Definitions, Types of Elder Mistreatment, Related Harms, and Prevalence

Definitions

Though there is increasing consensus on the core components of elder mistreatment, the field has not adopted a universally accepted definition of abuse.¹ Several reasons have been suggested for the lack of uniformity. Different professional disciplines, each with their own objectives, interests, and perspectives may use distinct approaches to classify elder abuse.

Conceptual understandings may also vary based on differing cultural and social norms among communities. Perceptions may derive from numerous factors including faith, family, circumstances, context, and community, resulting in diverse descriptions of, and responses to, mistreatment. Notably, in the United States legal definitions of abuse vary by state statute. Internationally, definitional variability is observed both between and within countries.² A lack of consistency in definitions and data elements on elder mistreatment across jurisdictions makes it challenging for researchers to measure elder mistreatment and identify trends.³

Notwithstanding deficits in classification, the following definitions are commonly cited by researchers in their studies on elder mistreatment.

According to the Centers for Disease Control and Prevention, “Elder abuse is an intentional act or failure to act that causes or creates a risk of harm to an older adult. An older adult is someone age 60 or older. The abuse often occurs at the hands of a caregiver or a person the elder trusts.”⁴

The World Health Organization states that “Elder abuse can be defined as ‘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.’ Elder abuse can take various forms such as financial, physical, psychological, and sexual. It can also be the result of intentional or unintentional neglect.”⁵

The National Research Council describes elder abuse as “(a) intentional actions that cause harm or create a serious risk of harm to a vulnerable elder by a caregiver or other person who stands in a trust relationship to the elder, or (b) failure by a caregiver to satisfy the elder’s basic needs or to protect the elder from harm.”⁶

Types of Elder
Mistreatment

Elder mistreatment typically takes one of five forms: physical abuse, psychological or emotional abuse, sexual abuse, financial abuse, and neglect.⁷ As with the broader definition of elder mistreatment, understandings of specific types of mistreatment may vary. They are often impacted and informed by socio-cultural orientations and may be differently construed by different constituencies and individuals.

Physical Abuse:

the intentional use of physical force or physical coercion that may result in bodily injury, physical pain, or impairment. Acts of physical violence include, but are not limited to, hitting, beating, pushing, shoving, shaking, slapping, kicking, pinching, and burning. Physical abuse also embraces any unlawful, excessive, or unnecessary use of physical or chemical means to restrain or confine an elder, such as force-feeding and physical punishment.⁸ ⁹

Sexual Abuse:

non-consensual sexual contact of any kind with an older adult, perpetrated through force, threats, or the exploitation of authority. Sexual abuse includes, but is not limited to, unwanted touching, sexual assault or battery, sexual harassment, and sexual interaction with elders who lack the capacity to give consent.¹⁰ ¹¹

Emotional or Psychological Abuse:

the infliction of anguish, pain, or distress through verbal or nonverbal acts including, but not limited to, verbal assaults, insults, threats, intimidation, humiliation, isolation, and harassment.¹² ¹³

Financial Abuse:

the illegal or improper use of an elder’s funds, property, or assets including, but not limited to, misusing or stealing an older person’s money or possessions, coercing or deceiving an older person into signing any document (e.g., contracts or will), and the improper use of conservatorship, guardianship, or power of attorney.¹⁴

Neglect:

the refusal or failure to fulfill any part of a person’s obligations or duties of care to an elder which include, but are not limited to, life necessities such as food, water, clothing, shelter, personal hygiene, medicine, comfort, and personal safety.¹⁵

Related Harms

There are certain conditions that are not considered traditional forms of abuse, but are related concepts and may cause or create significant harm.

Self-neglect

is a phenomenon related to but distinct from elder neglect.¹⁶ Self-neglect is a form of self-harm that may co-occur with, provoke, or be triggered by elder mistreatment. It is characterized as the behavior of an older person that threatens their own health or safety, including but not limited to the refusal or failure to provide themselves with life necessities.¹⁷ Self-neglect is the most frequently reported form of mistreatment referred to Adult Protective Services, with the highest rate of recurrence. The estimated prevalence of self-neglect among community-dwelling older adults ranges from 18.4% to 29.1%,¹⁸ though it is believed to be underrecognized and underreported.

Abandonment

is oftentimes considered a subtype of neglect and other times believed to constitute a separate category of mistreatment.¹⁹ By definition, it is the desertion of an older adult by an individual who has physical custody of an elder, or who has assumed responsibility for providing care for that elder.

Elder Financial  Frauds and Scams

Elder frauds and scams are typically perpetrated by strangers, compared with elder financial abuse committed by trusted others.²⁰ Monetary losses can be significant, resulting in medical and mental health impairments, eviction, poverty, and homelessness. Economic costs may also be accompanied by emotional and psychological injury, including a loss of independence, stability, and social connection in elderhood.²¹

Financial crimes are frequently unreported, unrecognized, and unaddressed. It is estimated that only 1 in 44 cases of exploitation receives formal supportive services.²² Older victims may be reluctant to reveal harms because of shame and embarrassment, concerns that a complaint will result in loss of independence and autonomy, fears of retaliation by the offender, or the cognitive inability to recognize, discover, and communicate abuse to authorities.

