Elder abuse

Elder abuse (also called "elder mistreatment," "senior abuse," "abuse in later life," "abuse of older adults," "abuse of older women," and "abuse of older men") is "a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person."[1] This definition has been adopted by the World Health Organization (WHO) from a definition put forward by Action on Elder Abuse in the UK. Laws protecting the elderly from abuse are similar to and related to, laws protecting dependent adults from abuse.

The core element to the harm of elder abuse is the "expectation of trust" of the older person toward their abuser. Thus, it includes harms by people the older person knows, or have a relationship with, such as a spouse, partner or family member, a friend or neighbor, or people that the older person relies on for services. Many forms of elder abuse are recognized as types of domestic violence or family violence since they are committed by family members. Paid caregivers have also been known to prey on their elderly patients.

While there are a variety of circumstances considered as elder abuse, it does not include general criminal activity against older persons, such as home break-ins, "muggings" in the street or "distraction burglary", where a stranger distracts an older person at the doorstep, while another person enters the property to steal.

The abuse of elders by caregivers is a worldwide issue. In 2002, WHO brought international attention to the issue of elder abuse.[2] Over the years, government agencies and community professional groups, worldwide, have specified elder abuse as a social problem.[3] In 2006 the International Network for Prevention of Elder Abuse (INPEA) designated June 15 as World Elder Abuse Awareness Day (WEAAD) and an increasing number of events are held across the globe on this day to raise awareness of elder abuse, and highlight ways to challenge such abuse.[4]


Although there are common themes of elder abuse across nations, there are also unique manifestations based upon history, culture, economic strength, and societal perceptions of older people within nations themselves. The fundamental common denominator is the use of power and control by one individual to affect the well-being and status of another, older, individual.

There are several types of abuse of older people that are generally recognized as being elder abuse, including:[5][6]

In addition, some U.S. state laws[7] also recognize the following as elder abuse:

Warning signs

The key to prevention and intervention of elder abuse is the ability to recognize the warning signs of its occurrence. Signs of elder abuse differ depending on the type of abuse the victim is suffering. Each type of abuse has distinct signs associated with it.

In addition to observing signs in the elderly individual, abuse can also be detected by monitoring changes in the caregiver's behavior. For example, the caregiver may not allow them to speak to or receive visitors, exhibit indifference or a lack of affection towards the elder, or refer to the elder as "a burden." Caregivers who have a history of substance abuse or mental illness are more likely to commit elder abuse than other individuals.[12]

Abuse can sometimes be subtle, and therefore difficult, to detect. Regardless, awareness organizations and research advise to take any suspicion seriously and to address concerns adequately and immediately.

Health consequences

The health consequences of elder abuse are serious. Elder abuse can destroy an elderly person's quality of life in the forms of:[13]

The risk of death for elder abuse victims are three times higher than for non-victims.[14]

Common abusers

An abuser can be a spouse, partner, relative, a friend or neighbor, a volunteer worker, a paid worker, practitioner, solicitor, or any other individual with the intent to deprive a vulnerable person of their resources. Relatives include adult children and their spouses or partners, their offspring and other extended family members. Children and living relatives who have a history of substance abuse or have had other life troubles are of particular concern. For example, HFE abusive individuals are more likely to be a relative, chronically unemployed, and dependent on the elderly person.[15]

Perpetrators of elder abuse can include anyone in a position of trust, control or authority over the individual. Family relationships, neighbors and friends, are all socially considered as relationships of trust, whether or not the older adult actually thinks of the people as "trustworthy". Some perpetrators may "groom" an older person (befriend or build a relationship with them) in order to establish a relationship of trust. Older people living alone who have no adult children living nearby are particularly vulnerable to "grooming" by neighbors and friends who would hope to gain control of their estates.

The majority of abusers are relatives, typically the older adult's spouse/partner or sons and daughters, although the type of abuse differs according to the relationship. In some situations the abuse is "domestic violence grown old," a situation in which the abusive behavior of a spouse or partner continues into old age.

