Elder Abuse ( 1 Page) Essay

The Complexities of Elder Abuse
Karen A. Roberto
Virginia Tech
Elder abuse is a growing societal concern, affecting at least 1 in 10 older Americans.
Researchers and practitioners alike consistently assert that a dramatic discrepancy exists
between the prevalence rates of elder abuse and the number of elder abuse cases reported. As
a field of study, recognition and understanding of elder abuse is still emerging. Comparing
findings of a small, but growing, body of literature on perceived and substantiated cases of
elder abuse is challenging because there is no uniform term or agreed-upon definition used
among state governments, researchers, health care and service providers, and advocates. This
article summarizes current understanding of elder abuse, including what constitutes elder
abuse, risk factors for elder abuse, perpetrators of elder abuse, and outcomes of elder abuse.
Issues associated with the detection of elder abuse and intervention strategies for victims of
abuse are addressed. In the final section, potential roles and contributions of psychologists for
advancing elder abuse research, professional practice, and policy development are
highlighted.
Keywords: elderly, detection, interventions, mistreatment, perpetrators
Since first identified in the mid-1970s as “granny bashing” (A. A. Baker, 1975), elder abuse has become a pressing
concern throughout much of the world. Most recent estimates based on The National Elder Mistreatment Survey
(Acierno, Hernandez-Tejada, Muzzy, & Steve, 2009) suggest that at least 10% of community-dwelling older adults in
the United States, or approximately 4.3 million older persons, experience one or more forms of elder abuse annually
(Kaplan & Pillemer, 2015). Prevalence rates among survey
respondents were highest for self-reported financial abuse
by a family member (5.2%), potential neglect by a caregiver
(5.1%), and emotional abuse (4.5%). Substantially lower
rates were found for self-reported physical abuse (1.6%) and
sexual abuse (0.6%).
Researchers and practitioners alike consistently assert that
a dramatic discrepancy exists between the actual prevalence
of elder abuse and the number of elder abuse cases encountered by health and service providers as well as criminal
justice authorities. Underestimation of elder abuse occurs
because older victims do not discuss their situation with
others and rarely report incidences to the authorities. For
example, of the 4.5% of older adults in the national prevalence study who reported experiencing emotional abuse, 8%
of the individuals reported the event to the police (Acierno
et al., 2009). Reasons older adults give for not disclosing
abuse include embarrassment (Kosberg, 2014), belief that
they are responsible for what happened (Moon & Benton,
2000), worry that the perpetrator might harm them even
more (Ziminski Pickering & Rempusheski, 2014), fear of
being placed in a nursing home (Jackson & Hafemeister,
2014), not believing that help is available if they expose the
abuse (DeLiema, Navarro, Enguidanos, & Wilber, 2015),
acceptance of a long-standing abusive situation as one that
must be tolerated (Teaster, Roberto, & Dugar, 2006), and
not recognizing their situation as an abusive one (Dakin &
Pearlmutter, 2009). Community members’ reluctance to
recognize elder abuse as a problem and hesitance to get
involved, particularly when options for intervention are
perceived to be lacking, also contributes to the underreporting of elder abuse (Roberto, Teaster, McPherson, Mancini,
& Savla, 2015).
Acknowledging this widespread and growing social issue,
the 2015 White House Conference on Aging (2015) included elder abuse, neglect, and financial exploitation as
one of its four priority topics. The purpose of this article is
threefold: (a) to summarize current understanding of elder
abuse including what constitutes elder abuse, risk factors for
elder abuse, perpetrators of elder abuse, and outcomes of
elder abuse; (b) to describe current assessment and intervention strategies to address elder abuse; and (c) to identify
Editor’s note. This article is one of nine in the special issue, “Aging in
America: Perspectives From Psychological Science,” published in American
Psychologist (May–June 2016). Karen A. Roberto and Deborah A. DiGilio
provided scholarly lead for the special issue.
Author’s note. Correspondence concerning this article should be addressed to Karen A. Roberto, Center for Gerontology and Institute for
Society, Culture and Environment, Virginia Tech, 230 Grove Lane (0555),
Blacksburg, VA 24061. E-mail: kroberto@vt.edu
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American Psychologist © 2016 American Psychological Association
2016, Vol. 71, No. 4, 302–311 0003-066X/16/$12.00 http://dx.doi.org/10.1037/a0040259
302
gaps in and future directions for elder abuse research, professional practice, and policy development. Primary attention is given to abuse of older adults living in the community. Elder abuse in long-term care settings (see Post et al.,
2010) and elder self-neglect (see Dong, Simon, Mosqueda,
& Evans, 2012), while of significant concern, are beyond
the scope of this article.
