Why do some people
hurt family members and/or those they provide care for?
How the problem is defined determines where resources are
committed for services and interventions. Practitioners
who believe stress is the primary cause of abuse will focus
on stress reduction methods. Workers who think abuse is
part of poor family dynamics will create strategies to improve
communication. Those who believe that an imbalance of power
and control are central to abuse will work on empowerment
strategies and methods that hold abusers accountable. This
paper will review research that asks the question: why
do perpetrators abuse?
This series of papers
defines domestic abuse in later life as male and female
victims, age 50 and older, abused by someone in a trusted,
ongoing relationship like a spouse/partner, family member,
or caregiver. The victims lived primarily in the community,
not institutions (e.g., nursing homes). Studies from the
United States and Canada were included.
ARTICLES REVIEWED
Thirteen articles published between 1988 and 2000 were
reviewed for this article.
| Author(s)Pub.
Date |
Sample
size and demographics |
Type(s)
of abuse covered |
Selected
finding(s)
(page number/s in parentheses) |
| Phillips, et
al
2000 |
93 cases of
women aged 55+ caring for dependent spouse or other
elder family member |
Verbal and
physical abuse; being threatened by or having gun
or knife used on them - all by the elder for whom
they were caring. |
·
"Other investigators.have suggested
an important reason for abuse of caregivers is cognitive
impairment of the elder. These data do not support
that assertion." (138) |
| Reis and Nahmiash
1998 |
341 cases
of elders (aged 55+) being cared for by unpaid family/friends,
in Montreal, Canada. Abuse was assessed as "likely"
in 69 cases; "not likely" in 272 cases |
Physical,
psycho-social, and financial abuse; both passive and
active neglect |
·
"[T]he caregiver stress theory of abuse
is not supported by the findings of this study. Nor
does caregiver burden consequent to increased impairment
or need for ADL [activities of daily living] assistance
signal abuse." (478) |
| Lachs, et al
1997 (a) |
2,812 adults
65 and older from a stratified community sample in
CT; 47 were substantiated cases |
Physical abuse,
neglect, exploitation |
·
Depression, urinary incontinence, and
prevalence of chronic disease were all NOT associated
with abuse. (472) |
| Reis and Nahmiash
1997 |
6 groups from
Montreal, Canada were compared: a family caregiver
group (total caregivers 136) and a care receiver (age
55+) group (total care receivers 128) for confirmed
abuse cases receiving services; confirmed nonabuse
cases receiving services; and confirmed nonabuse cases
not receiving services. |
Physical,
psycho-social, and financial abuse; both passive and
active neglect |
·
"Caregiver stress does not distinguish
abusers and non-abusers who receive agency assistance..Greater
caregiver stress is.directly connected with needing
help and being an agency client, but not with abuse.
Stress is only linked with abuse indirectly, through
greater caregiver depression.." (351)
·
"Abused care receivers are no more
disagreeable or more neurotic than care receivers
who are not abused." (351) |
| Wolf and Pillemer
1997 |
73 abused
women aged 60+ from 4 US cities. 22 were abused by
husband, 51 by children (review of written case assessment
data) |
Physical and
psychological abuse, neglect, financial exploitation |
·
76.6% of adult child abusers were somewhat
to entirely financially dependent on abused mother.
(331)
·
64.6% of adult child abusers were somewhat
to entirely dependent on abused mother for housing.
(331) |
| Harris
1996 |
5168 couples
19+ from the 1985 U.S. Family Violence Resurvey, separated
into under 60 (4476) and 60+ (842); violence in the
past year was reported by 819 couples aged 19-59 and
49 couples 60+ |
Physical violence |
·
"Spouse abuse over 60 is not significantly
different from spouse abuse in the under 60 population."
