What are the forms of domestic abuse in later life? What
tactics do perpetrators use? Understanding the forms of
abuse helps criminal justice professionals identify potential
crimes, such as assault or theft. Social service workers
or advocates can learn what questions to ask to fully appreciate
the victim's experience.
This paper will examine the forms of abuse identified by
researchers. Since relatively little attention is paid
to sexual abuse/assault or it is subsumed into other categories
(see, for instance, Brownell, 1999 and Lithwick, 1999),
this article will highlight it separately. Similarly, homicide/suicide
is examined separately because while it is, by definition,
the most lethal of types of domestic violence, it is not
covered in any other broad studies of domestic abuse in
later life.
In looking at research on types of abuse in later life,
it is critical to understand that there is no consistent
definition of abuse used by the studies. Not only did each
study look at a different mixture of abuse types, but also
those that studied the "same" abuse type often defined that
abuse quite differently.
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: TYPES OF ABUSE
Eighteen 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) |
| Brownell, et
al
1999 |
401 cases
of abuse of elders 60+ (with 404 identified abusers)
known to Elderly Crime Victims Resource Center in
New York City |
Physical,
psychological, financial abuse and neglect (one case
of sexual abuse was counted as physical abuse) |
·
54% of cases involved psychological
abuse (86)
·
51% of cases involved financial abuse
(86)
·
28% of cases involved physical abuse
(86)
·
19% of cases involved neglect (86) |
| Crichton et
al
1999 |
50 Canadians
age 60+ abused by adult child; 50 abused by spouse
from Elder Abuse Resource Center in Winnipeg |
Agency-substantiated
cases of physical, psychological, and material abuse;
neglect |
·
41% of incidents were psychological
abuse (123)
·
27% of incidents were financial abuse
(123)
·
25% of incidents were physical abuse
(123)
·
7% of incidents were neglect (123)
·
"Financial abuse was more likely to
be committed by an adult child (37 instances) than
a spouse (13 instances);.no other relationship between
types of abuse and whether the perpetrator was an
adult child or a spouse was found." (124) |
| Lithwick and
Beaulieu 1999 |
128 cases
of mistreatment of adults aged 60+ brought to the
attention of community service agencies in Quebec |
Physical or
sexual abuse; psychological abuse; financial and material
exploitation; neglect (both active and passive) by
family members and acquaintances |
·
Of cases perpetrated by a spouse:
o
87% included psychological abuse;
o
13% included financial exploitation;
o
23% included neglect; and
o
31% included physical abuse. (103)
·
Of cases perpetrated by an adult child:
o
59% included psychological abuse;
o
59% included financial exploitation;
o
49% included neglect; and
o
13% included physical abuse. (103)
·
Where there was physical abuse by spouse,
it was always accompanied by psychological abuse.
(102) |
| Sanchez
1999 |
62 individuals
age 60+, Mexican immigrants or self-identified as
Mexican-American, who participated in community centers
in Detroit, Michigan, and Carson City, Nevada. |
Physical abuse,
neglect, financial abuse, and denial of shelter |
·
Of the 20 respondents (33%) who knew
of at least one incident of elder abuse in the Mexican
American community, the types of mistreatment cited
were:
o
40.3% denial of shelter
o
22.6% neglect
o
12.9% financial abuse
o
11.3% physical abuse (72) |
| Vladescu, et
al
1999 |
26 abused
elders (age limit unspecified) served between 1/1/97
and 1/1/99 by Seniors' Case Management program in
Hamilton, Ontario |
Physical,
psychological, and financial abuse |
·
73.1% of the cases involved psychological
abuse (13)
·
39.2% of cases involved financial exploitation
(13)
·
30.8% of cases involved physical abuse
(13) |
| Anetzberger
1998 |
289 cases
receiving protective services investigation in Cleveland
from 1987 to 1995 |
Cases investigated
by a Cleveland APS agency from 1987 to 1995, focusing
particularly on psychological abuse and psychological
neglect |
·
10% of the cases included psychological
abuse or neglect. (146)
·
In cases where there was psychological
abuse or neglect, additional forms of abuse were present
89.7% of the time, including (in 50.0% of the cases)
physical neglect and (in 46.2% of the cases) exploitation.
