Elder Abuse Prevalence and Risk Factors: Findings from the Canadian Longitudinal Study on Aging

doi:10.21203/rs.3.rs-1443850/v1

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Elder Abuse Prevalence and Risk Factors: Findings from the Canadian Longitudinal Study on Aging

https://doi.org/10.21203/rs.3.rs-1443850/v1

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Elder abuse (EA) is a pervasive problem with serious consequences. Prior population-based EA risk factor research has largely used cross-sectional designs that limit causal inferences, or agency records to identify victims which threatens external validity. Based on a national, prospective, population-based cohort sample of older adults (n = 23,468) over a three-year period from the Canadian Longitudinal Study on Aging, the current study sought to estimate the prevalence of EA and identify risk and protective factors. Past-year prevalence of any EA was 10.0%. Older adults with greater vulnerability related to physical, cognitive and mental health, childhood maltreatment, and shared living were at higher EA risk, while social support was protective against EA. Older adults identifying as Black or reporting financial need were at heightened EA risk. This longitudinal, population-based study advances our understanding of EA risk/protective factors across several domains and informs the development of EA prevention strategies.

Elder Abuse

Risk Factors

Protective Factors

Prevalence

Longitudinal

CLSA

Elder abuse (EA) is recognized by policymakers, researchers, and clinicians as a pervasive public health issue affecting an aging population with major health and psychosocial consequences. The Centers for Disease Control and Prevention recently highlighted EA as a public health problem requiring formal surveillance.¹ The 2015 decennial White House Conference on Aging designated EA as one of four top-priority issues affecting older adults,² and the World Health Organization highlighted EA as a key issue affecting older adults in its recent World Report on Ageing and Health.³ EA refers to an intentional act or lack of action by a person in a relationship involving an expectation of trust that causes harm or risk of harm to an older adult; it comprises five subtypes, including financial abuse/exploitation, emotional/psychological abuse, physical abuse, sexual abuse, and neglect by others.⁴

Recent reviews of population-based EA studies have found pooled one-year prevalence rates between 14% and 16% globally, and between 4% and 8% in Canada, among cognitively intact, community-dwelling older adults.^5,6 EA victimization is associated with serious consequences such as poor physical and mental health, diminished quality of life, and increased rates of emergency services use, hospitalization, and nursing home placement.^7-9 Despite the scope and consequences of this problem, our understanding of EA risk and protective factors remains limited, as existing studies have used convenience sampling designs in social service or clinical health settings,^10-13 Adult Protective Services (APS) case records as a means to identify EA victims,^14-16 or cross-sectional population-based designs that carry greater external validity but violate the temporal link between proposed risk/protective factors and EA necessary to make causal inferences.^17-21 Risk/protective factor knowledge is necessary to inform the development of targeted, mechanistic EA prevention strategies. Evidence-based prevention strategies currently do not existand, without them, the absolute number of EA cases is expected to increase substantially over the next two decades in proportion with the projected growth in older adult population.⁶

To capture the complex etiology of EA, risk/protection is predominantly examined in the literature from an ecological-systemic perspective. This perspective considers factors attached to the individual older adult or individual trusted other (level of the individuals), the older adult-trusted other relationship (level of the relationship), and surrounding context or environment, including home, family, social, and broader socio-cultural environments.^4,22,23 At the level of the individual older adult, EA risk is conceptualized as a result of physical, cognitive, emotional, and psychosocial vulnerabilities that may contribute to status inequality and power imbalance in relation to a trusted other.⁴ Consistent with these expectations, prior research has found that older adult functional impairment, poor physical health, poor mental health, behavioral problems, and cognitive impairment are strong candidate EA risk factors.^6,8 Evidence also suggests that historical factors attached to the individual older adult, including a history of child maltreatment, interpersonal violence, or other traumatic experiences, contributes to EA risk.^18,24,25

Within the home environment, a shared living arrangement is considered a candidate EA risk factor, as it provides greater, unhindered access to the victim and more opportunity for mistreatment escalation.⁴ In relation to the social environment, higher levels of social support and greater embeddedness in a social network are found to be protective in lowering the risk of EA.^18,25 Situated within the context of broader social determinants and socio-structural processes, EA risk is viewed as greater under conditions of everyday contextual stress²⁶ and, thus, unequal social arrangements contributing to hardship and accumulative stress, such as socioeconomic strain, ethnic/racial marginalization, and low access to resources may contribute to higher risk.

Addressing methodological limitations outlined above, the current study sought to advance our understanding of EA risk and protective factors using two waves of data from the prospective, population-based Canadian Longitudinal Study on Aging (CLSA). Guided by an ecological-systemic perspective, this study had the following hypotheses (H):

H1: Older adults reporting higher vulnerability in physical, cognitive, mental health, childhood experience, shared living, and social determinant domains at baseline will be at increased risk of EA at follow-up, whereas those reporting higher social support at baseline will be at reduced risk of EA at follow-up.

H2: Older adults reporting a decline (change) in physical, cognitive, or mental health status or an increase in shared living status from baseline to follow-up will be at increased risk of EA, whereas those reporting an increase in social support from baseline to follow-up will be at reduced risk of EA at follow-up.

Descriptive Characteristics

Table 1 presents descriptive characteristics of the baseline CLSA analytic sample of older adults. The sample was slightly higher proportion female (52.6%) with mean age 69.4 (SD = 6.50), and a majority of older adults identifying as White (96.8%). The majority of respondents attained an education with some form of post-secondary degree or diploma (50.1%) and fell into household income categories between $20,000 and $100,000. Most respondents lived in an urban geographical context (78.1%), and the majority of the sample was married/partnered (72.1%).

Past-Year EA Prevalence

Past-year prevalence of any EA (or EA aggregate) was 10.0% (n = 2349; 95% Confidence Interval (CI): 9.6%-10.4%). The past-year prevalence of EA subtypes were: emotional abuse [8.8% (n = 2063), 95% CI: 8.4%-9.2%]; financial abuse [1.4% (n = 329), 95% CI: 1.25%-1.55%]; and physical abuse [1.3% (n = 298), 95% CI: 1.16%-1.44%] (see Table 1).

H1: Baseline Factors Associated with Follow-Up EA

Tables 2 and 3 present results from models regressing baseline independent variables on follow-up aggregate EA and EA subtypes.

Physical. An increase in each level of baseline functional impairment (13 total levels) was significantly associated with greater odds of follow-up aggregate EA (Odds Ratio [OR], 1.16; 95% CI, 1.08-1.24) and emotional abuse (OR, 1.15; 95% CI, 1.08-1.23). Poor self-reported health was significantly associated with financial abuse (OR, 1.96; 95% CI, 1.35-2.85). Each increase in the number of chronic health conditions (38 total conditions) was significantly associated with aggregate EA (OR, 1.05; 95% CI, 1.04-1.07), emotional abuse (OR, 1.05; 95% CI, 1.03-1.07), and physical abuse (OR, 1.06; 95% CI, 1.02-1.11).

