Elder abuse is one of the more controversial subjects in domestic violence. Many people do not want to hear about it, deny its existence, and do not know what to do when confronted with it. Researchers and academics cannot agree among themselves about the definition or extent of elder abuse. The term ‘‘elder abuse’’ was first used during congressional hearings in the late 1970s, when Congress was examining the mistreatment of the elderly in the United States. This research paper will examine various aspects of elder abuse by intimate partners.
III. Theories or Reasons for Abuse
A. Cycle of Violence Theory
B. Psychopathology Theory
C. Social Exchange Theory
D. Neutralization Theory
E. Family Stress Theory
IV. Types of Abuse by Intimate Partners
A. Physical Abuse
B. Sexual Abuse
C. Psychological or Emotional Abuse
F. Material Abuse
V. Characteristics of Elder Abusers
VIII. Guardians and Conservators
Some scholars use the term elder abuse to refer to the abuse of persons over the age of sixty-five, while others who use the term include those who are much younger. Some well-respected researchers use the term to signify abuse perpetrated by someone who shares a home or residence with the elder victim, while other well-known researchers use the term to include acts of abuse that occur in an institutional setting. It is clear that attempts to reach agreement on the definition of elder abuse have generated controversy and debate. What is significant about elder abuse, and what makes it different from other forms of domestic violence, is that the age, psychological condition, and perspective of the elder victim in many cases make this abuse harsher and more life threatening.
For purposes of this research paper, elder abuse will be defined as conduct that results in physical, sexual, psychological, or material neglect, harm, or injury to an elder (Wallace 2005); an ‘‘elder’’ being defined as someone who is sixty-five years of age or older. Physical harm includes inflicting bruises, scratches, cuts, or burns, or other acts that result in a nonaccidental injury by a person who has care, custody, or control of an elder. Sexual harm includes either nonconsensual direct or indirect sexual contact with or sexual exploitation of an elder. Neglect is the negligent treatment of an elder by a caretaker that may cause harm or threatened harm by the caretaker. Self-neglect occurs when an elder acts in such a manner that threatens his or her own health or safety. Psychological or emotional abuse includes acts or omissions that are judged by community standards and professional expertise to be psychologically damaging to the elder. Material abuse includes the direct or indirect use or exploitation of an elder’s financial or material resources. This definition includes elders who are abused at home or in an institutional setting.
An intimate partner is usually viewed as someone who is married to or cohabitating with another person. However, with elder abuse, many times the abuser may be a child or relative of the elder. The elder’s spouse or cohabitating mate may have predeceased the elder, leaving him or her with no other caretaker than another family member. Therefore, ‘‘intimate partner,’’ for purposes of this research paper, will be defined as any family member, by blood or marriage, who assumes primary caretaking responsibilities for the elder.
The extent of elder abuse, like other forms of domestic violence, is subject to continuing debate, since it occurs behind closed doors or in private. The National Elder Abuse Incidence Study (NEAIS) was the first nationwide study of elder abuse. It estimated that approximately a half million elders were abused or neglected in 1996. This study also set forth the proposition that for every reported case, there were at least five cases that were not reported. More recent studies estimate that one in fourteen incidents come to attention of the authorities (Pillemer and Finkelhor 1988). There have been other studies regarding the extent of elder abuse that set the number of cases at over two million per year. The complexity of defining elder abuse and the different reporting requirements in various states compound the task of accurately estimating its prevalence. Regardless of the actual numbers, it is obvious that elder abuse is a serious problem that must be addressed by society.
Theories or Reasons for Abuse
Why would an intimate partner commit these types of acts? Researchers and scholars do not have the answer to that question, but they do have some general information that may help in understanding why an intimate partner would commit elder abuse.
Cycle of Violence Theory
The Cycle of Violence theory is also known as the Intergeneration Transmission of Violence theory. This theory holds that violent behavior is learned within the family and bequeathed from one generation to the next. For example, if a child is raised in a family where there is abuse, the child may grow up to likewise become an abuser. According to the Cycle of Violence theory, the childhood survivor of a violent family thus develops a tendency toward violence as an adult. This theory fails to explain how some children who were raised in abusive families can grow up to not be abusive.