(146) |
| NCEA National
Elder Abuse Incidence Study
1998 |
APS reports
and community "sentinel" reports of abused and neglected
persons age 60+ from 20 counties in 15 states in U.S. |
Physical abuse;
sexual abuse; emotional or psychological abuse; neglect;
abandonment; financial or material exploitation |
·
Types of abuse substantiated by APS
agencies:
o
48.7% neglect (43.2% of perpetrators were adult children;
30.3% spouses)
o
35.4% emotional/psychological abuse (53.9% adult children;
12.6% spouses)
o
30.2% financial/material exploitation (60.4% adult
children; 4.9% spouses)
o
25.6% physical abuse (48.6% adult children, 23.4%
spouses)
o
3.6% abandonment (79.5% adult children, 6.4% spouses)
o
0.3% sexual abuse
o
1.4% other (pages 4-7, 4-28, and 4-29) |
| Otiniano
1998 |
24,648 Hispanic
elders referred to the Texas APS system from 1991-1995 |
Cases referred
to APS |
·
Caretaker neglect was present in 25.3%
of cases. (194)
·
Abuse [undefined] was present in 16.2%
of the cases. (194)
·
Exploitation was present in 11.4% of
the cases. (194)
·
Self-neglect cases made up the remainder
(47.1%). (194) |
| Lachs, et al
1997 (a) |
2,812 adults
65 and older from a stratified sample of residence
types in Connecticut; 47 were substantiated cases
of abuse, neglect, or exploitation by someone else |
Elder abuse;
neglect; exploitation. Self-neglect cases were excluded. |
·
Of 47 cases:
o
30 (64%) were neglect;
o
9 (19%) were abuse;
o
8 (17%) were exploitation. (471) |
| Le
1997 |
20 Vietnamese
age 60+, living in a house headed by an adult child,
at least somewhat dependent on child, in Southern
California |
Verbal, emotional,
financial and physical abuse |
·
Only one case of financial abuse and
no cases of physical abuse was detected. (55)
·
There were 13 cases where the elder
was encouraged to leave the house if unhappy; 10 cases
of coercion to stay in the house; 9 cases of insult,
1 case of eviction without advance notice. Researcher
classed all of these as verbal abuse. (55)
·
There were 5 cases of harassment by
daughter-in-law; 14 cases of silent treatment; 9 cases
of avoidance. Researcher classed all of these as
emotional abuse. (55) |
| Wolf and Pillemer
1997 |
73 abused
women aged 60+ from New York City, San Francisco,
Honolulu, and Madison, WI. 22 were abused by husband,
51 by children (review of written case assessment
data) |
Physical abuse,
psychological abuse, neglect, financial exploitation |
·
61.9% of spouse, 31.4% of parent abuse
was primarily physical. (329)
·
23.8% of spouse, 31.4% of parent abuse
was primarily psychological. (329)
·
0% of spouse, 21.6% of parent abuse
was primarily financial exploitation. (329)
·
14.3% of spouse, 15.7% of parent abuse
was primarily neglect. (329) |
| 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) |
·
20% reported actual or attempted material
abuse. (87)
·
14.3% of sample had been physically
abused since turning 55. (84)
·
14% of the sample had been chronically
verbally abused. (84)
·
13.8% had been intentionally or unintentionally
neglected. (89) |
| Podnieks 1992
(a) |
Random sample
telephone survey of 2008 persons 65+ living in community
settings in Canada |
Physical abuse;
neglect; psychological abuse; financial exploitation
|
Of the 2008
elders interviewed,
·
2.5% of elders materially abused (41)
·
1.4% of elders chronically verbally
abused (41)
·
.5% of elders physically abused (41)
·
.4% of elders neglected (41)
·
19% of victims were victims of more
than one type of abuse. (41) |
| Podnieks
1992 (b) |
42 elder abuse
victims in Canada identified through Podnieks, 1992(a)
study |
See Podnieks,
1992(a) |
Of the 42
elder abuse victims found from the random sample of
2008 persons,
·
57.1% were materially abused (50% of
men, 61.5% of women). (70)
·
18.0% were physically abused (25% of
men, 15.4% of women). (70)
·
16.7% were verbally abused (25% of
men, 11.5% of women). (70)
·
7.1% were neglected (0% of men, 11.5%
of women). (70) |
| Greenberg et
al
1990 |
204 cases
of abuse of person 60+ by adult child in Wisconsin |
APS-substantiated
cases of physical abuse, material abuse, and neglect |
·
39% of cases physical abuse (77)
·
20% material abuse (77)
·
21% neglect (77)
·
20% multiple forms of abuse (77) |
| Brown
1989 |
Random sample
of 37 Southwest reservation-dwelling male and female
Navajo aged 60+, and their family members; 22 cases
of elder abuse found |
5 types of
neglect; 5 types of verbal/psychological abuse; 4
types of physical abuse; financial exploitation |
·
45.9% of sample neglected (24)
·
21.6% psychologically abused (24)
·
21.6% financially exploited (24)
·
16.2% physically abused (24) |
| 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 |
·
Types of abuse perpetrated:
o
72.9% included psychological abuse;
o
57.7% involved neglect;
o
44% included physical abuse; and
o
39% included material abuse. (212) |
| Pillemer and
Finkelhor
1988 |
Random sample
of 2020 community dwelling people aged 65+ in Boston,
Massachusetts; 63 cases of elder abuse found |
Physical assault;
psychological abuse; neglect |
·
Rate of physical violence: 20 per 1,000
(53)
·
Rate of chronic verbal aggression:
11 per 1,000 (53)
·
Rate of neglect: 4 per 1,000 (53) |
GENERALIZED FINDINGS: TYPES OF ABUSE
A noteworthy finding is that in every study that allowed
cases to be recorded in more than one category, a significant
proportion of cases involved more than one type of abuse.