Research shows that older adults with cognitive decline or impairments are at a higher risk of being financially exploited.²³ A study on financial decision making found that nearly two-thirds of older adults who were involved in a scam and were investigated by Adult Protective Services were rated as having decision-making deficits.²⁴ New evidence also suggests certain neuropsychological factors may indicate vulnerability to financial exploitation. A study on older adults without dementia found that individuals at higher risk for financial exploitation demonstrated worse verbal memory, confrontation naming, phonemic fluency, and set shifting.²⁵

Studies indicate the possibility that vulnerability to financial exploitation could be an early behavioral manifestation of preclinical Alzheimer’s disease. Longitudinal cohort studies with measures of both vulnerability to financial exploitation and Alzheimer’s disease pathology are needed to enhance understanding of the temporal relationship between neuropathology and financial exploitation vulnerability.²⁶

Prevalence of Abuse

Incidence and prevalence rates of mistreatment are informed by the core definitions, inclusion criteria, theoretical basis, and methodology utilized by respective researchers to guide the collection of data.²⁷ As a result, prevalence estimates of abuse, as reflected in recent studies, are variable.

Abuse in the Community

Studies have found that at least one in 10 community-dwelling older adults experienced some form of abuse in the prior year.²⁸ ²⁹ Global estimates from a recent meta-analysis reflect that one in six elders, or 15.7%, in the community experienced past year abuse.³⁰

Prevalence rates by type of abuse differ across studies. One study, relying on self-reports of abuse, assigned the following percentages by type of abuse: psychological (11.6%), physical (2.6%), financial (6.8%), neglect (4.2%), and sexual (0.9%) abuse.³¹ Another recent study found the following: emotional (4.6%), physical (1.6%), financial (family: 5.2%), financial (stranger: 6.5%), neglect (5.1%), and sexual (.6%).³²

A recent meta-analysis assessing the global prevalence rates of the abuse of older women found that one in six experienced abuse in the prior year. By type, the pooled prevalence rates reflected the following percentages: psychological abuse (11.8%), physical abuse (1.9%), financial abuse (3.8%), neglect (4.1%), and sexual abuse (2.2%).³³

A systematic review and meta-analysis of the prevalence of elder abuse and neglect in rural areas around the globe found that at least three out of ten older persons in rural areas have experienced abuse and neglect, which is higher than current global estimates of elder abuse. Neglect was the most common (26%), followed by psychological or emotional abuse (17%), physical abuse (7%), and financial abuse (5%), while sexual abuse was rarely reported.³⁴

Findings from the 2016/2017 National Intimate Partner and Sexual Violence Survey (NISVS) revealed an estimated 1.4 million adults in the U.S. aged 60 years or older experienced at least one incident of psychological aggression by an intimate partner in the past 12 months and over half a million experienced past-year intimate partner physical violence. An estimated 1.1 million older adults experienced sexual violence by any perpetrator in the past year.³⁵

Abuse in Institutions

Few studies have investigated the prevalence of mistreatment within institutions, in particular residents’ experiences of abuse in residential care settings.³⁶ Studies that have been conducted have provided wide-ranging, sometimes disparate estimates. A recent systematic review that collected staff self-reports of abuse of residents found high levels of institutional abuse. By type, prevalence estimates reported: psychological abuse (33.4%), physical (14.1%), financial (13.8%), neglect (11.6%), and sexual abuse (1.9%).³⁷

Note: A study of 100 nursing homes in 30 states found that approximately 240 residents experienced fear of retaliation when voicing care concerns and making complaints related to rights violations and mistreatment. In some cases, residents’ cognitive disability due to dementia prevented them from reporting their concerns. Many issues were not reported, delaying or inhibiting investigation³⁸

NCEA Technical Assistance Data

In a study examining the types of elder abuse reported to the National Center on Elder Abuse’s resource line, researchers found that financial abuse was the most commonly reported form of mistreatment. Allegations of physical abuse were most likely to co-occur with another type of abuse. Family members were the most often identified offenders.³⁹

Note: Studies have recognized that projections of abuse likely underestimate the actual population prevalence.⁴⁰ For every incident of abuse reported to authorities, nearly 24 additional cases remain undetected.⁴¹ Underreports may be caused by a number of factors including an older person’s fear of retaliation by the offender, reluctance to disclose the incident because of shame or embarrassment, concern they will be institutionalized, dependency on the offender, and an inability to report because of physical limitations or cognitive impairments.⁴²

Research, Statistics, and Data Signs, Risk Factors, Ageism, and Impacts of Mistreatment

References

¹ Storey, J. E. (2020). Risk factors for elder abuse and neglect: A review of the literature. Aggression and violent behavior, 50, 101339.
² Wallace, R. B., & Crabb, V. L. (2017). Toward definitions of elder mistreatment. Elder Abuse, 3-20.
³ Carney, A. (2020). Epidemiology of elder abuse and neglect. Elder Abuse, 1-17.
⁴ Centers for Disease Control and Prevention, (2020, May). Violence prevention: Preventing elder abuse. Retrieved from https://www.cdc.gov/violenceprevention/elderabuse/fastfact.html
⁵ World Health Organization. (2020). Ageing and life-course: Elder Abuse. Retrieved from https://www.who.int/ageing/projects/elder_abuse/en/
⁶ National Research Council. (2003). Elder mistreatment: Abuse, neglect, and exploitation in an aging America. Panel to Review Risk and Prevalence of Elder Abuse and Neglect. Committee on National Statistics and Committee on Law and Justice, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.
⁷ Storey, J. E. (2020). Risk factors for elder abuse and neglect: A review of the literature. Aggression and violent behavior, 50, 101339.
⁸ Wallace, R. B., & Crabb, V. L. (2017). Toward definitions of elder mistreatment. Elder Abuse, 3-20.
⁹ Storey, J. E. (2020). Risk factors for elder abuse and neglect: A review of the literature. Aggression and violent behavior, 50, 101339.
¹⁰ Wallace, R. B., & Crabb, V. L. (2017). Toward definitions of elder mistreatment. Elder Abuse, 3-20.
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