Financial Exploitation Research Articles

Mental Health Consequences and Service Use of Older Adults at Risk of Financial Exploitation

Abstract This study examines whether the experience of financial exploitation is associated with increased likelihood of mental health consequences and subsequent use of mental health services. Interviews were conducted with 99 participants, age 60 and older, at risk for elder abuse. The authors and research team administered standardized measures of elder mistreatment, depression, trauma, social support, and service use. Older adults who experienced financial exploitation reported worse trauma symptoms and depression than those who did not experience financial exploitation. Those with increased functional impairment were least likely to rely on mental health services. The findings highlight the importance of interventions to address and enhance response to depression, trauma, and social support in older adults who are victims of financial exploitation.

Implementation of financial decision making scales into statewide APS practice: the Michigan experience

ABSTRACT One of the long recognized challenges in Adult Protective Services and other human service works is the implementation of empirically validated tools into regular practice. One area where this is evident is the assessment of financial decision-making abilities in cases investigated for financial exploitation. Using the Promoting Action in Research Implementation in the Health Services (PARIHS) we examined the core aspects of evidence, facilitation and context. Further, the empirical findings of the scale usage were investigated. Over 400 APS workers were trained and certified using an online narrated training system. Over 500 scales were administered across a 12 month period, with 50% demonstrating financial decision-making deficits, and in 88% of the time the APS workers concurred with the risk rating system of the web-based system (https://olderadultnestegg.com).

Insular and Hippocampal Connectivity Is Associated With Perceived Financial Exploitation in Older Adults

Little is known about the neural correlates of financial exploitation (FE) in older adults. Cognitively-intact older adults who self-reported a history of FE (N=19; M age=69.84, SD=13.06) and demographically-matched non-FE older adults (N=16; M age=65.13, SD=8.48) underwent resting-state fMRI. Predefined regions of interest were prescribed using the Harvard-Oxford atlas for their involvement in tasks of economic decision making: insula, hippocampus, and the medial prefrontal cortex (mPFC). Analyses adjusted for age, education, sex, and MoCA scores; groups did not differ on these factors. Clusters were FDR-corrected with a threshold of p<0.05 (voxel threshold p<0.005), two-tailed. Compared to the non-FE group, the FE group exhibited greater functional connectivity (FC) between the right insula and left temporal lobe regions (t(29)= -4.81), and between the left insula and right temporal lobe regions (t(29)= -5.78). The FE group showed less FC between the left insula and two clusters in the right lateral occipital cortex (t(29)= 5.18) and left cerebellum (t(29)= 4.68). Additionally, FE was associated with greater FC between the right hippocampus and five clusters spanning the right temporal lobe, parietal lobe, and frontal pole (ts(29)= -4.11 to -4.51), and less FC between the right hippocampus and three clusters spanning the bilateral caudate and the left intracalcarine cortex (ts(29)= 4.76-6.03). Groups did not differ in FC patterns with the mPFC. Results suggest that FE is associated with whole-brain FC differences involving the insula and hippocampus among cognitively-intact older adults.

Financial Exploitation Vulnerability and Social Isolation in Older Adults: Results From a Longitudinal Survey

OBJECTIVE: This study examined the prevalence and characteristics of socially isolated older adult participants in a survey funded by National Institute of Aging (NIA), and the association of social isolation with financial exploitation (FE) vulnerability. METHODS: Baseline data were collected from 528 participants (age 60+ years) and recruited from two regions. Assessments included a detailed cognitive battery and an array of self-report measures including socio-demographic and psychosocial variables. Social isolation was measured with the Friendship Scale (Hawthorne, 2006). Participants also read six randomly ordered “scam” scenarios (investment opportunity; Medicare phishing and prescription drug fraud; health product; sweepstakes; telemarketing) and provided credibility ratings for each (1 = Not at all credible; 10 = Extremely credible). Ratings are coded “0” (credibility rating 1); “1” (ratings 2-4); “2” (ratings 5-10) and summed, with total FE “vulnerability” scores ranging from 0-12. RESULTS: Preliminary results showed the prevalence of social isolation was 12.5% overall. Social isolation was higher for males (17.4% vs. 9.8%, p<.05); single / never married (28.7% vs. 12.5%, p<.01); and those in the lowest household income (under $10,000) category (28.3% vs. 12.5%, p<.05). However, we did not find evidence that social isolation varied significantly by race or educational attainment. FE vulnerability risk was higher for socially isolated older adults (2.44 vs. 1.44, p<.001) compared to non-isolated participants. CONCLUSION: Social isolation is associated with FE vulnerability. Therefore, identifying the prevalence and characteristics of socially isolated older adults is needed to improve the targeting of interventions for those at greater risk of FE vulnerability.

