Excerpt

Elder mistreatment is a recognized social problem of uncertain, though probably increasing, magnitude. According to the best available estimates, between 1 and 2 million Americans age 65 or older have been injured, exploited, or otherwise mistreated by someone on whom they depended for care or protection. The frequency of occurrence of elder mistreatment will undoubtedly increase over the next several decades, as the population ages. Yet little is known about its characteristics, causes, or consequences or about effective means of prevention. This report is intended to point the way toward better understanding of the nature and scope of the problem, a necessary condition for the development of informed policies and programs.

Contents

• THE NATIONAL ACADEMIES
• PANEL TO REVIEW RISK AND PREVALANCE OF ELDER ABUSE AND NEGLECT
• COMMITTEE ON NATIONAL STATISTICS 2001-2002
• COMMITTEE ON LAW AND JUSTICE 2001
• Acknowledgments
• Preface
• Executive Summary
  • RECOMMENDED RESEARCH AGENDA
  • CONCLUSION
• I. PANEL REPORT
  • 1. Introduction
    • AN AGING AND VULNERABLE POPULATION
    • HISTORICAL AND SOCIAL CONTEXT
    • WEAKNESSES IN EXISTING RESEARCH
    • IMPEDIMENTS TO ELDER MISTREATMENT RESEARCH
    • OUTLINE OF REPORT
  • 2. Concepts, Definitions, and Guidelines for Measurement
    • TOWARD A SCIENTIFIC VOCABULARY
    • GUIDELINES FOR MEASURMENT
    • OPERATIONALIZING THE ESSENTIAL ELEMENTS
    • CONCLUSIONS
  • 3. A Theoretical Model of Elder Mistreatment
    • RISK MODEL OF ELDER MISTREATMENT IN DOMESTIC SETTINGS
    • RISK MODEL OF ELDER MISTREATMENT IN INSTITUTIONAL SETTINGS
    • RECOMMENDATION
  • 4. The Occurrence of Elder Mistreatment
    • OCCURRENCE OF ELDER MISTREATMENT
    • IMPORTANT EPIDEMIOLOGICAL CONSIDERATIONS
    • CONCLUSIONS AND RECOMMENDATIONS
  • 5. Risk Factors for Elder Mistreatment
    • PROBLEMS IN THE RESEARCH BASE
    • FRAMEWORK FOR ELDER MISTREATMENT RISK FACTORS
    • RISK FACTORS VALIDATED BY SUBSTANTIAL EVIDENCE
    • POSSIBLE RISK FACTORS
    • CONTESTED RISK FACTORS
    • ELDER MISTREATMENT IN INSTITUTIONAL SETTINGS
    • CONCLUSIONS AND RECOMMENDATIONS
  • 6. Screening and Case Identification in Clinical Settings
    • A FRAMEWORK FOR ELDER MISTREATMENT SCREENING AND CASE IDENTIFICATION
    • SCREENING
    • CASE IDENTIFICATION
    • CONCLUSIONS
  • 7. Evaluating Interventions
    • REPORTING ELDER MISTREATMENT
    • ADULT PROTECTIVE SERVICES
    • HEALTH SYSTEM INTERVENTIONS
    • CRIMINAL JUSTICE INTERVENTIONS
    • PROFESSIONAL SPECIALIZATION AND COLLABORATION
    • INTERVENTIONS IN RESIDENTIAL CARE FACILITIES
    • URGENT NEED FOR OUTCOME RESEARCH
  • 8. Research Ethics
    • DECISIONAL CAPACITY
    • PROPER RESPONSES TO EVIDENCE OF MISTREATMENT
    • CONCLUSION
  • 9. Moving Forward
    • FROM THE MARGINS TO THE MAINSTREAM
    • BUILDING THE INFRASTRUCTURE
    • CONCLUSION
  • References
  • Appendices
    • APPENDIX A Elder Mistreatment Measures and Studies
    • APPENDIX B Analysis of Elder Abuse and Neglect Definitions Under State Law
    • APPENDIX C Elder Abuse and Neglect: History and Concepts
    • APPENDIX D Biographical Sketches
• II. BACKGROUND PAPERS
  • 10. Elder Mistreatment: Epidemiological Assessment Methodology
    Ron Acierno, Ph.D.
    • ISSUES RELEVANT TO ASSESSMENT OF VIOLENCE AGAINST OLDER ADULTS
    • ASSESSMENT OF ELDER MISTREATMENT: EXISTING METHODS AND MEASURES