Mental Health. An increase in each point score on the CESD-10 (30 total points) denoting depressive symptoms was significantly associated with aggregate EA (OR, 1.03; 95% CI, 1.02-1.04) and emotional abuse (OR, 1.03; 95% CI, 1.02-1.05). Each increase in life satisfaction point score (30 total points) was significantly associated with lower odds of all EA types: aggregate EA (OR, 0.96; 95% CI, 0.95-0.97), emotional abuse (OR, 0.96; 95% CI, 0.95-0.97), physical abuse (OR, 0.96; 95% CI, 0.94-0.98), and financial abuse (OR, 0.96; 95% CI, 0.94-0.99). An increase in each point score indicating PTSD symptoms (4 total points) was significantly associated with aggregate EA (OR, 1.13; 95% CI, 1.07-1.19), emotional abuse (OR, 1.11; 95% CI, 1.05-1.17), and physical abuse (OR, 1.25; 95% CI, 1.12-1.41).

Childhood. An increase in each level of child maltreatment (36 total levels) was associated with all EA types: aggregate EA (OR, 1.01; 95% CI, 1.01-1.01), emotional abuse (OR, 1.01; 95% CI, 1.01-1.01), physical abuse (OR, 1.01; 95% CI, 1.01-1.02), and financial abuse (OR, 1.01; 95% CI, 1.01-1.02). Each increase in adverse childhood experience (3 total experiences) was significantly associated with financial abuse (OR, 1.30; 95% CI, 1.08-1.58).

Shared Living. An increase in each household co-habitant was significantly associated with aggregate EA (OR, 1.17; 95% CI, 1.10-1.25) and emotional abuse (OR, 1.19; 95% CI, 1.12-1.28).

Social Support. Each increase in point score on the MOSSSS (100 total points) assessing total social support was significantly associated with lower odds of aggregate EA (OR, 0.99; 95% CI, 0.99-0.99), emotional abuse (OR, 0.99; 95% CI, 0.99-0.99), and financial abuse (OR, 0.99; 95% CI, 0.98-1.00).

Socio-Demographic. Identifying as female was significantly associated with lower odds of aggregate EA (OR, 0.84; 95% CI, 0.76-0.93), physical abuse (OR, 0.61; 95% CI, 0.47-0.80), and financial abuse (OR, 0.69; 95% CI, 0.51-0.92). Higher age categories were significantly associated with lower odds of emotional abuse (Age 75-84: OR, 0.83; 95% CI, 0.73-0.93; Age 85+: OR, 0.63; 95% CI, 0.44-0.90). Compared to White older adults, those identifying as Black had significantly higher odds of financial abuse (OR, 7.92; 95% CI, 3.62-17.32). Older adults with the lowest level of education had significantly lower odds of aggregate EA (OR, 0.78; 95% CI, 0.69-0.89) and emotional abuse (OR, 0.78; 95% CI, 0.68-0.89). Compared to married/partnered older adults, those identifying as single/never married had significantly lower odds of aggregate EA (OR, 0.68; 95% CI, 0.53-0.88) and emotional abuse (OR, 0.69; 95% CI, 0.53-0.90), while those identifying as widowed were significantly less likely to report aggregate EA (OR, 0.52; 95% CI, 0.43-0.64), emotional abuse (OR, 0.51; 95% CI, 0.41-0.62), and physical abuse (OR, 0.59; 95% CI, 0.37-0.93). Older adults with an inadequate income to support basic needs were significantly more likely to report aggregate EA (OR, 1.46; 95% CI, 1.25-1.70), emotional abuse (OR, 1.41; 95% CI, 1.20-1.66), and physical abuse (OR, 1.95; 95% CI, 1.41-2.70).

Finally, as a methodological finding, compared to older adults interviewed in person, those interviewed by telephone had significantly lower odds of reporting aggregate EA (OR, 0.77; 95% CI, 0.69-0.85), emotional abuse (OR, 0.76; 95% CI, 0.68-0.85), and physical abuse (OR, 0.74; 95% CI, 0.57-0.98).

H2: Change Variables Associated with EA

Tables 4 and 5 present results from models regressing independent change variables (from baseline to follow-up) on aggregate EA and EA subtypes.

Physical. A decline in functional status from baseline to follow-up was significantly associated with all EA types: aggregate EA (OR, 1.46; 95% CI, 1.27-1.66), emotional abuse (OR, 1.46; 95% CI, 1.27-1.68), physical abuse (OR, 1.58; 95% CI, 1.15-2.16), and financial abuse (OR, 1.51; 95% CI, 1.07-2.13). A decline in perceived health from “good” to “poor” over time was significantly associated with physical abuse (OR, 1.84; 95% CI, 1.28-2.66). A increased number of chronic health conditions over time was significantly associated with aggregate EA (OR, 1.30; 95% CI, 1.17-1.44), emotional abuse (OR, 1.31; 95% CI, 1.17-1.46), and physical abuse (OR, 1.35; 95% CI, 1.03-1.78).

Cognitive. A decline in cognitive status on the MAT was significantly associated with aggregate EA (OR, 1.19; 95% CI, 1.07-1.32) and emotional abuse (OR, 1.21; 95% CI, 1.08-1.36), while cognitive decline on the Rey Auditory Verbal Learning Test 2 was significantly associated with physical abuse (OR, 1.39; 95% CI, 1.06-1.82).

Mental Health. A change in perceived mental health from “good’ to “poor” over time was significantly associated with aggregate EA (OR, 1.62; 95% CI, 1.31-2.00) and emotional abuse (OR, 1.63; 95% CI, 1.31-2.03). A change in status on depressive symptoms from “not depressed” to “depressed” was significantly associated with aggregate EA (OR, 1.50; 95% CI, 1.29-1.75), emotional abuse (OR, 1.52; 95% CI, 1.29-1.78), and financial abuse (OR, 1.72; 95% CI, 1.18-2.52). A decline in life satisfaction from “satisfied” to “dissatisfied” over time was significantly associated with aggregate EA (OR, 1.54; 95% CI, 1.28-1.86), emotional abuse (OR, 1.67; 95% CI, 1.37-2.02), and physical abuse (OR, 1.60; 95% CI, 1.03-2.49).

Shared Living. An increase in the number of household co-habitants was significantly associated with lower odds of physical abuse (OR, 0.47; 95% CI, 0.22-0.99).

Social Support. A decline in total social support was significantly associated with aggregate EA (OR, 1.14; 95% CI, 1.04-1.26) and emotional abuse (OR, 1.17; 95% CI, 1.05-1.29).

Socio-Demographic. A change in income from being “adequate” to “inadequate” in satisfying basic needs was significantly associated with all EA types: aggregate EA (OR, 2.26; 95% CI, 1.83-2.79), emotional abuse (OR, 2.08; 95% CI, 1.67-2.60), physical abuse (OR, 1.74; 95% CI, 1.01-3.01), and financial abuse (OR, 2.42; 95% CI, 1.48-3.96).

The current study used longitudinal, population-based data from the CLSA to estimate a one-year period EA prevalence rate and to identify EA risk and protective factors.