In some situations, an older couple may be attempting to care and support each other and failing, in the absence of external support. With sons and daughters it tends to be financial abuse, justified by a belief that it is nothing more than the "advance inheritance" of property, valuables and money.

Within paid care environments, abuse can occur for a variety of reasons. Some abuse is the willful act of cruelty inflicted by a single individual upon an older person. In fact, a case study in Canada suggests that the high elder abuse statistics are from repeat offenders who, like in other forms of abuse, practice elder abuse for the Schadenfreude associated with the act. More commonly, institutional abuses or neglect may reflect lack of knowledge, lack of training, lack of support, or insufficient resourcing. Institutional abuse may be the consequence of common practices or processes that are part of the running of a care institution or service. Sometimes this type of abuse is referred to as "poor practice," although this term reflects the motive of the perpetrator (the causation) rather than the impact upon the older person.

With the aging of today's population, there is the potential that elder abuse will increase unless it is more comprehensively recognized and addressed.

Risk factors

There are several risk factors, which increase the likelihood that an elderly person will become a victim of elder abuse. Such risk factors for elder abuse include an elderly person who:[16]

There are also several risk factors, which increase the likelihood that a caregiver will participate in elder abuse. Such risk factors for elder abuse include a caregiver who:[16]

Risk factors can also be categorized into individual, relationship, community and socio-cultural levels. At individual level, elders who have poor physical and mental health are at higher risk. At relationship level, a shared living situations is a huge risk factors for the elderly. Living in the same area with the abuser is more likely to cause an abuse. Third, at community level, social isolation is cased by the caregivers. In addition, some socio-cultural risk factors that can contribute to elder abuse is a representation of an older person as weak and dependent, lack of funds to pay for care, children leaving elderly parents alone and destruction of bonds between the generation of a family.[17]

Research and statistics

There has been a general lack of reliable data in this area and it is often argued that the absence of data is a reflection of the low priority given to work associated with older people. However, over the past decade there has been a growing amount of research into the nature and extent of elder abuse. The research still varies considerably in the definitions being used, who is being asked, and what is being asked. As a result, the statistics used in this area vary considerably.

One study suggests that around 25% of vulnerable older adults will report abuse in the previous month, totaling up to 6% of the general elderly population.[18] However, some consistent themes are beginning to emerge from interaction with abused elders, and through limited and small scale research projects. Work undertaken in Canada suggests that approximately 70% of elder abuse is perpetrated against women and this is supported by evidence from the AEA helpline in the UK, which identifies women as victims in 67% of calls. Also domestic violence in later life may be a continuation of long term partner abuse and in some cases, abuse may begin with retirement or the onset of a health condition.[19] Certainly, abuse increases with age, with 78% of victims being over 70 years of age.[20]

The higher proportion of spousal homicides supports the suggestion that abuse of older women is often a continuation of long term spousal abuse against women. In contrast, the risk of homicide for older men was far greater outside the family than within.[21] This is an important point because the domestic violence of older people is often not recognized and consequently strategies, which have proved effective within the domestic violence arena, have not been routinely transferred into circumstances involving the family abuse of older people.

According to the AEA helpline in the UK, abuse occurs primarily in the family home (64%), followed by residential care (23%), and then hospitals (5%), although a helpline does not necessarily provide a true reflection of such situations as it is based upon the physical and mental ability of people to utilize such a resource.[20]

Research conducted in New Zealand broadly supports the above findings, with some variations. Of 1288 cases in 2002–2004, 1201 individuals, 42 couples, and 45 groups were found to have been abused. Of these, 70 percent were female. Psychological abuse (59%), followed by material/financial (42%), and physical abuse (12%) were the most frequently identified types of abuse. Sexual abuse occurred in 2% of reported cases.[22] Age Concern New Zealand found that most abusers are family members (70%), most commonly sons or daughters (40%). Older abusers (those over 65 years) are more likely to be husbands.[22]

