Risk factors associated with elder abuse: the importance of differentiating by type of elder maltreatment

Elder abuse research rarely differentiates by the type of elder maltreatment involved when identifying risk factors. The purpose of this study was to compare risk factors across four predominant types of elder maltreatment (financial exploitation, physical abuse, neglect by others, and hybrid financial exploitation [HFE]). Data were collected from two sources: interviews with victims of substantiated elder abuse, responding adult protective services (APS) caseworkers (N = 71), and third-party informants; and a statewide database that contained all substantiated cases over a corresponding 2-year period (N = 2,142). Using chi-square (interview data) and logistic regressions (Adult Services/Adult Protective Services [ASAPS] data), significant differences across the four types of elder maltreatment were found. These two datasets provide converging evidence for the importance of differentiating by type of maltreatment when identifying risk factors for elder maltreatment and for the importance of considering both the elderly victim and the abusive individual when predicting type of elder maltreatment.     

Financial exploitation of older persons in adult care settings: comparisons to physical abuse and the justice system's response

The current study uses a sample of 242 elder financial abuse cases and 314 elder physical abuse cases handled by fraud control units to shed some light on the dynamics of elder financial exploitation and the way the justice system processes these cases. Attention also is given to the way that the processing of elder financial exploitation cases can be distinguished from the processing of elder physical abuse cases. Results show that a wide range of elder financial exploitations cases are committed, and these cases should be broadly defined. Implications are provided.     

Australian Service Providers' Responses to Elder Abuse

This article presents the findings of a survey of 175 service providers in Sydney, Australia, the majority of whom were doctors in general practice. Thirty-two percent of respondents had encountered cases of physical, psychological, or financial abuse or caregiver neglect of people 65 years old and over. Community nurses and social/welfare workers were particularly likely to have encountered cases of abuse. The findings suggest that coordination between health, welfare, and criminal justice agencies in Australia needs improvement. Policies to address elder abuse and neglect in Australia are in their infancy. As a priority governments should work towards effective training of professionals and appropriate intervention guidelines for services.     

Five-year all-cause mortality rates across five categories of substantiated elder abuse occurring in the community

ABSTRACT

Elder abuse increases the likelihood of early mortality, but little is known regarding which types of abuse may be resulting in the greatest mortality risk. This study included N = 1,670 cases of substantiated elder abuse and estimated the 5-year all-cause mortality for five types of elder abuse (caregiver neglect, physical abuse, emotional abuse, financial exploitation, and polyvictimization). Statistically significant differences in 5-year mortality risks were found between abuse types and across gender. Caregiver neglect and financial exploitation had the lowest survival rates, underscoring the value of considering the long-term consequences associated with different forms of abuse. Likewise, mortality differences between genders and abuse types indicate the need to consider this interaction in elder abuse case investigations and responses. Further mortality studies are needed in this population to better understand these patterns and implications for public health and clinical management of community-dwelling elder abuse victims.     

Is Elder Abuse and Neglect a Social Phenomenon? Data from the First National Prevalence Survey in Israel

This article discusses findings from the First National Survey on Elder Abuse and Neglect in Israel, conducted during 2004–2005 under the sponsorship of The Association for Planning and Development of Services for the Aged in Israel (ESHEL) and the National Insurance Institute. The goals were to examine the prevalence and severity of various forms of abuse and neglect from the victims' perspective, to examine correlates and predictors, and to develop profiles of elders at risk. Data were collected through personal interviews from a national representative sample of community urban dwellers age 65 and older, using cluster sampling techniques and sampling proportionately both Arab and Jewish elders. The sample was composed of 392 males and 650 females, 89% were Jews and 11% were non-Jews. The instrument included sociodemographic data, health and activities of daily living (ADL), a measure of safety, and a battery to examine seven types of abuse (physical, emotional, verbal, limitation of freedom, financial exploitation, sexual, and neglect). Findings indicate that 18.4% of the respondents were exposed to at least one type of abuse during the 12 months preceding the interview, the highest form being verbal abuse followed by financial exploitation. The rates were quite similar between Jews and Arabs. Women were more exposed to physical violence and Arab women were the most vulnerable. Physical, emotional, verbal, limitation of freedom, and sexual abuse occurred mostly among partners. The rates of physical, sexual, and limitation of freedom abuse, however, were relatively low. Financial exploitation was mostly inflicted by adult children. Partners as perpetrators had more chronic health problems and physical and mental disabilities. Children as perpetrators were unemployed, had various mental health problems, and were substance abusers, often in a process of separation or divorce and tended to live with the victims. Neglect in answering primary needs was found among 20% of the sample, regarding the 3 months preceding the interview. This high rate might be related to elders tending to avoid seeking help or sharing their needs with their families. When victims sought help it was mostly from medical and health services. The findings thus corroborate that elder abuse and neglect is a social problem in Israeli society and has to be addressed in policy discourse and service developments.     