Effects of Household Size and Partner Status on Financial Well-Being and Financial Exploitation

Social isolation and loneliness are significant risk factors for older adults (adults over the age of 50) for a multitude of reasons. This study explored the connections between social isolation, vulnerability to financial exploitation, and financial wellbeing in a sample of older adults. Using the concept of precarity as a guiding framework, this study assessed behaviors that expose individuals to financial exploitation as well as indicators of financial wellbeing in individuals with varying degrees of social isolation. One-hundred-eight community-dwelling older adults completed a pen-and-paper survey containing measures of risk to financial exploitation and financial wellbeing. Participants were predominantly female (75.9%), White (90.7%), and highly educated. Fifty-eight participants were unpartnered (53.7%) and 67 participants (62%) lived with at least one other person. Chi-square analyses resulted in a significant association between partner status and being a victim of financial exploitation (χ2(1) = 10.842, p≤.001). Furthermore, there was an association between social isolation and engaging in certain behaviors that put someone at risk for financial exploitation (such as reading junk mail). As for measures of financial wellbeing, partner status was significantly associated with feelings of financial freedom (χ2(3) =8.608, p =.035). These findings indicate that socially isolated individuals may be at greater risk of financial exploitation and have lower levels of financial wellbeing, such as feeling unprepared for retirement (χ2(2) =7.358, p =.025). The results of this study highlight the risks involved with social isolation and indicate further research is needed into ways to mitigate these negative effects.

Vulnerability to Financial Scams Among Older Adults: Cognitive and Psychosocial Factors

This paper presents baseline results from a longitudinal study funded by National Institute on Aging examining financial exploitation (FE) among 720 White, African-American, and Hispanic adults age 60 and older. Our proposed conceptual model links socio-demographics, cognitive function, financial skills, and psychosocial factors to both scam exposure and vulnerability, which increases risk for experienced FE. This paper focuses on correlates of scam vulnerability, using a novel measure in which participants read six randomly ordered “scam” scenarios (investment opportunity; Medicare phishing and prescription drug fraud; health product; sweepstakes; telemarketing) and provide credibility ratings for each (1 = Not at all credible; 10 = Extremely credible). Ratings are coded “0” (credibility rating 1); “1” (ratings 2-4); “2” (ratings 5-10) and summed, with total “vulnerability” scores ranging from 0-12. Preliminary results from ~500 participants (Mean age = 73.6) show support for the proposed model. Older adults with poorer cognitive function in multiple domains (memory; reasoning ability; processing speed; other aspects of executive function; and crystallized intelligence); lower financial literacy; lower numeracy; those reporting difficulty with day-to-day financial management; and those performing worse on web-based banking skills tests were more vulnerable to scams. Scam vulnerability was a also higher among those with lower social integration; higher social isolation and loneliness; higher impulsivity; and higher ratings of depression. Use of “scam scenario” credibility ratings shows promise as a simple assessment approach for FE vulnerability. Understanding multiple pathways to FE is important to advance theory and for development of interventions to minimize risk among older adults.

