Older adult maltreatment — elder abuse — holds its grip on society’s vulnerable adults with an uncomfortable frequency, hiding behind trusted relationships, isolation and illness.
This story is the first of a three-part series on elder abuse. We’ll define the issue with facts and numbers, introduce you to people who have overcome their abuse and faced their abusers, and finally, offer an action plan for victims and families.
– Marie Elium, editor
In the Shadows:
The Elder Abuse Epidemic
By Estelle Rodis-Brown
Reality check: One of the most pervasive, traumatizing problems affecting older adults may not even be on your radar.
Elder abuse —also known as older adult maltreatment — is a problem of epidemic proportions, yet is dramatically under-reported. For every reported case, 24 go unreported. Victims often trust and respect the very people responsible for their abuse.
So, how do we gain a handle on this insidious situation? To start, we need to identify the components of elder abuse, local statistics, and how older adults become victims of maltreatment. Then we can recognize it, report it, and become part of the solution.
Elder abuse impacts at least one in 10 adults nationwide over the age of 60. Two-thirds are women. That’s according to a study of 5,777 people who responded to a questionnaire on the subject. Ten percent said a family member abused them within the past year through financial abuse, potential neglect, emotional abuse, physical abuse and sexual abuse — in the order of prevalence.
Abuse among people with advanced stages of dementia or cognitive impairment is as high as 50 percent, says Courtney Reynolds, Senior Research Analyst at the Benjamin Rose Institute on Aging. “Even worse is the recognition that, as high as this rate of abuse seems to be, it is under-reported.”
Elder Abuse, Defined
Reynolds says, “Generally speaking, elder mistreatment (or elder abuse) is the harm of an older adult: emotional/psychological abuse, physical abuse, sexual abuse, financial abuse/exploitation and neglect. Each of these types of abuse is inflicted upon an older adult by a trusted individual in their life.”
Local elder abuse statistics can be found on Ohio’s Jobs and Family Services (ODJFS) website. Reynolds says, “Please keep in mind that this is reported elder abuse, not necessarily all elder abuse. In 2013, Adult Protective Services in Ohio received 13,151 reports of abuse, neglect and exploitation for people aged 60 and over. By 2020, that number had almost tripled.”
If 10 percent of Ohio’s more than 2 million older adults experience abuse, then 200,000 people should have filed reports, well above the 32,072 who did.
Who are the Abusers?
ODJFS reports that nearly 90 percent of elder abuse occurs at home. As Ohio ages, this issue is expected to worsen. By 2030, more than 25 percent of Ohio’s population will be 60 and older.
Abusers are usually family members. According to national Adult Protective Services data from 31 states, only 23 percent of perpetrators had no familial relationship to the older adult they abused. “This tells us that the vast majority of people abusing older adults are known individuals who are also related in some way,” Reynolds points out.
“Although this may seem counterintuitive at first –—Why would you abuse your own family? — it also makes sense. Our family members are the ones who have the most access to us, have the most complex relationships with us, and are most likely to be dependent on us financially, emotionally or physically in a way that can lead to conflict.”
What Can We Do?
Every state has laws to prevent elder abuse (any intentional or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult). Some address self-inflicted neglect, the most common type of abuse investigated nationally by Adult Protective Services agencies.
Ohio recognizes seven forms of abuse: physical abuse, sexual abuse, emotional or psychological abuse, self-neglect, neglect by others, abandonment and exploitation. Those found guilty of elder abuse can be charged with misdemeanors and felonies punishable by prison time, depending on the severity of the crime; convicted financial abusers must pay full restitution.
Reynolds is part of a team developing and testing interventions for elder abuse and self-neglect, and is developing training for Ohio’s mandated reporters, such as caregivers, physicians and attorneys.
While it’s never easy to acknowledge traumas like elder abuse, pretending it doesn’t exist only allows the problem to perpetuate. We must face it in order to stop its spread.
A Thorny Issue: Self-Neglect
Self-neglect is its own phenomenon. Although some experts do not consider self-neglect to be a form of elder maltreatment/abuse (but a related issue), it is the most common type of abuse reported to Adult Protective Services agencies nationally.
Self-neglect is when someone fails to care for themselves, either intentionally or unintentionally. It becomes an issue when the person’s health and safety are impacted or when community health and safety are affected.
Self-neglect is ongoing, not a one-time event. Common examples are when a person doesn’t take their medications consistently or stops bathing.
“Even when it is identified, an individual may refuse help from family and loved ones. This can be very challenging for people who care and want to intervene to help the situation. However, in our society, we value the right of self-determination. This means a person has the right to make decisions — even bad ones — as long as they don’t legally impact someone else,” Reynolds explains.
The only way this changes is if a judge takes those rights away. “As you can imagine, there are various degrees of severity of self-neglect, making this a complicated issue for families, practitioners and policymakers,” she says.
Reynolds and other researchers at Cleveland’s Benjamin Rose Institute on Aging, a nonprofit organization that supports older adults and caregivers, are taking the lead locally on the subject; they’ve studied self-neglect for more than a decade.
The team led by Dr. Farida Ejaz has received two grants from the U.S. Administration for Community Living (ACL), to study interventions to prevent self-neglect among at-risk adult primary care patients in Texas and people reported to Adult Protective Services for self-neglect in Oklahoma.
They are creating profiles of people who self-neglect, analyzing the data to help better understand the problem.
