Elder abuse in the United States: prevalence, forms, and federal responses

¶ … Elder Abuse

About one in every eight Americans is considered to be an older person aged 60 years or over and their numbers of growing faster than any other segment of the population today. Moreover, current estimates indicate that this growth will continue well into the foreseeable future, with more than twice as many elderly in the U.S. by 2030 than there were in 2000 (The demographics of aging, 2017). A concomitant of this explosive growth in the elderly population has been increased attention on elder abuse, including its causes and consequences. This paper reviews the literature to determine the facts about this social problem and how the dramatic increase in the number of elderly people in the future will likely shape the elder abuse problem, followed by a summary of the research and important findings concerning elder abuse in the conclusion.

Review and Analysis

What is elder abuse?

The National Committee for the Prevention of Elder Abuse (NCPEA) defines elder abuse as \"any form of mistreatment that results in harm or loss to an older person\" (Elder abuse, 2017, para. 2). While precise numbers are not available, the NCPEA estimates that approximately 4.6% of the elderly population in the United States is abused in some fashion. Elder abuse can assume a number of different forms, including financial abuse, psychological abuse, sexual abuse, physical abuse, and neglect (Elder abuse, 2017).

There has been significant progress made in recent years at the federal level in response to elder abuse. For instance, Blancato (2013), the national coordinator of the Elder Justice Coalition, reports that, \"A landmark law on elder justice has been enacted and is now being implemented and provided with initial funding\" (p. 10). The landmark law is the Elder Justice Act of 2010 which provides $100 million in funding for elder abuse-related interventions and national programs (Elder Justice Act, 2017).

Other proposed legislation that is currently pending which is intended to combat elder abuse in the U.S. includes:

• The Elder Abuse Victims Act (S.462): This law would advance the rights of victims of elder abuse and exploitation, and increase resources aimed at the investigation and prosecution of elder abuse.

• Elder Protection and Abuse Prevention Act (S.2077): This law would amend the Older Americans Act to create in statute a National Adult Protective Services Resource Center, would require the aging network to screen and report elder abuse, and would improve coordination of efforts amongst allied agencies.

• Home Care Consumer Bill of Rights Act (S. 1750): This law would extend the rights, protections and advocacy services available to long-term care facility residents to consumers receiving long-term care at home, including creating a Home Care Ombudsman Program and a National Adult Protective Services Resource Center (Elder Justice Act, 2017).

In addition, Blancato (2013) reports that the National Adult Protective Services Resource Center and the National Center on Elder Abuse have also received substantial federal funding in recent years. Likewise, the Department of Justice has launched an elder abuse roadmap project and federal agencies including the Securities and Exchange Commission and the Federal Trade Commission have increasingly focused on combating the financial abuse of elders (Blancato, 2013). Despite this progress, elder abuse can have devastating consequences as discussed further below.

Causes and consequences of elder abuse

Although the estimate of above-cited 4.6% of the elder population being abused may not appear to represent a significant percentage, it actually translates into millions of older Americans. One of the more influential fallacies about the causes of elder abuse, though, is that caregiver stress is the overarching cause of the problem. For instance, Brandl and Raymond (2012) emphasize that, \"Every year millions of older adults are abused, neglected, or financially exploited. Studies show the causes of elder abuse to be wide-ranging and not necessarily an outcome of caregiver stress\" (p. 32).

In the past, researchers were convinced that caregiver stress was the main cause of elder abuse but their studies were constrained by the small number of subjects involved as well as the lack of understanding concerning the multifaceted nature of the problem (Brandl & Raymond, 2012). In fact, Venne (2013) emphasizes that elder abuse was only identified as legitimate social problem a mere 30 years ago. Not surprisingly, then, the research at the time was based on the assumption that caregiver stress was the main cause of elder abuse. For example, during the period from 1979 through 1985, a number of studies were conducted that reached the conclusion that caregiver stress was the main cause of elder abuse, including the following:

• \"Most (75%) abusers were experiencing some form of stress\" (1979);

• \"Abuse was cyclical and precipitated by stress\" (1980);

• \"The elder was a source of stress to the abuser, who was experiencing a variety of stressors\" (1981);

• \"These families were under stress 80% of the time, with the elderly person being the scapegoat for the caregivers\' frustrations\" (1981);

• \"Abusers 67% were under stress\" (1981); and,

• \"The most frequently reported cause of elder abuse was frustration of the caregiver due to change in lifestyle and burden of the elder\" (1983).

Over the past 2 decades or so, however, there is a growing body of evidence that the causes of elder abuse may include some level of caregiver stress, but there are a number of other factors involved that must be taken into account in this analysis. Indeed, some of the findings by Brandl and Raymond (2012) directly refute the fallacy that stress is the primary cause of elder abuse. For example, these authors point out that:

• Everyone experiences stress, yet few people, especially caregivers, respond by intentionally abusing, neglecting, or exploiting loved ones.

• Under stress, most people experience some anxiety and may be impatient or tense. When most people have a bad moment, for example, yelling at a family member, they apologize and make amends. They see others as deserving of respect and kindness, and do not believe it is right to treat others badly.

