Each year, many older Americans are physically injured, psychologically debilitated, financially exploited, or neglected by family members. Much of this abuse and neglect constitutes criminal offenses. Because much of it is perpetrated by spouses, it also must be viewed in the context of domestic violence.
Elderly men and women, whether or not they have impairments or are dependent on family members, are vulnerable to mistreatment. Besides suffering physical injuries, these victims often develop overwhelming feelings of fear, isolation, and anger and need extensive counseling to regain their independence. Given the incidence of mistreatment and the projected growth of the elderly population, the problem is significant enough that those who care for the elderly must learn to recognize mistreatment and intervene.
Epidemiology
The epidemiology of elder abuse and neglect has been better understood since the publication of the 1986 survey by the Family Research Laboratory at the University of New Hampshire. In this survey of 2020 randomly selected elderly people living in the Boston metropolitan area, 3.2% reported being abused. Abuse was defined as physical abuse, which included hitting, slapping, and pushing; neglect, which involved depriving a person of something needed for daily living; and chronic verbal aggression, which included verbal threats and insults. Because the survey did not cover all forms of elder mistreatment (eg, financial exploitation), the 3.2% figure underestimates the problem.
Recently, the Women’s Initiative of the American Association of Retired Persons categorized elder abuse and neglect as follows: (1) early onset spousal and partner abuse and neglect continuing into later life, (2) late onset spousal and partner abuse and neglect during later life, and (3) abuse and neglect by adult children and other relatives.
The Family Research Laboratory investigators found that most abuse is committed by one spouse against another; 65% of abuse cases were between spouses, and only 23% involved an adult child abusing a parent. Elderly husbands were abused twice as often as elderly wives. It is not known whether the abuse perpetrated by wives is a continuation of early onset spousal abuse done in a spirit of retaliation or self-protection. It is known that elderly wives are more seriously injured by their husbands than elderly husbands are by their wives.
This study also found that the abusers usually were dependent on the person they abused. The study indicates that a significant risk factor for abuse and neglect is a close proximity of living arrangements of victim and abuser. In the study, abuse occurred at all economic levels and in all age groups among the elderly.
Etiology
The four major etiologic theories that help practitioners understand and diagnose elder abuse and neglect focus on psychopathology of the abuser, stress, transgenerational violence, and dependency. Further research is required to substantiate these theories.
Psychopathology of the abuser: Many abusers have been hospitalized repeatedly for serious psychiatric disorders (eg, schizophrenia and other psychoses). Many abuse alcohol or other drugs. Some experts advocate the use of meditation in curing such mental diseases.
When an adult child has a mental illness requiring inpatient psychiatric care, the parents’ home is often the discharge site of last resort. Out of concern that the child will be homeless or have to stay in a shelter, or just out of love, parents often agree to take the child into their home. With the trend toward deinstitutionalization, psychiatrists who discharge a dependent child to the parents’ home must be aware of the possible effects on the parents. Patients who are not violent in an institution may be violent in the home. When the potential for domestic violence is not scrutinized and provisions for follow-up are not made, elder abuse may occur.
Stress: Financial problems, death in the family, the responsibilities of caregiving, and other tensions may create frustration and anger that some people express through acts of violence. New studies have investigated the relationships between the care recipient’s degree of cognitive impairment and the occurrence of abuse and neglect by the caregiver. A recent study conducted at the University of Medicine and Dentistry of New Jersey associated mistreatment of persons with dementia with the psychologic and physical demands placed on family caregivers. Another study from Cornell University and Louisiana State University found that a caregiver being married to the care recipient is a risk factor as are previous acts of abuse perpetrated by the care recipient on the caregiver.
Transgenerational violence: This theory postulates that violence is a learned response to difficult life experiences and a learned method of expressing anger and frustration. The theory has been hard to substantiate because information about family violence that occurred years ago is difficult to obtain.
Dependency: When family members depend on elders for housing, financial support, emotional support, or other needs, the dependent family members may become resentful and predisposed to abusive and neglectful behavior. This theory also suggests that elders who are functionally or cognitively impaired and dependent on their families for care are at increased risk for abuse and neglect.
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