The statistics are alarming: approximately 1 in 10 Americans 60 or older have experienced some form of elder abuse. Among those with dementia, the rate is closer to 1 in 12. At least 5 5 million elders are abused each year, according to some estimates. Sadly, that figure is probably much too low, since only about 1 in 14 cases are likely reported to authorities.
Elder abuse can happen to anyone, in any setting, from any community or background, say researchers at the National Clearinghouse on Abuse Later in Life. Abuse comes in many forms—financial, physical, psychological, sexual, or neglect. Any “violation of an individual’s human and civil rights by another person or persons,” is considered abuse, according to the U.S. Department of Health and Human Services. And despite some well publicized scams, it turns out the majority of abuse happens by family members, not by strangers.
“The most difficult cases are when you get family conflict, and arguments about what’s in the best interest of mom, says Kathleen Wilber, Professor of Gerontology at USC and co-director of the School of Gerontology Secure Old Age Lab. “It’s not a slam dunk in terms of being easy to sort out. And on the other side, we don’t have very good remedies. “
Elders who have been abused have a 300% higher risk of death when compared to those who have not been mistreated. Estimates of elder financial abuse and fraud costs to older Americans range from $2.9 billion to $36.5 billion annually, according to the National Council on Aging.
The causes of elder abuse are wide-ranging—and while caregiver stress may play a role, it’s often another adult family member who takes advantage of the older person, says Robert Blancato, National Coordinator at the Elder Justice Coalition. “It’s important to make that distinction.” Many caregivers experience stress, he points out, yet the majority do not harm older individuals.
Perpetrators are most likely to be adult children or spouses, more likely to be male, have history of past or current substance abuse, mental or physical health problems, a history of trouble with the police, be socially isolated, unemployed or have financial problems, and be experiencing major stress, according to research by the National Council on Elder Abuse.
Abusers often use coercion to gain and maintain power over a victim. They may intimidate or manipulate them to gain some kind of benefit—such as access to finances, the deed to a house, or title to a car. The National Care Planning Council says dependence on caregivers or family members makes an older person more vulnerable to abuse. But research on specifics is slim.
Older people are often reluctant to report abuse, either out of fear of getting their family member in trouble or that they will be the one removed from the home, says Wilber, who also co-directs USC’s National Center on Elder Abuse. “Sometimes I think families know more than we think they do about what’s going on.”
“You can’t stop what you don’t report,” says Blancato. While several laws, including the National Family Caregivers Support Act, the Lifespan Respite Care Support Act, and the RAISE Act provide some practical resources for families, it’s not enough, says Blancato, who frequently testifies before Congress on elder justice issues.
“Since 2009, Congress has appropriated approximately $2.5 million per year to implement Lifespan Respite Programs. That’s a drop in the bucket,” he says.
What can caregivers or family members do if they suspect a loved one is being abused or neglected?
“The family dynamic stuff is really fraught.,” Wilbur says. She wants researchers and program experts to develop more effective solutions, such as ongoing counseling, more respite options or other community services that families are comfortable using.
Caregivers can also try to be more attuned to their own behavior and tools that are available—such as mindfulness to reduce stress or seeking out adult day programs, which can provide a few hours of respite. Additionally, caregivers and older adults need better understanding of the boundaries to put around behavior, what is and is not acceptable.
It’s also important for caregivers or other family members to pay attention when things don’t seem normal—if grandma always let her grandson use the car, that’s one thing. But if this is a new situation, take notice and ask questions. “We need to do a better job of educating caregivers, helping them understand the complexities of the role in supporting elders,” says Wilber.
There’s also a need for more aggressive efforts to prepare family caregivers for their responsibilities. “We’re not doing enough, frankly,” says Blancato. “However well meaning, they may not completely grasp what they’re walking into.”
One source of help may be Medicare Managed Care plans, which are now permitted to offer non-medical supplemental services, like home care aides, nutritional services, home modification, transportation or respite care. However, it’s not yet clear which insurers will offer these benefits, or what limits may be placed on them. These extras can provide opportunities for new community programs or services, as well as opportunities for those in the longevity field to step up to help elders live more independently and provide more eyes and ears to help spot potential abuse.
Anyone who suspects an abusive situation should contact their local adult protective services office or call 911.