Findings from this study indicate that one out of every ten adults in Canada age 65 years or older experience some form of EA each year, which extrapolates to approximately 970,000 older Canadians in the broader population.⁴⁵ An overall 10.0% one-year period EA prevalence rate is consistent with prior EA prevalence research. A recent national population-based EA prevalence study in Canada found an overall EA prevalence rate of 8.2%.²⁵ Similarly, recent estimates of EA prevalence in the U.S based on population-based studies found an overall pooled one-year EA prevalence of 9.5%.⁶ Like other EA prevalence research, the prevalence rates reported in the current study may under-estimate true population EA prevalence, since older adults tend to under-report personal problems.³¹ Taken together, findings from this study highlight EA as a pervasive issue in the community with a pressing need to develop prevention strategies.

Hypotheses relating physical, mental, and cognitive vulnerabilities to EA risk were generally supported. Within the physical domain, specifically, level of functional capacity and the total number of chronic health conditions, whether measured as a static indicator at baseline or as a decline over time, were consistent predictors of EA across several subtypes. Health and functional impairments are conceptualized as contributing to diminished capacities for self-care and self-protection and may position an older adult into a particularly vulnerable dynamic as dependent on others, such as family members or paid caregivers, to assist with health and day-to-day needs.⁴ Older adults with poorer mental health at baseline or who reported a decline in mental health (e.g., from good to poor) over time were at higher risk of EA in relation to several measures, including depression, life satisfaction, PTSD, and perceived mental health. Poor mental health may contribute to lower levels of self-worth or issues of denial, self-blame, and isolation that, in turn, increase susceptibility to EA and may also serve to disarm a person’s capacity to protect themselves.⁴⁶

Cognitive capacity as a static characteristic at baseline was not predictive of follow-up EA, but a decline in cognitive status over time was associated with increased EA risk. This finding suggests that vulnerability may arise during periods of cognitive transition when an older adult is in flux in their capacity, living situation, and systems of care. Overall, findings in this study relating physical, mental, and cognitive vulnerability to EA risk suggest that health and allied health professionals who work with older adults can play key roles in detecting and preventing EA, including efforts related to screening, education, and appropriate service referrals.

In line with our hypotheses, childhood maltreatment was a consistent predictor of EA across all subtypes. Older adults who experienced higher levels of childhood maltreatment were more likely to report EA in later life. This finding adds to a limited, yet growing, body of evidence linking early-life maltreatment to later-life mistreatment.^25,46 Although the precise mechanisms that connect early maltreatment experiences to later-life EA are unclear, these findings suggest that interpersonal/family violence should be examined and understood as a life course issue, rather than organized according to discrete life stage domains of childhood maltreatment, intimate partner/domestic violence, and EA separately. Understanding the conditions and processes that link these forms of interpersonal/family violence across the life course is a key priority for future research.

Consistent with expectations, a higher number of household co-habitants at baseline was associated with higher odds of EA. Unexpectedly, however, an increase in household co-habitants over time was associated with lower odds of physical abuse. Prior research has found that the presence of non-perpetrator others in the household serves as a protective factor against severe forms of EA,⁴⁷ and the finding related to physical abuse may similarly indicate that others in the household buffer against this particularly egregious form of EA.

Building on prior research,⁶ this study also found social support to be a protective factor against EA. Social support strengthens the protective system surrounding an older adult to provide third-party surveillance (e.g., holding a prospective perpetrator accountable) or emotional support, monitor financial decisions, or to encourage the older adults to seek help if indications of EA arise.

Regarding socio-demographic characteristics, the current study found that Black older adults are at higher risk of financial abuse. This finding builds on similar findings from prior EA risk factor research,^48,49 including a recent longitudinal, population-based study finding Black older adults to be at higher risk of becoming victims of financial abuse over time.³³ The growing evidence across studies that Black older adults are disproportionately victimized by financial abuse indicates race as a social determinant of EA with a need to understand the mechanism underlying this form of racial disparity.

The current study found that females were less likely to experience EA. Population-based studies outside of North America have found female sex to be a risk factor for EA.⁶ However, within North America, some population-based studies in Canada^50,51 and the U.S.⁵² have found females to be less likely to experience EA, while a host of other studies have found non-significance on older adult sex in relation to EA.⁶ Although geo-cultural factors may be influencing these discrepant findings, further research is required to understand the relationship between sex and EA. Finally, older adults in this study reporting an inadequate income (or whose income status changed from adequate to inadequate over time) in satisfying basic needs were at higher risk of all EA subtypes. In framing income specifically in relation to basic needs, this finding helps contextualize prior research indicating that low household income, in general, is a correlate of EA.⁶

Without EA data collection at both baseline and follow-up, it is not possible to identify risk factors for new cases (or incidence) of EA or to establish true causality in relation to risk factors. The CLSA sampling strategy excluded Canadians living in the three territories, as well as those living on federal First Nations reserves and other First Nations settlements in the provinces. Therefore, EA findings in this report are not generalizable to Indigenous communities, and future research should aim to understand EA within these communities. While the CLSA assessed EA subtypes of emotional, physical, and financial abuse, issues of sexual abuse and neglect were unavailable. Although sexual abuse and neglect represent the least common forms of EA,⁶ non-coverage in the current study likely under-estimates the reported prevalence rates. Although the mode of survey administration (telephone versus in-person) was controlled for in analyses, administration mode was associated with EA reporting differences, which may have resulted in under-estimating EA prevalence rates.

In conclusion, based on a longitudinal, population-based design, findings from this study strengthen and advance our understanding of EA risk and protective factors beyond the convenience sampling and/or cross-sectional designs of prior research. This study found EA to be a highly pervasive problem. In turn, the development of prevention strategies is a priority. To inform such prevention development, the current study identified EA risk and protective factors spanning several domains, including older adult physical health, functional capacity, cognitive capacity, mental health, and social support. Findings also linked child maltreatment to EA and support a need to develop our understanding of interpersonal/family violence from a life course, rather than life stage, perspective.

Sample

The CLSA is one of the largest prospective, population-based cohort studies on aging worldwide. It uses telephone and in-person interviews with a national, stratified, random sample of over 50,000 adults aged 45 to 85 at the time of baseline recruitment.²⁷ The current study used data from the most recent and available CLSA baseline (2015) (Time 1) and follow-up (2018) (Time 2) data collection waves. The EA module (covering emotional, physical, and financial abuse subtypes) was introduced into the CLSA at follow-up and administered to older adults aged 65 or older. In turn, the analytic sample for this study involved CLSA participants who completed both baseline and follow-up interviews and were age 65 or older at follow-up (n = 23,468). The CLSA yielded an overall participation rate of 50%.²⁸ To mitigate concerns related to the generalizability of findings, data were weighted (and adjusted for sample size) for all analyses, which accounted for sample misrepresentation resulting from unequal sampling probabilities, frame coverage error and non-response. The weighted CLSA data are generalizable to the Canadian population on key variables such as age and sex.^28,29 Further details about the CLSA methods are available online.³⁰

