Many types of family violence have been recognized, including child abuse, wife abuse, and, more recently, elder abuse. All forms of family violence are at epidemic levels in the United States, yet considerably less investment has been made in reducing elder abuse than child and wife abuse.
What Is Elder Abuse?
Elder abuse, like other forms of maltreatment in families, can take several different forms. The National Elder Abuse Incidence Study (NEAIS) of 1996 defined domestic elder abuse—that is, elder abuse perpetrated by members of the family or household—as including the following forms of maltreatment: (1) physical abuse—any form of physical aggression that could result in bodily injury, physical pain, or impairment; unwarranted administration of drugs and physical restraints; force-feeding; and physical punishment; (2) sexual abuse—any form of nonconsensual sexual contact; (3) emotional or psychological abuse—the inflicting of anguish, emotional pain, or distress; (4) neglect—the refusal or failure to provide such life necessities as food, water, clothing, shelter, personal hygiene, medicine, comfort, and personal safety; (5) abandonment; (6) financial or material exploitation—the illegal or improper use of the elderly person’s funds, property, or assets; and (7) self-neglect—behaviors by older people that can be injurious to their own health or safety. Although this definition has the advantage of being broad and inclusive, it raises a number of issues that have generated debate—particularly with regard to what constitutes neglect, whether “self-neglect” is a form of maltreatment, and whether using an elderly parent’s economic resources for personal gain is abusive. If older adults wish to maintain their autonomy and avoid dependence on adult children, is it correct to say that the adult children neglected them if poor health leads to bedsores and other serious health problems? If older people neglect their personal care and hygiene, are they being maltreated? Or should terms such as “maltreatment” be reserved for acts committed (or omitted) by someone other than the individuals themselves? Finally, is financial exploitation of elderly parents abusive if those parents feel an obligation to help their grown children?
How Common Is Elder Maltreatment?
Estimates of the extent to which elder maltreatment occurs in the United States vary considerably. One important source of information is the NEAIS of 1996, which collected two types of information: (1) official reports on domestic elder abuse from Adult Protective Service (APS) agencies, and (2) reports on personal experience with elder abuse cases from individuals in “sentinel agencies.” APS agencies are the agencies in each state that have the responsibility for investigating reports of elder abuse. Sentinel agencies, such as financial institutions, law enforcement agencies, hospitals, and elder care providers, are agencies that are mandated by law to report suspected cases of elder abuse. Because many more cases of domestic elder abuse occur than come to the attention of professionals, reports from both APS and sentinel personnel are likely to significantly underestimate the actual frequency with which elder abuse occurs in the United States.
Based on information from sentinel agency personnel, approximately 450,000 of the 44 million U.S. residents older than age 60 were abused and/or neglected in a domestic setting in 1966. This number is equivalent to a rate of 11.3 cases of maltreatment per 1,000 elders. Only 16% of these incidents were reported to APS for investigation. This underreporting reflects to a considerable extent the disbelief of mandated reporters that reporting will actually help the victims of maltreatment. When self-neglect, the most commonly reported type of abuse, is added to the definition of elder abuse, more than 551,000 elders were abused in 1996; 21% of these were reported to APS for investigation. Other estimates of the incidence of elder abuse are much higher. For example, the U.S. House Select Committee on Aging suggested in 1991 that somewhere between 1 million and 2 million elders are abused each year in the United States. Given that not all cases are reported, this is likely to be a better estimate of the actual extent of elder maltreatment.
Of the types of elder abuse that are reported and substantiated by APS agencies, the largest percentage is typically for neglect, followed by emotional/ psychological abuse, financial exploitation, physical abuse, abandonment, and sexual abuse. Within domestic settings, older men and women may be abused by a variety of family members, including grown children, grandchildren, spouses, and others. Abuse by spouses is more likely to go unreported than reported. Spouses are the perpetrators in only 19% of cases reported to APS, as compared to more than 30% of unreported cases. The rate of abuse by elderly spouses may be as much as 41 per 1,000 elders. As is true of spousal abuse at younger ages, husbands are more likely to hurt their wives than wives are to hurt their husbands. Injuries have been shown to occur in approximately 6% of physically abused elderly husbands and 57% of physically abused elderly wives.
