ATrain Education

 

Continuing Education for Health Professionals

IA: Abuse of Dependent Adults

Module 2

Our Aging Population and Elder Abuse

In the United States the population age 65 and over has increased from 36.6 million in 2005 to 47.8 million in 2015 (a 30% increase) and is projected to more than double to 98 million in 2060. By 2040 there will be about 82.3 million older people, over twice their number in 2000 (U.S. Administration on Aging, 2016).

People 65 and older represented 14.9% of the population in the year 2015 but are expected to grow to be 21.7% of the population by 2040. The population over 85 is projected to more than double from 6.3 million in 2015 to 14.6 million in 2040 (USAOA, 2016).

Racial and ethnic minority populations have increased from 6.7 million in 2005 (18% of the older adult population) to 10.6 million in 2015 (22% of older adults) and are projected to increase to 21.1 million in 2030 (28% of older adults) (USAOA, 2016).

Between 2015 and 2030, the white (not Hispanic) population 65+ is projected to increase by 43% compared with 99% for older racial and ethnic minority populations, including Hispanics (123%), African-Americans (81%), American Indian and Native Alaskans (82%), and Asians (90%) (USAOA, 2016).

 

Number of Persons 65+, 1900 to 2060 (numbers in millions)

chart: number of persons 65+ 1900 to 2060

Note: Increments in years are uneven. Source: U.S. Census Bureau, Population Estimates and Projections (USAOA, 2016, p. 3).

 

It is estimated that in 2014 there were 491,349 people age 65 and older living in Iowa, which represented 15.8% of the total population. Women accounted for 275,624 or 56.1% of this age group, and 52,632 of them were age 85 or older (66.9%).

Iowa ranked thirteenth in the United States in the percentage of population age 65 and older. Projections indicate that in 2050 Iowa’s population age 65 and older will be 696,450, constituting 20% of the state’s total population (IowaSDC, 2016).

Elder Abuse

In a review study done in 2003, the National Research Council (NRC) noted that between 1 and 2 million Americans age 65 or older had been injured, exploited, or otherwise mistreated by someone on whom they depended for care or protection (NRC, 2003). Despite the increase in the aging population and a broad concern that abuse is a serious problem, only a few national studies of the incidence of elder abuse have been published since 1998. However, Iowa’s Attorney General and others have asserted that local and regional studies can also provide information that is generally useful and pertinent (NIJ, 2015; IDJ/OAG, 2017).

In general, elder abuse refers to “any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult.” Although all fifty states have passed some form of elder abuse prevention laws, these laws and definitions of terms can vary considerably. However, broadly defined, abuse may be:

  • Physical abuse—inflicting physical pain or injury on a senior, eg, slapping, bruising, or restraining by physical or chemical means
  • Sexual abuse—non-consensual sexual contact of any kind
  • Neglect—the failure by those responsible to provide food, shelter, health care, or protection for a vulnerable elder
  • Exploitation—the illegal taking, misuse, or concealment of funds, property, or assets of a senior for someone else’s benefit
  • Emotional abuse—inflicting mental pain, anguish, or distress on an elder through verbal or nonverbal acts, eg, humiliating, intimidating, or threatening
  • Abandonment—desertion of a vulnerable elder by anyone who has assumed the responsibility for care or custody of that person
  • Self-neglect—characterized as the failure of a person to perform essential, self-care tasks and that such failure threatens his/her own health or safety (USAOA, 2016)

Iowa defines the following categories of abuse when the action is a result of the willful or negligent acts or omissions of a caretaker:

  • Physical Abuse
  • Sexual Abuse
  • Sexual Exploitation
  • Exploitation
  • Denial of Critical Care
  • Self Denial of Critical Care (Iowa Code Chapter 235B; IDA, 2016)

Prevalence

In 2009 a National Institute of Justice (NIJ) study of 5,777 adults over 60 years of age found that 11% reported some form of mistreatment other than financial exploitation in the previous year. Among them, the reporting of the mistreatment to authorities ranged from a low of 8% for emotional abuse, to 16% for sexual abuse, to 31% for physical abuse. Thus, 69% of the adults over 60 who are experiencing physical abuse are not reporting that abuse (Acierno et al., 2009). The problem of under-reporting remains a critical concern.