The CLSA sampling strategy excluded individuals with the following characteristics: lived in institutions including 24-hour long-term care settings; lived in the three Canadian territories or on federal First Nations reserves and other First Nations settlements in the provinces; full-time members of the Canadian Armed Forces; temporary VISA holders or had transitional health coverage; cognitive impairment; and unable to respond in English or French languages. Individuals living in senior residence settings providing minimal levels of care were included in the sample. Individuals who became institutionalized between baseline and follow-up (e.g., moved into long-term care) were included in follow-up interviews either through personal or proxy-based interviewing.³⁰

Dependent Variables

In accordance with recognized procedures to maximize sensitivity in epidemiological interpersonal/family violence research, each EA subtype was assessed using multiple, behaviorally defined items describing specific mistreatment events as opposed to using a single-item catch-all question, and each subtype module included an initial preamble to help contextualize the content.^31,32The CLSA EA module used questions from the Canadian National Survey on the Mistreatment of Older Canadians, which used a modified version of the Conflict Tactics Scale to assess elder emotional and physical abuse.²⁵ Emotional abuse was assessed using four items related to criticism, insulting, threats/intimidation, and exclusion/ignoring. Physical abuse was assessed using six items related to pushing/shoving/grabbing, throwing, hitting/slapping, trying to hit with something, choking, and threatening to use a weapon. In the absence of an existing financial abuse measure validated for use with general population-based older adult samples, the National Survey study developed a financial abuse tool based on a review of the literature and the ”known groups” validation of financial abuse involving 267 older adults who were known to be ether abused or non abused.²⁴ Financial abuse was assessed using three items related to someone making the participant give money/possessions/property, someone taking money/possessions/property, and someone deliberately preventing access to money/possessions/property against the older adult’s will.

EA was measured dichotomously as the presence/absence of emotional, physical, and/or financial abuse. Across each EA subtype, respondents were asked if they had experienced specific mistreatment behaviors (items) over the past year. An affirmative response to any subtype mistreatment behavior initiated a follow-up question about the frequency of the behavior over the past year (once, a few times, many times, every day/almost every day). Physical and financial abuse were deemed present if an older adult affirmed one or more of the mistreatment subtype behaviours in the past year, regardless of frequency. In accordance with recent recommendations to enhance emotional abuse measurement specificity,⁶ emotional abuse was deemed present if the criticism, insulting, or exclusion/ignoring items were affirmed with a past-year frequency of at least “many times”, or the threats/intimidation item was affirmed with any level of past-year frequency.^20,33 Integration of past-year frequency ratings provided a threshold for emotional abuse caseness that was meant to distinguish EA cases from everyday family events that do not belong under the categorization of EA. In accordance with accepted EA definitions,⁴ EA was framed as events perpetrated by a person in a relationship involving an expectation of trust, including a family member, friend, caregiver, or other person considered close or trusting.

Specific techniques were used to help enhance participant safety/privacy and accurate reporting during interviews in the event that a perpetrator was in the home. Participants were provided advance notice that upcoming questions covered topics of EA. Participants were asked if they anticipated anyone entering the room during the proceeding module and, if so, whether they would have privacy to continue or if the interview should be rescheduled. Participants were asked if there was anyone in the home who they would be uncomfortable asking to leave the room and, if so, a code word was established to indicate that this person was present. Respondents were advised that they could opt out of any question or withdraw from the interview at any time. EA questions describing mistreatment behaviors were specifically worded to elicit yes/no responses from participants to maintain privacy about the topic on the respondents’ end of the conversation.

Independent Variables

Physical vulnerability was represented by measures of functional and health status. Using modified questions from the Older Americans’ Resources and Services (OARS) Multidimensional Functional Assessment Questionnaire,³⁴ functional impairment was measured continuously (range: 0-13) as the number of activities of daily living (ADL) or instrumental ADL (IADL) tasks at baseline an older adult required help with. A dichotomous functional impairment change variable characterized whether an older adult’s functional status, based on total score, from baseline to follow-up remained the same/improved or declined. General perceived health was measured dichotomously according to whether an older adult rated their health at baseline as poor (poor, fair) or good (good, very good, excellent).³⁵ A dichotomous perceived health change variable measured whether an older adult’s perceived health status as poor or good remained the same/improved or declined from baseline to follow-up. Health conditions total was measured continuously (0-38) as the number of long-term/chronic health conditions the older adult was living with and had been diagnosed by a doctor (see Supplementary Information Appendix A for list of conditions), providing an indication of an individual’s overall health, including the presence of multimorbidity. A dichotomous health conditions change variable measured whether the number of chronic health conditions, based on total score, an older adult reported from baseline to follow-up remained the same/improved or declined.

Cognitive vulnerability was assessed using three cognitive tests with continuous scores. The Rey Auditory Verbal Learning Test 1 (range: 0-15) involved playing a list of 15 words and asking the respondent to recall as many words as possible in any order within 90 seconds (1 point per correctly recalled word).³⁶ Similarly, in the Rey Auditory Verbal Learning Test 2 (range: 0-15), respondents were given 60 seconds to recall as many of the words played previously in the Rey Auditory Verbal Learning Test 1.³⁶ For the Mental Alternation Test (MAT, no range limit), respondents were first asked to count from 1 to 20 and recite the alphabet. Upon successful completion, respondents were asked to state alternate numbers and letters (e.g., 1, A, 2, B, etc.) with 1 point awarded for each successful alternation.³⁷ For each of the cognitive tests, a dichotomous change score assessed whether a respondent’s total score remained the same/improved or declined from baseline to follow-up.

Mental health vulnerability was assessed using measures of general mental health, depression, life satisfaction, and posttraumatic stress disorder (PTSD). General perceived mental health was measured dichotomously according to whether an older adult rated their mental health as poor (poor, fair) or good (good, very good, excellent).³⁸ A dichotomous perceived mental health change variable measured whether an older adult’s perceived mental health status as poor or good remained the same/improved or declined from baseline to follow-up. Depressive symptoms were measured continuously (range: 0-30) using the Center for Epidemiologic Studies Short Depression Scale (CESD-10) with higher scores indicating higher levels of depression.³⁹ A dichotomous depressive symptoms change variable assessed whether a respondent’s depression status as not depressed or depressed (based on CESD-10 cut-off scores) remained the same/improved or declined from baseline to follow-up. Satisfaction with life was measured continuously (range: 5-35) using the Satisfaction with Life Scale (SWLS)⁴⁰ with higher scores indicating greater life satisfaction. A dichotomous life satisfaction change score assessed whether a respondent’s life satisfaction status as satisfied or dissatisfied (based on SWLS cut-off scores) remained the same/improved or declined from baseline to follow-up. PTSD was measured continuously (range: 0-4) using the Primary Care Posttraumatic Stress Disorder (PC-PTSD) screening instrument, with higher scores indicating higher indication of PTSD.⁴¹ PTSD was not assessed at follow-up and, therefore, a change variable could not be generated.

