How many older people are being abused? What percentage
of older people has been abused, neglected, battered or
sexually assaulted in their lifetime (prevalence)? How
many are abused each year (incidence)?
Understanding how many victims have been harmed or are
currently being hurt is critical to practitioners and funders
who are designing services and interventions. This paper
will examine research that focuses on prevalence (extent
of the problem) and incidence (rate of occurrence) of domestic
abuse in later life.
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
Ten articles published between 1988 and 1999 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) |
| Hudson and
Carlson
1999 (a) |
424 Caucasians,
318 African Americans, and 202 Native Americans aged
40+ (mean age 62) residing in six N. Carolina counties |
Elder abuse
(not including neglect) |
·
7.5% of 452 answering had been abused
since turning 65. (195)
·
19.1% of the 930 who answered said
they had been abused at some time in their lives.
(195)
·
6.2% of 917 answering said they had
abused an elder. (195) |
| Hudson, et
al
1999 (b) |
Interviews
of 944 community dwelling persons in NC ages 40 -
93 years old. 424 White Americans; 318 African American;
and 202 Native Americans. Half of the sample was
aged 40-64, half 65+. Half were female, half male. |
"Elder mistreatment:
destructive behavior that is directed toward an older
adult, occurs within the context of a relationship
connoting trust and is of sufficient intensity and/or
frequency to produce harmful physical, psychological
social and/or financial effects of unnecessary suffering,
injury, pain, loss, and/or violation of human rights
and poorer quality of life for the older adult."
"Elder abuse: aggressive or invasive behavior/action(s)
or threats of same, inflicted on an older adult and
resulting in harmful effects for the older adult." |
·
Been abused at some time in life:
o
White Americans 18%
o
Native Americans 25.5%
o
African Americans 16.6%
o
Total 19.1% (924)
·
Ever abused another person
o
White Americans 6.7%
o
Native Americans 8.1%
o
African Americans 4.3%
o
Total 6.2% (924)
·
Abused after age 65
o
White Americans 7.7%
o
Native Americans 4.3%
o
African Americans 9.2%
o
Total 7.5% (924)
·
Ever abused an elder
o
White Americans 3.6%
o
Native Americans 1.5%
o
African Americans 0.3%
o
Total 2.0% (924) |
| Mouton
1999 |
257 women
ages 50 - 79 who participated in the Women's Health
Initiative in Newark, New Jersey |
Physical assault
or threat of assault by a spouse/partner or "someone
important to you" |
·
31.9% (82) had experienced domestic
physical assault or threat at some time in their lives.
(1175)
·
Thirty-one (15%) had been physically
assaulted; 51 (22.6%) had been physically threatened.
(1175)
·
Of those experiencing assault/threat,
11 (4.3%) were currently in an abusive relationship.
(1176) |
| NCEA National
Elder Abuse Incidence Study
1998 |
APS and local
"sentinel" reports of abused and neglected persons
age 60+ from 20 counties in 15 states in U.S. |
Physical,
sexual, emotional or psychological abuse; neglect,
abandonment, financial exploitation |
·
Estimates 449,924 persons, aged 60
and over, experienced abuse and/or neglect in domestic
settings in 1996. (Standard error suggests 210,900
to 688,948.) (4)
·
Only 21% of cases are reported to and
substantiated by APS agencies. (4) |
| Lachs, et al
1997 (a) |
2,812 adults
65 and older from a stratified sample of residence
types in CT |
Physical abuse,
neglect, and exploitation |
·
47 (1.6%) elders had been abused, neglected,
or exploited within a nine-year period. (471) |
| Harris
1996 |
5168 couples
from 1985 U.S. Family Violence Resurvey, two groups:
ages 19-59 (4476) and 60+ (842) |
Physical violence |
·
18.2% of couples under age 60 and 5.8%
of couples aged 60+ experienced physical violence
in their relationship within the past year. (13)
·
"More than half of the older respondents
reported that spousal abuse began more than 10 years
ago. 40% of this group reported the first incidence
of violence occurred 25 or more years ago." (19) |
| Pittaway
1993 |
605 adults
aged 55-100 who accessed health and social service
organizations in London, Ontario during a 3-month
period |
Physical abuse
(including sexual abuse), chronic verbal aggression,
material abuse (actual and attempted), and neglect
(intentional and unintentional) |
·
"The overall prevalence rate for all
forms of abuse, physical, chronic verbal aggression,
attempted and actual material abuse, is 31.9%. For
intentional and unintentional neglect, it is 16.4%."
(89)
·
"Just over a quarter (28.3%) of the
sample, [sic] reported at least one form of physical
violence over the lifetime." (84) |
| Podnieks
1992 (a) |
Random sample
telephone survey of 2008 persons 65+ living in the
community in Canada |
Physical and
psychological abuse, neglect and financial exploitation
|
·
"Estimated 98,000 - 137,000 elders
abused in Canada." (48)
·
"40 persons per 1,000 elderly population
recently experienced some serious form of maltreatment
at the hands of a partner, relative, or significant
others." (5) |
| Brown
1989 |
Random sample
of 37 Southwest reservation-dwelling Navajo aged 60+,
and their family members |
Neglect, psychological
and physical abuse, and financial exploitation |
·
59.4% of sample had experienced at
least one form of abuse [time frame unspecified].
(24) |
| Pillemer and
Finkelhor
1988 |
Random sample
of 2020 persons aged 65+ in Boston, MA; 63 cases of
elder abuse found |
Physical assault,
psychological abuse, and neglect |
·
"Estimates between 701,000 and 1,093,560
abused elders in the nation." (54).
·
Rate of 32 maltreated elderly per 1,000.
(53) |
GENERALIZED FINDINGS
Three categories of findings emerged from these studies:
abuse in later life; abuse over the life span; and incidence
of domestic elder abuse. Two studies examined abuse in
later life by asking older participants if they were currently
experiencing abuse. Mouton (1999) found that 4.3% were
currently in an abusive relationship. Harris (1996) found
that 5.8% of older couples had experienced domestic violence
in the past year. A third study that examined APS records
found that 1.6% of elders had been abused, neglected, or
exploited over a nine year period (Lachs, 1997a). Hudson
(1999b) found that 7.5% of surveyed elders had been abused
at some point after turning 65. Hudson and Carlson (1999a)
found that 6.2% of adults stated that they had abused an
elder in one study, and 2.0% had in a second (1999b) study.
Five studies asked questions about abuse occurring at any
point across the lifespan. A range of 19.1% - 59.4% of
older participants acknowledged that they had been abused
or sexually assaulted at some time in their life (Hudson,
1999a and b; Mouton, 1999; Pittaway, 1993; Brown, 1989).
Three studies attempted to estimate the incidence of abuse
against elders. Two studies, one in the United States and
one in Canada, are more than nine years old. In 1988, Pillemer
and Finklehor estimated 701,000 - 1,093,560 older Americans
are victims of abuse each year (Pillemer, 1988). In the
early 1990's, Podnieks estimated 98,000 - 137,000 older
Canadians are elder abuse victims each year (Podnieks, 1992a).
These figures lead to estimates that 32 out of every 1,000
elders in the United States are abused per year and 40 elders
per 1,000 in Canada. More recently, the National Center
on Elder Abuse commissioned a National Elder Abuse Incidence
Study (NEAIS), which estimated approximately 450,000 older
people were being abused in 1996 (NEAIS, 1998).
LIMITATIONS OF STUDIES
The NEAIS estimate of incidence of domestic elder abuse
is significantly lower than previous studies. The study's
authors acknowledge that this estimate may be low because
the study was designed not to determine how much elder abuse
exists but rather to look at the proportion of cases reported
to adult protective services versus the proportion of cases
seen. The study estimated only 21% of cases are reported
to and substantiated by adult protective services (APS)
agencies. The researchers recognized and stated in the study
that using substantiated APS cases and community sentinels
(trained volunteers to look for elder abuse) does not include
the large (but unmeasured) segment of elders that are isolated
and do not come in contact with community services (Cook-Daniels,
1999; Otto & Quinn, 1999).
