Although elder abuse is a pervasive and growing problem, much about this topic remains unknown, and inconsistency in definitions has hampered research and practice. Both the lack of clarity of definition and the underreporting of cases have prevented a clear picture of prevalence. Notwithstanding, it is estimated that between 1 and 2 million Americans over age 65 have experienced some type of abuse. Elder abuse occurs in both institutional and domestic settings. Currently six types of abuse are generally agreed on. Profiles of victims have found no gender differences, but likelihood of abuse is higher in elders with low income and in those who are depressed or who have experienced earlier domestic abuse. Abusers are most often children and other family members of victims. Regarding treatment and prevention, collaborative approaches have been shown to be best suited for elder abuse victims; psychologists play an important role on these teams. Finally, additional funding has been noted as critical for improving prevention and treatment services, but equally important is the need for additional research.
Elder Abuse Definition and Prevalence
Early attempts to compile statistics on elder abuse suffered from a lack of consistency in definition. While there is still some disagreement among the various interested professional groups, a generally accepted definition of elder abuse now exists. Elder abuse is the umbrella term used to refer to any act that causes harm or risk of harm to a vulnerable adult. The acts can occur to elders living in domestic settings (private homes, apartments, etc.) and to elders in institutional or residential facilities. Regardless of site, six different types of abuse have been identified. For all types, acts are considered abuse whether they are intentional or not and whether they include verbal or nonverbal behavior. Physical abuse includes inflicting pain or injury or depriving a basic need. Sexual abuse includes nonconsensual sexual contact of any kind. Emotional or psychological abuse is the infliction of emotional anguish or distress. Financial or material exploitation involves funds, property, and assets. Neglect is the loss of food, shelter, health care, or protection and is the most common type in domestic settings. Self-neglect is any act by the elder himself or herself that threatens health or safety. Finally, abandonment is the desertion of an elder by anyone who has assumed responsibility for care.
An accurate picture of the incidence and prevalence of elder abuse is elusive for a number of reasons. First, not all states use the preceding definitions. Second, there are no uniform reporting standards or systems. This has prevented the collection of comprehensive national data. Third, only a portion of elder abuse cases is ever reported. Vulnerable elders are even less able or willing, and thus less likely, than are victims of other domestic abuse to report abuse or neglect. Current estimates suggest that only 1 out of every 5 cases in all settings is reported and only 1 in every 14 cases in domestic settings. Consequently, statistics suffer from underreporting. The National Center on Elder Abuse estimates that between 1 and 2 million Americans aged 65 and over, a frequency of 2% to 10%, have been injured, exploited, or otherwise mistreated. Specific studies indicated that in 1996, nearly 450,000 adults aged 65 and over were abused and/or neglected in domestic settings, and in 2003, the Long Term Care Ombudsmen programs reported 20,673 complaints from institutional residents. A survey of State Adult Protective Services (the agencies responsible for collecting and investigating reports of elder abuse) by the Administration on Aging, in 2004, found an increase of 19.7% in reports from 2000 to 2004 and an increase of 15.6% in substantiated cases. In considering these data, it should be remembered that the population of elders and of vulnerable elders is increasing. Furthermore, improvements in reporting and investigating may also underlie some of the increase in the number of cases reported and certainly in the substantiation of those cases. As evidence for this, states with mandatory reporting and tracking have higher rates of investigation.
Profiles of Victims and Perpetrators of Elder Abuse
Research has examined both who is most likely to be abused or neglected and who is most likely to perpetrate these crimes. The median age of abuse victims in 1996 was 77.9. In 2004, more than two in five of the cases reported involved elders aged 80 or over. In 1996, 66.4% of the victims of domestic elder abuse were White, while 18.7% were Black; Hispanic elders accounted for 10% of the domestic elder abuse cases. Minority elders may be even less likely than majority elders to report abuse, for doing so would bring shame on the family. Men and women are equally likely to be abused; men may be more likely to be victims of self-neglect. Elder abuse is more likely in situations where the husband has a lower level of education (wife’s education does not seem to play a role), when family income is low, when depression is present, and when abuse occurred earlier in the household. Again, reporting problems hamper accurate data.
