Elder abuse is any form of mistreatment (e.g., physical, sexual, psychological, emotional or financial) that results in harm or loss inflicted on an older person. In addition, elder abuse may include domestic violence. Elder abuse need not be intentionally inflicted through an action; neglect can also be a form of elder abuse. In addition, elders can neglect themselves through the process of self-neglect. Caring for an elder can be a stressful responsibility, particularly for familial caregivers who have other responsibilities and may not have either the knowledge or skill necessary to adequately care for their elders. While it is possible to understand the antecedents to abuse and neglect, this does not make them either excusable or acceptable. Suspected cases of abuse or neglect need to be reported to the proper authorities. In addition, there are many programs available to help ease the caregiving burden and give elders the support or care that they need.
Keywords Caregiver; Cognitive Ability; Domestic Violence; Elder Abuse; Financial Abuse; Neglect; Physical Abuse; Psychological Abuse; Sampling; Sandwich Generation; Self-Neglect; Sexual Abuse; Society; Socioeconomic Status; Status
The Aging Process
Lower Social Status
As a society, we often tend to discount the value of older persons and relegate them to positions of lower status. Given the fact that many Americans feel that they are best defined by their career or job, the loss of status that accompanies aging, specifically retirement, is partially understandable. To complicate matters, this loss of status is often accompanied by a concomitant loss of income, giving many elders a lower socioeconomic status than they once had. In fact, many social scientists have observed that there is age stratification within society in which different social roles are ascribed to individuals during different periods in their lives. These roles are not necessarily based on their physical capabilities or constraints at different times in their lives. So, for example, despite elders' capabilities or desires, they may find themselves unable to continue to work due to ageism (i.e., discrimination based on age or discrimination against the elderly) in the workplace or find themselves in the advisory role of grandparents rather than the decision-making role of parent, despite the fact that they may have more experience and concomitant insight than the person making the decision. Some sociologists go so far to say that this is not only a natural process, but a desirable one as well. For example, the structural functionalist disengagement theory posits that society and the individual mutually severs many relationships during the aging process.
To make matters worse, as cognitive abilities and physical capabilities decline with old age, many elders who are parents find themselves in a situation of role reversal in which their children are now taking care of them. When the caretaker is a member of the sandwich generation that needs to take care not only of its children but its parents as well, difficulties often arise. For most people, aging is a gradual and subtle process: Just as creaky joints and spreading waistlines do not happen overnight, so, too, the loss of cognitive abilities tends to be gradual. The gradual changes of old age can be invisible not only to the person to which they are happening, but also to others around them. For example, one may find the need to occasionally run an errand for Mom and Dad as they age. This task is usually easy to fit in with one's own errands and goes virtually unnoticed. However, as the parents continue to age, they may need increasing help with the instrumental activities of daily living such as going outside the home, light housework, preparing meals, taking medications in the manner prescribed, using the telephone, paying bills, and keeping track of money. What started as an occasional errand and concomitant feeling of doing a good deed may soon become an onerous responsibility that seems to demand more and more time. As the need for help with the instrumental activities of daily living segues into the need for help with the activities of daily living (e.g., bathing, dressing, grooming, eating, using the toilet, transferring to or from the bed or chair, getting around the house), the sandwich generation caretaker may soon find that the responsibilities are overwhelming, and tempers may flare or care may become cursory.
Although it is easy to see why elders are often relegated to lower status positions or even abused or neglected, that does not make such actions either excusable or acceptable. Elder abuse is defined as any form of mistreatment that results in harm or loss inflicted on an older person. Physical abuse includes any physical behavior towards an elder that is violent towards that person (e.g., assault, battery, inappropriate restraint). Included in physical abuse is domestic violence, or any action by one member of a family that causes physical harm to one or more members of his/her family. Domestic violence is typically an escalating pattern of violence by a spouse or intimate partner in which violence is used to express power and exert control over the other person. However, in cases where the elder is being taken care of by a family member, domestic violence can be perpetrated by the caregiver relative (e.g., adult child) toward the elder, as well. Another common type of elder abuse is emotional or psychological abuse. This category of abuse includes verbal or other nonphysical behavior that is violent toward or demeaning or invasive of another person. Psychological abuse is the intentional infliction of mental or emotional anguish through the use of threats, humiliation or shaming, emotional control, withholding of affection or financial support, or other verbal or nonverbal means. Abuse toward an elder can also be sexual in nature. Specifically, sexual abuse is the violation or exploitation of another person by sexual means. For adults, sexual abuse includes all non-consensual sexual contact. Sexual abuse can arise in relationships of trust (e.g., between a caregiver and the person being cared for). In addition to these fairly well-known types of abuse, an elder can also be the victim of financial abuse. This type of abuse includes any behavior that financially harms another person such as the illegal or improper use of an older person's funds, property, or other resources. Elder abuse can also take the form of neglect, in which a caregiver fails to meet the basic needs of the elder in his/her care. Neglect may be material (e.g., the withholding of food or clothing), emotional (e.g., rejection of or apathy towards the person), or service-oriented (e.g., depriving the individual of medical care). In active neglect, the caregiver intentionally fails to meet the person's needs. In passive neglect, the caregiver is unable to meet the needs of the individual due to any number of reasons including the caregiver's stress, ignorance, immaturity, or lack of resources.