The Legal Response to Elder Abuse and Neglect

ABSTRACT

The United States legal system, both civil and criminal, has been underutilised in dealing with elder abuse and neglect. Social service and health practitioners have been unfamiliar with the language and procedures in legal settings. Legal remedies have been obscure or inadequate to address the problems. When elder abuse and neglect were first “discovered” in the late 1970s, efforts focused on safeguarding the victim through civil justice remedies, i.e., guardianships, mandatory reporting laws, adult protective services. The criminal justice system also became involved in order to hold the alleged wrongdoer accountable. Specialised units have developed in police departments and prosecutor offices to deal with the criminal behavior. New laws are providing more flexibility for the legal system, both civil and criminal. A multidisciplinary approach to elder abuse and neglect is needed because abused or neglected elders are frequently involved with many agencies. Attention to the legal aspects of the issue are apparent in the Summit Conference held by the National Center on Elder Abuse in 2001 and the development of the Elder Justice Act which was introduced into the U.S. Senate in 2003.     

Parent gender and child removal in physical abuse and neglect cases

Criminal justice research frequently investigates relationships between punishment decisions and demographic characteristics of the accused, such as gender, race, and age. While there are many similarities between criminal justice and child welfare cases, research on child maltreatment has yet to examine potential demographic influences on case outcomes. The current study examines relationships between parent gender, type of maltreatment, and child removal among agency responses to child maltreatment cases. Using data collected by the National Data Archive on Child Abuse and Neglect Data System (NCANDS), we identify differences in the likelihood of child removal from the parental home across type of maltreatment and perpetrator gender. Our results indicate that mother perpetrators of physical abuse not only face significantly higher likelihood of removal than mother perpetrators of neglect, but are more at risk for losing their children than father perpetrators of both physical abuse and neglect. Findings suggest that gendered attributions and stereotypes regarding parenting can shape assessments of parents' blameworthiness, dangerousness, and rehabilitative potential. We propose that future research on child maltreatment cases adapt and apply justice concepts and frameworks to uncover potential unwarranted demographic disparities in agency decision-making.     

Elder abuse and neglect in an urban chinese population

This study aims to investigate the prevalence of elder abuse and neglect in an urban Chinese population. A cross-sectional study was performed in a major urban medical center in NanJing, China. A total of 412 participants completed the survey and 145 (35%) participants screened positive for elder abuse and neglect. The mean age of the victims was 69 years and 59% were male. Caregiver neglect was the most common form of abuse, followed by financial exploitation, psychological abuse, physical abuse, sexual abuse, and abandonment. Thirty-six percent of the victims suffered multiple forms of abuse and neglect. In the logistical regression analyses of the data, female gender, lower education and lower income were demographic risk factors associated with elder abuse and neglect. A better understanding of these and additional risk factors associated with elder abuse and neglect in older Chinese people is needed.     

Elder Abuse and Neglect in an Urban Chinese Population

ABSTRACT

This study aims to investigate the prevalence of elder abuse and neglect in an urban Chinese population. A cross-sectional study was performed in a major urban medical center in NanJing, China. A total of 412 participants completed the survey and 145 (35%) participants screened positive for elder abuse and neglect. The mean age of the victims was 69 years and 59% were male. Caregiver neglect was the most common form of abuse, followed by financial exploitation, psychological abuse, physical abuse, sexual abuse, and abandonment. Thirty-six percent of the victims suffered multiple forms of abuse and neglect. In the logistical regression analyses of the data, female gender, lower education and lower income were demographic risk factors associated with elder abuse and neglect. A better understanding of these and additional risk factors associated with elder abuse and neglect in older Chinese people is needed.     

