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Forum on Global Violence Prevention; Board on Global Health; Institute of Medicine; National Research Council. Elder Abuse and Its Prevention: Workshop Summary. Washington (DC): National Academies Press (US); 2014 Mar 18.

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Elder Abuse and Its Prevention: Workshop Summary.

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Lori L. Jervis, Ph.D. Department of Anthropology and Center for Applied Research, University of Oklahoma


This paper examines elder mistreatment among American Indians/Alaskan Natives (AIs/ANs). To date, only limited empirical research has been conducted on this phenomenon due to the sensitivity of the topic, cultural nuances around what constitutes mistreatment, practical challenges involved in carrying out research among the numerous sovereign tribes across the United States, and lack of targeted funding devoted to this issue. Although the knowledge base on Native elder mistreatment is sparse, the small studies that have been conducted are sufficient to suggest directions for future investigation.

Prevalence and Risk Factors

The prevalence of elder mistreatment in the AI/AN population is unknown. To date, a large-scale, population-based prevalence study of Native elder abuse or neglect has not been carried out. Several factors complicate the possibility of prevalence studies among AIs/ANs. Perhaps the most notable of these is the great number and diversity of Native groups, which include 566 federally recognized AI tribes and AN villages, more than 64 state-recognized tribes, and 14 tribes with active petitions with the Bureau of Indian Affairs for recognition (Bureau of Indian Affairs, 2013). Federally recognized AI tribes and AN corporations are sovereign nations, each of which has its own approaches to dealing with researchers who wish to work with them. Moreover, the great diversity found among the Native population makes it difficult to adapt items or generalize across so many cultural groups/nations.

While a large-scale prevalence study has not yet been conducted, several smaller studies give a preliminary indication of prevalence in select settings. Medical record reviews of 550 AI/AN urban primary care clinic patients ages 50 and older found that 10 percent were definitely or probably physically abused. In 88.8 percent of cases where the gender of the abuser(s) was known, the victim was female and the perpetrator male (Buchwald et al., 2000). Those who were abused were significantly more likely to be female (p < 0.001), younger (p < 0.001), depressed (p < 0.001), and dependent on others for food (p < 0.05). Authorities were notified in only 31 percent of cases of definite abuse. In a study of 100 AIs ages 60 and older (both reservation and metropolitan), more than half (53 percent) were found to be at risk of mistreatment based on either the Hwalek-Sengstock Elder Abuse Screening Test (HS-EAST) (Neale et al., 1990, 1991) or the Native Elder Life Scale-Financial Exploitation or Neglect measures (Jervis et al., 2013).

A study of 152 health and human service providers to Navajo elders found that neglect and financial exploitation were considered the most common types of abuse (Brown et al., 1990). Physically abusive caregivers tended to be younger, be unemployed, have more personal problems, live with victims, have other responsibilities, and be less likely to receive help from others. Having any kind of income was a risk factor for physical and psychological abuse, as were shared caregiving arrangements and mental confusion (Brown, 1989). A study of risk factors among two different groups of Plains Indians found that higher levels of abuse were found on the more isolated and impoverished reservation (Maxwell and Maxwell, 1992). Although it is not yet clear how economic conditions and elder mistreatment intersect, the poverty within many Native communities may increase risk by fostering economic dependency of the young on the relatively stable elderly (Brown, 1989).

Cultural Conceptions of Abuse

Physical abuse seems relatively “straightforward” compared to many other forms of mistreatment (e.g., psychological abuse, financial exploitation, neglect). After all, what cultural group would condone physically harming an elder? As the ethnographic record demonstrates, however, elders are treated in a variety of ways across the globe—which includes great esteem and extensive support at one extreme to profound ridicule and even homicide on the other (Barker, 2009; Glascock, 2009). Mistreatment is, in fact, a culturally relative issue in the sense that cultural groups have their own notions of “right” and “wrong” treatment of elders. In the United States, what appears to be abusive to the majority population may not be interpreted that way by ethnic minority elders themselves (Rittman et al., 1999). Likewise, what appears to be abusive to Native elders may not be seen as abusive by the general population. Particular cultural groups may also have unique ways of describing or categorizing abuse. For instance, the term “spiritual abuse” has been used among some AIs to apply to situations such as elders being denied access to ceremonies or to traditional healing (NIEJI, 2013). Notions of severity may also differ among ethnic/cultural groups. In a comparison of perceptions of elder abuse among 944 AIs, European Americans, and African Americans using case vignettes, similar notions of abuse across groups were found (Hudson and Carlson, 1999). However, AIs classified the greatest number of vignettes as abusive and severe. It is crucial to understand how individuals and communities experiencing mistreatment conceptualize it because this ultimately affects many aspects of how these behaviors will be responded to and managed within communities.

The Shielding American Indian Elders (SAIE) project6 examined cultural understandings of elder mistreatment among 100 AIs ages 60 and older from a Northern Plains reservation and a South–Central metropolitan area using a Community Based Participatory Research approach (Jervis et al., 2013). The project's qualitative component examined participants' ideas about what it meant to be treated well and poorly by family (self-defined because “family” in Native communities frequently encompasses individuals who are not biological relatives). Good treatment emerged as a complex mixture of being taken care of, having one's needs met, and being respected. Poor treatment, on the other hand, was defined as financial exploitation, neglect, and lack of respect (Jervis et al., in preparation). Respect was a crucial component of what it meant to be treated well, while disrespect was largely equated with abuse.

