Bruising as a Forensic Marker of Physical Elder Abuse in Orange County, California, 2006-2008 (ICPSR 28144)

Time Period(s)

2006-07 -- 2008-05

Date of Collection

2006-07 -- 2008-05

Data Collection Notes

This data collection is comprised of hierarchical data on 67 study participants and 155 bruises. Of the 67 study participants, no bruises were found on 19 individuals, 1 bruise was found on 15 individuals, and more than 1 bruise was found on 33 individuals (140 bruises across 33 adults), resulting in 174 observations.

Study Purpose

The purpose of this study was to describe bruising as a marker of physical elder abuse.

Study Design

Adult Protective Services (APS) clients who met study criteria and agreed to participate were formally consented. If APS Clients were assessed as lacking decision-making capacity, a qualified surrogate was identified to consent for them. Consenting older adults were examined by a Research Nurse (RN) to document location and size of bruises and assess whether they were inflicted during physical abuse. Study sites included the participant's home, a neutral site where the participant felt safe (such as a relative's house), or an inpatient setting. In total, 67 abused elders participated in the study.

The same RN conducted a series of study assessments on the 67 study participants. Participants removed their clothing and had all of their skin examined to document any bruising. Location, width and length (using a clear pliable circular measurement tool), and colors present were recorded along with the participant's or surrogate's recollection of the cause of the bruise and the time elapsed since the alleged abuse incident. RNs also administered several tests to compile data on the client's functional status, medical conditions, cognitive status, history of falls, and an inventory of the alleged physical abuse. Functional status was measured by responses to an Activities of Daily Living (ADL) scale and to an Instrumental Activities of Daily Living (IADL) scale. Functional mobility was also measured through a gait and balance survey test of participants. Participants answered questions about their medical conditions and use of prescription and over-the-counter (OTC) medications and use of assistive devices. Cognitive status was measured through a Mini Mental Status Exam (MMSE). Participants or surrogates were asked to report falls over the last week, month, six months and year. The 12-item CTS2 physical assault scale indicated whether specific tactics (e.g., slapping, choking) were used against the respondent, as well as the frequency of the events over the prior year. The EAI was used to rate 12 possible abuse indicators, including other types of injuries. Perpetrator data was not collected initially, but was later coded from the RN's notes.

Longitudinal Experts, All Data (LEAD) methodology was applied as a criterion standard to assess whether the study participants had experienced physical elder abuse.

Sample

Study participants were a convenience sample of Adult Protective Services Clients reported for suspected physical elder abuse in Orange County, California. Inclusion criteria were: (1) age 65 or greater, (2) an allegation of physical elder abuse occurring within the last six weeks, and (3) alleged perpetrator was someone in a position of trust to the older adult (i.e., not a stranger).

Between July 2006 and May 2008, participating APS social workers approached 407 individuals alleged to have been physically abused to assess their interest in being in the study. Of these, 234 were categorized as "failed attempts" (e.g., unable to locate the client, client refuses APS contact, client was moved to a skilled nursing facility that is not participating in the study, client appears psychotic or is too anxious or agitated to assess interest in the research, client lacks decision-making capacity and no surrogate is available). Another 93 were initially interested in participating but ultimately refused to participate. The remaining 80 APS clients were enrolled in the study. Of these, 13 were excluded from the final analyses for the following reasons: refused to allow a full body inspection (1), the alleged perpetrator was found not to be a person in a position of trust (2), suspected date for abuse incident more than six weeks prior to assessment (2), no allegation of physical abuse (1), a Longitudinal Experts, All Data (LEAD) panel finding of no abuse (6), and the LEAD was unable to reach consensus (1). Thus, the final sample is comprised of 67 participants.

Universe

All adults aged 65 and older reported to Adult Protection Services in Orange County, California for suspected physical elder abuse between July 2006 and May 2008.

Unit(s) of Observation

individual

bruise

Data Source

Consenting older adults were examined by a research nurse to document location and size of bruises and assess whether they were inflicted during physical abuse. The research nurse also conducted other study assessments to measure characteristics of the participant.

clinical data

observational data

survey data

Mode of Data Collection

coded on-site observation

cognitive assessment test

face-to-face interview

paper and pencil interview (PAPI)

on-site questionnaire

Description of Variables

The study contains a total of 142 variables including age, sex, ethnicity, functional status, medical conditions, cognitive status, history of falls, bruise size, bruise location and color, recall of cause, and responses to the Revised Conflicts Tactics Scales (CTS2) and to the Elder Abuse Inventory (EAI).

Response Rates

Between July 2006 and May 2008, participating Adult Protective Services social workers approached 407 individuals alleged to have been physically abused to assess their interest in being in the study. Of these, 234 were categorized as "failed attempts" (e.g., unable to locate the client, client refuses APS contact, client was moved to a skilled nursing facility that is not participating in the study, client appears psychotic or is too anxious or agitated to assess interest in the research, client lacks decision-making capacity and no surrogate is available). Data were collected on 67 of the remaining 173 individuals, yielding a response rate of 38.7 percent.

Presence of Common Scales

The study used the following scales:

• Mini Mental Status Exam (MMSE).
• Katz Activities of Daily Living (ADL) scale.
• Lawton Instrumental Activities of Daily Living (IADL) scale.
• Tinetti Gait and Balance scales.
• Revised Conflict Tactics Scales (CTS2) scale.
• Elder Abuse Inventory (EAI)

Original Release Date

2012-12-21

Version Date

2012-12-21

Version History

2012-12-21 ICPSR data undergo a confidentiality review and are altered when necessary to limit the risk of disclosure. ICPSR also routinely creates ready-to-go data files along with setups in the major statistical software formats as well as standard codebooks to accompany the data. In addition to these procedures, ICPSR performed the following processing steps for this data collection:

• Standardized missing values.
• Checked for undocumented or out-of-range codes.

Weight

Not applicable.