• Abusers who claim stress as an excuse generally do not lash out at everyone they meet. Often they are charming and kind to neighbors, friends, and professionals. Abusers who claim to be out of control due to anger or stress can control their behavior-it is rare for law enforcement to see enraged abusers. Typically the victim is hysterical and the abuser is calm as soon as law enforcement arrives on the scene.

• Abusers who claim to be out of control due to anger or stress are often strategic, hiding physical evidence of blows by directing them at areas usually covered by clothing so no one will see marks and bruises. For an offender who suspects his partner is having an affair, blows may be directed at the face so she will not go out in public.

• Often the abuse is not an isolated incident as reported by the offender but part of a larger pattern of behavior.

• Stress, anger, and substance abuse may coexist with abusive behavior. Abusers may have been abused or were child witnesses of domestic violence. None of these issues cause the offender to engage in abusive behavior (Brandl & Raymond, 2012, p. 33).

While the consequences of elder abuse vary depending on the type of abuse involved as well as its severity and duration, all types of elder abuse can have profoundly severe effects. For example, the NCPEA stresses that, \"The personal losses associated with abuse can be devastating and include the loss of independence, homes, life savings, health, dignity, and security. Victims of abuse have been shown to have shorter expectancies than non-abused older people\" (Elder abuse, 2017, para. 4). Moreover, not only are there several different types of elder abuse, there are a number of different types of perpetrators that can inflict abuse on the elderly, including intimate partners or spouse, other caregivers, or individuals in a position of authority or trust (Brandl & Raymond, 2012).

A study by Venne (2013) identified several risk factors for becoming a victim of elder abuse which support the assertions by Brandl and Raymond (2012) concerning the multifaceted nature of the problem. For instance, according to Venne (2013), \"Risk factors for elder abuse include social isolation, the ageist societal depiction of older persons and the erosion of bonds between generations\" (p. 9). Elders in long-term care settings are likewise at greater risk of becoming elder abuse victims, particularly in those cases where staff members lack adequate training or the standards of care of suboptimal and lack enforcement (Venne, 2013).

Taken together, the multifaceted and complex nature of elder abuse indicates that because there is no single overarching cause, there is no single intervention available that will completely resolve the problem (Brandl & Raymond, 2012). As a result, a growing number of clinicians and researchers have rejected a single causation theory for elder abuse. As noted above, although the cause of elder abuse in some cases is in fact attributable to caregiver stress, the majority of cases appear to be more related to the inability of caregivers to provide the level of care needed by elders without outside assistance, resulting in neglect or abuse. In the remaining cases, Brandl and Raymond (2012) conclude that they are \"are narcissistic, domineering, or bullying and sadistic\" (p. 34).

Indeed, some researchers have found that elder abuse offenders are the individuals who are reliant on the victim in some fashion, such as emotionally or financially. In many instances, the elder abuse victim and offender cohabitate, with the victim being responsible for the provision of daily living expenses and household needs (Brandl & Raymond, 2012). In some instances, the caregivers become the victims of abuse by the older individual who provides this financial assistance (Brandl & Raymond, 2012). In yet other cases, elder abuse is a continuation of previously established patterns of domestic violence that can extend into later life (Bradl & Raymond, 2012).

In those cases where family members or caregivers are in fact the offenders, a wide array of methods are used to abuse the elderly, including threats, intimidation, isolation assuming control over household finances, as well as emotional, sexual and physical abuse; however, in the case of financial abuse of elders, Brandl and Raymond (2012) conclude that \"greed appears to be a primary driver in cases of elder financial exploitation\" (p. 35). This assertion is consistent with the findings that emerged from a recent study of 600 self-reported elderly financial abuse victims by Ramsey-Klawsnik, Quinn and Brownell (2016) who found that the non-financial costs of fraud (e.g., stress, health problems, etc.) are widespread among victims of financial fraud. Some of the indirect costs of financial abuse include legal fees, charges for bounced checks, opportunity costs, and lost wages (Ramsey-Klawsnik et al., 2016).

Based on the results of their survey of these 600 elders, Ramsey-Klawsnik and her associates found that almost two out of three respondents (65%) had been the victim of some type of serious financial abuse with corresponding elevated stress, depression and problems sleeping as a result. Interestingly, nearly half (47%) of the respondents in the Ramsey-Klawsnik et al. study (2016) blamed themselves for the financial abuse, and nearly two-thirds (61%) reported the cause of the abuse was that \"they were too trusting\" (p. 7).

Moreover, even when elders reported the abuse to family members or friends, only about 33% actually reported the abuse to competent authorities because the majority of these family members and friends believed that reporting the incident would make a substantive difference (Ramsey-Klawsnik et al., 2016). Unfortunately, there is a distinct potential for all types of elder abuse to increase in the future as this demographic segment of the American population continues to increase and these issues are discussed further below.

Likely effects of the dramatic increase in the number of elderly people in the future

Although definitions vary, older persons are generally considered to be those aged 60 years or older (World population aging, 2013). At present, about 12.85% of the U.S. population is aged between 55 and 64 years and 15.25% are aged 65 years and over as shown in Figure 1 below.

Figure 1. U.S. population pyramid

Source: https://www.cia.gov/library/publications/the-world-factbook/graphics/population/US_ popgraph%202016.bmp