This theory is based upon the belief that abusers of the elderly have some sort of mental disorder that causes them to be abusive. Some researchers have found psychopathology present in abusers charged with physical and verbal abuse of elders, while others have found it lacking.
Social Exchange Theory
The Social Exchange theory assumes that dependency in relationships contributes to elder abuse. One aspect of this theory holds that the victim’s increased dependence on the abuser results in acts of abuse. This theory holds that when there is a loss of mutual sharing of resources between the elder and the intimate caretaker, the quality of the relationship degenerates. This results in the intimate partner perceiving the relationship as unfair, with an increase in hostility toward the elder. This imbalance may cause some intimate partners to abuse their elder victims.
This theory was originally developed to explain juvenile delinquency (Sykes and Matza 1978). It holds that to commit crimes, the delinquents must develop techniques of neutralization. These techniques include denial of responsibility, denial of injury, denial of the status of the victim, condemnation of the condemners, and appeal to higher loyalty. Tomita (1990) has applied this theory to elder abuse and believes it may be employed by the intimate abuser to justify his or her acts.
Family Stress Theory
This is one of the most popular theories about the cause of elder abuse. The Family Stress theory is based upon the premise that providing care for the elder induces stress for the intimate partner. This stress may include the economic hardship of providing for medical care for the elder, the increased cost of having the elder live with family members, and payment for special transportation or other needs for the elder. This stress may also include loss of sleep due to getting up during the night to take care of the elder’s needs and intrusions into the family privacy and activities.
There is no one accepted theory or reason that explains why intimate partners abuse elders. Scholars are still researching the causes and dynamics of elder abuse. Unfortunately, at this time, there is no ‘‘cure’’ for elder abuse. Therefore, it is important to understand the different types of elder abuse committed by intimate partners.
Types of Abuse by Intimate Partners
Abuse by intimate partners is one of the most controversial topics within the area of elder abuse. The definitions already given provide a broad overview of this form of abuse. This section will discuss these acts in more detail.
In some cases, the elder may not remember how, why, or when the abuse occurred. The victim may not disclose the abuse to innocent caretakers or other members of the family. Therefore it is essential that professionals in the field carefully document any unusual or unexplained physical injuries.
Common injuries may include bruising. Any unusual bruises that form a pattern or shape of another object such as a belt, cord, or hand should be investigated. Bruising that occurs after visits with relatives should also be carefully examined. Bite marks should immediately be reported to the authorities. These should raise immediate questions on when, how, and why the intimate partner was last alone with the elder. Bite marks are very seldom accidental in nature.
Burns are also possible indicators of physical abuse. Types include cigarette burns, burns with distinctive shapes such as that of a stovetop grate, and immersion burns which occur when the elder is held under or in extremely hot water. Fractures are common in elder abuse because as a person ages, bones become more brittle. However, multiple injuries to the head, multiple fractures or spinal fractures (where the bone is turned and broken in a circular pattern) should be reported and questions asked of the caretaker regarding the injury. Lacerations, abrasions, or hair loss can also be a sign of elder abuse. It is also true that hair loss can occur with aging for both men and women, and elders can bump against a wall and receive a laceration or abrasion. However, any of these injuries should be examined with care and concern and the possibility of elder abuse evaluated.
In some cases, the intimate partner may sexually abuse the elder. This abuse may involve forced sex or indirect sexual exploitations such as taking pictures of the elder and selling them on the Internet. Sexual assault of an elder raises additional concerns, as it causes additional consequences. Some elders are so fragile that the assailant may break bones during the sexual assault.