For instance, Podnieks (1992a) found that 19% of her victims
were abused or neglected in more than one way, and Greenberg's
figure was 20% (1990). In Anetzberger's study of psychological
abuse, 89.7% of the time the psychological abuse was accompanied
by other types of abuse (1998).
Two articles [(Podnieks 1992 (a) and (b) used the same
database, and one article (Anetzberger 1998)] focused on
cases that involved psychological abuse. Thus, there were
14 articles that compared the frequency with which different
types of abuse occur. Six of these found that verbal/psychological
abuse was the most prevalent type (Brownell, 1999; Crichton,
1999; Lithwick, 1999; Vladescu, 1999; Le, 1997; Godkin,
1989). Another four studies found that neglect was the
most prevalent type of abuse (NCEA, 1998; Otiniano, 1998;
Lachs, 1997a; and Brown, 1989). Three studies found that
physical abuse was the most prevalent type of abuse (Wolf,
1997; Greenberg, 1990; Pillemer, 1988). One study found
that "denial of shelter" was the most common type (Sanchez,
1999) and two said financial abuse was the most prevalent
type (with the Pittaway study also counting "attempted"
financial abuse) (Pittaway, 1993; Podnieks, 1992).
Not all studies included all major types of abuse. For
instance, four of the studies that did not find psychological
abuse as the most common type did not appear to include
that type within their scope of research (Sanchez, 1999;
Otiniano, 1998; Lachs, 1997a; Greenberg, 1990).
It is also important to note that most of the studies included
all types of family abusers. In the studies that compared
spouse abuse to parent abuse, spouses were more likely than
adult children to physically abuse and adult children were
more likely than spouses to financially abuse (Lithwick,
1999; Wolf, 1997). Crichton likewise found that adult children
were the more likely financial abusers, although they did
not find a difference in how often spouses and adult
children physically abuse (1999). In contrast, the NEAIS
found that adult children were the more frequent abusers
in all types of abuse cases (1998).
ARTICLES REVIEWED: SEXUAL ABUSE
Eight articles published between 1991 and 2002 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) |
|
|
|
|
·
"Although older and younger women evidenced
great differences in reported prevalence of .[rape]
(6.2% vs. 17.4%), they did not report that the characteristics
of their assault were hugely different." (691)
·
"Statistically similar proportions
of both groups reported that they had seen the perpetrators
before, that the event was one in a series, that they
or the perpetrator or both were under the influence
of a substance, that they actually experienced injury
and that they reported the assault to authorities."
(691)
·
"The average age of first rape for
both older and younger adult victims was about 14
years." (690)
·
Authors speculate the reasons for differences
in victimization rates between ages may include reporting
bias (older women may not perceive coerced sexual
contact as rape, may blame themselves for the rape,
or may believe the rape was a personal, private matter)
and cohort effects (younger women live in a more violent
society). (693) |
| Burgess, et
al
2000 |
20 civil cases
brought by/on behalf of a sexually assaulted nursing
home resident; 2 were under age 55 |
Sexual assault
of a nursing home resident |
·
Of the 20 victims, 18 were female.
(12)
·
Five of the residents could ambulate
on their own; the rest were bedridden or used a wheelchair.
