Perceived stress and elder abuse: A population-based study of adult protective services cases in Chicago

Objectives To characterize the relationship between perceived stress and Adult Protective Services (APS) elder abuse cases in a population-based sample. Design Cross-sectional. Setting Chicago. Participants community-dwelling, older adults (N = 8,558; mean age 74 ± 7, 62% female, 64% African American). Measurements Perceived Stress Scale (PSS), APS database linkage. Results Bivariate and adjusted analyses showed that perceived stress was significantly higher in APS clients than in participants without any APS interaction for various subtypes of abuse (e.g., abuse from a perpetrator and self-neglect). This relationship was strongest for those with a confirmed history of abuse from a perpetrator, with a medium-large effect size (t = -5.8, P <.001, Cohen D = -0.6). Those in the highest stress tertile had a likelihood of having confirmed history of abuse from a perpetrator that was nearly three times as great as that of those in lower stress tertiles (odds ratio = 2.7, 95% confidence interval = 1.2-6.2). Analyses of individual PSS items revealed a robust relationship between distress items and APS involvement. Items reflecting coping were inconsistently associated with elder abuse. Conclusion Clients of APS have higher levels of perceived stress, and abuse from a perpetrator strengthens this relationship. Therefore, victims of abuse from a perpetrator may be at the highest risk of stress-related consequences and should be targeted for intervention efforts that enhance empowerment and effective coping strategies.