Experts suggest that domestic elder abuse is perhaps the most underreported crime.

The U.S. Administration on Aging reports that there are 43 million Americans over the age of 60, and 3 million who are 85 or older. Due to improved health and standards of living, it is predicted that by the year 2030, more than 85 million Americans will be over 60 and more than 8 million will be over the age of 85 (Administration on Aging, 2001). While other issues affecting the elderly, such as retirement security and affordable long-term care, have received national attention, the abuse and neglect of the elderly has historically been ignored (National Center on Elder Abuse, 2001). Elder abuse has traditionally been associated with street crimes, abuse in nursing homes, and financial fraud (Quinn & Tomita, 1997). Only recently has elder abuse by family members and intimates attracted scholarly attention, public outrage, and public funding for prevention and education.

Experts suggest that domestic elder abuse is perhaps the most underreported crime. Older adults may be especially reluctant to report abuse because they are ashamed to admit that their spouse or children have mistreated them, fear retaliation, or dread being institutionalized if they are removed from the care of the abuser (Payne, 2000, Quinn & Tomita, 1997). In addition, cognitive and physical impairments may make it impossible for some elderly individuals to report their abuse. Unlike children who must attend school, abused elders may remain isolated in their homes.

Elder abuse has been particularly difficult to define. There is considerable disagreement over what constitutes abuse and the age at which one becomes elderly. Some experts believe the term elder abuse should be limited to physical or psychological abuse of impaired and dependent seniors; others believe that failure to provide appropriate care also constitutes abuse. The National Center on Elder Abuse (2001) defines domestic elder abuse as "any of several forms of maltreatment of an older person by someone who has a special relation with the elder (e.g., a spouse, a sibling, a child, a friend, or a caregiver in the older person’s home or in the home of the caregiver)" ( p. 1). Elder abuse includes physical abuse, sexual abuse, emotional or psychological abuse, neglect, abandonment, and financial or material exploitation. As with child abuse, legal definitions of elder abuse vary from state to state.

Scope

The National Elder Abuse Incidence Study (NEAIS), conducted by the National Center on Elder Abuse, collected data on domestic elder abuse, neglect, and self-neglect through a nationally representative sample of 20 counties in 15 states (National Center on Elder Abuse, 1998). Data were collected from local Adult Protective Services agencies and from professionals in community agencies who had frequent contact with the elderly. The methodology was designed to be consistent with the National Incidence Studies conducted by the National Center on Child Abuse and Neglect. Based on the NEAIS findings and U. S. Census data, it is estimated that a total of 449,924 persons aged 60 and over experienced abuse and/or neglect in domestic settings in 1996. 70,942 of these cases (16 %) were reported to and substantiated by APS agencies; 378,982 (84%) were not. The researchers also found that females are abused more frequently than males, and that elders over 80 are at the greatest risk for abuse and neglect. In 90 % of the incidents of elder abuse and neglect by a known perpetrator, the perpetrator is a family member; two-thirds of the perpetrators are adult children or spouses.

Pillemer and Finkelhor (1988) conducted a large scale, random sample telephone survey of elder abuse and neglect. They interviewed 2,020 Boston area residents over the age of 65 and found that 3.2 % (N = 63) of the respondents reported being maltreated. Forty respondents (2 %) had experienced physical abuse, 26 (1.1 %) chronic verbal aggression, and 7 (0.4 %) neglect. Thirty-five of the perpetrators were spouses, 10 were sons, 5 were daughters, and 11 were other persons (e.g, grandchildren, siblings.) On the basis of these survey findings, the authors estimate that only 1 in 14 cases of elder abuse is reported to the authorities.

History

Elder abuse first came to public attention in the 1960s when it was discussed in British medical journals under the misguided label of "granny bashing." In 1979, The Battered Elder Syndrome was published by Block and Sinnot (1979), bringing the problem of elder abuse to the attention of health professionals and human service scholars.

In the late 1960s, the U. S. Department of Social and Rehabilitation Services began funding National Protective Services. The first congressional hearing on elder abuse was held in 1979 by the House Select Committee on Aging. In 1981, the National Center for Adult Abuse was established. By 1982, every state developed an adult protection program and 42 states had adopted a mandatory elder abuse reporting law (Payne, 2000).

In 1987, amendments to the Older Americans Act (OAA) mandated that states provide outreach services to identify elder abuse cases, devise procedures to process elder abuse reports, and conduct public education. Title VII, a subsequent amendment to the OAA, included provisions for long term care ombudsmen, legal assistance, and services to prevent abuse. Through Title IV of the OAA, the Administration on Aging (AoA) provided funding for research and service delivery projects. The AoA also funded a national resource center and a national survey on the incidence of elder abuse, neglect, and exploitation (Nerenberg, 1997). Several national advocacy groups, such as the American Association of Retired Persons, the Older Woman’s League, and the National Organization of Women, have held forums, assembled committees, and organized congressional hearings to address the problem of elder abuse. Recently, health-care system and community-based services for abused and neglected elders have begun to be developed (Barnett et al., 1997; Vinton, 2001).

Health Consequences

Like other forms of domestic violence, elder abuse is associated with a myriad of physical consequences. Quinn and Tomita (1997) listed a number of physical effects that are indicators of elder abuse, including scratches, cuts, and bruises; sprains and dislocations; pressure sores, fractures, and detached retinas. Signs and symptoms of possible sexual abuse include genital or urinary irritation, injury or scarring, and intense fear in reaction to an invasive pelvic procedure. Signs and symptoms of possible physical neglect include poor hygiene (body odor, matted hair, unexplained rashes), hypothermia, untreated sores, failure to thrive, malnutrition and dehydration. The psychological consequences of elder abuse have not been systematically researched.

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