In 2007, 4,766 cases of suspected abuse, neglect, or financial exploitation involving older adults were reported, an increase of 9 percent over 2006. 19 incidents were related to a death, and a total of 303 incidents were considered life-threatening. About one in 11 incidents involved a life-threatening or fatal situation.[23]

In 2012, the study called Pure Financial Exploitation vs. Hybrid Exploitation Co-Occurring With Physical Abuse and/or Neglect of Elderly Persons�by Shelly L. Jackson and Thomas L. Hafemeister brought attention to the hybrid abuse that elderly persons can experience. This study revealed that victims of hybrid financial exploitation or HFE lost an average of $185,574, a range of $20–$750,000.[15]

Barriers to obtaining statistics

Several conditions make it hard for researchers to obtain accurate statistics on elder abuse. Researchers may have difficulty obtaining accurate elder abuse statistics for the following reasons:


Doctors, nurses, and other medical personnel can play a vital role in assisting elder abuse victims. Studies have shown that elderly individuals, on average, make 13.9 visits per year to a physician.[33] Although there has been an increase in awareness of elder abuse over the years, physicians tend to only report 2% of elder abuse cases.[13] Reasons for lack of reporting by physicians include a lack of current knowledge concerning state laws on elder abuse, concern about angering the abuser and ruining the relationship with the elderly patient, possible court appearances, lack of cooperation from elderly patients or families, and lack of time and reimbursement.[13] Through education and training on elder abuse, health care professionals can better assist elder abuse victims.

Educating and training those in the criminal justice system, such as police, prosecutors, and the judiciary, on elder abuse, as well as increased legislation to protect elders, will also help to minimize elder abuse and will also provide improved assistance to victims of elder abuse.

In addition, community involvement in responding to elder abuse can contribute to elderly persons' safety. Communities can develop programs that are structured around meeting the needs of elderly persons. For example, several communities throughout the United States have created Financial Abuse Specialist Teams,[34] which are multi-disciplinary groups that consist of public and private professionals who volunteer their time to advise Adult Protective Services (APS), law enforcement, and private attorneys on matters of vulnerable adult financial abuse.[35]