Definitions of Elder Abuse
There is no consensus on the definition of elder abuse or
standard term for elder abuse consistently used by the
scientific and practice communities, advocates, or state and
local governments. The lack of a uniformed definition of
elder abuse stems back to when elder abuse first was being
recognized and there were no federal mandates or incentives
to compel states to use common definitions (Anetzberger,
2012). Although terms such as “elder abuse” (World Health
Organization, 2002), “elder mistreatment” (Bonnie & Wallace, 2003), and “elder maltreatment” (World Health Organization, 2011) are often used interchangeably, the parameters of both the abuse and persons covered vary widely
(Roberto, 2016). Such discrepancies create confusion in
discriminating what is elder abuse, limits generalizing findings across studies, and prohibits identifying common
courses for effective intervention (Henderson, Buchanan, &
Fisher, 2002).
Regardless of terminology used, most definitions of elder
abuse recognize five types of abuse: (a) physical abuse—
use of physical force that may result in bodily injury,
physical pain, or impairment; (b) sexual abuse—nonconsensual sexual contact of any kind; (c) psychological and
emotional abuse—infliction of anguish, pain, or distress
through verbal or nonverbal acts; (d) financial abuse and
exploitation—illegal or improper use of an older person’s
funds, property, or assets; and (e) neglect and abandonment—intentional or unintentional refusal or failure to fulfill any part of a person’s obligations or caregiving duties to
an older adult (American Psychological Association, 2012;
Table 1). Current scientific investigations tend to address
either one or more types of abuse collectively or narrowly
focus on one specific subtype of abuse (e.g., psychological
abuse, sexual abuse). Yet evidence embedded within the
research literature and practitioner reports suggest that older
adults often experience more than one type of abuse simultaneously, that is, polyvictimization (Ramsey-Klawsnik &
Heisler, 2014). In addition, behaviors associated with each
type of abuse vary (National Center on Elder Abuse
[NCEA], n.d.-b, Table 2) and are included selectively and
inconsistently across studies of elder abuse.
Risk Factors Associated With Elder Abuse
A number of interacting factors contribute to a person’s
vulnerability to abuse in late life, including age, gender,
race, ethnicity, living arrangements, cultural beliefs and
values, as well as physical and cognitive impairments, social isolation, and loneliness. Much of the research on risk
factors for elder abuse relies upon small, cross-sectional
studies; does not include comparison groups; and does not
differentiate type of abuse, identify discrete contributions of
individual risk factors, or address how risk factors interacts
to increase susceptibility to elder abuse (Roberto, 2016). As
a result, empirical evidence for most risk factors for elder
abuse is mixed (Johannesen & LoGiudice, 2013).
Age and Gender
National findings suggest that older adults aged 60 to 69
were more susceptible to abuse than older age groups (Acierno et al., 2009), whereas investigations focused on specific types of abuse (i.e., financial) identified adults age 75
and older as being particularly susceptible to abuse (Metlife
Mature Market Institute, 2011). One possible reason for the
different findings is that younger old adults more often live
with a spouse or with adult children, the two groups that are
the most likely abusers (Lachs & Pillemer, 2015). Conversely, living with a larger number of individuals other
than a spouse is associated with an increased risk of abuse,
especially financial abuse (Peterson et al., 2014). The association between age and risk of abuse also may be linked to
a decline in functional health, which often occurs later in
life and results in a greater dependence on others for care
and a higher level of individual vulnerability (Amstadter,
Cisler, et al., 2011a).
Although women are more often identified as victims of
elder abuse than are men (Laumann, Leitsch, & Waite,
Karen A.
Roberto
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COMPLEXITIES OF ELDER ABUSE 303
2008), greater longevity resulting in associated age-related
changes and dependencies may contribute to older women’s
risk for abuse. The higher likelihood of experiencing family
violence (Wisconsin Coalition Against Domestic Violence,
2009) may increase older women’s risk for abuse, particularly physical and sexual abuse (Acierno et al., 2010).
Recently, Kosberg (2014) argued against a gender bias in
elder abuse, stating that older men have been deemed “invisible,” in part because of the failure of older men to
acknowledge and report abuse. Research focused specifically on elder abuse of older men (see Kosberg, 2007)
suggests that elder abuse is not only a problem for older
women—it adversely affects the lives of older men as well.
Race, Ethnicity, and Culture
Although racial or ethnic minority status is a frequently
identified risk factor for elder abuse (Lachs, Williams,
O’Brien, Hurst, & Horwitz, 1997), analysis of national data
did not reveal significant race- and ethnicity-based differences in the prevalence of abuse (Hernandez-Tejada, Amstadter, Muzzy, & Acierno, 2013). Evidence exists that
cultural norms and beliefs about abuse and tolerance for
abusive behaviors intersect with race and ethnicity (Horsford, Parra-Cardona, Schiamberg, & Post, 2011; Moon &
Benton, 2000) and socioeconomic status (Dakin & Pearlmutter, 2009) to increase risk for elder abuse. Focus group
Table 2
Examples of Abusive Behaviors
Type of elder abuse Abusive behaviors
Physical abuse Hitting; slapping; pushing; shoving; kicking; pinching; burning; biting; beatings; restraining with ropes or chains
Sexual abuse Unwanted touching; making the person look at pornography; forcing sexual contact with a third party; coerced
nudity; unwanted sexualized behavior; rape; sodomy
Verbal/emotional/psychological Name calling; yelling, swearing, insulting, disrespectful, or threatening comments; threats; intimidation; isolating
the person from others
Financial abuse/exploitation Misuse of funds; taking money under false pretenses; forgery; forced property transfers; purchasing expensive items
with the older person’s money without that person’s knowledge or permission; denying the older person access to
his or her own funds; embezzlement
Caregiver neglect/abandonment Withholding appropriate attention; failure to provide food, water, clothing, medications, and assistance with
activities of daily living; failing to meet the physical, social, or emotional needs of the older person
Note. Adapted from Types of Elder Abuse by the National Center on Elder Abuse (n.d.-b). Retrieved from http://www.ncea.aoa.gov/FAQ/Type_Abuse/
index.aspx.
Table 1
Types of Elder Abuse and Frequently Associated Indicators of Abuse
Type of elder abuse Indicators of elder abuse
Physical abuse Bruises or grip marks around the arms or neck
Rope marks or welts on the wrists and/or ankles
Repeated unexplained injuries
Dismissive attitude or statements about injuries
Refusal to go to same emergency department for repeated injuries
Verbal/emotional/psychological abuse Uncommunicative and unresponsive
Unreasonably fearful or suspicious
Lack of interest in social contacts
Evasiveness or isolation
Unexplained or uncharacteristic changes in behavior
Sexual abuse Unexplained vaginal or anal bleeding
Torn or bloody underwear
Bruised breasts or buttocks
Venereal diseases or vaginal infections
Financial abuse/exploitation Life circumstances do not match what is known about the individual’s financial assets
Large withdrawals from bank accounts, switching accounts, unusual ATM activity
Signatures on checks do not match elder’s signature
Caregiver neglect Lack of basic hygiene, adequate food and water, or clean and appropriate clothing
Sunken eyes or loss of weight
Person with dementia left unsupervised
Untreated pressure bed sores
Lack of medical aids (glasses, walker, teeth, hearing aid, medications)
Note. Adapted from Elder Abuse and Neglect: In Search of Solutions by the American Psychological Association (2012). Retrieved from http://www
.apa.org/pi/aging/resources/guides/elder-abuse.aspx.
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304 ROBERTO
data revealed that African American and White older
women with high socioeconomic status, as well as Latina
older women, did not identify financial abuse as a type of
elder abuse, whereas working-class White women did not
identify verbal abuse as elder abuse (Dakin & Pearlmutter,
2009).
Cognitive Impairment
Cognitive impairment is perhaps the most agreed-upon
risk factor for elder abuse. As cognitive abilities decline, the
risk of all forms of elder abuse increases significantly
(Dong, Simon, Rajan, & Evans, 2011). Financial capacity,
defined as the ability to manage one’s financial affairs in a
manner consistent with self-interest, begins to diminish very
early in the trajectory of cognitive impairment (Okonkwo,
Wadley, Griffith, Ball, & Marson, 2006), placing older
adults at risk particularly for financial abuse and exploitation. Compromises in judgment and decision-making capacity and the tendency to judge others’ trustworthiness less
stringently than younger individuals (Charles & Carstensen,
2010) may also increase older adults’ susceptibility to undue influence, a tactic used by many perpetrators of elder
abuse.
Social Support
Older adults’ positive perceptions of, and engagement
with, their informal social network has the potential to
reduce the influence of other risk factors of abuse (Luo &
Waite, 2011). Perceptions of low social support more than
triple the likelihood that older adults reported any form of
abuse (Acierno et al., 2009). Social isolation and negative
social interactions have been associated with increased risk
of elder abuse (Dong & Simon, 2008; Fulmer et al., 2005),
whereas positive social support and social participation
moderated the risk of abuse (Luo & Waite, 2011). Most
recently, Schafer and Koltai (2015) provided additional
evidence for the significance of social embeddedness for
deterring elder abuse. They found that older adults with
dense social support in which members knew one another
had a lower risk of elder abuse, even when perpetrators were
found within these close networks.
Perpetrators of Elder Abuse
The relationships between older adults and potential perpetrators of elder abuse is often cited as a contributing factor
leading up to abuse (Roberto, 2016). Older adults typically
know their perpetrators, who are usually family members
(e.g., spouse, adult child, grandchildren, nieces/nephews),
friends, and others they trust and rely upon for help and
services. Outsiders often perceive alleged perpetrators as
primary sources of support for older adults rather than
individuals who are causing them harm. Beyond basic descriptive information, the empirical literature provides little
information about perpetrators and their motivations for the
abuse.
Spouse/partner abuse in late life can be viewed on a
continuum from longstanding abuse within a single relationship to abuse that begins with a new relationship in later
life. It often involves multiple forms of abuse, including
physical harm, sexual assault, and psychological humiliation or intimidation. In longstanding abusive relationships,
physical violence tends to decline with age, often replaced
with new or intensified types of psychological and emotional abuse endured in earlier years (Mezey, Post, & Maxwell, 2002; Teaster et al., 2006). National prevalence studies support this contention, with spouses/partners identified
in one fourth or more of situations involving verbal or
emotional abuse (Acierno et al., 2009).
Interdependencies within late-life parent– child relationships may place the older adult at risk for abuse. Adult
children who are abusive are often dependent on their
parents for shelter, finances, and emotional support (Jackson & Hafemeister, 2012). Salient factors underlying dependency in adulthood includes addiction to alcohol, pain
medications, or recreational drugs (Jogerst, Daly, Galloway,
Zheng, & Xu, 2012); a history of mental or emotional
illness (Acierno et al., 2009); and chronic unemployment
(Jackson & Hafemeister, 2011). It is unlikely that any one of
these factors precipitates elder abuse, but rather abuse
within these relationships stems from a combination of
multiple personal struggles. Conversely, when older persons
are dependent on an adult child for their care, the potential
for abuse also may escalate. The overwhelming majority of
adult children provide appropriate care for their older parents; however, caregiving can become stressful and lead to
potentially harmful or abusive behaviors (Amstadter, Zajac,
et al., 2011b; Beach et al., 2005). However, compared with
overwhelmed caregivers who often seek help to improve the
situation, perpetrators with narcissistic and domineering
personalities tend to be quick to espouse justifications for
their abusive actions (Ramsey-Klawsnik, 2000).
Paid caregivers and other professionals in which a trusting relationship is expected (e.g., guardians, lawyers, investment counselors) also are perpetrators of elder abuse.
These perpetrators are good at cultivating relationships;
they are charming and attentive, while waiting to take
advantage of the trusting relationship they establish with the
older person. For example, in cases of financial abuse and
exploitation presented in the media (Metlife Mature Market
Institute, 2011), some perpetrators purported that, in return
for providing assistance and care for the older adult, they
were entitled to additional compensation (e.g., money, possessions). Other perpetrators had access to older adults’
money and assets, and when an occasion presented itself,
they availed themselves to the older adults’ resources.
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COMPLEXITIES OF ELDER ABUSE 305
Outcomes of Elder Abuse
Elder abuse, in all its forms, has a profound impact on the
health and psychological well-being of late-life victims. Although some markers of elder abuse are instantly obvious, such
as injuries ranging from bruises and sprains, to broken bones
and lost teeth, to severe brain trauma (Friedman, Avila,
Tanouye, & Joseph, 2011), older victims often experience
numerous adverse health effects that may not be immediately
evident and persist long after the abuse has stopped (Bonomi,
Anderson, Rivara, & Thompson, 2007). The long-term effects
of elder abuse include new or exacerbated health problems and
hospitalizations (Dong & Simon, 2013), premature institutionalization (Rovi, Chen, Vega, Johnson, & Mouton, 2009), and a
hastened death (M. W. Baker et al., 2009; Dong et al., 2011).
The impact of sexual abuse, perhaps the most egregious
and underreported type of elder abuse (Teaster & Roberto,
2004), has received less attention in the research literature
than other types of abuse. In addition to the physical remnants of being sexually abused (e.g., genital injuries; human
bite marks; bruising on the thighs, buttocks, breasts), older
sexual abuse victims often exhibited substantial psychosocial indicators of trauma, including symptoms of posttraumatic stress disorder (Ramsey-Klawsnik, 2004). Bonomi et
al. (2007) found that sexual intimate-partner violence exposure, alone or in combination with physical abuse, resulted
in numerous adverse health effects that “persisted for many
years after the abuse stopped” (p. 993), including a high
likelihood of depression and poor social and mental functioning.
Psychological and emotional abuse is one of the most
underreported yet damaging forms of elder abuse. The intangible nature of psychological abuse makes it difficult to
quantify and often means it goes unrecognized, even by
older victims themselves. Older adults who experience
chronic emotional mistreatment often internalize their abuser’s verbal aggression, which leads to increased physical
health symptoms and behaviors indicative of anxiety and
depression (Begle et al., 2011). While acknowledging that
physical and sexual abuse impact victims’ psychological
health, Cisler, Begle, Amstadter, and Acierno (2012) suggested that emotional abuse may have a more potent and
direct effect on mental health. Accounting for other known
correlates of poor mental health in late life, they found
psychological mistreatment to be a significant predictor of
late-life negative emotional symptoms and functional impairment.
Often referred to as the “Crime of the 21st Century,”
financial abuse and exploitation costs older Americans
nearly 3 billion dollars annually (Metlife Mature Market
Institute, 2011). But the loss of financial resources and
valued possessions of older victims extend far beyond the
savings and material goods that are not easily recouped late
in life. Financial abuse and exploitation “engenders health
care inequities, fractures families, reduces available health
care options . . . increases rates of mental health issues
among elders [and]… invariably results in losses of human
rights and dignity” (Metlife Mature Market Institute, 2011,
p. 4).
Detection of Elder Abuse
Psychologists and others working in clinical practice often struggle with identifying whether an older client has
experienced abuse and when to report suspected abuse
(Mosqueda & Olsen, 2015). To date, there is no single
gold-standard test to ascertain abuse, with numerous tools
employed by both researchers and clinicians. A review of 26
empirical articles found that modified versions of the Conflict Tactics Scale (CTS; Straus, 1979) was the most commonly used measure to identify elder abuse (Sooryanarayana,
Choo, & Hairi, 2013). The CTS has strong psychometric
properties and focuses on the use of negotiation, physical
assault, and psychological aggression in relationships. Reviews of measures for use primarily in clinical practice (Anthony, Lehning, Austin, & Peck, 2009; Fulmer, Guadagno,
Bitondo Dyer, & Connolly, 2004; Pisani & Walsh, 2012)
identified a number of screening and assessment instruments,
none of which have gained widespread use. Moreover, the
reliability and validity of most of the measures identified has
yet to be established (Cooper, Selwood, & Livingston, 2008).
Taking a more informal approach, Mosqueda and Olsen (2015)
suggested that psychologists and other health care providers
ask their older clients whom they suspect may be involved
in an abusive situation a series of questions (e.g., “Are you
afraid of anyone?” or “Is anyone mistreating you?”). The
client’s response will help clinicians determine the need to
report suspected abuse or to pursue another course of therapeutic action (Zeranski & Halgin, 2011).
As mandatory reporters in most states—and in keeping
with the American Psychological Association’s (2010) ethics code’s general principles of beneficence and nonmaleficence, and respect for people’s rights and dignity—psychologists are responsible to report suspected elder abuse when
they have “reasonable” cause to believe that an older adult
is experiencing abuse or neglect (p. 296). However, the
decision to take action and report any suspected case of
elder abuse is a challenging balancing act between protecting the clients’ personal well-being and respecting their
dignity and self-determination to make their own decisions
about their lives (Scheiderer, 2012; Zeranski & Halgin,
2011).
Once a report of suspected abuse is made, psychologists
are not responsible for identifying ways in which to remedy
the situation, but they do have continued responsibility to
their client regardless if the client is the victim, perpetrator,
or other party involved in the situation (Mosqueda & Olsen,
2015). Psychologists must strive to preserve the therapeutic
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306 ROBERTO
relationship while taking action to protect the vulnerable
older adult (Zeranski & Halgin, 2011). Although reporting
suspected abuse is a legally mandated breach of confidentiality, determining if anyone else (e.g., client, family member) should be informed requires careful consideration
(Mosqueda & Olsen, 2015).
Elder Abuse Interventions
Whenever a potential abusive situation is identified, either by the victim or by a third party, in most states, Adult
Protective Services (APS) is the principle public agency
responsible for investigating the situation occurring in the
community (NCEA, n.d.-a). When APS receives a report of
elder abuse, workers investigate and, if warranted, take
action to ameliorate the situation with legal, medical, psychological, and social services. In nonemergency cases,
APS cannot investigate alleged abuse without consent from
the older individual or his or her caregiver or legal guardian,
a court order, or a search warrant (Roby & Sullivan, 2001).
If consent is denied, APS can petition the court for assistance upon showing of probable cause. Once abuse is substantiated, APS provides overall management of the case
along with law enforcement and, in some cases, the judiciary system. Immediate response to the abusive situation
may involve removing either the older victim or the perpetrator from the home and securing medical care, supportive
services, and mental health services.
Mental Health Services
Once the situation is stabilized, older victims who are
receptive to receiving help may benefit from psychological
interventions to address the trauma, anxiety, and stress
associated with abuse. A recent pilot study provided preliminary evidence for the feasibility of providing evidencebased psychotherapy for anxiety and depression at the same
time that older adults were receiving mistreatment resolution services (Sirey et al., 2015). Most eligible clients (69 of
81; 85%) were willing to accept mental health services.
Therapeutic interventions used for postabuse treatment of
elder abuse have included individual counseling, psychoeducational support groups, case management, and volunteer
victim assistance services (Ploeg, Fear, Hutchison, MacMillan, & Bolan, 2009). Early studies often reported no
differences between treatment and control groups, and in
some cases, interventions were reported to have negative
impacts for older victims (Davis & Medina-Ariza, 2001).
Differences also have been reported in the effectiveness for
different modes of intervention. For example, approximately 67% of older victims who received individual counseling primarily for psychological abuse self-reported improvements in their ability to cope with their situation,
whereas no change was reported for 31% of the older adults;
deterioration occurred for less than 2% of the participants
(Alon & Berg-Warman, 2014). Conversely, 50% of support
group participants self-reported better coping abilities,
whereas the other participants did not. Methodological issues may explain some of the mixed findings across and
within studies, including inclusion of small, selective samples; limited use of rigorously designed randomized clinical
trials; lack of established and agreed upon outcome measures; and use of descriptive and bivariate evaluation strategies (Ploeg et al., 2009).
Multidisciplinary Teams
Many communities have created multidisciplinary teams
(MDTs) comprising local professionals (e.g., physicians,
social workers, law enforcement, APS workers) to work
with, or on behalf of, older victims. Such teams offer an
integrative and holistic approach to elder abuse by actively
engaging multiple professional disciplines and perspectives
in the prevention and intervention process. The primary
function of MDTs is to offer expert consultation to service
providers, identify service gaps and systems problems, advocate for change, provide training events, and coordinate
investigations or care planning (Teaster, Nerenberg, &
Stansbury, 2003). Although published information about
MDTs is mostly anecdotal and descriptive, a recent empirical evaluation of a multidisciplinary model suggested that
these models are indeed effective (Rizzo, Burnes, & Chalfy,
2015). Specifically, an examination of 250 randomly selected cases of elder abuse found that older adults’ gender
(female), marital status (married), and living arrangement
(living with the perpetrator) were significant covariate predictors of unfavorable mistreatment status at case closure.
Taking these variables into account, older persons who
received intervention services from an integrated legal and
social services team compared with outcomes of a socialwork-only intervention had a greater reduction in mistreatment risk at case closure.