A Telephone Counseling Program for Elder Abuse in Japan

ABSTRACT

In the 21st century, one-fourth of the Japanese population will be 65 years and older. Not only is the duty to report elder abuse not defined by the law but there is no special organization with clinical facilities to respond to incidents of elder abuse. A report in 1994 by the Society for the Study of Elder Abuse (SSEA) showed the need for definitive social measures to prevent elder abuse. Based on that research, SSEA organized the Japan Elder Abuse Prevention Center and initiated a volunteer telephone counseling service “Help Line” that was available for several hours on Mondays. Within an 18 month period, 209 cases were handled of which 150 concerned abuse, neglect, and financial exploitation. Callers were more often the elder or the daughter than other relatives or outsiders. Sons were the more prevalent perpetrators, and financial abuse the most common type of mistreatment reported. Recommendations include new laws and social welfare policies that adapt to the changes in an aging society.     

Elder Abuse and Neglect:

The study analyzes data from a 1987 survey of 1,137 adult protective service workers in forty states and Washington, D.C. A four-page questionnaire was mailed to obtain information on the perceptions and practices of those practitioners in dealing with cases of elder abuse neglect. Data were collected on the incidence of elder abuse, neglect, self-neglect, and exploitation; the observed frequencies of hypothesized causes of elder abuse and neglect in actual cases; barriers to service; the effectiveness of various methods of intervention; the outcomes of elder abuse and neglect cases; adn the perceived potential of community resources for reducing elder abuse and neglect.     

Recommendations for the elder abuse, health, and justice fields about medical forensic issues related to elder abuse and neglect

Increased interest in pursuing criminal and civil actions against alleged perpetrators of elder abuse and neglect has revealed that efforts to assist victims and hold perpetrators accountable are often hampered by the lack of knowledge about the detection and diagnosis of elder abuse and neglect and by the lack of resources for development of research and assistance in these matters. This report sets forth recommendations for the elder abuse, health, and justice fields about medical forensic issues related to elder abuse and neglect. The recommendations were developed by a "working group" of experts representing an array of disciplines that address the problem of elder abuse and neglect pursuant to a grant project funded by the National Institute of Justice (NIJ), the research, development, and evaluation agency of the U.S. Department of Justice (DOJ). The project was conducted by the American Bar Association Commission on Law and Aging, with the assistance of the University of California, Irvine School of Medicine. This was the final project report submitted to NIJ; it has been updated to include information about the availability of reports and products from other grant projects that are discussed in the report.     

Recommendations for the elder abuse, health, and justice fields about medical forensic issues related to elder abuse and neglect

Increased interest in pursuing criminal and civil actions against alleged perpetrators of elder abuse and neglect has revealed that efforts to assist victims and hold perpetrators accountable are often hampered by the lack of knowledge about the detection and diagnosis of elder abuse and neglect and by the lack of resources for development of research and assistance in these matters. This report sets forth recommendations for the elder abuse, health, and justice fields about medical forensic issues related to elder abuse and neglect. The recommendations were developed by a "working group" of experts representing an array of disciplines that address the problem of elder abuse and neglect pursuant to a grant project funded by the National Institute of Justice (NIJ), the research, development, and evaluation agency of the U.S. Department of Justice (DOJ). The project was conducted by the American Bar Association Commission on Law and Aging, with the assistance of the University of California, Irvine School of Medicine. This was the final project report submitted to NIJ; it has been updated to include information about the availability of reports and products from other grant projects that are discussed in the report.     

Racial Differences in Abused Older African American Males, Caucasian Males, and their Abusers

This study examined racial differences between mistreated and abused older African American and Caucasian men. The racial and gender differences of their perpetrators were also examined. Data from a single elder abuse provider agency in the State of Illinois were analyzed. Differences with respect to physical abuse, emotional abuse, physical neglect, deprivation, confinement, and financial exploitation were examined, as were demographic characteristics and limitations of victims and abusers.     

Financial Exploitation of Elders: Analysis of Risk Factors Based on County Adult Protective Services Data

ABSTRACT

While all types of elder abuse and neglect are serious problems affecting thousands of vulnerable elders, financial exploitation has especially serious implications for the victims’ economic well-being and quality of life, because it may deprive the victims of their life savings and assets and thus their economic foundation for independence. In this study, data from the case files of a county adult protective services program were analyzed to identify risk factors associated with financial exploitation of and mismanagement by elders. The elders who were financially exploited were, on average, in their late seventies and tended to be cognitively impaired. We also found that owner-occupant elders were especially vulnerable to exploitation and that financial mismanagement and exploitation often occurred together. Approximately 60% of the perpetrators were relatives of the elderly victims, mostly their adult children, and the rest of the perpetrators were not related to the victims. Implications for interventions include case management for frail, cognitively impaired elders; preventive educational programs; and ongoing collaboration among adult protective services, financial institutions, and law enforcement agencies.     