(13)
·
Twelve of the victims had a primary
diagnosis of Alzheimer's disease or dementia. (13)
·
Ten of the victims told a family member
(7) or a staff member (3) of the assault; 6 assaults
were witnessed by staff; clues detected by staff or
family led to identification of 4 assaults. (13)
·
Forensic examinations were made on
10 of the cases; 8 of these showed physical evidence
of assault. (14)
·
Victims showed many trauma-related
symptoms, including expressions of fear or avoidance
of male staff; withdrawn behavior; staying near nurses
station; lying in bed in a fetal position; reenacting
parts of the assault; sexualized behavior; refusing
to sleep on the bed; and refusing to cooperate with
usual routines such as bathing or having vital signs
taken. "More than half of the residents made new
comments of feeling cold." (15-16)
·
Eleven of the victimized residents
died within a year of their assault. (16)
·
Researchers identified two distinct
responses to assault: compounded rape trauma ("victims
have a past and/or current history of psychiatric,
psychosocial, or physical problems that compound the
effects of the sexual assault") and silent rape trauma
(in which "expression of assault-related symptomatology
is muted, undetected, or absent"). (17) |
| Teaster, et
al
2000 |
42 substantiated
cases of sexual abuse against persons 60+, collected
over a 3-year period in Virginia |
APS-substantiated
cases of elder sexual abuse |
·
Of the 42 victims, 40 were female.
All of the identified perpetrators were male. (5,
9)
·
80.9% of the victims lived in a nursing
home; 70.7% of the incidents took place in a nursing
home. Other assault sites were victim's home (12.2%),
adult care residence (2.4%), and perpetrator's home
(14.6%). (5, 8)
·
Nearly all of the victims were unable
to manage their own finances (92.7%), the majority
had orientation difficulties in at least two of three
areas (orientation to person, time and place); and
fewer than a quarter (21.4%) could walk without assistance.
(5-6)
·
In more than a third of the cases (35.7%),
the sexual abuse was known to be ongoing over a period
of time. (7-8)
·
Vaginal rape was relatively uncommon
(5.8% of cases); sexualized kissing and fondling was
most prevalent (48.2% of cases), followed by unwelcome
sexual interest in victim's body (23.2%) and digital
penetration of vagina or anus (13.5%). (7)
·
In three-quarters of the cases (75.0%),
the perpetrator was a facility resident. Other perpetrators
were: 7.5% family members in household; 7.5% facility
staff; 5.0% non-relative in household; 5.0% non-relative
living outside the household. (10)
·
In only two cases was the alleged offender
prosecuted in court. Other outcomes for perpetrators
were: relocation (47.8%); psychiatric treatment (34.8%);
behavior modification (13.0%); and monthly hormone
injection (4.4%). (11, 14)
·
Victims were relocated 38.5% of the
time. Only 38.5% of victims received treatment for
the abuse. 23.0% of victims were classified as remaining
at risk for sexual abuse. (14)
·
The vast majority of cases were witnessed;
only 23.8% of the substantiated cases had no witnesses.
(9) |
| Mouton
1999 |
257 women
ages 50 - 79 who participated in the Women's Health
Initiative in Newark, New Jersey |
Forced sexual
intercourse with a spouse or partner |
·
Eighteen women (7%) had been forced
to have sexual intercourse with their spouse or husband
at some time. (1176) |
| 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) |
·
Husbands were the abusers in 100% of
sexual abuse cases. (84) |
| Muram, et al
1992 |
53 female
clients of the Memphis Sexual Assault Resource Center
aged 55-87, matched with 53 female clients aged 18-45
as controls |
Sexual assault |
·
Genital injury was more common and
more serious among older women: 50.9% of older women
were genitally injured compared to 13.2% of the younger
women, and 28% of older women vs. 6% of younger women
required surgical repair. (74)
·
"The majority of assaults involving
elderly women took place in the victim's home by an
assailant who was unknown to the victim. This is in
contrast to younger women for whom the majority of
assaults occurred outside the home" by friends or
acquaintances. (75)
·
"Younger victims were more likely to
report a previous sexual assault - 24.5% of the younger
women compared to 9.4% of the elderly victims." (75) |
| Ramin, et al
1992 |
Medical record
review of 129 postmenopausal women (ages 50-100) matched
with 129 women age 14-49, all sexually assaulted in
Dallas, TX between 1986-1991 |
Sexual assault |
·
Postmenopausal women represented 2.2%
of women reporting sexual assault in the county.