See also


  1. elderabuse.org.uk, accessed October 12, 2007.
  2. Cook-Daniels,L., (2003b, January/February). "2003 is the year elder abuse hits the international state." Victimization of the Elderly and Disabled. 5, 65-66, 76.
  3. Rinkler A.G. (2009). "Recognition and perception of elder abuse by prehospital and hospital-based care providers". Archives of Gerontology and Geriatrics. 48: 110–115.
  4. International Network for the Prevention of Elder Abuse, accessed June 26, 2007.
  5. Robinson, De Benedictis, Segal. "Elder Abuse and Neglect". Help Guide. Retrieved 15 December 2012.
  6. "What is Elder Abuse?". Administration on Aging. Retrieved 17 December 2012.
  7. Nursing Home Abuse Laws (NHAL)
  8. 1 2 Oregon Revised Statutes.
  9. Tina de Benedictis, Ph.D., Jaelline Jaffe, Ph.D., and Jeanne Segal, Ph.D., (2007) Elder Abuse Types, Signs, Symptoms, Causes, and Help. Helpguide, helpguide.org.
  10. Johnson, Christopher, JD. "Elder Abuse: Neglect and Self Abuse", California, 19 February 2015. Retrieved on 25 February 2015.
  11. 1 2 3 4 5 Robinson, Lawrence; Tina De Benedictis; Jeanne Segal (November 2012). "Elder abuse and neglect: Warning signs, risk factors, prevention, and help". Retrieved 16 December 2012.
  12. "Signs and symptoms of elder abuse and neglect in care". Advocare Incorporated. Retrieved 16 December 2012.
  13. 1 2 3 Dong X (2005). "Medical Implications of Elder Abuse and Neglect". Clinics in Geriatric Medicine. 21: 293–313. doi:10.1016/j.cger.2004.10.006.
  14. American Medical Association White Paper on Elderly Health (1990). "report on the Council on Scientific Affairs". Arch Intern Med. 150: 2459–72. doi:10.1001/archinte.1990.00390230019004.
  15. 1 2 Jackson S, Hafemeister T (2012). "Pure financial exploitation vs. Hybrid financial exploitation co-occurring with physical abuse and/or neglect of elderly persons". Psychology Of Violence. 2 (3): 285–296. doi:10.1037/a0027273.
  16. 1 2 Hildreth C.J. (2011). "Elder Abuse". JAMA. 306 (5): 568. doi:10.1001/jama.306.5.568.
  17. "Elder abuse". World Health Organization. Retrieved 2016-11-29.
  18. Cooper C, Selwood A, Livingston G (March 2008). "The prevalence of elder abuse and neglect: a systematic review". Age Ageing. 37 (2): 151–60. doi:10.1093/ageing/afm194. PMID 18349012.
  19. Silent and Invisible: A Report on Abuse and Violence in the Lives of Older Women in British Columbia and Yukon, 2001.
  20. 1 2 Hidden Voices, Action on Elder Abuse, 2005.
  21. Statistics Canada, 1999, 38.
  22. 1 2 Age Concern Elder Abuse and Neglect Prevention Services: An Analysis of Referrals for the period 1 July 2002 to 30 June 2004. Age Concern New Zealand, November 2005.
  23. "Types of Nursing Home Abuse". Retrieved 13 July 2016.
  24. Administration on Aging. (1998). The national elder abuse incidence study: Final report. [Online], Available:www.aoa.gov/abuse/report/default.html
  25. Acierno, R., Hernandex-Tejada, M., Muzzy, W., and Steve, K. (2009). The national elder mistreatment study (NCJ Publication No. 2264560. Washington, DC: U.S. Department of Justice
  26. Bulman P (2010). "Elder abuse emerges form the shadows of public consciousness". NIJ Journal. 265: 4–7. doi:10.1037/e546482010-002.
  27. Klein, A., Tobin, T., Salomon, A., and Dubois, J. (2008). A statewide profile of abuse of older women and the criminal justice response (NCJ Publication No. 222459). Washington, DC: U.S. Department of Justice.
  28. Ayalon, Liat (2009). "Fears come true: the experiences of older care recipients and their family members of live-in foreign home care workers.". International Psychogeriatric. 21 (4): 779–86. doi:10.1017/S1041610209990421. PMID 19538830.
  29. Choi N.G.; Mayer J. (2000). "Elder Abuse, Neglect, and Exploitation". Journal of Gerontological Social Work. 33 (4): 5–25. doi:10.1300/J083v33n02_02.
  30. Laumann E.O.; Leitsch S.A.; Waite L.J. (2008). "Elder mistreatment in the United States: Prevalence estimate from a nationally representative study". Journals of Gerontology: Series B, Psychological Sciences and Social Sciences. 63 (4): S248–S254. doi:10.1093/geronb/63.4.s248.
  31. Ayalon, Liat (2011). "Abuse is in the eyes of the beholder: using multiple perspectives to evaluate elder mistreatment under round-the-clock foreign home carers in Israel". Ageing and Society. 31 (3): 499–520. doi:10.1017/S0144686X1000108X.
  32. Brownell, P., & Rosich, G. (2007). Elder abuse. In J. Blackburn & C. Dulmus (Eds.), Handbook of gerontologyUnited States of America: John Wiley & Sons, Inc.
  33. Federal Interagency Forum on Aging-Related Statistics. Older Americans 2008: Key indicators of well-being. Federal Interagency Forum on Aging-Related Statistics, Washington, DC: Government Printing Office, March 2008.
  34. http://www.coaoc.org/html/services_fast_description.htm
  35. Council on Aging Orange County, http://www.coaoc.org/html/services_fast_description.htm

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