Estimates indicate that one million elderly people are victims of domestic violence every year. Forty percent of cases occur when adult children victimize their parents. The victimization includes psychological, physical, and financial abuse. Adult children perpetrating elder abuse are more likely to inflict psychological maltreatment than physical or financial abuse. Combining the fact that the baby boomer generation is graying and families typically provide care for aged loved ones, scholars believe that abuse of the elderly is growing. Also, due to the intimate nature of the parent–child relationship, researchers believe that elder parent abuse is one of the most underreported forms of violence.
I. Profiling Abusers
II. Variations of Elderly-Parent Abusers
A. Hostile adult children
B. Authoritarian adult children
C. Dependent adult children
III. Methods of Abuse
IV. Theory and Research
V. Limits of Traditional Theories
VI. Integrated Theories
VII. Abuse Reduction
Previous research gives insight into the characteristics of abusers of elderly parents. An adult child abusive toward a parent tends to be financially dependent on the elder. Of adult children abusive to mothers, 77 percent are somewhat or fully financially dependent, and 65 percent are somewhat or entirely dependent for housing. Unemployment rates are higher among abusive adult children, and drug or alcohol problems are common. Many have histories with the criminal justice system and hospitalization for mental problems. They are also more reluctant to provide care for the parent, experience conflict with spouses over caring for the parent, and have unrealistic expectations of the parent considering the parent’s reliant state. Low rates of social support in caring for the adult parent also perpetuate abuse. Situations involving one child as exclusive care provider are more problematic than when siblings are available to assist. One study found that 64 percent of parent abusers were sons, while 36 percent were daughters. Mild forms of psychological neglect are more likely to come from a daughter, and severe forms of psychological abuse are more likely to come from a son. Daughters are more likely to use physical violence than sons are. Younger perpetrators are more likely to be sons; older perpetrators tend to be daughters. Almost 30 percent of the abusers claim that the elderly person in the relationship previously abused them. This history of previous childhood abuse may serve as a justification for the adult child to abuse the elder parent. In general, adult children are more likely to abuse if they’d had poor relationships with their parents before the need to provide care arose. Old conflicts come back to life. Contradictory ideas on politics, religion, relationships, child rearing, education, work, or lifestyle renew anger, thus triggering abusive episodes.
Variations of Elderly-Parent Abusers
With abuser characteristics in mind, research provides a typology of adult children abusive to their elderly parents. Typologies are basic classifications or ideal types that help researchers understand social relations. In the literature, three variations of adult children who abuse their elderly parents exist. They include hostile children, authoritarian caregivers, and dependents.
Hostile adult children
Hostile adult children have long-term relationship problems with their aged parents, reporting that even at early ages they did not get along with them. This type also claims that the elderly parent has pathological problems. Deflecting their own actions as a source of conflict, they believe that the parent has mental or substance abuse issues that trigger most of the problems in their relationship. Pressure from other family members fosters a sense of obligation to provide care. Adult children of this type also indicate a preference to provide care for a passive parent. In some cases, they even convey a desire for the parent to die. Research often describes adult children in this classification as irate, mistrustful, and tense. Anger felt toward the elderly parent they are caring for is evident in their discussions about providing care. Their body language also indicates apparent hostility toward the parent. In addition, research indicates that the hostile adult child acknowledges general feelings of anger toward all people. These abusers tend to be highly educated but feel a sense of underachievement. Not surprisingly, they blame the elderly parent for holding them back and limiting their potential. They are less likely to live in the same house as the parent but are the most abusive. Moreover, life crises trigger episodes of abuse.
Authoritarian adult children
Authoritarian adult children have a domineering, rigid, punitive personality. Research describes them as critical, impatient, and blunt. They are not typically substance abusers, are less educated than the hostile type, and see providing care as less of a burden. Their expectations are high in regard to care, possibly explaining why they choose to care for the elderly parent themselves. They do not believe that anyone can provide care as well as they can. While having high expectations for the elderly parent, they do not have sympathy for the dependency status of the aged parent. They feel that the elderly parent could do more to fight off dependency but will not put forth the effort. Regardless, children in this category have a need to control multiple aspects of the elderly parent’s life. When the parent comes to live with them, they begin abuse by lashing out when a household rule is broken. Usually married, they treat the elderly parent like an infant or young child. The few pleasures they report in providing care involve grooming or shopping for the aged parent. They resent the parent for discussing personal matters with others living outside of the house. In fact, they sometimes institutionalize the parent if information control cannot occur.
