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Release: May 5, 2000

NOTE TO EDITORS: To request a copy of the journal article mentioned in this news release, call the Journal of the American Geriatrics Society at (410) 528-4416. In addition, please note that Jeffrey Dawson's Sc.D. degree is analogous to a Ph.D. degree.

UI study raises concerns about detecting and responding to elder abuse

IOWA CITY, Iowa -- Certain community characteristics, including higher rates of child abuse, seem to be related to increased reported or substantiated elder abuse, according to a University of Iowa Health Care study that examined 10 years of statewide data in Iowa.

The study, published in the May issue of the Journal of the American Geriatrics Society, is the first to examine elder abuse risk factors in all 99 Iowa counties and is believed to be the first to look at the problem for a 10-year period across an entire state. Elder abuse, as defined in the study, included cases that occur outside of nursing homes for the elderly.

The UI team wanted to determine if there were any community risk factors related to reported or actual elder abuse because many elder abuse reports come through health care workers, said Gerald J. Jogerst, M.D., UI associate professor of family medicine. He said the findings have implications for how well society will respond to an increasing at-risk population of elderly people as baby-boomers age.

"We found that reported cases of elder abuse are higher in areas with higher population density, higher rates of reported child abuse and more children under age 6 living in poverty," Jogerst said. "We also initially thought that increased availability of health care resources, such as hospital beds, non-federally funded hospitals and social workers, primary care physicians and nurses, might be related to higher rates of reported and substantiated elder abuse cases."

However, when the researchers factored in other community variables, including child poverty, population density and the number of people under the age of 18, the health care resources no longer showed an effect on elderly abuse rates.

In Iowa, as in 13 other states, social workers handle both elderly abuse and child abuse cases, raising the question for the UI researchers whether this combined system affects elderly abuse reporting or substantiation.

"You would think that the resulting workload in areas with the highest rates of reported child abuse would decrease how much time caseworkers could devote to substantiating elderly abuse," Jogerst said. "However, we found counties with higher rates of reported child abuse actually have higher rates of elderly abuse reporting and substantiation."

The UI researchers will further investigate the issue by studying substantiated rates of elder abuse in states where social workers are responsible for both child and elder abuse cases and the comparable rates in states where caseworkers are assigned to only one type of abuse case or the other.

In the recent study, the UI researchers also reported a "district effect" for elder abuse in Iowa. During the time of the study, the state's 99 counties were divided into a total of eight districts.

"After considering each county's population, number of investigators and number of elder abuse cases, there were districts that still had more reports and more substantiations," he said.

District 6 in central Iowa, which included Polk County and the state capital, Des Moines, had the highest rates of both reported and substantiated elder abuse cases. Polk County was the individual county with the highest rate of substantiated elder abuse cases.

"These differences may be related to levels of community awareness of elder abuse and the way investigators in those counties are trained to investigate elderly abuse," Jogerst said.

The district findings also suggest there are differences among caseworkers in districts with greater numbers of reports and substantiation, and caseworkers in the other districts. The UI nationwide survey of caseworkers will help investigate this issue. However, Jogerst noted that one problem in studying elder abuse is that statutes related to elder abuse differ from state to state.

In Iowa, an elder abuse case involves a "dependent adult," defined as a person age 18 or older who is not able to care for him or herself as a result of a physical or mental condition and depends on assistance from others. Based on this definition, some older adults mistreated by family members or other people are not included in elder mistreatment statistics.

"If an elderly person is still making decisions, yet being abused, the case is not defined as elder abuse," Jogerst said. "Yet the difficulty with the elderly is that they can slip into abuse. There may not be a clear dividing line between dependency and autonomy."

"I think one way we assess the worth of a society is how we treat our elders," he added.

Jeffrey D. Dawson, Sc.D., UI associate professor of biostatistics in the UI College of Public Health, provided the statistical analysis for the study. Other UI researchers contributing to the study included Arthur J. Hartz, M.D., Ph.D., professor of family medicine; John W. Ely, M.D., associate professor of family medicine; and L.A. Schweitzer, research assistant in the UI Public Policy Center.

The UI team used data collected from 1984 to 1993 by the Iowa Department of Human Services. The researchers also used data from agencies and programs including the UI Physician Assistant Program and the Office of Statewide Clinical Education Programs housed at the UI.

University of Iowa Health Care describes the partnership between the UI College of Medicine and the UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide.