The following is a guest blog post by Jason Burnett, Ph.D., Co-Director of the Texas Elder Abuse and Mistreatment Institute (TEAM). This post is part of SIFMA’s “Protecting Senior Investors” blog series, raising awareness and sharing information to help prevent elder financial exploitation. See our full series here. 

Increasing numbers of older Americans are being targeted and financially exploited every year. The financial loss is in the billions¹ and many experience financial ruin.² However, losing money through scams, seemingly beneficial friendships and familial betrayal takes a toll on more than just the older adult’s bank account. For many, it results in a loss of independence³, reduced quality of life⁴ and even death.⁵ Understanding this correlation could lead to possible intervention and prevention of poor health outcomes in older victims of financial exploitation (FE) and stem their risks of early mortality.

Financial exploitation linked to poor health outcomes

Multiple studies link elder financial exploitation to poor health outcomes. For example, Nerenberg et al., 2000 report that elder FE victims experience mental health consequences such as shame, depression and anxiety.⁶ In some cases, the victimization can be so afflicting that the older adult turns to self-harm and commits suicide.⁷ It is well known that general elder abuse is associated with significantly higher mortality rates, but far less is known about the specific association between elder FE and mortality. The link between the two is plausible.

Dong et al. [2013] have shown that exploited older adults are more likely to end up in the emergency department than non-abused adults.⁸ Moreover, they are also more likely to be hospitalized.⁹ Some reasons for this is that elder FE may remain hidden for long periods of time and the loss of income may be substantial. Jackson and Hafemeister (2012) found that elder FE occurring in the presence of other forms of abuse (i.e. hybrid FE) tend to go on for longer periods of time and the older adults tends to lose twice as much money than when it occurs in the absence of other forms of abuse (i.e. pure FE). These losses are associated with lower self-rated health and the ability to afford medications and other health care needs.¹⁰

Financial exploitation and mortality

Unfortunately, elder abuse types such as physical abuse and caregiver neglect often get the spotlight. The theory is that these forms of abuse are more readily observable, more easily intervened upon and they lead to physical injury. Therefore, establishing a link between elder FE and mortality, the ultimate injury an older adult can face, is critical if one in fact exists.

A study by Burnett et al. 2016 showed exactly this. Using a large Adult Protective Services database of confirmed elder abuse cases and state mortality data, Burnett et al. compared the 5-year all-cause mortality rates between five categories of abuse. These types were caregiver neglect, physical abuse, psychological abuse, financial exploitation and polyvictimization (i.e. more than one type of co-occurring abuse). The findings showed that older adults suffering neglect by a caregiver had the highest 5-year all-cause mortality rate. However, surprisingly:

• Elder FE was found to have the second highest mortality rate, and this was not statistically different than the rate of caregiver neglect;
• Elder FE victims did, however, have mortality rates statistically higher than physical abuse;
• Those experiencing polyvictimization had the third highest mortality rate.⁵

These findings are important because they show that some types of elder abuse (i.e. elder FE) – other than those where physical injury occurs – can be particularly harmful and threaten an older adult’s life. It remains unclear why those experiencing elder FE died. Perhaps they were unable to afford their medications or other adequate healthcare.¹¹ It is possible that they became depressed, anxious and isolated; all of which are associated with higher mortality in older adults. The “why?” remains an unknown that needs to be explicated. Future studies should aim to better understand the mechanisms and patterns that fall between elder FE victimization and death.

Jason Burnett, Ph.D., is the Co-Director of the Texas Elder Abuse and Mistreatment Institute (TEAM) and Assistant Professor, Geriatric and Palliative Medicine at McGovern Medical School, The University of Texas Health Science Center at Houston.

References:

¹Metlife (Metlife Mature Market Institute, National Committee for the Prevention of Elder Abuse, & the Center for Gerontology at Virginia Polytechnic Institute and State University) (2009). Broken trust: Elders, family, and finances. Retrieved from: http://www.metlife.com/assets/cao/mmi/publications/studies/mmistudy-broken-trust-elders-family-finances.pdf

²Dessin, CL. (2000). Financial abuse of the elderly. Idaho Law Review, 36, 203-226.

³Choi, NG, Kulick DB., & Mayer, J. (1999). Financial exploitation of elders: Analysis of risk factors based on county adult protective services data. Journal of Elder Abuse and Neglect, 10, 39-62.

⁴Coker J, & Little B. (1997). Investing in the future: Protecting the elderly from financial abuse. FBI Law Enforcement Bulletin, 1-5.

⁵Burnett J, Jackson SL, Sinha A, Aschenbrenner AR, Xia R, Murphy KP & Diamond PM. Differential Mortality across Five Types of Substantiated Elder Abuse. Journal of Elder Abuse and Neglect, 2016; 28:2, 59-75.

⁶Nerenberg L. (2000). Forgotten victims of financial crime and abuse: Facing the challenge. Journal of Elder Abuse and Neglect, 12, 49-72.

⁷Podnieks E. National survey on abuse of the elderly in Canada. Journal of Elder Abuse and Neglect, 1992, 4, 5-58.

⁸Dong X, Simon MA. Association between elder abuse and use of ED: findings from the Chicago Health and Aging Project. American Journal of Emergency Medicine 2013;31:693-698.

⁹Dong X & Simon MA. Elder abuse as a risk factor for hospitalization in older persons. JAMA Intern Med. 2013, 173(10):911-917.

¹⁰Jackson SL &TL Hafemeister. Pure financial exploitation versus hybrid financial exploitation co-occurring with physical and/or neglect of elderly persons. Psychol of Violence, 2012; 2(3):285-296.

¹¹Kemp BJ & Mosqueda LA. Elder financial abuse: an evaluation framework and supporting evidence. J Am Geriatr. Soc., 2005, Jul. 53(7):1123-7.