(860)
·
"Genital trauma was more common in
the postmenopausal group (43 versus 18%)." (860) |
| Ramsey-Klawsnik
1991 |
28 community-dwelling
older (ages 65 - 101) women suspected by Massachusetts
adult protective services workers of being sexually
abused |
APS suspicion
elder was sexually abused |
·
71% of victims were described as "totally
dependent" or functioning "very poorly" or "poorly."
(78)
·
Rape was suspected in 61% of the cases.
(79)
·
32% of victims disclosed sexual abuse;
two more made coded or hinted disclosure. (80)
·
29% of suspected perpetrators were
spouses/boyfriends; 39% were sons; 7% were brothers.
A total of 81% perpetrators were caregivers; 78% were
family members. (81)
·
All but 1 perpetrator was male. (73)
·
In almost 1/3 of cases, sexually abusive
acts were witnessed by others; in 71% of the cases,
other service providers suspected sexual abuse. (79,
81) |
GENERALIZED FINDINGS: SEXUAL ABUSE
These eight studies are particularly difficult to compare
since each focused on different populations and identified
cases in very different ways. However, it is clear that
neither being healthy and married nor frail and living in
an institution protects older women from being sexually
abused.
Spouses/partners were the abusers in 100% of the Mouton
(1999) cases (by design of the study); 100% of the Pittaway
(1993) cases, and 29% of the Ramsey-Klawsnik (1991) cases.
Other sexual abusers were other residents of the nursing
home (75.0% of the Teaster (2000) cases); sons (39.0% of
the Ramsey-Klawsnik cases); paid caregivers (7.5% of the
Teaster cases); and brothers (7% of Ramsey-Klawsnik cases).
The majority of older sexual assault victims in Muram's
study (1992) said they did not know their perpetrator.
Nearly all the sexual abuse victims studied were women,
and all but one identified perpetrator were male. Identified
victims in three studies were overwhelmingly impaired: 80%
of the Burgess (2000) victims used a wheelchair or were
bedridden and 60% had dementia; 80.9% of the Teaster victims
lived in a nursing home and fewer than a quarter could walk
without assistance, and 71% of the Ramsey-Klawsnik victims
were classified as "totally dependent" or functioning "very
poorly" or "poorly."
Many of the sexual abuse cases had witnesses: 76.2% of
the Teaster cases, and nearly a third of both the Burgess
and Ramsey-Klawsnik cases.
Three studies looked at differences between younger and
older sexual assault victims. Acierno and Muram found that
older women were significantly less likely to have ever
been a sexual assault victim (Acierno, 2002), or to have
been assaulted more than once (Muram, 1992), than were younger
women. Two studies found that older sexual assault victims
were more likely to experience genital trauma (Muram, 1992;
Ramin, 1992), and that such trauma had more serious ramifications
(Muram, 1992).
Burgess pointed out that while many victims did report
their assaults, those that could not often displayed trauma-related
behavior that staff could be trained to identify as possible
signals of sexual assault.
ARTICLES REVIEWED: HOMICIDE/SUICIDE
Two articles published between 1998 - 2001 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) |
| Malphurs et
al
2001 |
27 men aged
55+ who perpetrated spousal homicide-suicides matched
by age with 36 married men who committed suicide in
Florida |
Instances
of homicide/
suicide |
·
"A dependent-protective attachment
to the spouse and the need to control the relationship.play
an important role in spousal homicide-suicides."
(54)
·
"A common feature of all spousal/consortial
homicide-suicides is a perception by the perpetrator
of an unacceptable threat to the integrity of a highly
valued relationship." (54)
·
Homicide-suicide perpetrators were
almost three times more likely to be in caregiving
roles than men who only committed suicide." (48.1%
of the h-s perpetrators were in caregiving roles)
(53)
·
51.9% of homicide-suicide and 61.1%
of suicide perpetrators had psychiatric symptoms,
although only 5% of both groups were receiving psychiatric
care at time of death. (53)
·
11% of the murdered wives lived in
a nursing home at the time of death. (51) |
| Cohen et al
1998 |
137 spousal/
|
Instances
of homicide/
suicide |
·
0.4 - 0.9 per 100,000 occurrence of
homicide-suicide for persons age 55+. (392)
·
Rates of homicide-suicides were higher
for older persons than younger in all but 2 years.