In contrast to spousal elder abuse, the abuse of elders by adult relatives who are entrusted with their care is the most researched and most widely recognized type of elder abuse. According to both reported APS cases and the larger number of identified sentinel cases in the NEAIS, elderly females were more likely to be abused than elderly males. This was the case for every type of use reported to APS except for abandonment, in which males were more likely to be victimized. Finally, several researchers point out that much elder abuse is committed by adult children who are dependent on the elders. These researchers find that in comparison to nonvictimized elders, elders who are abused are more likely to have their adult children dependent upon them in several areas, including housing, household repair, financial assistance, transportation, and cooking and cleaning.
By 1991, all states had elder abuse statutes in their laws and/or had amended their existing laws to bring elders under APS protection. Currently, every state has an intervention agency, usually APS, that handles cases of elder abuse. However, there is little to no uniformity in the laws for, definitions of, or provisions for elder abuse across states. For instance, 46 states have mandatory reporting laws, such that professionals who care for elders must report suspected cases of abuse. Failure to do so can usually make the reporter guilty of some kind of misdemeanor. The other four states (Colorado, New York, Wisconsin, and Illinois) have voluntary reporting. Of those states with mandatory reporting, 15 require mandatory reporting not only from professionals, but also from anyone who suspects elder abuse. Furthermore, in many cases of elder abuse, domestic violence laws (for cases of spousal elder abuse) or guardianship laws (for cases in which a frail elder needs to be removed from an abusive home) are applicable. Despite the existence of mandatory reporting laws, many professionals do not report all the cases in which they suspect elder maltreatment. Physicians appear to be particularly unlikely to report all of the cases of elder mistreatment that they see.
More attention has been given to intervention in cases of elder maltreatment (although even in this area resources are inadequate) than has been given to prevention of the problem. When cases of elder abuse are reported to APS, agency workers are responsible for assessing the referred client’s level of risk, taking immediate action to protect the client’s safety and property, collecting evidence to substantiate abuse, assessing the need for services, providing crisis intervention, arranging for needed services, and serving as client advocates—all forms of intervention that follow an incident of potential maltreatment.
The few available prevention programs generally focus on preventing financial exploitation by family members or others. One of the better known programs is the Fiduciary Abuse Specialist Team (FAST), which originated in Los Angeles. FAST is a multiagency task force established to stop elder financial abuse before it is accomplished. Typical members of FAST include police, public guardians, APS personnel, and probate court representatives. Although other efforts to prevent elder abuse are limited, there has been some effort to develop family-life curricula to help prevent elder abuse in stressed multigenerational families. One curriculum has components on teaching older individuals and their relatives how to cope with common sources of stress and conflict, how to communicate effectively with each other, and how to use family and community resources. There are also recommendations for engaging and empowering elders in an integrative response
to elder abuse—for example, through involving them directly in developing programs, detecting abuse, processing cases, assisting victims, and evaluating programs. Finally, concerned advocates from the American Psychological Association have argued that, to deal effectively with elder maltreatment, it is essential to educate the public more fully about the problem, increase the availability of respite care, increase the supports available for families caring for elders, and encourage counseling and treatment for problems that contribute to elder abuse.
- American Psychological (2002). Elder abuse and neglect: In search of solutions. Retrieved from http://ww.apa.org/pi/aging/eldabuse.html
- Hines, A., & Malley-Morrison, K. (2005). Family violence in the United States: Defining, understanding, and combating abuse. Thousand Oaks, CA: Sage.
- House Select Committee on Aging, S. Congress. (1991).Elder abuse: What can be done? Washington, DC: U.S. Government Printing Office.
- National Center on Elder Ab (1998). The National Elder Abuse Incidence Study. Retrieved from http://www.aoa.dhhs.gov/abuse/report/Cexecsum.htm