    • ISSUES PERTAINING TO ASSESSMENT OF VICTIMIZATION: WHAT WE'VE LEARNED FROM RESEARCH ON VIOLENCE AGAINST CHILDREN AND YOUNG ADULTS
    • TELEPHONE VERSUS IN-PERSON INTERVIEW SURVEY METHODOLOGY
    • COLLECTING SUPPLEMENTAL DATA IN ADDITION TO THE VIOLENT EVENT
    • CONCLUSIONS AND SUGGESTIONS FOR FUTURE RESEARCH
    • SUMMARY
    • REFERENCES
    • APPENDIX ASSESSMENT TOOLS
  • 11. Ethical and Policy Issues in Research on Elder Abuse and Neglect
    Rebecca Dresser.
    • WHICH PROJECTS ARE GOVERNED BY RESEARCH ETHICS PRINCIPLES AND FEDERAL POLICY?
    • RESPECT FOR PERSONS IN RESEARCH ON ELDER ABUSE AND NEGLECT
    • BENEFICENCE IN RESEARCH ON ELDER ABUSE AND NEGLECT
    • JUSTICE IN RESEARCH ON ELDER ABUSE AND NEGLECT
    • CONFRONTING THE MAJOR ETHICAL CONFLICTS IN RESEARCH ON ELDER ABUSE AND NEGLECT
    • CONCLUSION: EXPANDING THE DELIBERATIONS
    • REFERENCES
  • 12. The Clinical and Medical Forensics of Elder Abuse and Neglect
    Carmel Bitondo Dyer, Marie-Therese Connolly, and Patricia McFeeley.
    • DETECTING ABUSE AND NEGLECT IN ELDERS
    • POTENTIAL MARKERS OF ABUSE AND NEGLECT
    • SPECIAL CONSIDERATIONS IN THE POSTMORTEM ANALYSIS
    • OTHER FORENSICS CONSIDERATIONS
    • RECOMMENDATIONS FOR RESEARCH
    • CONCLUSION
    • REFERENCES
  • 13. Financial Abuse of the Elderly in Domestic Setting
    Thomas L. Hafemeister.
    • PREVALENCE OF ELDER ABUSE IN GENERAL
    • FORMS OF ELDER ABUSE
    • PARAMETERS OF FINANCIAL ABUSE OF THE ELDERLY
    • TYPES OF FINANCIAL ABUSE OF THE ELDERLY
    • PREVALENCE AND IMPACT OF FINANCIAL ABUSE
    • WHY ELDER PERSONS ARE TARGETS FOR FINANCIAL ABUSE
    • RISK FACTORS AND CHARACTERISTICS OF VICTIMS
    • SIGNALS OF FINANCIAL ABUSE
    • MOTIVATIONS AND CHARACTERISTICS OF PERPETRATORS
    • APPROPRIATENESS OF ADOPTING MODELS ADDRESSING CHILD AND SPOUSE ABUSE
    • REPORTING STATUTES
    • OTHER SYSTEMIC POST-ABUSE RESPONSES
    • PREVENTIVE MEASURES
    • FUTURE RESEARCH NEEDED
    • REFERENCES
  • 14. Elder Abuse in Residential Long-Term Care Settings: What Is Known and What Information Is Needed?
    Catherine Hawes.
    • DEFINITIONS OF ABUSE AND NEGLECT
    • EVIDENCE ABOUT THE NATURE AND PREVALENCE OF ABUSE AND NEGLECT IN NURSING HOMES
    • EVIDENCE ABOUT THE NATURE AND PREVALENCE OF ABUSE AND NEGLECT IN RESIDENTIAL CARE FACILITIES
    • LIMITATIONS OF ESTIMATES OF PREVALENCE OF ABUSE AND NEGLECT IN LONG-TERM CARE SETTINGS
    • RESEARCH CHALLENGES ASSOCIATED WITH DETERMINING THE PREVALENCE OF ABUSE AND NEGLECT IN NURSING HOMES AND RESIDENTIAL CARE FACILITIES
    • CAUSES OF ABUSE AND NEGLECT AND IMPLICATIONS FOR RESEARCH
    • REFERENCES
  • 15. Elder Abuse Intervention: Lessons from Child Abuse and Domestic Violence Initiatives
    David A. Wolfe.
    • ASSESSMENT AND INTERVENTION ISSUES
    • EDUCATION AND PREVENTION
    • RECOMMENDATIONS FOR PRACTICE AND RESEARCH
    • SUMMARY
    • REFERENCES

This study was supported by Contract/Grant No. N01-OD-4-2139 between the National Academy of Sciences and DHHS/National Institutes of Health.

Suggested citation:

National Research Council. (2003). Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Panel to Review Risk and Prevalence of Elder Abuse and Neglect. Richard J. Bonnie and Robert B. Wallace, Editors. Committee on National Statistics and Committee on Law and Justice, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.

Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.