126). Although there are an increasing number of elderly in the United States today with many more expected in the future, the study of elder abuse is of fairly recent origin. During the last three decades of the 20th century, following the "discovery" of child abuse and domestic violence, scholars and professionals started taking an active interest in the subject of elder abuse. This increased attention from the academic community, together with a clear indication from the respective state and federal governments that they were willing to intervene in family matters and the growing aging population of elders at risk for violence in the home, makes it understandable what elder abuse has gained public and scholarly attention in recent years. In this regard, Nadien (1995) notes that, "Violence against the elderly, often referred to as elder abuse, emerged as a serious concern only in the late 1970s and early 1980s. At that time, the first set of published research and governmental findings revealed that maltreatment, while only 4% among the well elderly, reached 10% among the frail or impaired elderly. Today elder maltreatment is thought to be six times greater than these figures suggest" (p. 177).
Despite this growing attention, though, some observers suggest that elder mistreatment research is lagging 20 years behind (Kurst-Swanger & Petcosky, 2003). Indeed, although the abuse of elders has generated considerable interest over the past two decades as the prevalence of the problem has become more discernible, the problem has not received the attention it needs (Ebersole & Hess, 1998). According to these authors, "States on average spend $22 per child for youth protective services but only $2.90 per elder for protective services, though 40% of reported abuse involves elders" (Ebersole & Hess, p. 562). The results of an 11-year longtitudinal study of community elders showed that almost 10% of them were referred for adult protective services at some point in time (Lachs et al., 1996). Moreover, recent increases in the incidence of elder abuse has introduced some difficult questions concerning the advantages of separating family members when abuse or neglect has been reported, especially when the abused person is dependent on the relationship for important benefits (Chalk & King, 1998). Finally, as Proctor (2004) emphasizes, "Nearly half a million cases of elder abuse are reported each year. Yet, we know very little about it. The little that is known comes from small studies or anecdotal information. Thus, research on the correlates and causes of elder abuse are badly needed" (p. 131).
Scope of Study
Although the study examined the issues surrounding elder abuse across various cultural settings, there was a specific focus on the United States.
Rationale of Study
Because there are going to be more elderly people in the United States in the years to come, it is reasonable to posit that the incidence of elder abuse will also continue to increase as well. According to Adler and Denmark (1995), "The need to identify and remedy elder abuse takes on urgency in the light of a burgeoning of the aged population, who currently make up almost 13% of the U.S. population and who are projected to account for over 20% of the population by the year 2020, with 21% of all males and 24% of all females expected to be 65 years or older" (p. 177). Indeed, it goes without saying that elders who are emotionally, physically, or sexually abused are at increased risk for the entire constellation of comorbidities that can accompany such abuse, including death.
Furthermore, besides being the fastest-growing age segment, the elderly segment of the American population today is living much longer. As Adler and Denmark point out, "Among U.S. residents who reached age 65 during the 1980s, males can expect to live until age 80, and females to age 84. Thus, it is important to find ways of detecting and checking the maltreatment of impaired old-agers" (p. 177). Much has been written about improving the quality of life for senior citizens over the years, but the bottom line outcome for the purposes of this investigation is the relationship of such abuse to premature deaths. As one authority notes, "The ultimate measure of the quality of life is mortality" (Kosberg, 2005, p. 9).
There are some profound constraints involved in investigating instances of abuse among the elderly, though, because it requires a long-term casework approach. In this regard, Bergeron (2000) emphasizes that, "The building of trust with older clients, particularly abused older clients, is paramount in creating a working relationship. Elderly people traditionally are skeptical of the helping profession. They are slow to disclose, and they fear being removed from their homes and placed in nursing homes" (p. 40). In fact, at least one study has shown that elder victims of abuse would choose to remain in their own homes and continue to suffer from the abuse than be uprooted to a nursing home setting (Bergeron). Indeed, this fear is not without basis. As Kohl (2003) reports, "Despite the stringent federal regulation of long-term care facilities, nursing home abuse remains rampant throughout the United States" (p. 2083).
Overview of Study
This study used a five-chapter format to achieve the above-stated research purpose. The first chapter introduced the topics under consideration, the purpose of the study and its importance, scope and rationale. The second chapter presents a critical review of the relevant peer-reviewed and scholarly literature concerning elder abuse, including its incidence, causes and current intervention approaches. Chapter three describes more fully the research methodology used to develop the research findings, and chapter four provides a recapitulation and summary of key findings from the research. Finally, chapter five provides a summary of the research, salient conclusions and recommendations for policymakers and those providing caregiving services for the elderly, as well as directions for future directions in research.
Review of Related Literature
Background and Overview.
Although no specific legal definition is provided for elder abuse by Black's Law Dictionary (1990), Gellert (1997) provides a useful working definition of the topic under consideration: "Elder abuse is any action that, either by commission or omission, harms an elderly person. Elder abuse and neglect are complex problems that have evaded clear definition" (p. 183). Likewise, Adler and Denmark (1995) note that, "Violence against the elderly assumes different forms. Although all forms entail suffering for the victim, the source of that pain may derive either from something inflicted or something withheld" (p. 178). Researchers concerned with elder abuse differ significantly, though, on precisely what constitutes elder abuse. According to Gellert, "While child and spouse abuse have been clearly recognized for a number of years, elder abuse has received substantial attention only quite recently. Abuse of the elderly involves physical injury by care givers, psychological abuse, financial exploitation, violation of human rights, and neglect. The varying aspects have not been shaped into a single definition" (p. 183). It remains nebulous, for instance, as to whether the definition of physical abuse should include the failure to provide medical care to an elderly person. Should it include lack of supervision or lack of personal care, or should it be restricted to include only physical injuries? Does elder abuse occur when the victim is fifty-five years and older or sixty-five and older? Widely differing viewpoints have been expressed on these and other issues (Gellert).
It is possible to identify several aspects of elder abuse. Physical or sexual abuse involves direct physical assault. This would include intentionally striking an elderly person, rough handling, sexual assault, and threats with a weapon. Force-feeding and improper use of restraints or medications also constitute physical abuse of the elderly. Psychological elder abuse would include verbal assault, social isolation, or threats that create fear, anguish, and anxiety. Psychological abuse occurs when an elderly person is humiliated or intimidated. It may also include denying older persons participation in decisions that affect their lives (Gellert). In their study of elder abuse patterns, Oktay and Tompkins (2004) report that, "Verbal abuse, (sometimes called psychological abuse) is usually the most frequent type of mistreatment, followed by physical abuse and neglect; sexual abuse is usually the least prevalent type of abuse" (p. 177).
Victimization of the elderly can take place in a number of other ways as well. For example, the elderly are frequently easy marks for entrapment in financial schemes in which they are coerced or otherwise manipulated to give others their money, rewrite their wills, give up control over their finances, assign durable power of attorney, or sign away ownership of their homes and property (Gellert). According to this author, "Financial elder abuse involves fraud, theft, or unauthorized use of an elderly person's money or property for the gain of an advisor or caretaker. Neglect is failure to meet the needs of an elderly person and withholding or failing to provide that person with the essentials of life, such as food, shelter, clothing, the means for personal hygiene, medical care, and social stimulations. Neglect often overlaps…