Home Health Registered Nurses’ Experiences With Financial Exploitation of Older Women With Cognitive Impairment

Older adults diagnosed with cognitive impairment (CI) who live at home are at high risk for FE due to dependence on caregivers and diminishing cognitive and financial capacities. Health care providers are mandated reporters for elder abuse, that includes financial exploitation (FE), one of the seven types of older adult maltreatments. Twenty Home Health Care Nurses (HHRN) of older adults in Oklahoma were interviewed to discover their understanding and experiences with FE. Transcripts were analyzed by conventional content analysis. Line-by-line codes were generated inductively and codes were grouped into categories and themes until data saturation was reached. Five themes emerged: Red Flags, Familiar Offenders, Dire Consequences, Barriers/Facilitators, Doing Better. Conclusions: HHRNs are an untapped resource to provide suggestions for improvements of FE detection/reporting of older adults with CI and to help formulate policies, procedures, strategies to improve coordination and communication among healthcare, law enforcement, and social service systems.

A Short Screening Measure of Contextual Vulnerability for Financial Exploitation

Financial exploitation (FE) among older adults is an expensive personal and societal problem. Many professionals who work with older adults need fast and reliable measures to detect FE, including: APS workers, financial professionals, and healthcare providers. Very few standardized measures exist to assess an older adult’s risk for FE, and fewer still that do not require extensive training to administer. Lichtenberg et al. (in press) presented the Financial Exploitation Vulnerability Scale (FEVS), which assesses the context (i.e. financial, social, and psychological) in which an older adult is making a financial decision. This 17-item scale differentiates between older adults who’ve experienced FE and those who have not. It has excellent psychometric properties and clinical utility to detect FE beyond demographic and neuropsychological variables. We utilized exploratory factor analysis to examine the factor structure of the FEVS and reduce the number of items. Participant data (n=243) were drawn from two samples: a community-based sample and a group of individuals who were seeking financial coaching services following a financial scam or theft. Examination of the eigenvalues yielded a unidimensional scale. An iterative process was used to remove items that did not load on the single factor or with low corrected item total correlations. The final scale contained nine items and retained its ability to detect financial exploitation (AUC=0.778) and good internal consistency (a=0.845). This short form scale (FEVS-SF) is a brief, standardized screening measure to assess contextual vulnerability for FE that is accessible to professionals who work with older adults.

Family Dynamics and Elder Financial Exploitation by Family-Member Powers-of-Attorney Agents

Elder family financial exploitation (EFFE) is a growing problem likely to increase due to population aging. Older people, often considered vulnerable, are frequently targeted for financial exploitation. Relatives, identified as the largest group of perpetrators often misuse powers of attorney (POA); nevertheless, relationship complexity and dependencies, and family privacy result in underreporting and infrequent prosecutions. The aim of this research is to understand family risk factors that could be used for prevention and early detection. We hypothesized that family dynamics in EFFE families compared to non-EFFE families having family-member POA agents would be at greater risk when these risk factors were present. Our larger multi-state research team created a survey to collect demographic and situational data and to explore family-member and elder characteristics and specific family dynamics that could later place older relatives at risk for EFFE. Analyses consisted of testing whether poor family functioning, ineffective communication/problem-solving dynamics, resource exchange patterns, conflict before/during resource distribution, and entitlement attitudes were statistically associated with the occurrence of EFFE. Specifically, we tested a series of hierarchical logistic regressions to examine the association of family dynamic variables with EFFE. Results suggest that fairness conflict, exchange expectations, entitlement expectations, and communication patterns were statistically associated with EFFE. Current family communication patterns were not a statistical predictor of EFFE. These results could prompt older persons and relevant healthcare, legal, financial, law enforcement, social service, and counseling professionals to work proactively with families and mid-life and older adults to consider risk factors before making end-of-life decisions.

A Direct Reporting Platform for Financial Exploitation: From Banks to APS

Despite encouraging changes in regulations and practices, opportunities remain to strengthen the collaboration between Financial Services Institutions (FSI) and Financial Exploitation (FE) investigative agencies such as Adult Protective Services (APS). A major barrier to these collaborations is timely and effective information exchange, between the agencies, for maximizing client protection. Often times, the need for more information from the agencies involved delays or mitigates the provision of financial protection to the client/victim. Through the U.S. Office for Victims of Crime, funding has been provided to develop a single reporting platform for enhancing communication and collaboration between FSI and APS. The helpful platform provides an innovative conduit for providing timely and effective information exchange between FSI and APS agencies to better serve and protect older adults against FE. This presentation will discuss the platform development, the lessons learned, preliminary data and future research. Part of a symposium sponsored by Abuse, Neglect and Exploitation of Elderly People Interest Group.