Dependent adult children
Dependent adult children are financially reliant on elderly parents. Unemployed or in a low-paying job, they have lived with their parent continuously, occasionally, or during some period of time into their adulthood. Research indicates that they lack maturity and have never gained the economic or social status of others their age. They care little about their appearance, fail to adequately clean their surroundings, and are passive. However, their passivity subsides when abusive episodes occur. They are uneasy in social situations. Compared with the hostile and authoritarian categories, research indicates that they participate in fewer formal activities with others and are less likely to be married. Although their primary relationship is with the elderly parent, they provide fewer variations of care for them than members of the other groups. Compared with hostile or authoritarian types, dependents are more hesitant to discuss the abuse they inflict on aged parents.
Methods of Abuse
‘‘Double direction’’ violence occurs with some children caring for elderly parents. This involves scenarios in which both the child and the parent try to control each other. Methods used by adult children to gain advantage in these situations vary. Studies indicate that 40 percent of adult children scream or yell at the parent to gain authority. Lower numbers use physical restraints (6 percent), overmedication and force-feeding (6 percent), threats of physical force (4 percent), and actual hitting (3 percent). Some play into stereotypical harsh conditions of institutionalized care such as alleged in nursing homes. In fact, a small percentage actually use threats of sending the parent to a nursing home to intimidate them.
Theory and Research
Existing literature shows six traditional theoretical explanations for elder abuse by adult children. Four of these explanations focus on the adult child as perpetrator. They include abuse socialization, pathology, stress, and social isolation. A fifth focuses on the elderly parent as the victim and deals with vulnerability. The sixth—exchange theory— concerns the imbalance of power that can occur with the adult child and elderly parent.
Abuse socialization theory suggests that adult children attain motives to abuse parents. They acquire norms and attitudes that promote abuse and negative feelings toward elders. Researchers base this theory on the social learning perspective promoted in the fields of psychology and social psychology. Studies in this area focus on the observation of and later participation in abuse. These studies frequently indicate that children and young adults imitate aggressive, violent behaviors they witness. In turn, as adults, they are more likely to abuse. Their offspring witness the behavior and repeat it as well. This generates what many refer to as a cycle of abuse. Generations of families ritualize a lifestyle characterized by an extensive acceptance of violence. Scholars often discuss this cycle in terms of child and spouse abuse. However, in the field of elder abuse, there is a widespread belief that abused children are more likely to abuse their parents if they provide care for them in old age. An abundant amount of research supports this concept of intergenerational transfer. It also indicates that there is an amplification of abuse by adult children when a cultural backdrop of ageism exists. However, some studies do indicate that a majority of children abusive to adult parents did not grow up in abusive families. Their parents typically dealt with highly charged disagreements by arguing and yelling. Regarding extended family, research finds that they also typically had positive, nonviolent relations with aunts and uncles.
The pathology perspective indicates that adult children abuse because of a mental defect or impairment. Research supports that individuals labeled with developmental disability, mental retardation, mental illness, or personality disorder are at a greater risk to abuse elderly parents. Studies find a positive history of psychotic illness in many elder abuse situations. Abused elders are three times more likely to report that their abusers have mental problems, and literature confirms high rates of abuse among mentally impaired adult children caring for parents. Altered cognitive states due to drug or alcohol use are included in this theoretical tradition. When present, drugs and alcohol reduce the ability to control violent, aggressive actions. Critics of the pathology perspective argue the emphasis on the individual. They agree that mental problems and substance abuse increase rates of maltreatment of elderly parents but view these as parts of the explanation. An additional limitation of the pathology perspective is failure to account for external factors that trigger repeated abuse. However, research shows that 38 percent of children abusive toward adult parents have a history of psychotic hospitalization, 56 percent are alcoholics, and 6 percent are drug users.