Childhood experience vulnerability was represented by childhood maltreatment and certain adverse childhood experiences. Childhood maltreatment was assessed with a modified version of the Childhood Experiences of Violence Questionnaire^42,43 using nine mistreatment behaviors (before age 16) related to parental verbal hurt, exposure to parental hitting, exposure to parental verbal, being slapped, being pushed/shoved/grabbed/thrown, being kicked/bitten/choked/punched/burned/attacked, failure to meet basic needs, unwanted sexual activity, and unwanted touching. It was measured continuously (range: 9-45) by summing the number of different mistreatment behaviors experienced and the frequency of each type (never=1, one/two times=2, three to five times=3, six to ten times=4, more than ten times=5). Adverse experiences were measured continuously (range: 0-3) by summing responses (no=0, yes=1) on the three adverse experience types (parental death/illness, parental divorce/separation, family mental illness).

Shared living vulnerability was measured continuously (no range limit) as the number of co-habitants living in the household. A dichotomous shared living change variable measured whether the total number of co-habitants from baseline to follow-up remained the same/decreased or increased.

Social support was measured continuously (range: 0-100) using the Medical Outcomes Study Social Support Survey (MOSSSS).⁴⁴ The MOSSSS covers several dimensions of social support, including tangible, affection, positive social interaction, and emotional/informational support, with higher scores indicating higher levels of total social support. A dichotomous social support change variable assessed whether a respondent’s total MOSSSS score remained the same/improved or declined from baseline to follow-up.

Socio-structural/demographic variables included sex (male, female), age (65-74, 75-84, 85+), race/culture (White, Asian, Black, Latin American, other, multiple), immigration history (born in Canada, immigrated within last 20 years, immigrated over 20 years ago), education (less than high-school, high-school graduation, some post-secondary, post-secondary degree/diploma), marital status (married/partnered, single/never married, widowed, divorced/separated), and geo-cultural context (urban, rural). Income need was measured dichotomously according to whether a respondent rated their current income as satisfying basic needs adequately (very well, adequate) or inadequately (some difficulty, not well, totally inadequate). A dichotomous income needs change variable assessed whether a respondent’s status as adequate or inadequate remained the same/improved or worsened from baseline to follow-up.

Analysis

The H1 analysis examined how independent variables at baseline were related to EA victimization at follow-up, providing a temporal basis for inferences above and beyond a cross-sectional design at a single time. The H2 analysis used independent change variables as a way to confirm the direction of change on potential risk/protective conditions leading up to victimization, which provided an opportunity to discern whether a change in status over time on a given condition (e.g., not depressed to depressed) was associated with EA risk. In both sets of analyses, bivariate, unadjusted logistic regression was conducted on independent variables individually to explore relationships with EA outcomes. Multivariate logistic regression models were then applied to independent variables simultaneously. Selection of independent variables into the multivariate models was based on significance in the unadjusted analysis (p < .05), as well as tolerance and variance inflation factor (VIF) diagnostics to account for issues of multicollinearity. The Omnibus Test of Model Coefficients was used to understand multivariate logistic regression model fit. All multivariate models controlled for sex, race/culture, and age as basic demographic characteristics, as well as whether the interview was conducted in person or over the telephone. Although most of the interviews were conducted over the telephone (75.6%), some respondents were selected for in-person assessments as a part of a larger effort to collect additional bio-physical specimens/data (24.4%). Analyses were undertaken for aggregate EA (any type of abuse) and separately for emotional abuse, physical abuse, and financial abuse subtypes. This study received ethics approval from the Blinded for Review.

Acknowledgements

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Table 1: Descriptive characteristics of the baseline CLSA older adult analytic sample and follow-up EA prevalence rates

Characteristic	Sample (n = 23,468)
Characteristic	Categorical: n (%) Continuous: median (IQR), mean (SD)
Socio-Demographic
Sex Male Female	11134 (47.4) 12334 (52.6)
Age 65-74 75-84 85+	14580 (62.1) 7348 (31.3) 1096 (4.7)
Race/Culture White Asian Black Latin American Other Multiple	22725 (96.8) 248 (1.1) 160 (0.7) 21 (0.1) 142 (0.6) 153 (0.7)
Immigration History Born in Canada Immigrated within last 20 years Immigrated over 20 years ago	19368 (82.5) 111 (0.5) 3948 (16.8)
Education Less than high-school High school graduation Some post-secondary Post-secondary degree/ diploma	6308 (26.9) 3226 (13.7) 2090 (8.9) 11,750 (50.1)
Marital Status Married/partnered Single/never married Widowed Divorced/separated	16925 (72.1) 1064 (4.5) 3156 (13.4) 2312 (9.9)
Geo-Cultural Context Urban Rural	18320 (78.1) 5148 (21.9)
Income Need Inadequate Adequate	1917 (8.2) 21098 (89.9)
Physical
Functional impairment (cont.) [range: 0-13]	0.00 (0), 0.19 (0.66)
General Perceived Health Poor Good	2828 (12.1) 20612 (87.8)
Health Conditions Total (cont.) [range: 0-33]	4.69 (3.02)
Cognitive
Rey Auditory Verbal Learning Test 1 (cont.) [range: 0-15]	5.0 (3), 5.53 (2.18)
Rey Auditory Verbal Learning Test 2 (cont.) [range: 0-15]	4.0 (3), 3.89 (2.42)
Mental Alternation Test (cont.)	25.0 (12), 24.23 (9.23)
Mental Health
General Perceived Mental Health Poor Good	964 (4.1) 22495 (95.9)
Depression (cont.) [range: 0-30]	4.0 (6), 5.38 (4.61)
Life Satisfaction (cont.) [range: 5-35]	30.0 (7), 28.55 (6.20)
Posttraumatic Stress Disorder (cont.) [range: 0-4]	0 (0), 0.42 (0.86)
Childhood Experiences
Child Maltreatment Score (cont.) [range: 9-45]	1.0 (12), 10.10 (19.01)
Adverse Experiences Score (cont.) [range: 0-3]	0 (1), 0.44 (0.65)
Shared Living
Number of Co-Habitants (cont.)	1.0 (0), 0.97 (0.77)
Social Support
Social Support Total (cont.) [range: 0-100]	86.84 (24), 82.57 (17.53)
Control
Interview Mode In-person Telephone	5716 (24.4) 17752 (75.6)
Elder Abuse (Follow-Up)
Aggregate (Any Type) No Yes	20160 (85.9) 2349 (10.0)
Emotional Abuse No Yes	20458 (87.2) 2063 (8.8)
Physical Abuse No Yes	22446 (95.6) 298 (1.3)
Financial Abuse No Yes	22386 (95.4) 329 (1.4)

Table 2 (H1): Bivariate and multivariate logistic regression models of baseline independent variables predicting past-year aggregate EA at follow-up.