Psychological or Emotional Abuse
This type of abuse is much harder to identify than physical or sexual abuse. However, as with other forms of domestic violence involving psychological abuse, its effects can be quite severe and long-lasting. The elder victim of psychological abuse may be deprived of other family support or may fear continued rejection by the intimate caretaker relative and therefore come to believe that there is no further purpose in living. These elders may suffer depression or may become overly anxious or fearful of younger adults, especially if the abusive caretaker is younger. Psychologically or emotionally abused elders may also develop sleep disorders or hysteria.
This type of abuse may be defined as the negligent treatment of an elder by a caretaker that may cause harm or the threat of harm. Neglect may occur in a number of different ways. The intimate caretaker may simply not feed the elder sufficient food to stay healthy. The caretaker may not change the elder’s clothing if there is a need to do so—for instance, if the elder is incontinent and has soiled himself. The caretaker may also fail to take the elder to the doctor for proper health care and other medical treatment.
This is a very emotional topic for many in the field of domestic violence. Self-neglect occurs when an elder acts in such a manner as to threaten her own health or safety. Self-neglect may involve the elder’s decision to refuse food or medicine. Elders in this situation may be mentally incompetent to act for themselves. While this type of abuse does not involve an intimate partner, it is included here for the sake of comparison with other types of abuse. This category excludes elders who are competent and make certain decisions as matters of personal choice.
This type of abuse involves the exploitation of the elder’s finances or resources. Similar to other forms of domestic violence, the definition of material abuse of elders is subject to conflicting definitions. However, the legal system has responded to this form of abuse. Forty-eight states and the District of Columbia have statutes that specifically mention financial abuse of elders (Roby and Sullivan 2000), but there is little if any uniformity among the statutes. Some states require dishonest tactics by the perpetrators, while others limit this form of abuse to neglect or at least reckless abuse or conduct. This is made more difficult by the acknowledgment that even professionals may have trouble distinguishing between an unwise financial transaction and an exploitative transaction that was the result of undue influence, duress, or fraud.
Material abuse is similar to other forms of elder abuse in that it is devastating to the victim and frequently can be traced to intimate partners, whether they are spouses, children, or other family members. However, unlike other forms of abuse, material abuse may occur with the ‘‘consent’’ of the elder and thus is very hard in many situations to detect. This abuse may be as direct and open as taking money from elders’ wallets or banking accounts. The use of undue influence may involve subtle or not so subtle pressure on elders to sign over their property to the abusers. Or the abusers may suggest that since they are caring for them, the elders should show gratitude by leaving property or other assets to them. The abusers may threaten to stop caring for the elders unless these assets are signed over. Additional forms of material abuse can be:
- Taking, misusing, or using without the elder’s knowledge money or property
- Forging an elder’s signature on a legal document
- Abusing the joint signature authority of a bank account
- Misusing credit cards
- Cashing an elder’s check without permission
- Persuading an impaired elder to change his or her will or insurance policy
- Overcharging for caretaker services
- Denying elders access to their money
The risk factors associated with elder abuse are hard to determine, but some authorities suggest that most victims of elder abuse are white females over the age of seventy (Coker and Little 1997). One reason why this group is more likely to be victims of elder abuse has to do with the facts that women live longer than men and white females live longer than females from other races. A second reason is that the perpetrator perceives these women as weak and vulnerable. A third factor that applies to any victim is a lack of knowledge regarding financial matters in general.
Characteristics of Elder Abusers
Who would abuse an elderly family member in their care? What kind of person would beat, sexually assault, or steal from his or her elderly family member? These questions are for the most part unanswerable because of the lack of research in this area. However, the few studies that have been conducted provide some information, albeit conflicting, about the profile of an abuser. One study indicated that most perpetrators were between the ages of thirty-six and fifty (Teaster 2003), while another had figures to show that 75 percent of abusers were over the age of fifty (Pillemer and Finkelhor 1988).
While females are usually the caretakers, they do not commit most of the incidents of abuse. Fifty-two percent of the perpetrators in one survey were males (Teaster 2003). While spouses may account for most of the physical abuse and neglect, children appear to carry out most of the material abuse. What is known is that the perpetrators may be of either sex, come from various economic positions, and be of different ages. As with so many factors of elder abuse, more study is needed in this area.
