The National Center on Elder Abuse (NCEA)
The NCEA (https://ncea.acl.gov/) provides information and resources to individuals and community groups through multiple outlets, including a telephone line, website, and social media pages (all referred to as the NCEA resource line for purposes of this study). Individuals can contact the NCEA through these various outlets (for expediency, all forms of contact made to the NCEA resource line will be referred to as “calls” consistent with previously published work [13]. Calls made to the NCEA are summarized and logged into a database by NCEA staff. Responses to the calls by NCEA staff are also logged.
Procedure
Study procedures were approved by the institutional review board of the University of Southern California. Calls made during the COVID-19 pandemic over a one-year period between March 16, 2020 and March 15, 2021 were coded (Time 2). To serve as a comparison, we also examined a one-year period of calls made prior to the pandemic from March 16, 2018 to March 15, 2019 (Time 1). Both years had an equal number of days (365).
A detailed description of the methodology for coding NCEA calls has been described in previous work [13]. In brief, prior to coding calls, an NCEA staff member de-identified the call narratives. Two independent raters then coded the calls with regard to whether or not abuse was reported, caller, victim, and perpetrator characteristics, the types of abuse alleged, whether multiple subtypes of abuse were alleged, and who perpetrated the alleged abuse. Call narratives and NCEA staff responses were utilized to code whether or not abuse was alleged. Single calls that reported two completely unique scenarios of abuse (two different victims or two different and unrelated perpetrators) were coded separately for each scenario of abuse and considered unique “calls” for analyses purposes. After identifying whether abuse was alleged, abuse calls were categorized into one or more of five elder abuse subtypes: financial, physical, sexual, emotional, and neglect. Calls were also coded for number of abusers reported per call (one abuser, more than one abuser, staff of a company or facility, or unable to determine) and the relationship of the abuser to the victim (family; non-family, non-medical caretaker; non-family, medical caretaker; caretaker, relationship unknown; an individual or entity known to the victim who does not fit the other categories; a stranger such as a telephone solicitor; or unable to determine). Two study co-authors (GHW, ACL) resolved any disagreements between the two independent raters.
Procedures for rating the calls followed the same codebook developed in previously published work [13]. The codebook was developed through a review of the scientific literature and expert knowledge on elder abuse. The two raters agreed on 85.35% of the initial codes (353 disagreements out of the 2410 total calls received) for overall alleged abuse prior to resolution of disagreements. Percent disagreement between raters on subtypes of abuse was calculated based on the number of times the raters disagreed about the subtype of abuse being reported out of the 1365 total calls reporting abuse across the two time periods. Disagreement was highest for financial and emotional abuse (11.2% and 11.8%, respectively), followed by neglect (9.01%), physical abuse (4.1%), and sexual abuse (0.4%). Non-abuse calls mostly consisted of general requests for information about the NCEA and elder abuse services.
Elder abuse and its subtypes were defined based on a Center for Disease Control and Prevention (CDC) report [18]. Per the CDC report, elder abuse is defined as “an intentional act or failure to act by a caregiver or another person in a relationship involving an expectation of trust that causes or creates a risk of harm to an older adult.” An older adult is defined as an individual 60 years of age or older. Consistent with previous work [13], we chose to include “strangers” when classifying abuser-victim relationships, a modification consistent with the U.S. Department of Justice’s Elder Justice Roadmap definition [19]. The general definition of elder abuse, definitions of specific subtypes applied in this study, and descriptions of relationships coded are described in detail in previous work [13] and in Supplemental Table 1.
Additional criteria for coding abuse
Per CDC guidelines, alleged abuse between residents of long-term care facilities was not considered abuse. Calls reporting suboptimal living situations due to low income were not considered to be abuse for the purposes of this study.
Calls that reported abuse of an individual who is now deceased were only considered to be abuse if the death was presumed to be a result of the alleged abuse. This was done to ensure that abuse occurred within the two time periods of interest. Calls alleging abuse of victims residing outside of the United States or its territories and calls that alleged an abusive event that occurred prior to the windows of time under consideration were excluded from descriptive analyses. In the case of vague call narratives, abuse was only considered if the NCEA response narrative provided Adult Protective Services (APS) or police numbers to the caller or referenced a specific case of abuse.
Analyses of calls
Total calls identifying alleged abuse for each time period were tallied and characteristics of the calls were summarized separately for each of the two time periods. Descriptive analyses procedures were as follows. If a call described two or more unique and unrelated instances of abuse, these instances were counted separately into the total. Percent of each abuse subtype was calculated by dividing the number of calls alleging a specific abuse subtype by the total number of calls reporting abuse. This same procedure was done to determine other characteristics of the calls, including caller, perpetrator, and victim characteristics, abuser-victim relationships and number of abusers. Calls that identified more than one subtype of abuse or relationship were included within each relevant descriptive analysis, such that some calls were represented more than once. In cases in which calls reported more than one subtype of abuse or other characteristic of interest (e.g., perpetrator relationship), the denominator remained the total number of calls reporting abuse, or the total number of calls reporting a subtype of abuse, in the case of subtype analyses (e.g., examining perpetrator relationships separately by subtype).
To investigate whether there were statistical differences in call characteristics between the two time periods, a series of chi-square tests of independence were conducted. Adjustments for multiple comparisons were made using Bonferroni corrections.