Characteristic	EA Aggregate
	Bivariate Models	Multivariate Model
	OR (95%CI)	OR (95%CI)
Physical
Functional Impairment (range: 0-13)	1.33 (1.27-1.40)***	1.16 (1.08-1.24)***
General Perceived Health Poor Good	1.90 (1.67-2.13)*** Ref.	0.97 (0.83-1.14) Ref.
Health Conditions Total (range: 0-38)	1.12 (1.10-1.13)***	1.05 (1.04-1.07)***
Cognitive
Rey Auditory Verbal Learning Test 1 (range: 0-15)	1.01 (0.99-1.03)	-
Rey Auditory Verbal Learning Test 2 (range: 0-15)	1.01 (0.99-1.03)	-
Mental Alternation Test (cont.)	1.00 (1.0-1.01)	-
Mental Health
General Perceived Mental Health Poor Good	2.74 (2.35-3.19)*** Ref.	0.94 (0.76-1.16) Ref.
Depressive Symptoms (range: 0-30)	1.09 (1.09-1.10)***	1.03 (1.02-1.04)***
Satisfaction with Life (range: 5-35)	0.92 (0.92-0.93)***	0.96 (0.95-0.97)***
Posttraumatic Stress Disorder (range: 0-4)	1.40 (1.34-1.46)***	1.13 (1.07-1.19)***
Childhood Adversity
Child Maltreatment (range: 9-45)	1.02 (1.02-1.02)***	1.01 (1.01-1.01)***
Adverse Experiences (range: 0-3)	1.31 (1.23-1.39)***	1.03 (0.95-1.11)
Shared Living
Number of Co-Habitants (cont.)	1.16 (1.10-1.22)***	1.17 (1.10-1.25)***
Social Support
Social Support Total (range: 0-100)	0.98 (0.98-0.98)***	0.99 (0.99-0.99)***
Socio-Demographic
Sex Male Female	Ref. 1.03 (0.94-1.12)	Ref. 0.84 (0.76-0.93)***
Age 65-74 75-84 85+	Ref. 0.77 (0.70-0.85)* 0.51 (0.39-0.68)*	Ref. 0.90 (0.80-1.01)† 0.73 (0.53-1.01)†
Race/Culture White Asian Black Latin American Other Multiple	Ref. 0.72 (0.45-1.16) 0.97 (0.53-1.77) 2.03 (0.69-6.02) 0.92 (0.54-1.56) 1.42 (0.95-2.12)†	Ref. 0.63 (0.38-1.06)† 1.09 (0.58-2.05) 2.03 (0.46-9.02) 0.52 (0.28-0.97)* 1.26 (0.78-2.03)
Immigration History Born in Canada Immigrated within last 20 years Immigrated over 20 years ago	Ref. 1.31 (0.77-2.25) 1.11 (0.99-1.24)†	Ref. - -
Education Less than high-school High school graduation Some post-secondary Post-secondary degree/ diploma	0.89 (0.80-0.99)* 0.93 (0.81-1.06) 1.09 (0.95-1.26) Ref.	0.78 (0.69-0.89)*** 0.96 (0.82-1.11) 0.97 (0.82-1.14) Ref.
Marital Status Married/partnered Single/never married Widowed Divorced/separated	Ref. 1.08 (0.89-1.32) 0.63 (0.54-0.73)* 1.38 (1.21-1.56)*	Ref. 0.68 (0.53-0.88) 0.52 (0.43-0.64)* 0.86 (0.72-1.02)+
Geo-Cultural Context Urban Rural	Ref. 0.81 (0.71-0.92)**	Ref. 0.94 (0.81-1.00)
Income Need Inadequate Adequate	2.42 (2.14-2.73)*** Ref.	1.46 (1.25-1.70)*** Ref.
Interviewed Mode In-Person Telephone	Ref. 0.72 (0.66-0.78)***	Ref. 0.77 (0.69-0.85)***

Table 3 (H1): Bivariate and multivariate logistic regression models of baseline independent variables predicting past-year EA subtypes at follow-up.