The Impact of Financial Coaching on Health and Finances in Older Scam and ID Theft Victims

Population based and clinical samples consistently demonstrate that older financial exploitation (FE) victims are vulnerable across multiple domains. Our earlier research indicated that older scam and identity theft victims were vulnerable across multiple health and mental health dimensions as compared to a control group. The current work is a longitudinal study of 20 financial coaching participants and 20 controls. Program participants received individual financial coaching to help with credit problems, reporting and collections after they were scam or identity theft victims. Both groups received baseline assessment and 6 month followups (from the time of the end of the coaching). The mean age of the sample was 69 years, with a mean of 15 years of education. Seventy percent of the sample were women and African Americans. Control participants had fewer health conditions and better memory and executive functioning at baseline as compared to coaching participants. While there were no significant health measure changes in the control group, the coaching group demonstrated significantly decreased anxiety at follow up and trends for improved executive functioning and IADLs. Further, while financial stress and social support were significantly lower for the coaching group at baseline, at followup there were no group differences in these measures. The study results provide evidence that the financial coaching program has served as a protective factor in negating many of the adverse outcomes associated with FE and supports financial coaching programs as an appropriate intervention. In addition the coaching services saved or returned monies to nearly 65% of participants.

Innovative Strategies to Reach Diverse Elders: Using Age-Tastic to Improve Health and Well-Being

This session will present the findings of a randomized control trial evaluating the impact Age-Tastic has on behavioral change. Age-Tastic is an eight-week intervention that uses game play, group facilitated discussion, and at home activities to promote positive behavioral change. There are five behavioral change domains: emotional well-being, nutrition, financial exploitation, falls prevention, and health literacy. A randomized control trial was conducted in New York City senior centers and include a diverse group of older adults. There were 98 older adults assigned to an experimental or control group. Participants in both groups completed a baseline survey, which was repeated at the end of the intervention and at week sixteen. The experimental (n = 64) and control (n = 34) groups did not significantly differ at baseline in regard to behaviors; however, upon completion of the intervention, the experimental group had significantly changed health behaviors (p < .05) compared to the control group. The behavior change reported by the experimental group was maintained at week sixteen (p < .001) with a medium effect size (ε2 = .17). In addition the experimental group also reported significant improvements at weeks eight (p < .001) and sixteen (p < .001) with large effect sizes (r2 = .62 and .52, respectively). This study found that Age-Tastic is an effective intervention for engaging older adults holistically about their health and wellness and for promoting positive behavioral change among diverse racial and ethnic populations.

Caregiver Neurotic Personality Trait and Elder Abuse—The Moderating Role of Change in the Level of Caregiver Burden

Objectives: To investigate whether caregiver neuroticism has an effect on subsequent occurrence of elder abuse and whether change in the level of caregiver perceived burden alters this relationship. Methods: Using two-year longitudinal data, we analyzed a consecutive sample of 800 Chinese family caregivers and their care recipients with dementia recruited from the geriatric and neurological departments of three Grade-A hospitals in People’s Republic of China (PRC). All the participatory dyads were assessed between September 2015 and February 2016 and followed for two years. Results: Significant increase in the prevalence was found for physical and psychological abuse, caregiver neglect, and financial exploitation. Caregivers high in neuroticism were more likely to engage in subsequent physical and psychological abuse, however, change in the level of caregiver perceived burden altered this association. Specifically, absence and alleviation of care burden during the two-year observation prevented the subsequent occurrence of physical and psychological abuse. Although caregiver neuroticism was also associated with subsequent caregiver neglect, caregiver perceived burden did not appear to have an impact on this relationship. Discussion: This study provided evidence that caregiver neuroticism was associated with subsequent physical and psychological abuse, while change in the level of caregiver perceived burden may alter this trajectory. These findings suggest the importance of implementing caregiver-centered intervention and prevention programs for elder abuse by specifically targeting at caregivers’ behaviors related to their neurotic personality trait and cognitive appraisal of caregiving stressors associated with such personality trait.