The same NIJ study found that previous-year financial exploitation by a family member had affected 5.2% of respondents and lifetime incidents of financial exploitation by a stranger had affected 6.2% (Acierno et al., 2009). Financial exploitation can directly affect quality of care, depriving victims of the financial means to access medical treatment or obtain medications, sometimes with dire consequences.

Financial exploitation is a fast-growing form of abuse of dependent adults and, like other forms of abuse, is seriously under-reported. In recent research, 1 in 20 elders reported recent incidents of perceived financial mistreatment, and 90% of abusers are family members or trusted others, such as caretakers, neighbors, friends, and professionals (attorneys, doctors and nurses, pastors, bank employees) (NAPSA, 2017; Acierno et al., 2009).

Victims

Many factors—race, gender, age, income and employment, physical and mental health, prior traumatic events, social support—can play a role in the likelihood of becoming a victim. These factors operate differently for the various types of mistreatment; some are indicative of potential for all types of abuse while others are significant only for certain forms of abuse. For example, those reporting very low social support face a three-fold greater risk of emotional mistreatment, while those needing assistance with daily life activities face double the risk. In fact, low social support affects the potential for all types of mistreatment, which may provide clues to important potential avenues of prevention (Acierno et al., 2009).

The NIJ study found that those in the 60–70 age group—the younger old—have an increased risk of physical, emotional, and stranger-perpetrated financial mistreatment, while age was not related to increased or decreased risk of sexual abuse, financial mistreatment by family members, or neglect. Variation in these findings among studies may be related to whether the experience of institutionalized people is considered.

The NIJ study also found that gender (being female) only increased the risk for sexual abuse, while belonging to a non-white racial group was associated with increased risk of physical mistreatment, financial mistreatment, and potential neglect. It is important to note that the role of risk factors can be affected by many things and combinations of factors increase that complexity.

Perpetrators

In the landmark National Elder Abuse Incidence Study done in 1998 it was found that nearly half of the perpetrators of elder abuse were adult children of the victims. Spouses accounted for 20% of the perpetrators, while other relatives, grandchildren, and siblings were also noted as perpetrators (NCEA, 1998).

The 2009 NIJ study breaks down similar findings with more detail. It found that in emotional, physical, sexual, and neglect incidents the majority were perpetrated by a family member. Partners or spouses accounted for 57% of physical mistreatment, 40% of sexual mistreatment, 28% of neglect, and 25% of emotional mistreatment. Children, grandchildren, and other relatives also play a significant role in these events (Acierno et al., 2009).

 

Perpetrators of Most Recent Emotional Mistreatment Event

chart: perpetrators of emotional event (percentages)

Source: Acierno, 2009.

 

Perpetrators of Most Recent Physical Mistreatment Event

chart: perpetrators of physical event (percentages)

Source: Acierno, 2009.

 

Perpetrators of Most Recent Sexual Mistreatment Event

chart: perpetrators of sexual event (percentages)

 

Source: Acierno, 2009.

 

While the NCEA study in 1998 showed that more than half (53%) of abusers were male, 75% were white, and nearly 40% were middle-aged, the NIJ study helps demonstrate that many factors may play a role in who becomes a perpetrator. The better these factors are understood, the better intervention strategies may be developed. For example, “relative to the general population, it appears that perpetrators of emotional, physical, and sexual mistreatment had high unemployment, increased substance abuse, and increased likelihood of mental health problems. Particularly striking was the older adult report that perpetrators of mistreatment were socially isolated….[This] may present targets for intervention. Reducing substance abuse and increasing social connections in isolated family members of older adults may have the secondary benefit of reducing elder mistreatment” (Acierno, et al., 2009; NCEA, 1998).

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