Characteristic	Emotional Abuse		Physical Abuse^b		Financial Abuse^b
	Bivariate Models	Multivariate Model	Bivariate Models	Multivariate Model	Bivariate Models	Multivariate Model
	OR (95%CI)	OR (95%CI)	OR (95%CI)	OR (95%CI)	OR (95%CI)	OR (95%CI)
Physical
Functional Capacity (range: 0-13)	1.32 (1.26-1.39)***	1.15 (1.08-1.23)***	1.28 (1.15-1.42)***	1.02 (0.89-1.18)	1.45 (1.33-1.58)***	1.12 (0.97-1.29)
General Health Perceived Poor Good	1.88 (1.67-2.12)*** Ref.	0.98 (0.83-1.15) Ref.	1.57 (1.16-2.11)** Ref.	- Ref.	3.10 (2.39-4.02)*** Ref.	1.96 (1.35-2.85)*** Ref.
Health Conditions Total (range: 0-38)	1.11 (1.09-1.12)***	1.05 (1.03-1.07)***	1.15 (1.12-1.19)***	1.06 (1.02-1.11)**	1.15 (1.11-1.19)***	1.04 (1.00-1.10)+
Cognitive
Rey Auditory Verbal Learning Test 1 (range: 0-15)	1.02 (1.0-1.04)	-	1.02 (0.97-1.08)	-	0.99 (0.94-1.06)	-
Rey Auditory Verbal Learning Test 2 (range: 0-15)	1.01 (0.99-1.03)	-	1.02 (0.96-1.07)	-	1.02 (0.96-1.07)	-
Mental Alternation Test (cont.)	1.00 (1.0-1.01)	-	1.00 (0.99-1.01)	-	0.98 (0.97-1.0)*	1.00 (0.98-1.01)
Mental Health
General Perceived Mental Health Poor Good	2.73 (2.33-3.20)*** Ref.	0.95 (0.76-1.18) Ref.	3.62 (2.62-5.00)*** Ref.	1.48 (0.98-2.23)+ Ref.	2.79 (1.94-4.03)*** Ref.	0.74 (0.44-1.26) Ref.
Depression (range: 0-30)	1.10 (1.09-1.11)***	1.03 (1.02-1.05)***	1.10 (1.08-1.12)***	1.00 (0.97-1.03)	1.09 (1.07-1.11)***	1.01 (0.97-1.04)
Satisfaction with Life (range: 5-35)	0.92 (0.92-0.93)***	0.96 (0.95-0.97)***	0.91 (0.90-0.93)***	0.96 (0.94-0.98)***	0.92 (0.91-0.93)***	0.96 (0.94-0.99)**
Posttraumatic Stress Disorder (range: 0-4)	1.39 (1.33-1.44)***	1.11 (1.05-1.17)***	1.57 (1.43-1.71)***	1.25 (1.12-1.41)***	1.47 (1.33-1.61)***	1.11 (0.97-1.28)
Childhood Adversity
Child Maltreatment (range: 9-45)	1.02 (1.02-1.02)***	1.01 (1.01-1.01)***	1.02 (1.02-1.02)***	1.01 (1.01-1.02)***	1.02 (1.02-1.02)***	1.01 (1.01-1.02)***
Adverse Experiences (range: 0-3)	1.32 (1.23-1.40)***	1.03 (0.95-1.12)	1.07 (0.90-1.27)	-	1.66 (1.42-1.93)***	1.30 (1.08-1.58)**
Shared Living
Number of Co-Habitants (cont.)	1.19 (1.13-1.25)***	1.19 (1.12-1.28)***	1.12 (0.98-1.28)†	-	1.02 (0.88-1.18)	-
Social
Social Support Total (range: 0-100)	0.98 (0.98-0.98)***	0.99 (0.99-0.99)***	0.98 (0.98-0.99)***	0.99 (0.99-1.0)+	0.98 (0.97-0.98)***	0.99 (0.98-1.0)**
Socio-Demographic
Sex Male Female	Ref. 1.10 (1.01-1.20)*	Ref. 0.93 (0.84-1.04)	Ref. 0.86 (0.69-1.07)	Ref. 0.61 (0.47-0.80)***	Ref. 1.01 (0.80-1.27)	Ref. 0.69 (0.51-0.92)*
Age 65-74 75-84 85+	Ref. 0.70 (0.63-0.78)* 0.42 (0.31-0.58)*	Ref. 0.83 (0.73-0.93)* 0.63 (0.44-0.90)*	Ref. 0.96 (0.76-1.22) 0.52 (0.24-1.13)	Ref. 1.12 (0.85-1.48) 0.92 (0.41-2.05)	Ref. 0.96 (0.74-1.24) 0.95 (0.51-1.76)	Ref. 1.03 (0.75-1.43) 1.04 (0.46-2.39)
Race/Culture White Asian Black Latin American Other Multiple	Ref. 0.79 (0.49-1.27) 0.40 (0.16-1.02)† 1.98 (0.64-6.19) 0.84 (0.47-1.50) 1.45 (0.96-2.20)†	Ref. 0.69 (0.41-1.16) 0.43 (0.16-1.10)† 1.77 (0.35-8.92) 0.47 (0.24-0.94)* 1.25 (0.76-2.06)	Ref. 0.19 (0.02-2.17) 0.35 (0.02-4.91) - 2.45 (1.01-5.96)* 2.09 (0.89-4.88)†	Ref. 0.19 (0.02-2.18) 0.38 (0.03-5.42) - 1.46 (0.56-3.81) 1.64 (0.61-4.40)	Ref. 0.49 (0.10-2.43) 5.91 (2.84-12.28)*** - 1.96 (0.70-5.49) 0.60 (0.12-3.02)	Ref. 0.27 (0.02-3.76) 7.92 (3.62-17.32)*** - 0.44 (0.07-2.73) 0.72 (0.11-4.62) -
Immigration History Born in Canada Immigrated within last 20 years Immigrated over 20 years ago	Ref. 1.43 (0.83-2.47) 1.09 (0.96-1.22)	- - -	Ref. 0.75 (0.13-4.30) 0.97 (0.71-1.31)	- - -	Ref. 0.24 (0.01-6.18) 1.21 (0.90-1.62)	- - -
Education Less than high-school High school graduation Some post-secondary Post-secondary degree/ diploma	0.86 (0.77-0.96)** 0.91 (0.79-1.04) 1.12 (0.96-1.30) Ref.	0.78 (0.68-0.89)*** 0.93 (0.79-1.09) 1.02 (0.86-1.21) Ref.	1.18 (0.91-1.54) 1.05 (0.74-1.49) 1.38 (0.97-1.99)† Ref.	- - - Ref.	0.86 (0.64-1.14) 1.04 (0.74-1.47) 0.79 (0.51-1.23) Ref.	- - - -
Marital Status Married/partnered Single/never Married Widowed Divorced/separated	Ref. 1.07 (0.87-1.32) 0.58 (0.50-0.69)* 1.28 (1.12-1.46)*	Ref. 0.69 (0.53-0.90) 0.51 (0.41-0.62)* 0.80 (0.66-0.95)*	Ref. 1.41 (0.88-2.24) 0.62 (0.41-0.93)* 1.57 (1.15-2.14)**	Ref. 0.89 (0.51-1.55) 0.59 (0.37-0.93)* 0.92 (0.63-1.33)	Ref. 1.72 (1.07-2.79)* 1.19 (0.84-1.70) 2.58 (1.93-3.46)***	Ref. 0.90 (0.48-1.69) 0.83 (0.51-1.34) 1.15 (0.76-1.74)
Geo-Cultural Context Urban Rural	Ref. 0.82 (0.72-0.93)**	Ref. 0.92 (0.79-1.07)	Ref. 0.57 (0.39-0.84)**	Ref. 0.68 (0.45-1.05)+	Ref. 0.81 (0.57-1.15)	Ref. -
Income Need Inadequate Adequate	2.40 (2.12-2.73)*** Ref.	1.41 (1.20-1.66)*** Ref.	2.42 (2.14-2.73)*** Ref.	1.95 (1.41-2.70)*** Ref.	2.46 (1.81-3.34)*** Ref.	1.10 (0.73-1.66) Ref.
Interviewed Mode In-Person Telephone	Ref. 0.72 (0.65-0.79)***	Ref. 0.76 (0.68-0.85)***	Ref. 0.60 (0.47-0.77)***	Ref. 0.74 (0.57-0.98)*	Ref. 0.99 (0.79-1.26)	Ref. 1.21 (0.91-1.62)

CI: Confidence Interval; *p ≤ 0.05, **p < 0.01, ***p < 0.001, †p < 0.10 (borderline). The multivariate models satisfied the Omnibus Test of Model Coefficients (p < 0.01). Across models, independent variables had tolerance of 0.63 or above and VIF of 1.59 or below, indicating no concern of multicollinearity.

^bThe race/culture variable was collapsed into 5 categories in the models predicting physical and financial abuse due to instability in the Latin American and Other categories. The General Perceived Health variable demonstrated evidence of multicollinearity and, thus, was removed from the multivariate model.

Table 4 (H2): Bivariate and multivariate logistic regression models of change variables (from baseline to follow-up) predicting past-year aggregate EA at follow-up.

Characteristic

Elder Abuse Aggregate

Bivariate Models

Multivariate Model

OR (95%CI)

Physical

Functional Impairment Change

Same/Improved

Decline

Ref.

1.46 (1.30-1.64)***

Ref.

1.46 (1.27-1.66)***

General Perceived Health Change

Same/Improved

Decline

Ref.

1.63 (1.42-1.87)***

Ref.

1.16 (0.97-1.37)+

Health Conditions Total Change

Same/Improved

Decline

Missing^a

Ref.

1.31 (1.20-1.44)***

1.77 (1.56-2.00)***

Ref.

1.30 (1.17-1.44)***

1.70 (1.48-1.96)***

Cognitive

Rey Auditory Verbal Learning Test 1 Change

Same/Improved

Decline

Missing^a

Ref.

0.93 (0.85-1.03)

1.04 (0.93-1.18)

Rey Auditory Verbal Learning Test 2 Change

Same/Improved

Decline

Missing^a

Ref.

1.02 (0.92-1.12)

1.13 (1.01-1.27)*

Mental Alternation Test Change

Same/Improved

Decline

Missing^a

Ref.

1.19 (1.08-1.32)***

1.23 (1.10-1.38)***

Ref.

1.19 (1.07-1.32)**

1.14 (1.00-1.30)*

Mental Health

General Perceived Mental Health Change

Same/Improved

Decline

Ref.

2.15 (1.81-2.55)***

Ref.

1.62 (1.31-2.00)***

Depressive Symptoms Change

Same/Improved

Decline

Ref.

1.76 (1.54-2.00)***

Ref.

1.50 (1.29-1.75)***

Satisfaction with Life Change

Same/Improved

Decline

Ref.