Perpetrators of abuse and neglect are most often children of the victim (32.6%), followed by other family members (21.5%), and then spouses and intimate partners (11.3%). Early data indicated that men were more likely to be abusers, but more recent research suggests that both men and women are equally likely to perpetrate elder abuse and neglect crimes. This may be a reflection of better reporting, better definitions, or both. Furthermore, earlier studies focused primarily on physical and sexual abuse. More recent data on the abuser may reflect the incorporation of emotional and financial abuse and neglect. Research has yet to clarify the profile of perpetrators based on type of abuse.
Elder Abuse Prevention and Treatment Approaches
In addition to profiling victims and abusers, a significant proportion of the research has focused on identifying best practices to improve programs and services for victims, help prevent abuse and neglect, and inform policy and law. State adult protective services are charged with screening and investigating reports and coordinating with local service providers to care for victims and with the local police to detain perpetrators. Research on the benefits of collaborative approaches has shown that elder victims are cared for more quickly and efficiently, and prevention of recurrence of abuse is greater over the long term when multiple agencies work in partnership. The greatest potential benefit, however, is in the detection and prevention of abuse. Several models have been suggested and some efficacy data have emerged suggesting that a multiagency, interdisciplinary approach in each community has the potential to greatly reduce the incidence of elder abuse. Much more evaluation research is needed to identify the critical components of collaborative programs.
Finally, with regard to prevention, several experts in the field have implicated the widespread ageism present in society that allows elder abuse and neglect to flourish. Studies have shown that the same services available for victims of child or domestic abuse (e.g., foster homes, women’s shelters) are not available for elders. Funds devoted to prevention and treatment of elder abuse are significantly less than that devoted to other types of crimes. Even the paucity of law on the federal level and the inconsistency of state laws (although all 50 states and most territories do have laws regarding elder abuse) are indicative of the poor view of elders. There is substantial literature on the negative view of elders in society and the potential for maltreatment as a result of these stereotypes. Specific to elder abuse is the literature on perception of abuse. One example is a study that presented six different scenarios to college students and asked them to rate whether abuse was present in the scenario, whether the caregiver or the older adult was the abuser, and how justified the abuse was. Scenarios included those in which a daughter throws a frying pan at her mother, a daughter threatens to poison her mother’s food, a daughter withholds money belonging to her mother, and a daughter refuses to take her mother to a doctor’s appointment. Students also answered questions about their relationships with their grandparents. Results showed that students found caregiver abuse to be more justifiable when the older adult was portrayed as being agitated or senile but less so when the older adult was helpless. Students who reported closer contact with their own grandparents found more instances of abuse to be unjustifiable than those students who did not maintain close ties with grandparents.
Psychologists have increasingly been part of interdisciplinary teams of professionals involved in the prevention and treatment of victims of elder abuse. Important to the definition of elder abuse and to the design of services and care programs, psychologists have helped improve prevention and treatment efforts. Those with psychology and law training have the potential to make the greatest impact. In addition to the need for more funding and staff, state adult protective agencies reported in a 2004 survey that they had a pressing need for training. Specifically, they cited that forensic interviewing, cross-training with professionals in the legal system, and improved law enforcement were critical to improving services for their clients. Clearly, increased and continuing funding and research are needed in all areas of elder abuse to help ensure the health and well-being of vulnerable elders.
- American Bar Association Commission on Law and Aging. (2005). Information about laws related to elder abuse. Available at http://www.ncea.aoa.gov/
- Lachs, M. S., & Pillemer, K. (2004). Elder abuse. Lancet, 364, 1192-1263.
- National Center on Elder Abuse. (2005). Fact sheet: elder abuse prevalence and incidence. Available at http://www.ncea.aoa.gov/
- S. Administration on Aging. (2006). Elders rights protection. Retrieved July 17, 2007, fromhttp://www.aoa.gov/AoA_programs/elder_rights/