemiológicos, fatores de risco e características desse tipo de violência, inclusive dentro das instituições prestadoras de serviço a idosos, em diferentes países, aspectos essenciais para estruturar e repensar políticas públicas de proteção e valorização da pessoa idosa.

A Systematic Review of Financial Exploitation Measures in Prevalence Studies.

The financial exploitation of older adults has garnered the attention of society as well as state and federal governments in a way that elder abuse has never been able to achieve. It is frequently asserted that financial exploitation deserves this attention in part because it is the most prevalent form of elder abuse. This article systematically reviews the measurement of financial exploitation in comparison with other forms of elder abuse and concludes that its measurement is considerably more variable than other forms of abuse. Consequently, improvements in the measurement of financial exploitation are warranted.

Associations Between Social Support, Social Networks, and Financial Exploitation in Older Adults.

Social support and social networks are important correlates of elder mistreatment. This study tests hypothesized associations between perceived social support, social network size, and financial exploitation (FE). A population-based survey of 903 older adults (60+) in Allegheny County (Pittsburgh, Pennsylvania) found that lower perceived social support and larger social networks were simultaneously associated with higher risk for FE since age 60, controlling for known risk factors. The same associations were found for FE in the last 6 months. Older adults with larger social networks combined with lower perceived social support were most likely to report FE. When it comes to the role of social relationships and risk for FE, "more may not always be better." Encouragement to widen the social network by "making new friends" should be stressed less than making sure these new network members will truly be supportive of the older adult.

[Validation of a prevention and detection procedure for physical and economic abuse of the elderly]. / Validación de un procedimiento de prevención y detección de malos tratos físicos y económicos a personas mayores.

INTRODUCTION: The study carried out for the «Physical and economic abuse sign detection procedure for the elderly in the Basque Country¼ Pilotage and Validation is described. There barely exist appropriate and validated tools to assist the issue, and the existing ones are hardly adequate for people with cognitive deterioration; therefore, the issue's both visibility in our society and professional intervention are strained. The proposed procedure is a composed by screening tool that determines a likelihood of abuse and an evaluation of signs for determining the abuse practice. It is intended to be used in the social area as well as the sanitary one by any professional. It is composed of two questionnaires: one of risk-factor valuation and a second one concerning indicators based on three severity levels. METHODOLOGY: Both quantitative and qualitative methodologies were used. The sample was made of 649 elders: 596 evaluated by the risk-factor questionnaire, 138 by the indicators questionnaire, and 85 evaluated by both; 94 professionals from several backgrounds (sanitary, social and economic) participated. Eight of the detected cases were checked by the team of experts that elaborated the procedure; the sessions were analysed after their transcription. CONCLUSIONS: The procedure has been validated as sensitive for its goal, being equally valid for the social and health areas. It can be used by any professional, although some differences have been detected. As regards the ability to differentiate items and the final evaluation of the severity of the situation, some changes and corrections have been proposed.

Financial Exploitation Is Associated With Structural and Functional Brain Differences in Healthy Older Adults.

BACKGROUND: Age-related brain changes leading to altered socioemotional functioning may increase vulnerability to financial exploitation. If confirmed, this would suggest a novel mechanism leading to heightened financial exploitation risk in older adults. Development of predictive neural markers could facilitate increased vigilance and prevention. In this preliminary study, we sought to identify structural and functional brain differences associated with financial exploitation in older adults. METHODS: Financially exploited older adults (n = 13, 7 female) and a matched cohort of older adults who had been exposed to, but avoided, a potentially exploitative situation (n = 13, 7 female) were evaluated. Using magnetic resonance imaging, we examined cortical thickness and resting state functional connectivity. Behavioral data were collected using standardized cognitive assessments, self-report measures of mood and social functioning. RESULTS: The exploited group showed cortical thinning in anterior insula and posterior superior temporal cortices, regions associated with processing affective and social information, respectively. Functional connectivity encompassing these regions, within default and salience networks, was reduced, while between network connectivity was increased. Self-reported anger and hostility was higher for the exploited group. CONCLUSIONS: We observed financial exploitation associated with brain differences in regions involved in socioemotional functioning. These exploratory and preliminary findings suggest that alterations in brain regions implicated in socioemotional functioning may be a marker of financial exploitation risk. Large-scale, prospective studies are necessary to validate this neural mechanism, and develop predictive markers for use in clinical practice.