The stress explanation of abuse involves tension overload. Demands of providing care outweigh the resources available to those providing it. One study shows that 85 percent of abusive caregivers claim to have experienced at least five psychosocial stress events during the previous year. The source of the tension could be internal or external. Internal stress involves the inherited burdens of providing care for an elderly parent. External stress for the adult child involves environmental events such as a frustrated spouse, financial strain, time issues, or employment problems. When these events occur for an adult child caring for a parent, they compound the internal stress and lead to mistreatment. Psychosocial stress events need not be negative. Positive changes can also lead to stress, heightening a caregiver’s sense of anomie, and increasing the probability of abuse. Regardless, research shows that not all children caring for elderly parents react to stress the same way.
Various factors influence how stress affects a caregiver. Some include the level of desire to provide care, individual responses to providing care, burden perceptions, magnitude of change, and nature of care provided. With desire for caring, resentment toward the parent may result when situations force an adult child to provide care. Concerning individual responses to providing care, adult children have different perceptions. As previously mentioned, this is influenced by issues such as gender, financial position, or the previous state of relations between the adult child and parent. In terms of magnitude of change, stress levels are dependent on how much change takes place in order to care for the aged loved one. For example, the stress level for someone taking care of a parent who has always lived down the street may qualitatively be lower than for someone caring for an aged parent living many miles away. Regarding the nature of the care provided, the type of care determines stress levels. Relating to issues of functional status, an adult child supplying financial support will have a different level of stress than one feeding and bathing an elderly parent on a daily basis. Moreover, research indicates that intimate activities, such as bathing, create psychological strain for both the child and the parent due to their personal nature, especially if the burden of care falls solely on one person’s shoulders.
Social isolation theory implies that without social support, adult children caring for elderly parents are more likely to abuse. Isolation forces the adult child to handle the strains of elder care alone. Without others helping them, it is harder to obtain assistance and diffuse the responsibility of care. The marital status of an adult child caring for an elderly parent is also an important factor to consider. When the caregiver is single, no spouse is available to share in the burden of care. Strain and subsequent abuse are more likely to occur. One study supports this notion, showing 54 percent of elderly parent abusers are single. A socially isolated person caring for an aged parent also lowers the potential of outsiders to identify the presence of abusive attitudes and intervene before abuse occurs. On the other hand, an elder with low social support is more susceptible to having an abusive caregiver for the same reason. If multiple people live in the home of an elder being cared for by an adult child or if the elder has frequent visitors from outside of the home, abusers will be more likely to incur negative sanctions from others. Abuse rates then drop.
Vulnerability theory simply indicates that victim characteristics leave elderly parents open to abuse. Specifically, as parents get older, they become increasingly dependent on adult children. This dependence may be due to failing bodies, deteriorating minds, and depleted finances. As research in the field of victimology explains, the weak, feeble-minded, and monetarily challenged have higher risks of victimization. In addition, studies indicate that as elderly parents become older, their willingness to escape from abusive relationships lowers. This is due, in part, to a fear of the previously mentioned social isolation.
Exchange theory suggests that a lack of balance in the relationship between the adult child and dependent elderly parent promotes abuse. Using social psychological theories, this idea implies that the basis of interaction between the adult child and the elderly parent is a system of benefits and costs. When people equally contribute to a relationship, equality exists. However, once one person provides more benefits than the other does, control is established. That person will then have the power to continue the relationship as he or she pleases because the other person will be dependent on the benefits they provide. In terms of the adult child and elderly parent relationship, as the parent grows older, his or her resources may dissolve. Physically, mentally, and financially, the elder parent is unable to provide as much as they receive. They then become dependent on the adult child. With power and control in their hands, adult children can treat elderly parents as they please, knowing that their parents have few, if any, alternatives. On the other hand, research does imply that power in the hands of the child also leads to frustration and anger for the elderly parent. Negatively reacting to a state of dependency and lacking resources, older loved ones then become more likely to abuse the caregiver.