In addition, the sample size for the NEAIS was extremely
small. Only 20 counties in 15 states were used. In each
county only 12 -13 agencies were included and each agency
had typically only four - six trained sentinels. The data
was only collected for two months based on 1,498 actual
cases (Cook-Daniels, 1999; Otto & Quinn, 1999).
Even with the methodological flaws, NEAIS does provide
some useful information. The study confirmed the usefulness
of training professionals to improve awareness and recognition
of elder abuse. The study also provides the most far-reaching
confirmation that reported cases of elder abuse are only
a fraction of those elders being harmed, neglected or exploited
(Cook-Daniels, 1999).
In addition to the problems specific to NEAIS, 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
Too few studies have been done on incidence and/or prevalence
of domestic abuse in later life to give us a clear picture
of the numbers of older victims currently experiencing abuse
and neglect or how many older people have experienced abuse
or sexual assault in the past. The field would benefit
from replication of random-sample studies, such as those
done by Pillemer and Podnieks, to examine current trends.
A national incidence study, adequately funded and designed
to better establish incidence by overcoming the obstacles
encountered by the NEAIS, would be extremely beneficial.
The existing research supports what practitioners know:
too many older people are being harmed or neglected by people
they know and care about. Many of these victims are not
getting help to live safely. Service providers are only
seeing the "tip of the iceberg" when it comes to elder abuse.
Finally, it is time to recognize and study the impact of
past trauma and abuse for this population. Post traumatic
stress could be the result of abuse, war experience, migration
acculturation for immigrants, or other trauma. Post-traumatic
stress research should also examine potential connections
between past trauma and self-neglect, chronic physical illnesses,
substance abuse, depression, mental illness and some forms
of dementia. This research could help practitioners understand
if services that focus on healing from past trauma might
be helpful for some abused older persons.
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
Cook-Daniels,
L. (1999) Interpreting the National Elder Abuse Incidence
Study. Victimization of the Elderly and Disabled,
Vol. 2, No. 1, 1-2+. [CANE File No. N4897-4]*
Otto,
J and Quinn, K. (1999) The National Elder Abuse Incidence
Study: An Evaluation by the National Association of Adult
Protective Service Administrators. Victimization of
the Elderly and Disabled, Vol. 2, No. 1, 4+. [CANE
File No. N4898-2]*
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)
·
Causation theories
www.WordBridges.net/ElderAbuse/Research/2002-09-04R.html
(html) or
www.WordBridges.net/ElderAbuse/Research/2002-09-04R.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)
·
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]*
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]*
Hudson, M. and J. Carlson. (1999a). Elder Abuse: Its Meaning
to Caucasians, African Americans, and Native Americans.
Tatara (ed.), Understanding Elder Abuse in Minority Populations,
187-204. [CANE File No. N4678-12]*
Hudson, M. et al. (1999b). Elder Abuse: Some African
American Views. Journal of Interpersonal Violence,
14(9): 915-939. [CANE File No. K4205-13]*
Lachs, M. et al. (1997a). ED Use by Older Victims of Family
Violence. Annals of Emergency Medicine, Vol. 30,
No. 4, 448 - 454. [CANE File No. L4406-7]*
Mouton, C et al. (1999). The Associations between Health
and Domestic Violence in Older Women: Results of a Pilot
Study. Journal of Women's Health & Gender-Based
Medicine, Vol. 1, No. 9, 1173 - 1179. [CANE File No.
N4890-7]*
National Center on Elder Abuse. (1998). The National
Elder Abuse Incidence Study; Final Report. Available
at http://www.aoa.gov/abuse/report/default.htm.
[CANE File No. J4071-300]*
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. (1992a). National Survey on Abuse of the
Elderly in Canada. Journal of Elder Abuse & Neglect,
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Robert Wood Johnson Foundation. (2001). Designing
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[CANE File No. N4889-34]*
*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.