(24)
·
There was a significant positive relationship
between perceived stress and couple violence and the
depression index and couple violence in both older
and younger groups. (19)
·
"Nine of the 17 risk factors included
in this study were significantly related to couple
violence in the over 60 subsample...education, racial/ethnic
group, family income, verbal aggression, drug abuse,
reasoning, depression, perceived stress, and marital
conflict." (19) |
| Seaver
1996 |
132 women
aged 50+ who have attended older abused women's program
in Milwaukee, WI |
Unspecified |
·
Eleven of the husbands (14%) were dependent
on the women for caregiving. (15)
·
35 (66%) of the adult children were
financially dependent on their mothers. (15) |
| Korbin et al
1995 |
23 adult offspring
abusers of elders (age 60+); 21 parent abusers of
children (age 2-5) in Ohio |
Physical abuse |
·
Approximately 1/4 of elder abusing
adult offspring were subjected to abusive behaviors
by their parents. (7)
·
"These results suggest that while intergenerational
transmission of family violence is not an inevitable
process, it is a more useful construct for explaining
violence towards children than violence towards elder
parents." (1) |
| Podnieks 1992
(b) |
42 elder abuse
victims in Canada identified through Podnieks, 1992(a)
study |
Physical and
psychological abuse, neglect and financial exploitation
|
·
"Victims revealed that their own parents
had used physical force to ensure compliance when
they were growing up. Victims also reported violence
between their parents and siblings. Social learning
model would appear to be a relevant theory." (104) |
| Brown
1989 |
Random sample
of 37 Southwest reservation-dwelling Navajo aged
60+, and their family members; 22 cases of elder abuse
found |
Neglect, verbal/
psychological and physical abuse, and financial exploitation |
·
The more the elder perceived as dependent
by family, the more frequent neglect. (26)
·
Daily hours of help needed were not
related to abuse. (26)
·
The fewer hours of family care provided,
the greater the likelihood of neglect. (29)
·
The greater the number of hours of
family care provided, the greater the likelihood of
physical abuse and exploitation. (29)
·
Sharing caregiver responsibilities
raised risk of abuse. (30) |
| Godkin, et
al
1989 |
59 abused
elders (60 years and older) compared to 49 non-abused
elders, both served by a Massachusetts home care program |
Physical,
psychological, and material abuse; active and passive
neglect by a caregiver |
·
"[M]embers of abusive families are
more likely to have emotional problems which contribute
to interpersonal difficulties. Abused elders are
not more dependent on caregivers for many of their
daily needs. However, the abused elderly and their
caregivers have become increasingly interdependent
prior to the onset of abuse because of the loss of
other family members, increased social isolation,
and the increased financial dependency of the perpetrator
on the elderly person." (207)
·
"There were no significant differences
between abused/neglected elderly with respect to the
numbers of impairments requiring attention, nor the
numbers of prescribed medications. A significant
percentage of the maltreated elderly was reported
to have experienced a recent decline in physical health
(81.4%) in contrast to about one-fifth (21.3%) of
the non-victimized elders." (213)
·
"The relationship between elders and
caregivers was considered 'poor' in 77.2% of the [abuse]
cases and 4.8% of the controls." (217)
·
"Caregivers were said to have unrealistic
expectations of their elderly counterparts in 67.9%
of the abuse/neglect situations. Unrealistic expectations
were reported at a rate of 5.6% in the comparison
group." (217)
·
"An analysis of the data indicates
that all four factors under study play a role in cases
of elderly abuse/neglect: the characteristics of the
elder and caregiver, dependency and exchange relationships,
external stresses, and social isolation." (219)
·
".it appears that both abused elders
and the abusers experience emotional problems which
contribute to interpersonal difficulties in their
relationship." (223) |
| Pillemer and
Finkelhor 1989 |
Random sample
of 2020 community dwelling people aged 65+ in Boston,
MA; 46 abused elders were reinterviewed and compared
to 215 controls |
Physical assault;
psychological abuse; or neglect |
·
"Elder abuse results NOT from the increased
needs of victim but from the deviance and dependence
of abusers." (186)
·
"Overall, the items which distinguished
the abused group were those pertaining to the abuser
and his/her behavior and circumstances, and not items
pertaining to the victim." (183/186) |
| Pillemer and
Finkelhor 1988 |
Random sample
of 2020 community dwelling people aged 65+ in Boston,
MA; 46 abused elders were reinterviewed and compared
to 215 controls |
Physical assault;
psychological abuse; or neglect |
·
The findings of this study suggest
"a fundamental reformation of the problem of elder
maltreatment is necessary. In the past, elder abuse
was described primarily in analogy with child abuse.
The present study suggests that elder abuse has much
more in common with spouse abuse than child abuse."
(55) |
GENERALIZED FINDINGS
The popular notion that abuse in later life is the result
of a frail, dependent elderly person being abused by a stressed
caregiver is not supported by the research (Phillips,
2000; Reis, 1998 and 1997; Godkin, 1989; Pillemer 1989 and
1988). Only two studies suggested a possible correlation
between stress of caregiving and abuse (Harris, 1996; Brown,
1989). In many cases the abuser is dependent on the victim
in some way (Wolf and Pillemer, 1997; Seaver, 1996; Godkin,
1989; Pillemer 1989). Some studies found the dynamics of
abuse in later life to be similar to those experienced by
younger battered women (Harris, 1996; Pillemer, 1988).