A Follow-Up Content Analysis of Aging Network Conference Proceedings: Aligning Research and Practice

The federal government established a collective of agencies tasked with providing support and services to older adults and their caregivers known as the Aging Network. In order to effectively provide these services, the Aging Network must identify and disseminate current best practices. To this end, the Aging Network hosts three annual conferences: the National Association of Area Agencies on Aging (n4a), the Alliance of Information and Referral Systems (AIRS), and the National Association of States United for Aging and Disabilities (NASUAD). This content analysis of key themes emerging from Aging Network conference abstracts (N = 2,392) from 2009 to 2019 expanded upon a similar study analyzing the preceding decade of conference materials (Moone & Cagle, 2011). Reflexivity, analyst triangulation, and confirmability and dependability audits were used to enhance trustworthiness. The most common themes included planning and program development (n = 260), general policy (n = 166), and long-term services and supports system reform (n = 162). Although some themes, such as consumer-directed support (n = 122) and advocacy (n = 111) were consistent with the original article (Moone & Cagle, 2011), others, such as managed care (n = 124) and financial exploitation (n = 50), demonstrated a societal shift in older adult supports and services. These results offer an additional effort towards disseminating current best practices and emerging issues to advance translation between research and practice. Researchers can use these results to better align their research agendas with the needs of the Aging Network for evidence-based interventions.

Substance Use Is Common in Elder Abuse Cases: Qualitative Findings From a Multi-Disciplinary Team

Elder abuse is mistreatment of an older adult by a caregiver or another person in a position with an expectation of trust. Adversely affecting as many as 10% of community-dwelling older adults in the US, it may include physical abuse, sexual abuse, psychological abuse, financial exploitation and neglect. Mental illness and substance use by caregivers, family members and victims themselves have been described as risk factors for multiple forms of elder abuse in prior cross-sectional analyses but the impact on these cases is poorly understood. To explore this association we conducted a focus group using a semi-structured format involving an inter-disciplinary group of elder abuse professionals that are part of the New York City Elder Abuse Center enhanced multi-disciplinary team (EMDT) in Staten Island, New York. Focus group participants reported that opioid, cocaine, cannabis and alcohol use is common among perpetrators of elder abuse, especially in cases of financial mistreatment, verbal and physical abuse. Other potential consequences included eviction of the older adult victim, co-dependency and involvement of the older adult in the procurement of illicit substances, and substance use by the older adult. Respondents specifically expressed concerns that the opioid epidemic, including rising heroin use, may be changing the frequency and nature of elder abuse, and that case investigations offer an opportunity to facilitate referrals for formal substance use disorder assessment and treatment. Future work includes additional focus groups and quantitative analysis to clarify the intersection between substance use and elder abuse and inform intervention and prevention strategies.

Lest Death Do Them Part: Protection of Older Women From Intimate Partner Injury and Fatality

Protecting and preventing older women from fatal and near fatal violence by current or former intimate partners are public health and international human rights concerns. Older women are most often killed (“femicide”), injured in the home by a spouse, partner, x-partner, or family member. Older women experience physical, psychological, sexual abuse, neglect, and financial exploitation. Wherein there is more research on risk factors, study of protections lags behind. Through three very different studies, risks and protections will be explored with national and international policy implications for each.

When Concerned Family Members Intervene in Elder Family Financial Exploitation: Goals and Outcomes

The role and experience of non-abusing concerned family members (CFMs) in elder family financial exploitation (EFFE) is largely unexplored. This paper examines the experience of “trying to do the right thing,” focusing on what CFM’s were trying to accomplish (motivating goals), and resulting outcomes utilizing data from a qualitative study of 28 CFMs (primarily female adult children of an older victim, and siblings of primary perpetrator). Five common goals appear to be motivating CFM involvement, driven by a priority to ensuring the victim’s quality of life, as well as the desire to honor and respect the victim’s wishes, protect the victim’s financial well-being, preserve family relationships, and deal with the perpetrator(s). CFM help-seeking resulted in a wide range of outcomes, from making a difference by connecting victims to supportive services and interrupting the financial exploitation, to mixed results, and in other cases frustration with no desirable outcomes.

