Elder Abuse and Neglect: In Search of Solutions

Introduction

Older people today are more visible, more active and more independent than ever before. They are living longer and are in better health. But as the population of older Americans grows, so does the hidden problem of elder abuse, exploitation and neglect.

Every year, an estimated 4 million older Americans are victims of physical, psychological or other forms of abuse and neglect. Those statistics may not tell the whole story. For every case of elder abuse and neglect reported to authorities, experts estimate as many as 23 cases go undetected. The quality of life of older individuals who experience abuse is severely jeopardized, as they often experience worsened functional and financial status and progressive dependency, poor self-rated health, feelings of helplessness and loneliness and increased psychological distress. Research also suggests that older people who have been abused tend to die earlier than those who have not been abused, even in the absence of chronic conditions or life-threatening disease.

Agnes, 78 years old, lost her husband last year. Because of some physical limitations as a result of arthritis and declining cognitive abilities, Agnes moved in with her 55-year-old daughter, Emily. The situation is difficult for all of them. Sometimes Emily feels as if she's at the end of her rope, caring for her mother, worrying about her college-age son and her husband, who is about to be forced into early retirement. Emily has caught herself calling her mother names and accusing her mother of ruining her life. Recently, she lost her temper and slapped her mother. In addition to feeling frightened and isolated, Agnes feels trapped and worthless.

Like other forms of abuse, elder abuse is a complex problem, and it is easy for people to have misconceptions about it. Many people who hear "elder abuse and neglect" think about older people who live in nursing homes or older relatives who live all alone and never have visitors. But elder abuse is not just a problem of older people living on the margins of our everyday life. It is right in our midst:

  • Most incidents of elder abuse don't happen in nursing homes and other residential settings. Occasionally, there are shocking reports of staff who abuse residents in their care or of a resident who physically or sexually abuses another resident. Although such abuse does occur, the vast majority of older people living in nursing homes and other residential settings have their physical and emotional needs met without experiencing abuse or neglect.

  • Most elder abuse and neglect takes place at home. About 95 percent of older people live on their own or with their spouses, children, siblings or other relatives not in institutional settings. When elder abuse happens, family, other household members or paid caregivers are usually the abusers. Although there are extreme cases of elder abuse, often the abuse is subtle, and the distinction between normal interpersonal stress and abuse is not always easy to discern.

  • There is no single pattern of elder abuse. Sometimes elder abuse is a continuation of long-standing patterns of violence and physical, emotional or financial abuse within the family. More commonly, elder abuse is related to changes in living situations and relationships brought about either by the older person's growing frailty and dependence on others for companionship and for meeting basic needs or by a family member's increased reliance on an older relative for shelter and financial support.

  • It isn't just older adults who have poor physical health or cognitive impairments who are vulnerable to abuse. Older individuals who are frail, alone or depressed as well as those with a physical disability or mental illness are vulnerable to abuse. Even those who do not have these obvious risk factors can find themselves in abusive situations and relationships. Elder abuse affects older men and women across all socioeconomic groups, cultures, races and ethnicities.

Elder abuse, like other forms of violence, is never an acceptable response to any problem or situation, however stressful. Effective interventions can prevent or stop elder abuse. Increasing awareness among physicians, mental health professionals, home health care workers and others who provide services to older adults and family members can help break patterns of abuse or neglect, and both the person experiencing the abuse and the abuser can receive needed help.