Elder Abuse. Definition

Elder abuse is a term that has both specific and general meanings. Specifically, the term refers to volitional acts (acts of commission) of physical, sexual, or psychological violence perpetrated against individuals over age 65 by family members or other individuals in positions of trust, such as health care providers. The term is not usually used to denote acts of violence perpetrated against elders by strangers. The term is also used, generally, as a cover term to denote, by commission or omission, an array of harmful acts perpetrated against elders by intimate others including neglect, exploitation, and abandonment.

In  recent  years,  researchers  have  advocated  the use of the term “elder mistreatment” as the cover term, reserving the term “elder abuse” to refer to only volitional acts of violence. Some absence of clarity in the literature arises from this lack of distinction. Other definitional issues arise in the literature related to whether the term applies equally to vulnerable elders and nonvulnerable elders, whether cases include situations of self-neglect, and whether the identity of the perpetrator makes a difference in the definition. Because a substantial proportion of elder abuse is perpetrated by intimate partners, some researchers view abuse by spouses under the rubric of late-life intimate partner violence and consider it separately from abuse perpetrated by other family members. In general, how these definitions are applied is defined by individual state statutes.

Estimating the frequency of elder abuse is complicated because of definitional problems and the fact that there has never been a nationwide, population-based prevalence study. However, the National Center on Elder Abuse notes a steady increase in the number of cases reported since 1986. In 2003, reports from Adult Protective Service (APS) agencies estimated

166,019 substantiated cases of elder mistreatment in the United States. There is agreement that the number of substantiated cases reflects a small percentage of  the actual cases, and the discrepancy lies in failure to recognize and report mistreatment by those in contact with elders and the reluctance of many elders to self-identify.

The National Center on Elder Abuse indicates that signs requiring further investigation include bruises, broken bones, burns, abrasions, pressure marks, pressure sores, poor hygiene, and unusual weight loss. Also requiring investigation are sudden withdrawal from usual activities, a change in alertness, sudden changes in financial situations, frequent arguments or tense relationships between elders and their family caregivers, and evidence of belittling or threats. While no one characteristic of elders puts them at high risk for mistreatment, researchers agree that certain characteristics of caregivers should be considered red flags, including alcohol and drug problems; personal problems exacerbated by the caregiving situation; coexisting physical and mental problems; being overburdened by the demands of caregiving mainly due to unrealistic expectations, lack of knowledge or preparation, and dependence issues; the family’s social isolation; and previously existing interpersonal conflict.

Treatment for elder abuse is complicated because the autonomy of the elders and their preference for treatment  must  always  be  considered.  In  addition, in some states, treatment options are limited by the availability of resources and affordable, alternative living arrangements. Often the most feasible approach to treatment is the prevention of the next episode through counseling and education. In addition, APS agencies can often place outside workers in the home to act as monitors. In emergency situations, where the elder’s life is threatened or the elder is too mentally disabled to make an autonomous decision about a treatment preference, elders can be removed from abusive situations. Whether or not the elder is removed from the situation, in most states perpetrators can be prosecuted.

References:

1. National Center  on  Elder  Abuse,  http://www.elderabuse center.org
2. Tatara, T., & Kuzmeskus, (1997). Summaries of statistical data on elder abuse in domestic settings for FY 95 and FY
3. Washington, DC: National Center on Elder Abuse.
4. Teaser, P. (2003). A response to the abuse of vulnerable adults: The 2000 survey of Adult Protective Washington, DC: National Center on Elder Abuse.