1.92 (1.63-2.26)***

Ref.

1.54 (1.28-1.86)***

Shared Living

Number of Co-Habitants Change

Same/Improved

Increased

Ref.

1.18 (0.99-1.40)†

Social

Social Support Total Change

Same/Improved

Decline

Missing^a

Ref.

1.25 (1.14-1.36)***

1.11 (0.95-1.29)

Ref.

1.14 (1.04-1.26)**

1.21 (1.00-1.47)†

Socio-Demographic

Income Needs Change

Same/Improved

Decline

Ref.

2.46 (2.03-2.97)***

Ref.

2.26 (1.83-2.79)***

CI: Confidence Interval; *p ≤ 0.05, **p < 0.01, ***p < 0.001, †p < 0.10 (borderline). The multivariate model satisfied the Omnibus Test of Model Coefficients (p < 0.01). Independent variables had tolerance of 0.91 or above and VIF of 1.10 or below, indicating no concern of multicollinearity. The multivariate model controlled for sex, race/culture, and age, as well as whether the interview was conducted in person or over the telephone.

^aA “missing” category was created for variables with 10% or more missing values to avoid exclusion of excess cases from models.

Table 5 (H2): Bivariate and multivariate logistic regression models of change variables (from baseline to follow-up) predicting past-year EA subtypes at follow-up.

Characteristic

Emotional Abuse

Physical Abuse^b

Financial Abuse

Bivariate Models

Multivariate Model

Bivariate Models

Multivariate Model

Bivariate Models

Multivariate Model

OR (95%CI)

Physical

Functional Impairment Change

Same/Improved

Decline

Ref.

1.43 (1.27-1.62)***

Ref.

1.46 (1.27-1.68)***

Ref.

1.74 (1.32-2.29)***

Ref.

1.58 (1.15-2.16)**

Ref.

1.76 (1.32-2.36)***

Ref.

1.51 (1.07-2.13)*

General Perceived Health Change

Same/Improved

Decline

Ref.

1.64 (1.42-1.90)***

Ref.

1.16 (0.97-1.39)

Ref.

2.34 (1.72-3.20)***

Ref.

1.84 (1.28-2.66)**

Ref.

1.71 (1.19-2.44)**

Ref.

1.18 (0.75-1.85)

Health Conditions Change

Same/Improved

Decline

Missing^a

Ref.

1.33 (1.21-1.47)***

1.63 (1.43-1.86)***

Ref.

1.31 (1.17-1.46)***

1.57 (1.35-1.83)***

Ref.

1.29 (1.00-1.66)*

2.27 (1.69-3.06)***

Ref.

1.35 (1.03-1.78)*

1.93 (1.37-2.72)***

Ref.

1.11 (0.85-1.44)

2.45 (1.82-3.30)***

Cognitive

Rey Auditory Verbal Learning Test 1 Change

Same/Improved

Decline

Missing^a

Ref.

0.92 (0.83-1.02)

1.03 (0.91-1.17)

Ref.

1.33 (1.04-1.70)*

1.23 (0.90-1.68)

Ref.

1.08 (0.83-1.42)

1.36 (1.0-1.84)+

Rey Auditory Verbal Learning Test 2 Change

Same/Improved

Decline

Missing^a

Ref.

0.99 (0.89-1.09)

1.08 (0.95-1.22)

Ref.

1.38 (1.07-1.77)*

1.48 (1.10-1.99)**

Ref.

1.39 (1.06-1.82)*

1.53 (1.10-2.13)*

Ref.

1.17 (0.90-1.53)

1.45 (1.07-1.96)*

Mental Alternation Test Change

Same/Improved

Decline

Missing^a

Ref.

1.21 (1.09-1.35)***

1.21 (1.07-1.36)**

Ref.

1.21 (1.08-1.36)***

1.12 (0.97-1.28)

Ref.

1.06 (0.82-1.38)

1.17 (0.87-1.56)

Ref.

0.79 (0.60-1.03)+

1.16 (0.87-1.54)

Mental Health

General Perceived Mental Health Change

Same/Improved

Decline

Ref.

2.18 (1.83-2.61)***

Ref.

1.63 (1.31-2.03)***

Ref.

2.60 (1.77-3.81)***

Ref.

1.47 (0.91-2.37)

Ref.

2.11 (1.37-3.26)**

Ref.

1.56 (0.91-2.66)

Depressive Symptoms Change

Same/Improved

Decline

Ref.

1.77 (1.54-2.03)***

Ref.

1.52 (1.29-1.78)***

Ref.

1.46 (1.03-2.07)*

Ref.

1.13 (0.76-1.68)

Ref.

1.98 (1.42-2.75)***

Ref.

1.72 (1.18-2.52)**

Satisfaction with Life Change

Same/Improved

Decline

Ref.

2.06 (1.73-2.44)***

Ref.

1.67 (1.37-2.02)***

Ref.

2.05 (1.38-3.05)***

Ref.

1.60 (1.03-2.49)*

Ref.

1.73 (1.11-2.69)*

Ref.

1.39 (0.85-2.26)

Shared Living

Number of Co-Habitants Change

Same/Improved

Increased

Ref.

1.26 (1.00-1.58)*

Ref.

1.04 (0.84-1.29)

Ref.

0.30 (0.10-0.89)*

Ref.

0.47 (0.22-0.99)*

Ref.

1.78 (1.08-2.93)*

Ref.

1.47 (0.91-2.36)

Social

Social Support Total Change

Same/Improved

Decline

Missing^a

Ref.

1.29 (1.17-1.41)***

1.05 (0.89-1.24)

Ref.

1.17 (1.05-1.29)**

1.19 (0.97-1.46)

Ref.

1.27 (1.01-1.60)*

0.98 (0.64-1.50)

Ref.

1.18 (0.92-1.51)

0.96 (0.56-1.62)

Ref.

1.18 (0.92-1.51)

1.47 (1.00-2.14)*

Socio-Demographic

Income Needs Change

Same/Improved

Decline

Ref.

2.35 (1.92-2.86)***

Ref.

2.08 (1.67-2.60)***

Ref.

1.75 (1.05-2.91)*

Ref.

1.74 (1.01-3.01)*

Ref.

2.55 (1.63-4.01)***

Ref.

2.42 (1.48-3.96)***

CI: Confidence Interval; *p ≤ 0.05, **p < 0.01, ***p < 0.001, †p < 0.10 (borderline). The multivariate models satisfied the Omnibus Test of Model Coefficients (p < 0.01). Independent variables had tolerance of 0.91 or above and VIF of 1.10 or below, indicating no concern of multicollinearity. The multivariate model controlled for sex, race/culture, and age, as well as whether the interview was conducted in person or over the telephone.

^aA “missing” category as created for variables with 10% or more missing values to avoid exclusion of excess cases from models.

^bThe REYI I and REYI II test scores showed a high level of correlation and evidence of multicollinearity; therefore only the REY II variable was used in the multivariate model since it carried a slightly higher odds ratio in bivariate analysis.

There is NO Competing Interest.

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Elder Abuse Prevalence and Risk Factors: Findings from the Canadian Longitudinal Study on Aging

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