Cultural subtleties about mistreatment are especially pronounced when considering financial exploitation. In the SAIE project (as well as in other formal and informal conversations with Native communities), financial exploitation has proven to be a highly salient issue, evoking much concern about its presumed escalation. Yet, the question of what exactly constitutes financial exploitation and what factors propel it is far from resolved. While theft constituted the bulk of financial exploitation in SAIE, other variants that are woven into the fabric of Native life were noted. For instance, exploitive child care is often offered as a prime example of elder mistreatment by community members, yet it remains difficult for Native elders themselves to differentiate it from culturally normative and esteemed childcare (Jervis et al., in preparation). That this might constitute a “gray area” is understandable because close grandparent–grandchild relationships that include childcare (and where children may provide eldercare) are quite common among AIs/ANs (Schweitzer, 1999; Jervis et al., 2010), as are cultural values that emphasize familial (and financial) interdependence (Red Horse, 1983). Yet, in situations of pervasive poverty, dislocation, diminished health, and overcrowded tribal housing, traditional values and norms may be altered in such a way that they act to the detriment of elders (and sometimes to the children in the household as well). Indeed, it may be a mistake to assume that Native elder abuse is an isolated dyadic issue. Because of the centrality of the extended family among AIs/ANs (Red Horse, 1983, 1997), elder mistreatment should be viewed in the context of the larger family system, and the possibility of child abuse/neglect and/or interpersonal violence should be considered as well.

Law Enforcement and APS

The U.S. colonization of AIs/ANs has resulted in disrupted cultural, economic, and kinship systems, which no doubt affects the way in which elders are treated (Jervis et al., 2003; National Indian Council on Aging, 2004; Jervis and AI-SUPERPFP Team, 2009). In the contemporary era, those responsible for dealing with Native elder mistreatment face many challenges due to lack of resources coupled with the unique legal, jurisdictional, and law enforcement issues related to AIs/ANs' sovereign nation status (Biolsi, 2001, 2005). Victims of violence may feel the police or judicial system cannot help them, and therefore may be reluctant to seek help. Tribal police forces are often stretched thin in terms of economic resources and personnel, often with a small number of officers covering large reservations and rural areas (Wakeling et al., 2001). Geographic isolation from police and social services may heighten fear of retaliation. In smaller communities, it is often a reality that the elder will come into contact with the perpetrator/family of perpetrator even after abuse is reported. Underreporting of crime has also been attributed to shame/humiliation and the longstanding distrust of law enforcement authorities among AIs/ANs (Wakeling et al., 2001).

Complicating this picture is the fact that a large number of tribes do not yet have laws focused on elder abuse (NIEJI, 2013). In addition, many tribes have no APS of their own, necessitating that cases be investigated by the state in which they are located, which may not be equipped to handle the cultural subtleties involved. Some tribes that do have APS are staffed by volunteers who may not be able to devote their full attention to the cases they encounter. These factors may contribute to the sense that the risks of reporting mistreatment are not worth the possible benefits. Elders and family members may be additionally motivated by the desire to maintain a sense of privacy around their family's “business” or to keep the kin group together; concern about losing grandchildren; the fear of ending up in a nursing home; and/or a sense of responsibility for the abuser, for whom the elder may be a caregiver. When considered as a whole, it is not surprising that Native elder mistreatment so often goes unreported.

Future Directions

The empirical research thus far indicates a small but growing knowledge base with respect to AI/AN elder mistreatment. Several research directions have been identified that are especially worthy of future examination. In terms of determining prevalence, the ideal would be a population-based prevalence study that could shed light on how widespread elder mistreatment actually is among AIs/ANs. However, conceptualization studies are also necessary to better understand elder and community perceptions. With respect to this latter line of research, of particular importance are the following questions: Where is the breaking point for tolerating mistreatment, both from an individual and a community perspective? Perceived severity is important to understand, especially with respect to the various types of mistreatment. For instance, is financial exploitation worthy of intervention? Are all types of financial exploitation seen as equal? How about other forms of mistreatment? Where does the line get crossed such that various types of actions are believed to be necessary (e.g., telling a friend or relative what is going on, notifying APS, calling the police, etc.)? Another important area of exploration concerns the informal behaviors/actions people engage in when encountering mistreated elders in their communities. This might involve their willingness to involve themselves or attempts to circumvent systems that are seen as inadequate (e.g., dealing with mistreatment within/between families). Research that attempts to understand what actions/systems various actors deem desirable, useful, futile, etc., would be potentially fruitful.

Although it might seem that sexual and physical abuse are the most clear-cut forms of mistreatment, in fact the resources to deal even with these crimes are generally inadequate. It is exceedingly rare to hear of a successfully prosecuted case. Given these issues, alternatives to the existing criminal justice model, such as restorative justice (Holkup et al., 2007), should be explored. Research that can inform prevention, detection, mediation, and interventions for all types of mistreatment among AIs/ANs are called for at this juncture, especially given the challenges that many Native communities face with respect to law enforcement, APS, and the criminal justice system.



Funding for the Shielding American Indian Elders Project was provided by the National Institute of Aging (1 R21 AG030686-01, Jervis PI). The Shielding American Indian Elders Team includes David Baldridge, Jan Beals, Connie Bremner, Dedra Buchwald, John Compton, Alexandra Fickenscher, William Foote, Julie Holden, Yvonne M. Jackson, Lisa James, Chebon Kernell, Crystal LoudHawk-Hedgepeth, Spero M. Manson, Traci McClellan-Sorell, Lisa Nerenberg, Emily Matt Salois, William Sconzert-Hall, Bessie Smith, Charlene Smith, and Gloria Tallbull.

Copyright 2014 by the National Academy of Sciences. All rights reserved.
Bookshelf ID: NBK208560


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