(394)
·
All older perpetrators were men; 2
younger perpetrators were women. (392)
·
Many characteristics varied significantly
based on whether couple lived in west central Florida
(all older couples white) or southeastern Florida
(more than 2/3 of older couples Hispanic). (393)
·
Prior physical violence was rare among
older couples, but verbal discord was common. (393)
·
Illness, declining health, and pain
and suffering were common among both perpetrators
and victims in west central Florida (25.9% to 55.6%),
but less common (4.8% to 19.0%) in southeastern Florida.
(393)
·
29% of older perpetrators were depressed
and 18.7% had talked of suicide, but only one tested
positive for antidepressants at autopsy. (393) |
GENERALIZED FINDINGS: HOMICIDE/SUICIDE
Although the data is extremely limited, it is clear that
cases of homicide-suicide among elders is not rare; Cohen
(1998) found that the rate was higher among those aged 55+
than those younger than 55 in four out of six years studied.
Men are the perpetrators in the vast majority of cases.
Culture appears to play a role in incidence, since rates
and characteristics were quite different in a county that
was predominately white from those of a county that was
predominately Hispanic.
Depression or other psychiatric symptoms are common among
perpetrators, although very few perpetrators were receiving
psychiatric care or medications at the time of the murder-suicide.
Both studies found that the majority of both the
victims and perpetrators were ill, experiencing a general
decline in health, and/or experiencing pain and suffering,
except for the predominately Hispanic older population.
Both studies found that separation and jealousy and/or
"a perception by the perpetrator of an unacceptable threat
to the integrity of a highly valued relationship" were "common
circumstances" in which elder homicide-suicides took place.
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
A significant finding is that those who abuse older adults
frequently use more than one tactic. Therefore, where one
type of abuse is found, look for others to help ensure that
all aspects of the abusive situation are addressed.
Care should be taken not to associate certain types of
abuse only with some abusers or relationships. These studies
show that adult children as well as spouses physically assault
elders, that a significant minority of nursing home residents
and of adult sons are capable of sexual assault, and that
(old) siblings can be abusers, too. Since every type of
abuse, including financial exploitation, can be emotionally
and physically devastating, service providers who are serving
only victims of certain types of abuse may want to consider
expanding their scope of service.
Because some forms of elder abuse (including, for instance,
financial exploitation and abandonment) have not been major
focuses of the domestic violence field, more training about
these tactics and remedies for them need to be made available.
Sexual abuse of elders needs far more research. Professionals
who work with older adults need to recognize that sexual
abuse occurs, that it can be physically damaging, that family
members as well as paid caregivers can be perpetrators,
and that elders who are severely physically and/or cognitively
impaired are frequent targets of sexual abusers. Professionals
who work with older adults need to learn how to recognize
the signs of sexual abuse and what they should do when they
suspect such abuse. In particular, forensic investigations
need to be made since they frequently produce evidence.
Since both Teaster and Ramsey-Klawsnik found that often
someone witnessed or knew about the abuse, training on how
to respond to and report sexual abuse is critical. Systems
need to be put into place to protect frail elders from sexual
abuse, particularly in institutions that house other impaired
elders who may be sexually aggressive.
Professionals need to recognize that many deaths of older
couples are not due to "suicide pacts" or accidents but
are, instead, murders of one partner by the other. Elder
fatality review teams would help us identify more of these
murder-suicides. Far more research needs to be done to
help us identify couples that are at-risk for such violence.
In the meantime, those who work with domestic violence in
later life need to be aware that death of both elders is
a distinct possibility. Since it is clear that many elder
murderers suffer from untreated depression or other psychiatric
illnesses and/or experience pain or suffering, health care
providers as well as domestic violence professionals should
be careful to address all aspects of the physical, mental,
and emotional health of the older couples they serve.
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
ADDITIONAL RESOURCES
For more information on homicide-suicide, go to http://www.fmhi.usf.edu/amh/homicide-suicide/art_rt.html.
Wisconsin Coalition Against Sexual Assault. (2001). Transcending
the Silence. (Available from WCASA at (608) 257-1516.)
Wisconsin Coalition Against Sexual Assault. (1999). Widening
the Circle. (Available from WCASA at (608) 257-1516.)
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)
·
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)
·
Victims
www.WordBridges.net/ElderAbuse/Research/2002-09-10R.html
(html) or
www.WordBridges.net/ElderAbuse/Research/2002-09-10R.pdf
(Adobe Acrobat format)
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*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.