Intergenerational abuse is often considered as a possible
cause of family violence in later life. This theory postulates
that adults who were abused as children may retaliate against
their aging parents. Currently not enough research exists
to support or rule out this theory. Two studies indicate
that intergenerational transmission of violence is not an
inevitable process but may be a factor in some cases (Korbin,
1995; Podnieks, 1992b).
Some research indicates that a significant portion of abusers
of elders suffer impairments such as substance abuse, mental
illness or cognitive impairment. For an examination of
this research, see the paper in this series on abusers (add
link).
LIMITATIONS OF STUDIES
Numerous limitations in the research on abuse in later
life were found. In part because of the lack of financial
resources, only a few studies have been large (more than
1,000 respondents) random sample studies (Lachs 1997a; Podnieks,
1992a; Pillemer, 1988). Even these large studies ultimately
based their conclusions on relatively small numbers of abuse
victims, ranging from 47 to 80. Only one of the random
sample studies included cognitively impaired elders (achieved
by interviewing other family members), but using the reports
of proxies is considered unreliable (The Robert Wood Johnson
Foundation, 2001).
All the other studies had serious sampling biases because
they were based on elders who were using services of some
sort and/or were known to adult protective services or domestic
violence programs. This is problematic, because it is clear
that many abused elders are isolated and do not come to
the attention of professionals or seek help. With one exception
(Otiniano, 1998), these studies also involved relatively
small samples - 10 to 401, with the majority being under
100. Respecting the confidentiality and safety of victims
creates problems with many scientific methods. Very few
studies used control groups.
In addition, some elders deny that
what they are experiencing is abuse (see, for example, Phillips,
2000), introducing another source of underreporting. Perhaps
more importantly, studies have shown that elders' definitions
of abuse do not always correspond to professionals' definitions,
which may confound findings.
Comparing results across studies is practically impossible.
These studies varied widely in: the types of abuse studied,
the specific definitions of the types of abuse studied;
whether abuse was self-reported or from agency records;
the age of respondents (which ranged all the way down to
40); whether the target audience was predominately healthy
elders or vulnerable adults; and whether only women or men
and women were included.
POTENTIAL IMPLICATIONS
Despite the lack of supporting research, many people still
believe caregiver stress is the primary cause of elder abuse.
Professionals and policy makers who focus on caregiver stress
as the primary cause of elder abuse will make the following
fundamental errors:
Since domestic violence professionals and researchers understand
the dynamics of power and control from their experience
working with younger victims, it is critical that domestic
violence and elder abuse work collaboratively to create
safety, support and services for older victims.
Authors
Bonnie Brandl, M.S.W.
Project Coordinator
National Clearinghouse on Abuse in Later Life/WI Coalition
Against Domestic Violence
(608) 255-0539
bonnieb@wcadv.org
Loree Cook-Daniels
Consultant
National Center on Elder Abuse
(202) 898-2586
Loree@WordBridges.net
September 2002
ADDITIONAL RESOURCES
Bergeron, R. (2001) An Elder Abuse Case Study: Caregiver
Stress or Domestic Violence? You Decide. Journal of
Gerontological Social Work, Vol. 3, No. 4. [CANE File
No. L4499-9]*
Brandl, B. (2000) Power and Control: Understanding Domestic
Abuse in Later Life. Generations. Vol. XXIV, No.
II, 39 - 45. [CANE File No. N4554-7]*
Vinton, L. (1991) Abused Older Women: Battered Women or
Abused Elders? Journal of Women & Aging. Vol.
3, No. 3. [CANE File No. H3430-15]*
Wolf, R. (2000) The Nature and Scope of Elder Abuse. Generations.
Vol. XXIV, No. II, 6 - 12. [CANE File No. L4541-6]*
For a list of research questions on elder abuse and domestic
abuse in later life, go to http://www.elderabusecenter.org/research/agenda.html.
