Elder Abuse

Definitions and Prevalence

Early attempts to compile statistics on elder abuse suffered from a lack of consistency in definition. While there is still some disagreement among the various interested professional groups, a generally accepted definition of elder abuse now exists. Elder abuse is the umbrella term used to refer to any act that causes harm or risk of harm to a vulnerable adult. The acts can occur to elders living in domestic settings (private homes, apartments, etc.) and to elders in institutional or residential facilities. Regardless of site, six different types of abuse have been identified. For all types, acts are considered abuse whether they are intentional or not and whether they include verbal or nonverbal behavior. Physical abuse includes inflicting pain or injury or depriving a basic need. Sexual abuse includes nonconsensual sexual contact of any kind. Emotional or psychological abuse is the infliction of emotional anguish or distress. Financial or material exploitation involves funds, property, and assets. Neglect is the loss of food, shelter, health care, or protection and is the most common type in domestic settings. Self-neglect is any act by the elder himself or herself that threatens health or safety. Finally, abandonment is the desertion of an elder by anyone who has assumed responsibility for care.

An accurate picture of the incidence and prevalence of elder abuse is elusive for a number of reasons. First, not all states use the preceding definitions. Second, there are no uniform reporting standards or systems. This has prevented the collection of comprehensive national data. Third, only a portion of elder abuse cases is ever reported. Vulnerable elders are even less able or willing, and thus less likely, than are victims of other domestic abuse to report abuse or neglect. Current estimates suggest that only 1 out of every 5 cases in all settings is reported and only 1 in every 14 cases in domestic settings. Consequently, statistics suffer from underreporting. The National Center on Elder Abuse estimates that between 1 and 2 million Americans aged 65 and over, a frequency of 2% to 10%, have been injured, exploited, or otherwise mistreated. Specific [Page 250]studies indicated that in 1996, nearly 450,000 adults aged 65 and over were abused and/or neglected in domestic settings, and in 2003, the Long Term Care Ombudsmen programs reported 20,673 complaints from institutional residents. A survey of State Adult Protective Services (the agencies responsible for collecting and investigating reports of elder abuse) by the Administration on Aging, in 2004, found an increase of 19.7% in reports from 2000 to 2004 and an increase of 15.6% in substantiated cases. In considering these data, it should be remembered that the population of elders and of vulnerable elders is increasing. Furthermore, improvements in reporting and investigating may also underlie some of the increase in the number of cases reported and certainly in the substantiation of those cases. As evidence for this, states with mandatory reporting and tracking have higher rates of investigation.

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