Injury of African American Women by Financial Exploitation

Financial exploitation (FE) is one of the most common forms of older adult mistreatments. The World Bank defines FE as financial violence and the World Health Organization describes FE as financial or material abuse. Both international organizations recognize that FE causes deprivation/neglect leading to physical and emotional injury to victims. Older African Americans (OAA) are disproportionately affected by FE, impacting their health and welfare. A qualitative phenomenological study explored the lived experiences of FE among OAA. A Community Based Participatory Research approach was used to partner with a predominately African American-faith based community. Participant recruitment (n=12) was through community sponsored seminars that included verbal presentations, group discussions; individual surveys, Older Adult Financial Exploitation Measure (OAFEM). OAFEM data was analyzed to identify risks. Analysis of the interviews included Open and Axial coding, and data categorization. Using NVivo, Stevick-Colaizzi-Keen analysis as modified by Moustakas, five themes emerged.

Pathways to and Consequences of Surrogate Decision-Making for Older Adults

With a burgeoning aging population, there is a growing need for surrogate decision makers, yet oversight of and guidance for them remains inadequate. People needing surrogate decision makers are an especially vulnerable population because they rely on others for care and/or are unable to advocate for themselves. Their vulnerability leaves them susceptible to elder abuse (e.g., physical, sexual, psychological abuse; active and passive neglect; financial exploitation), which affects approximately five million older Americans each year. Personal, financial, and societal impacts can be devastating and are estimated to cost billions annually. The issue of abuse, neglect and exploitation by surrogates has been highly visible nationally, evidence indicates that some surrogate decision makers perpetrate abuse. One purpose of this symposium is to discuss ways in which surrogates do and do not make decisions for older adults. Ramsey-Klawsnik and Burnett present data at the systemic level to illustrate how self-neglect sequelae can result in placement under surrogate decision-making authority of either well-intended or opportunistic others. Bolkan, Teaster, Ramsey-Klawsnik, and Gerow present findings from a six-state study on surrogate decision maker victims and perpetrators who were substantiated in Adult Protective Services cases. Zhao, Katz, and Teaster show, using a survey of M-Turk participants, how a general population makes and is comfortable with surrogate decisions. Discussant Shawn Meyers will pull together the findings by exploring their translation to judicial best practices for making determinations regarding surrogate decision makers and the effects of their decisions on the surrogate as well as collaterals.

The Critical Help-Seeking Role of Family, Friends, and Neighbors in the Lives of Elder Abuse Victims

Elder abuse prevention and intervention is a complex puzzle. We focus on examining the typically invisible role, experience, and impact of nonabusing family, friends, and neighbors, or “concerned persons” in stopping elder abuse. Given the reality that most elder abuse goes unreported and unaddressed, it seems essential to understand if and how concerned persons can play a role in help-seeking for older victims, and to also understand the needs and issues faced by concerned persons as a consequence. First. Breckman presents evidence of the significant distress concerned person’s experience from knowing about elder abuse and trying to assist victims, and shares experience developing and implementing the first Elder Abuse Helpline for Concerned Persons in the U.S. Second, Fraga Dominguez et.al. present an important international perspective highlighting findings about concerned persons as users of a UK elder abuse helpline, their profile, the impact of helping, and variables relating to help-seeking. Third, Stum shares findings from a qualitative study of elder family financial exploitation related to what concerned family members were trying to accomplish by getting involved (motivating goals) and the resulting continuum of outcomes. Fourth, Kilaberia also explores the help-seeking experiences of concerned family members in elder family financial exploitation situations, specifically the range of tasks involved, and the impacts on the concerned family member’s individual health and well- The discussion led by Burnes will focus on understanding contributions of the research presented given the current state of the field, and offer suggestions for future research and intervention directions.