For other articles in this series, see:
·
Abusers
www.WordBridges.net/ElderAbuse/Research/2002-09-03R.html
(html) or
www.WordBridges.net/ElderAbuse/Research/2002-09-03R.pdf
(Adobe Acrobat format)
·
Culture
www.WordBridges.net/ElderAbuse/Research/2002-09-05R.html
(html) or
www.WordBridges.net/ElderAbuse/Research/2002-09-05R.pdf
(Adobe Acrobat format)
·
Prevalence and incidence
www.WordBridges.net/ElderAbuse/Research/2002-09-06R.html
(html) or
www.WordBridges.net/ElderAbuse/Research/2002-09-06R.pdf
(Adobe Acrobat format)
·
Relationships
www.WordBridges.net/ElderAbuse/Research/2002-09-07R.html
(html) or
www.WordBridges.net/ElderAbuse/Research/2002-09-07R.pdf
(Adobe Acrobat format)
·
Services and interventions
www.WordBridges.net/ElderAbuse/Research/2002-09-08R.html
(html) or
www.WordBridges.net/ElderAbuse/Research/2002-09-08R.pdf
(Adobe Acrobat format)
·
Types of abuse (includes
sexual assault and homicide/suicide)
www.WordBridges.net/ElderAbuse/Research/2002-09-09R.html
(html) or
www.WordBridges.net/ElderAbuse/Research/2002-09-09R.pdf
(Adobe Acrobat format)
·
Victims
www.WordBridges.net/ElderAbuse/Research/2002-09-10R.html
(html) or
www.WordBridges.net/ElderAbuse/Research/2002-09-10R.pdf
(Adobe Acrobat format)
BIBLIOGRAPHY
Brown, A. (1989). A Survey on Elder Abuse at One Native
American Tribe. Journal of Elder Abuse & Neglect,
Vol. 1, No. 2, 17 - 37. [CANE File No. G3232-11]*
Godkin, M., Wolf, R., and Pillemer, K. (1989). A Case-Comparison
Analysis of Elder Abuse and Neglect. International Journal
of Aging and Human Development, 28(3): 207-225. [CANE
File No. E2730-10]*
Harris, S. (1996). For Better or for Worse: Spouse Abuse
Grown Old. Journal of Elder Abuse & Neglect.
Vol. 8, No. 1, 1-33. [CANE File No. J4081-17]*
Korbin J. et al. (1995). The Intergenerational Cycle of
Violence in Child and Elder Abuse. Journal of Elder
Abuse & Neglect. Vol. 7, No. 1, 1-15. [CANE
File No. K4187-8]*
Lachs, M. et al. (1997a). ED Use by Older Victims of Family
Violence. Annals of Emergency Medicine, 30:4, 448
- 454. [CANE File No. L4406-7]*
Phillips, L. et al. (2000). Abuse of Female Caregivers
by Care Recipients: Another Form of Elder Abuse. Journal
of Elder Abuse & Neglect, Vol. 12. No. 3/4, 123
- 144. [CANE File No. L4431-21]*
Pillemer, K. and D. Finkelhor. (1989). Causes of Elder
Abuse: Caregiver Stress Versus Problem Relatives. American
Journal of Orthopsychiatry, Vol. 59, No. 2, 179-187.
[CANE File No. E2641-9]*
Pillemer, K. and D. Finkelhor. (1988). The Prevalence
of Elder Abuse: A Random Sample Survey. Gerontologist,
Vol. 28, No. 1, 51-57. [CANE File No. C2155-7]*
Podnieks, E. (1992b). Emerging Themes from a Follow-up
Study of Canadian Victims of Elder Abuse. Journal of
Elder Abuse & Neglect. Vol. 4, No. 1/2, 59 - 111.
[CANE File No. H3384-27]*
Reis, M. and D. Nahmiash. (1998). Validation of the Indicators
of Abuse (IOA) Screen. The Gerontologist, Vol.
38, No. 4, 471 - 480. [CANE File No. A44-10]*
Reis, M. and D. Nahmiash. (1997). Abuse of Seniors:
Personality, Stress, and Other Indicators. Journal of
Mental Health and Aging, Vol. 3, No. 3, 337 - 356.
[CANE File No. K4273-20]*
Robert Wood Johnson Foundation. (2001). Designing
Effective Survey Methods for Frail Elders: Symposium Proceedings.
[CANE File No. N4889-34]*
Seaver, C. (1996). Muted Lives: Older Battered Women.
Journal of Elder Abuse & Neglect. Vol.
8, No. 2, 3-21. [CANE File No. N4761-10]*
Wolf, R. and K. Pillemer. (1997). The Older Battered
Woman: Wives and Mothers Compared. Journal of Mental
Health and Aging. Vol. 3, No. 3, 325 - 336.
[CANE File No. J4067-12]*
*CANE - The Clearinghouse on Abuse and
Neglect of the Elderly - is the nation's largest computerized
collection of elder abuse resources and materials. Single
copies of articles in its holdings can be ordered from CANE
for $.20 per page. The digits following the hyphen in the
file number indicate how many pages the article has.
CANE
Department of Consumer Studies
University of Delaware
Newark, DE 19716.
Please note that a check made out to CANE-UD must accompany
your order. For further information on ordering materials
or conducting a customized search of the database, contact
CANE at (302) 831-3525, or at CANE-UD@udel.edu.
