Impairment and abuse of elderly by staff in long-term care in Michigan: Evidence from structural equation modeling

Elder abuse in long-term care has become a very important public health concern. Recent estimates of elder abuse prevalence are in the range of 2% to 10% (Lachs & Pillemer, 2004), and current changes in population structure indicate a potential for an upward trend in prevalence (Malley-Morrison, Nolido, & Chawla, 2006; Post et al., 2006). More than 20 years ago, Karl Pillemer called for sociological research on patient maltreatment in nursing homes and provided an overview model for the conduct of such research (Pillemer, 1988). The research literature since then has not provided the definitive model to account for patient maltreatment that Pillemer hoped for. Instead, it has produced a laundry list of risk factors that includes the patient's functional disability, cognitive impairment, social isolation, age, race, income, family background, life events, dementia, and depression (Dyer, Pavlik, Murphy, & Hyman, 2000; Lachs & Pillemer, 2004; Lachs,Williams, Obrien, Hurst, & Horwitz, 1997; Pavlik, Hyman, Festa, & Dyer, 2001; Schofield & Mishra, 2003). However, no theory exists to place these factors in a causal structure that relates the factors to each other and to whether abuse occurs. This study is a first step in that direction. Nine hypotheses were generated focusing on the effects of two dimensions of impairment-(a) physical and cognitive and (b) age and behavior problems-on susceptibility to abuse among elderly in long-term care.The relationships between factors and from factors to susceptibility to abuse are specified in a structural equation model where "susceptibility to abuse," "physical impairment," and "cognitive impairment" are latent variables, and behavior problems and age are directly measured.