The Nature and Scope of Elder Abuse

Abstract

For practitioners, cases are often frustrating. For elders, solutions are dificult and, frequently, unacceptable. Almost a quarter century has passed since elder abuse first became a matter of public concern. Although the topic had surfaced briefly in British medical journals in the mid 1970s, testimony about battering at a U.S. congressional subcommittee hearing on family violence in 1978 (U.S. House of Representatives, 1978) brought elder abuse from behind closed doors onto the national stage. Once elder abuse was linked to family violence, it became a hot topic in the media. Horrific case reports uncovered by the U.S. House of Representatives Select Committee on Aging (1979) fueled public consternation, and state policy makers reacted by pressing for special elderabuse legislation. A decade or so earlier, Congress had passed the 1962 Public Welfare Amendments to the Social Security Act. The amendments authorized payments to the states to establish protective services for persons with physical and/or mental limitations, who were unable to manage their own affairs . . . or who were neglected or exploited (U.S. Deptartment of Health, Education and Welfare, 1966). Twelve years later, with the adoption of the Title XX amendment to the 1974 Social Security Act, adult protective services (APS) became a state-mandated program covering all adults 18 years and older. Because the acs system for reporting and investigating cases was already in operation by the time elder abuse became a public issue, legislators could support action on elder abuse without having to call for additional state expenditures. Within a few years, most states had passed elder-abuse laws or had amended existing adult protective services legislation to address the issue. In the United States, the construction of elder abuse as a social problem was profoundly affected by the alignment of elder abuse with adult protective services and pre-existing stereo types about aging. The images of impaired, vulnerable victims that this association conveyed seemed to fit into the predominant model of how child abuse occurs. Many envisioned a dependent elderly parent being cared for by a well-intentioned but overburdened and guilt ridden daughter. The analogy extended further. Because there was no model statute and no database on elder abuse, child-abuse law with its mandatory reporting of suspected cases became the prototype for legislation in more than threequarters of the states. Before long, however, the inadequacies of this paradigm became apparent-along with its potential for infantalizing older adults and violating their civil rights. New findings on the prevalence of spouse abuse in the elderly population suggested that the domestic violence model might be a better fit. Working with this conceptualization, policy makers have expanded intervention and treatment possibilities to include the methods and instruments of the public health and criminal justice systems. Over the years, federal policy has reflected the various constituencies that have laid claim to the issue of elder abuse. Public welfare laws, some provisions of the Older Americans Act, and multiple crime bills have been national legislative responses to victims and their families. At the state level, laws addressing elder abuse and adult protective services are continually being amended to incorporate these new conceptualizations. The multifaceted nature of elder-abuse cases, which involve physical, psychological, social, legal, ethical, and environmental matters, requres that action take place on the psychological, social, and legal levels and that it involve multiple systems. For practitioners, the cases are demanding and often frustrating; for older adults, solutions are difficult and, frequently, unacceptable. A brief overview of the nature, scope, and consequences of elder abuse is given below. DEFINITIONS OF ELDER ABUSE In its common usage, elder abuse is an allinclusive term representing all types of mistreatment or abusive behavior toward older adults. …

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