Limits of Traditional Theories
All of the explanations for elder abuse by adult children have limitations. The socialization approach does not tell us why some people who grew up in abusive environments do not grow up to abuse. Studies find a large number of abusers suffer from some mental or emotional impairment. However, pathology theory has timing issues. Do mental health problems and substance abuse promote elder abuse, or do the pressures of elder care promote mental health problems and substance abuse? The stress explanation implies that tension leads to abuse, but research shows that all adult children experience stress. They simply handle it in differing ways. Social isolation is a plausible explanation. However, it makes sense only when connected to other concepts. It is possible that pathological problems push others away from caregivers, increasing the likelihood of isolation. Finally, vulnerability and exchange theory rely on long-term relationship dynamics involving dependency. They deal little with acute stress responses to providing care that trigger abusive episodes. Due to limitations cited with each theory, scholars are promoting an integrated approach in describing the dynamics of elder abuse.
Several integrated theories involving elder abuse by adult children exist. They combine the best of traditional models, emphasizing that abuse of an elder parent is a process rather than a single act. Considering cultural influences, research is increasingly placing importance on internal relationship factors as well as external events leading to abuse. Three integrated theories worthy of note are the human ecology model, the theory of developmental dysfunction, and stage theory.
The human ecology model implies that people will fall back on widespread cultural beliefs when they have no experience providing care to an elderly parent. These cultural beliefs inadvertently promote abuse. For example, cultural acceptance regarding use of force, lack of worth of the elderly, and social isolation guide the type of care given. Moreover, the lack of knowledge in providing care can create role confusion and push the adult child into abusive episodes.
The theory of developmental dysfunction views adult children as incapable of sustaining personal relationships with elderly parents. In part due to pathological issues, they abuse in the family context when external events push them over the edge. For example, the loss of a job or inadequate finances can trigger maltreatment.
The stage model consists of three phases, each of which contributes to the escalation of abuse. The first phase involves the point at which the adult child and the elderly parent establish that providing care for the latter is no longer a possibility but reality. Both the child and the parent define the situation by assessing social networks and types of care needed. The second phase involves the child and parent unconsciously processing their new roles and expectations. The third phase concerns abuse. It is the expressive stage, in which the child and the parent express their adjustment to their expectations and roles in a positive or negative way. Using this model, researchers indicate that a majority of abuse results from unreasonable and negative perceptions of the elder toward the caregiver and a lack of multiple people providing care.
It is relevant to mention gero-criminology in this discussion of integrated theories of abuse. Gerocriminology links ideas from multiple disciplines such as criminology, gerontology, psychology, sociology, and victimology to explain violence directed toward elders. Integrating concepts from multiple disciplines has theoretical potential. However, gerocriminology currently lacks a specific focus applicable to elder abuse perpetrated by adult children.
Theory and research provide a backdrop for the possibility of abuse reduction. Guidelines currently in existence focus on the perpetrator and the victim. Measures include pre-care planning, coordinating with elderly service providers, personal education, medical screening, contacting the local police, documenting conflict, building social networks, and providing temporary relief for caregivers.
With pre-care planning, literature suggests that adult children encourage their parents, when still healthy, to purchase long-term care insurance. Adult children may have a stronger sense of resentment toward the adult parent when care provision suddenly becomes their own financial responsibility. As mentioned above, the sudden burden of caring for a mentally or physically dependent loved one generates stress. Health insurance and Medicare funds are limited when caring for an elderly parent. Long-term care insurance guarantees a pool of monetary resources when elder care becomes necessary.
Anyone who has observed or has a reasonable cause to suspect that an adult child is abusing an elder should contact Adult Protective Services (APS) immediately. APS screens allegations of abuse, including neglect or exploitation, from various sources such as witnesses, victims, and mandatory reporters such as health care providers, social workers, law enforcement officers, and firefighters. Depending on the state of residence, APS may be located within criminal justice or social service agencies. APS investigates claims of elder abuse and, depending on the claim, will intervene and provide victim support. APS may also serve as an external buffer when conflict occurs. For example, if the adult child and elder parent experience a dispute over the cleanliness of the adult parent’s home, APS can step in before the situation escalates. They can serve as a mediator by providing information or making recommendations regarding sanitation. This deflects the parent’s anger at the adult child, decreases the strain on the caregiver relationship, and lessens the possibility of an abusive episode. Aside from social support, APS will also provide the adult child and elder parent with emotional support and legal services.