It is difficult to obtain an accurate picture of how widely spread elder abuse is in the United States. Many elders are reluctant to report their abusers for fear of losing the help that they need to take care of themselves or of being further abused. In addition, despite the recognition of elder abuse as an important issue, consistent definitions of elder abuse have still not been developed. As a result, state statistics often vary widely and there is no uniform national reporting system. Despite these problems, however, in recent years, elder abuse has emerged as a significant social problem. According to the National Center on Elder Abuse, as of 2005, best estimates indicate that between one and two million Americans aged 65 or older have been injured, exploited, or mistreated by a caregiver. Depending on the methods used for sampling, survey methods, and definitions, estimates of the frequency with which elder abuse occurs vary between 2 percent and 10 percent. However, it is estimated that only one in fourteen cases come to the attention of authorities and only one in twenty-five cases of financial abuse get reported. It has further been estimated that for every case of elder abuse that gets reported, another five are not reported. Of the cases of elder abuse that are reported, approximately 50 percent of the cases involve neglect, 16 percent involve physical abuse, and 12 percent involve financial abuse (Andersen & Taylor, 2002). In 2010, the American Journal of Public Healthpublished the results of a national study of the prevalence of elder abuse. Out of 5,777 respondents in the study, one in ten reported mistreatment or neglect during the previous year. The study reported rates of 4.6 percent for emotional abuse, 1.6 percent for physical abuse, 0.6 percent for sexual abuse, 5.1 percent for potential neglect, all during the previous year, and a current rate of financial abuse by a family member of 5.2 percent (Aciermo et al., 2010). In 2013, the American Psychological Association estimated that four million older Americans were victims of abuse and neglect annually.
Causes of Elder Abuse
One of the most common explanations for elder abuse is the additional stress that caring for the elder places on the caregiver. As discussed above, caregivers are often the older person’s adult children—members of the sandwich generation who are trying to juggle caring for an aging parent with caring for their own children, advancing in their career, and the other stressors of middle-aged life. Research has found that elder abusers tend to be middle-aged women, typically the daughter of the victim. In cases of physical abuse, however, the perpetrator tends to be the son or even the husband of the victim. Frequently, the abuser views the victim as a...
population age 65 and older increased by 188 percent, and the population 85 and older increased by 635 percent (Eberhardt et al., 2001, Hetzel and Smith, 2001). Over this same period, the life expectancy of people at age 65 increased from 13.9 to 17.9 years (Natonal Center for Health Statistics, unpublished data, 2001). These trends will likely be accentuated by the aging of the post-WWII baby boom generation. The U.S. Bureau of the Census predicts that by 2030, the population over age 65 will nearly triple to more than 70 million people, and older people will make up more than 20 percent of the population (up from 12.3 percent in 1990) (Population Projections Program, 2000).
It is heartening that large proportions of the nation’s older people are living without substantial disability. Among people age 75 and older in 1999, 70 percent described their health as good or excellent (Eberhardt et al., 2001). Inevitably, however, the aging of the population is also associated with increases in age-related diseases and disabilities. Of the estimated 12.8 million Americans reporting need for assistance with activities of daily living (ADLs—eating, dressing, bathing, transferring between the bed and a chair, toileting, controlling bladder and bowel) or instrumental activities of daily living (IADLs—preparing meals, performing housework, taking drugs, going on errands, managing finances, using a telephone), 57 percent (7.3 million people) were over the age of 65 (Administration on Aging, 1997). Dementia is present in approximately 5 to 10 percent of persons age 65 and older and 30 to 39 percent of persons age 85 and older (Rice et al., 2001; Henderson, 1998). Among people age 85 and older in 1999, 33 percent reported themselves to be in fair or poor health, 84 percent had disabilities involving mobility (unpublished data Natonal Center for Health Statistics, 2002), and 16 percent had Alzheimer’s disease (Brookmeyer et al., 1998).
Given the projected growth in the elderly population, long-term care for elderly people with disabilities has become an increasingly urgent policy concern (Institute of Medicine, 2001; Stone, 2000). The settings in which long-term care is provided depend on a variety of factors, including the older person’s needs and preferences, the availability of informal support, and the source of reimbursement for care. An increasing number of elderly people reside outside traditional home settings in highly restrictive institutional environments (such as skilled or intermediate nursing facilities) or in less restrictive community-based residential settings, such as assisted living facilities, board and care homes, and adult foster homes. Among the 34 million persons over age 65 in 1995, 5 percent were nursing home residents, and 12 percent lived in the community setting with ADL or IADL limitations. The number of nursing home residents increased between 1973–1974 and 1999 from 961,500 to 1,469,500 among those age 65 and older, and from 413,6000 to 757,100 among those 85 and older (Eberhardt et al., 2001). In 1999, another 500,000 elderly people were living in