State and National Initiatives
State and national initiatives also have implemented interventions to prevent and alleviate elder abuse, yet vary
considerably according to state and federal priorities. For
example, the AARP Foundation’s Elder Watch Colorado
(AARP Foundation, n.d.) is a program in which the Attorney General Office addresses financial exploitation by providing information to, and coordinating efforts by, the
state’s law enforcement offices, adult protection and mental
health agencies, and service organizations assisting older
adults. With support from the Administration for Community Living’s Administration on Aging unit, the NCEA
(Administration for Community Living, n.d.) serves as a
national resource center dedicated to the prevention of elder
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COMPLEXITIES OF ELDER ABUSE 307
abuse, and operates as a multidisciplinary consortium of
collaborators with expertise in elder abuse, neglect, and
exploitation. The NCEA disseminates information to professionals and the public about elder abuse, and it provides
technical assistance and training opportunities for professionals. The Training Resources on Elder Abuse (USC
Department of Family Medicine and Geriatrics and the
NCEA, n.d.) is a searchable web-based database of elderabuse-related training materials. It features a variety of
materials and resources created by organizations throughout
the country, including a library of videos appropriate for
training purposes.
Federal legislation and policy initiatives also have been
put forth to support intervention efforts to prevent and
respond to elder abuse. The most comprehensive federal bill
to shed light on interventions for elder abuse is the Elder
Justice Act of 2009 (2010). The intent of the Elder Justice
Act intent is to provide federal resources to prevent, detect,
treat, understand, intervene in, and, when appropriate, prosecute elder abuse, neglect, and exploitation. Specifically,
the act provides for the establishment of the Elder Justice
Coordinating Council, an advisory board, and forensic centers, as well as funding for improvements to long-term care,
APS, and the long-term care ombudsman program. In 2014,
the Departments of Justice and the Department of Health
and Human Services issued the Elder Justice Roadmap
(Departments of Justice & Department of Health and Human Services, 2014). Developed with input from hundreds
of public and private stakeholders from across the country,
this first national strategic plan for elder justice identifies
the most critical direct services, education, policy, and research priorities and concrete opportunities for greater public and private investment and engagement in elder abuse
issues.
New Directions for Psychological Science and
Practice in Elder Abuse
Eradicating elder abuse requires multiple solutions—it needs
to be a priority of psychologists working together on intervention efforts utilizing multiple players (e.g., general public,
professional communities, government policymakers) in multiple settings (i.e., community, long-term care facilities). To
date, elder abuse research has been hampered by methodological issues and other challenges associated with the complexity
of elder abuse, including human subject protection rules, mandatory reporting obligations, participant access and recruitment, agency cooperation, and a paucity of federal and private
funding (Pillemer et al., 2011).
To develop effective elder abuse preventive measures and
intervention programs and services requires researchers and
practitioners from the psychological sciences need to band
together and collaborate with members of other disciplines.
It will take concerted and sustained efforts from all professionals in the elder abuse space to resolve these issues and:
1. Develop a universally accepted definition of what
constitutes elder abuse that will provide greater understanding of the magnitude of elder abuse. Age
needs to be considered as part of the definition. There
currently is no standard age parameters for elder
abuse, which impedes both the generalization of
knowledge generated and the delivery of services.
2. Disentangle the individual, relational, cultural, and
societal factors that place older adults at risk for elder
abuse, particularly for ethnic and racial minority elders and other vulnerable groups (e.g., rural elders,
older adults with cognitive impairment, frail elders),
and identify the pathways of not only vulnerability for
abuse but also protective factors that prevent elder
abuse from occurring. Without meaningful risk factor
data, the development of intervention strategies will
languish.
3. Expand efforts to increase understanding about the
perpetrators of elder abuse beyond demographic characteristics and descriptions of personal behaviors.
This information is needed in order to develop, implement, and evaluate intervention protocols. Ultimately, reducing elder abuse requires better identification and treatment of its perpetrators.
4. Document the full range of costs and consequences of
elder abuse for older adults, families, communities,
and the nation. Elder abuse threatens the physical,
psychological, social, and economic well-being of all
involved, individually and collectively. But without
documentation of the outcome of abuse, efforts to
eliminate elder abuse will remain elusive.
5. Gather comprehensive, evidence-based data to determine which intervention strategies work best for specific groups of older adults and the cost-effectiveness
of current and newly developed programs. This information is essential not only for older persons who
experience abuse, but for the training of new clinicians and practitioners and for advocates seeking state
and federal support for their implementation.
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Received July 20, 2015
Revision received December 16, 2015
Accepted December 18, 2015
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