In terms of personal education, it is extremely important for the child and elderly parent to learn as much as possible about the process of providing care and issues of mental impairment. APS sometimes offers elder care training for adult children at risk to abuse parents. For the adult child confronted with parental dementia or Alzheimer’s disease, details regarding local support groups and information provided by the Alzheimer’s Association should be obtained. The adult child should arrange an evaluation by a geriatric specialist. Physicians diagnose Alzheimer’s disease in half of all people over eighty-five. Understanding the degenerative process of Alzheimer’s disease helps the caregiver to realize that the elderly parent may not be consciously lashing out. The outbursts could be symptoms related to the disease, not rational or retaliatory in nature. However, the literature does suggest that sometimes, due to a lack of power in the caregiver relationship, elderly parents play the dementia role for control purposes. If the caregiver suspects this, the adult child should push for medical screening, such as a CAT (computed axial tomography) scan, to properly diagnose the possibility of dementia as a factor in any personal conflict.
Research recommends contacting APS not as an option, but as a requirement for anyone even suspecting elder abuse. In abuse situations, it may also be necessary to contact local police. Some departments treat reports of elder abuse with high priority and have personnel specially trained in response and investigation of this type of violence. With elder abuse cases being hard to prove, some scholars encourage the documentation of conflict to ensure that prosecutors will have enough information to press charges. Compiling evidence is essential to the validity of a formal complaint. Documentation is necessary for parental victims of adult children and caregivers who are victims of violence from elderly parents. For some, collecting evidence involves the use of hidden cameras or tape recorders. Overt ways of collecting evidence include taking photographs or home video. Filing the complaint of abuse will usually bring APS into the situation if they are not already involved. Research shows that the police and APS do not always have a positive working relationship. It is often difficult for police and APS to prove a case of elderly abuse against an adult child. There are cultural beliefs that elder abuse is not a major social problem. Victims are also reluctant to press charges against family members. In some cases, reporting abuse seems to harm more than help. APS may recommend removal from the adult child’s care, potentially placing the victim in a less suitable environment. Consequently, the victim may then view reporting the abuse as punishment rather than a solution. Victims involved in substantiated cases are more likely than those in unconfirmed cases to refuse elder care support services.
APS contact helps to build social support networks for the adult child. To lower the potential for abuse, support networks for the elderly parent are important as well. The adult child can facilitate networks for the aged parent in a variety of ways. It is possible to privately hire home health care workers on a daily basis to visit with and assist in the care of the elderly parent. These workers provide companionship, but also help the adult child with a variety of tasks. While this type of assistance may benefit both the parent and the adult child, it is often difficult to locate quality, dependable workers. For some families, the cost of privately paying for assistance is unaffordable. To relieve the full-time pressure of providing care, it is also possible to enroll an elderly parent in Adult Day Care (ADC). These facilities typically operate during daytime hours and involve community programs specialized in providing services to older persons. They place emphasis on healthy rehabilitation and social activities and are located in a variety of settings, including churches, senior centers, and even hospitals. Having gained in popularity, there are over one thousand of these licensed facilities in the United States. Due to limited availability, enrolling an elderly parent in ADC may require a long-term contract. If long-term support is not what the caregiver needs, respite care is a possibility. This form of assistance provides adult children the option of temporarily leaving dependent parents at a facility where trained staff members provide care, or having a trained relief aid come into the home. Adult children commonly use respite services to meet an emergency need or as periodic relief from providing continuous care. In either condition, children providing care for elderly parents receive a break from the physical and emotional exhaustion that can trigger abuse.
The elderly will soon be the largest segment of society. With more elderly people, research indicates that elder abuse will increase. Since families still provide a majority of care for aged loved ones, analysts believe that adult children will continue to abuse. Research allows for the profiling of adult children who abuse elderly parents. It also offers a typology for understanding their actions. Moreover, traditional theories provide a general understanding of this type of abuse, while new, integrated theories focusing on internal and external factors provide complex models for study. Applying these theories to abuse-reduction strategies offers a great deal of promise for alleviating the problem of elder abuse perpetrated by adult children.
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