There are different types of consequences depending on the form of abuse. Physical consequences resulting from physical and sexual abuse and neglect take many forms. Elders heal more slowly than younger persons. Additionally, what may be a simple injury for a younger person may become debilitating for an elderly person. Mental consequences may include a crisis reaction to the abuse. Post-traumatic stress disorder may result from traumatic types of elder abuse, including physical assault. Susman and Vittert (1980) list some typical reactions that elders may feel as a result of abuse. These include pain and suffering, loss of affection or enjoyment of life, increased fear of crime, acute financial loss, unplanned change in lifestyle, increased isolation and loneliness, and reluctance to get involved in the criminal justice system. Finally, there are financial consequences to society as a result of elder abuse. These include increased costs of medical and mental health care, increased legal costs, and second-generation financial burdens on adult children for the costs associated with taking care of the injured elder.
The Administration on Aging is a federal agency of the U.S. Department of Health and Human Services that has a strong commitment to protecting seniors from elder abuse. The Administration on Aging supports a wide range of activities at the state and local levels to raise awareness about elder abuse. These activities include training law enforcement officials and medical professionals in how to recognize and respond to cases of elder abuse.
All fifty states have enacted laws that allow Adult Protective Services (APS) to intervene in cases of elder abuse. APS comprises those services provided to elders and people with disabilities who are in danger of being abused and are unable to protect themselves and have no one else to care for them. Each state is responsible for establishing its own APS. In most states, APS workers are the first professionals to respond to reports of abuse, neglect, or exploitation of elders. The section or division of APS that works with elders has a number of different intervention responses. These include receiving and investigating reports of elder abuse, assessing the elder’s risk of injury and ability to understand what is occurring, developing a case plan, arranging services, and monitoring and evaluating those services.
Some states designate professionals in certain occupations as ‘‘mandated reporters.’’ In other words, people who work in these occupations must report suspected cases of elder abuse if they are involved with the elderly population within the scope of their job. For example, in California, mandated reporters include any person who has assumed full or partial responsibility for the care of an elder, whether or not that person receives compensation. Mandated reporters also include any care custodian in a public or private facility that provides services to elders and any health practitioner, including doctors, nurses, social workers, and counselors.
Once a mandated reporter or anyone else contacts APS about possible elder abuse, the process begins. If it is an emergency, APS will forward a copy of the report to the local law enforcement agency and emergency medical staff. If it is a nonemergency case of suspected elder abuse, it will be assigned a response time based upon the potential risk to the elder, and the report will be assigned to a staff person to conduct an investigation. If the report does not meet the definition of elder abuse, the reporting party will be given information regarding community resources that might be of assistance to the elder.
The APS investigator makes contact with the elder victim and assesses the alleged victim’s risk factors. The investigator also assesses the victim’s capacity to make an informed consent. If the victim can make an informed consent, he or she has the right to refuse intervention. If the victim desires to go forward with the case, a case plan is developed and services may be provided by a number of agencies, including law enforcement responses (e.g., the filing of criminal charges), counseling, temporary emergency shelter, assistance from advocates for the elderly if the elder cannot act on his or her own behalf, and referrals to other agencies as necessary.
Another important party who interacts with the elder victim is the health care professional. This person in many cases is not only a mandated reporter, but is tasked with evaluating injuries to the elder victim and recommending alternative courses of action. Health care professionals should assess not only the health status of elderly victims and the nature of the abuse, but also their financial status and living arrangements and the presence of emotional support or stress.
Finally, another intervention or prevention concept involves the use of triads. Triads are formed when local law enforcement agrees to work with senior citizens groups and community groups to prevent the victimization of the elderly. The three groups establish programs to prevent elder abuse through education and to address the care of elders. The essence of the triad program is cooperation. Triads allow law enforcement to work with senior citizens groups and advocates to establish programs that enhance the safety and quality of life of seniors. The use of triads continues to grow. In 1992, there were only fifty-six triads in twenty states. Today almost all states have triads. In 2000, the National Association of Triads was formed in an attempt to provide more secure funding for this approach.
