Assault on the Aged

Elder abuse is the last form of family violence to be dealt with nationally. A bill before Congress could stimulate much-needed research and resources--if lame-duck legislators get around to voting on it. Familial abuse brings to mind bruised children and battered wives. But grandma and grandpa also fall prey to maltreatment. "Elder abuse is the last of the big three recognized components of family violence," says gerontologist Georgia Anetzberger of Cleveland State University in Ohio, a member of the National Committee for the Prevention of Elder Abuse. Unfortunately, when it comes to understanding and preventing senior victimization, this category of mistreatment is "at least 20 to 25 years behind child abuse and domestic violence."

Between 200,000 and 5,000,000 people over 65 are abused each year, and many die from it. Because relatively little attention has been paid to elder abuse and its definition is so broad--some experts say it includes fraud and self-neglect--no one knows how extensive the problem is or whether current efforts effectively combat it. Now, multidisciplinary organizations of researchers, physicians, and policymakers are promoting national legislation to fund studies to rectify this lack of information, to make recommendations on how to handle elder abuse, and to provide money for protective services.

Elder abuse comes in many forms. The traditional varieties make their mark--physical assault by kin or caretakers, neglect, or spousal abuse that has lasted into the autumn years. But seniors also provide unique opportunities for financial abuse. Older people often have a nest egg that can be targeted by family or strangers. Scam artists and other "new friends" are not the only ones who try to wheedle older folks out of their retirement funds; some adult children also try to keep their elderly parents from spending money and enjoying their golden years. "That's called 'protecting the will' because some adult children think their parents' money belongs to them," says criminologist Brian Payne of Old Dominion University in Norfolk, Virginia.

A novel form of abandonment known as "red tail light syndrome" also occurs with older people, says Payne. Caretakers who need a break from their duties drop their charges off in emergency rooms, sometimes without identifying information. "All the emergency room personnel see are the red tail lights speeding away," Payne says. "The personnel have the senior for the weekend until someone comes to get them."

Some experts even consider self-neglect--when an elderly person can't or won't take care of herself--a form of abuse. The broadness of the definition of "abuse" can make studying the problem somewhat challenging.

To make matters worse, investigators have yet to agree whether older people in hazardous situations should be treated like helpless children or autonomous adults who can decide if and when they need help. The distinction could determine who gets limited resources. For example, in a case of potential financial abuse, social workers might need to distinguish between a 60-year-old with dementia who's being bilked by his crooked caretaker and a healthy senior who just happens to have poor money-management skills. "The issue is vulnerability rather than age, but [elder-abuse researchers] haven't dealt with it like that yet," says Anetzberger.

According to studies, elder abuse can be fatal when left untreated. Five years ago, Mark Lachs of Cornell University Medical College and colleagues found that only 9% of older people who had been abused survived until the end of the 13-year study, compared to 40% of those who were treated well. And the death risk is only slightly less for individuals who harm or don't take care of themselves: Only 17% of self-abused individuals lived the entire 13 years. Regardless of who perpetrated the harm, the misused weren't dying of injuries sustained from battery but from other causes, the most common being cardiovascular disease. The authors suggest that the "extreme stress" of noxious situations might lead to early death.

Researchers are pursuing the interpersonal dynamics that lead people to push around or neglect their elders. As with other poorly understood crimes in which people blame the victims (such as rape before sociologists clarified that the crime is about power, not about sex), the public tends to think that elders are partly responsible for their abuse. According to popular wisdom, "seniors are old; they create a burden on their offspring; the offspring get stressed and are mean to their elders," says Payne. But the fault is misplaced, he says. Studies show that plenty of caretakers feel overburdened, "but not everyone gets abusive." Identifying the factors that underlie the problem will help reduce the number of victims.

Because mistreated elders often live with and depend on their abusers, throwing perpetrators in jail could leave seniors in the lurch. Payne and others propose an integrated response by police, adult protective services, nurses, physicians, and other health care and senior agencies. About a third of police chiefs say they have special policies to deal with elder abuse, Payne reports in a study about to be published. He finds that police officers support policies that avoid "purely punitive responses" and are willing to work with social services organizations in such crimes. Multidisciplinary approaches are important in dealing with the victims as well. Cornell's Lachs would like to see teams of geriatricians, social workers, and law enforcement agents cooperate to identify and aid elders in questionable situations.

Two summers ago, the National Academy of Sciences acknowledged the dearth of research on elder abuse and called for a national study on its prevalence, in addition to research that will determine whether the intervention strategies currently employed work. To prompt such investigations, the National Committee for the Prevention of Elder Abuse has developed legislation called the Elder Justice Act. The bill, if it passes, will create an Office of Elder Justice within the Department of Justice and "establish a framework for federal involvement in elder abuse," says sociologist Sara Aravanis, the director of the National Center on Elder Abuse. But Congress just entered a lame-duck session, says Anetzberger. She and Aravanis worry that if the act doesn't pass now, it will die.

Until elder abuse receives such federal attention, researchers and health workers rely on family doctors--and the average Joe--to detect abuse. "It behooves all of us to be aware, to be watchful, to believe it could occur"--and to help the senior when it happens, says Anetzberger. And we should all be mindful of our own behavior--even if it means kissing our inheritance goodbye.

Mary Beckman is a writer in southeastern Idaho who has already squandered her inheritance.

National Center on Elder Abuse

National Committee for the Prevention of Elder Abuse