Perceptions of Adult Protective Services Workers of the Support Provided by Criminal Justice Professionals in a Case of Elder Abuse

ABSTRACT

This paper summarizes results of a 1997 survey of adult protective services workers in 43 states. The survey yielded ratings of police and victim assistants in detecting and treating elder abuse and estimates of the likelihood that criminal justice professionals would provide ten forms of assistance in a case of elder abuse. Respondents also reported the most helpful services supplied by criminal justice professionals, the services that were most difficult to obtain, and overall ratings of criminal justice professionals in cases of elder abuse. Findings provide insights about relationships between adult protective services workers and criminal justice professionals.     

Mental health and criminal justice issues among perpetrators of elder abuse

ABSTRACT Recent studies on elder abuse suggest that the pathology or impairment of the abuser may be a stronger predictor of elder abuse than characteristics of the victim. To examine the relationship between elder abuse, abuser pathology, and the criminal justice system, the New York City Department for the Aging (DFTA) undertook a survey of older victims of reported domestic abuse seeking assistance from the DFTA Elderly Crime Victims Resource Center. Preliminary findings from the survey indicate that impaired abusers were significantly younger than unimpaired abusers and more likely to live with their elderly victims, to be unemployed, and to have a history of involvement with the criminal justice system.     

Domestic violence cases involving children: effects of an evidence-based prosecution approach

This article reports findings from the evaluation of a city-county criminal prosecution unit for domestic violence involving children. Data from 446 cases prosecuted in the first 2 years of the Joint Prosecution Unit (JPU) were compared to a matched group of 446 domestic abuse cases prosecuted by both the city and county attorneys' offices in the 2 years prior to inception of the JPU. Results of the comparisons indicated that fewer cases were declined or dismissed by the new unit, and that cases were prosecuted at a significantly more stringent level. Multinomial logistic regression analysis indicated that child and weapon factors were associated with increased likelihood of a more serious (i.e., felony) plea for the new prosecution unit, relative to the comparison group. Results are presented in the context of addressing the difficulties inherent in the prosecution of domestic abuse and in light of the increasing awareness of the detrimental effects of domestic violence on children.     

Mental Health and Criminal Justice Issues Among Perpetrators of Elder Abuse

ABSTRACT

Recent studies on elder abuse suggest that the pathology or impairment of the abuser may be a stronger predictor of elder abuse than characteristics of the victim. To examine the relationship between elder abuse, abuser pathology, and the criminal justice system, the New York City Department for the Aging (DFTA) undertook a survey of older victims of reported domestic abuse seeking assistance from the DFTA Elderly Crime Victims Resource Center. Preliminary findings from the survey indicate that impaired abusers were significantly younger than unimpaired abusers and more likely to live with their elderly victims, to be unemployed, and to have a history of involvement with the criminal justice system.     

The effect of a family-based intervention with a cognitive-behavioral approach on elder abuse

ABSTRACT

Elder abuse may become a health issue in developing countries, including Iran. The purpose of this investigation was to study the effectiveness of Family-Based Cognitive-Behavioral Social Work (FBCBSW) in reducing elder abuse. In a randomized clinical trial in Iran, 27 elders participated in intervention and control groups. The intervention groups received a five-session FBCBSW intervention and completed the Domestic-Elder-Abuse-Questionnaire (DEAQ), which evaluates elder abuse at baseline and follow-ups. Repeated measures of analysis of variance (ANOVA) and the Wilcoxon test were used to analyze the data. The repeated measures ANOVA revealed that FBCBSW was successful in reducing elder abuse. The Wilcoxon test indicated that emotional neglect, care neglect, financial neglect, curtailment of personal autonomy, psychological abuse, and financial abuse significantly decreased over time, but there was no statistically significant difference in physical abuse before and after the intervention. The findings from this study suggest that FBCBSW is a promising approach to reducing elder abuse and warrants further study with larger samples.