Guardians and Conservators
Elders may be unable to care for themselves and the only family members available are the abusers. In those situations, the state has the authority to intervene and care for those who cannot care for themselves. The state uses the legal concepts and authority of guardianships and conservatorships to intervene and proceed with care.
In most states, a conservator is a person or entity appointed by the court to manage the estate or property of one who is unable to manage his or her own affairs. Guardians are appointed to tend to such matters affecting their elderly charges as where they live, what medications they take, and any other aspects of their well-being. In some states, a person is appointed as the conservator of both the estate and the person and is tasked with the dual responsibility of caring for both.
To establish guardian- or conservatorship, most states require a court hearing, which may be initiated by a caretaker or by the local government agency assigned the task of caring for elders who are helpless and alone. The first step is the filing of pleadings, which are formal documents alleging that the elder cannot care for herself. In most jurisdictions, the elder has a right to an attorney. The elder’s attorney may contest the pleadings and has the right to cross-examine any witnesses who are called to prove that the elder cannot care for herself. If the court accepts the evidence of the pleadings, it imposes guardianship or conservatorship and lists the powers that the office may exercise. There is normally a review of the status of the case every year or two, depending on the jurisdiction. At these review hearings, the elder has the same rights she exercised in the first hearing.
Elder abuse by intimate partners is one of many controversial domestic violence topics. Elder abuse includes physical, sexual, psychological/emotional, and material abuse. These acts may be committed by strangers who work in an institutional setting which cares for the elderly or they may be inflicted by an intimate partner. This research paper has addressed elder abuse by intimate partners. The extent of elder abuse is underreported—according to some authorities by as low 1 in 25 cases.
There are a number of theories on why perpetrators commit elder abuse, including the Cycle of Violence theory, the Psychopathology theory, the Social Exchange theory, the Neutralization theory, and the Family Stress theory. However, as of this date, no one theory has explained all the different types of elder abuse. Much more research is needed in this area.
Similar to other forms of domestic violence, there are serious consequences suffered by victims of elder abuse, which may be more serious than those of other forms of domestic violence because of the special needs of the elderly. There are a number of agencies that work with and attempt to prevent elder abuse. These include federal, state, and local agencies and task forces whose concern is the health and welfare of the elderly.
Elder abuse is a critical topic in the area of domestic violence. With the ‘‘graying’’ of America and the aging of the baby boomers, elder abuse will take on a whole new significance in the near future. It is urgent that society understands its dynamics and is prepared to respond to it.
- Coker, Johnny, and Bobby Little. ‘‘Investing in the Future: Protecting the Elderly from Financial Abuse.’’ FBI Law Enforcement Bulletin (February 1997): 1–5.
- National Elder Abuse Incidence Study: Final Report. Washington DC: National Center on Elder Abuse, 1998. Pillemer, Karl, and David Finkelhor. ‘‘The Prevalence of Elder Abuse: A Random Sample Survey.’’ The Gerontologist 28, no. 1 (1988): 51–57.
- Susman, Marjorie, and Carol H. Vittert. Building a Solution: A Practical Guide for Establishing Crime Victim Service Agencies. St. Louis: National Council of Jewish Women, 1980.
- Sykes, Gresham M., and David Matza. ‘‘Techniques of Neutralization: A Theory of Delinquency.’’ American Sociological Review 22 (1978): 664–670.
- Teaster, Pamela B. A Response to the Abuse of Vulnerable Adults: The 2000 Survey of State Adult Protective Services. Washington DC: National Center on Elder Abuse, 2003.
- Tomita, S. K. ‘‘The Denial of Elder Mistreatment by Victims and Abusers: The Application of Neutralization Theory.’’ Violence and Victims 5, no. 3 (1990): 171–184.
- Wallace, Harvey. Family Violence, Legal, Medical, and Social Perspectives, 4th ed. Boston: Allyn & Bacon, 2005.