Chapter 19: Detecting, Assessing, & Responding to Elder Mistreatment

GENERAL PRINCIPLES

Elder mistreatment is a common, yet underappreciated and underrecognized health issue affecting older adults. Mistreatment can occur at home, in nursing homes, or in other long-term care facilities. Perpetrators may be family, friends, caregivers, or other residents in a long-term care facility. In the 2008 National Elder Mistreatment Study, a random-digit dialing telephone survey, 1 in 10 community-dwelling older adults in the United States reported mistreatment in the past year; 4.6% reported emotional abuse, 1.6% physical abuse, 0.6% sexual abuse, 5.1% potential neglect, and 5.2% current financial abuse by a family member, with some respondents reporting more than one type of mistreatment. A 2017 systematic review and meta-analysis estimated the worldwide prevalence of elder mistreatment to be 15.7%. Rates of mistreatment for persons with dementia are thought to be much higher, with many estimates ranging from 40% to 60%. Rates of elder mistreatment may vary by race, ethnicity, and cultural background, although more data are needed. There are limited data estimating mistreatment rates in settings such as acute care and long-term care facilities. Recognizing the marked worldwide growth in the number of older persons and the abuse and suffering inflicted on some, the United Nations designated June 15 every year as World Elder Abuse Awareness Day.

Elder mistreatment can have a variety of impacts on the physical, emotional, and financial health of older adults. Victims of elder mistreatment have higher rates of depression and anxiety, hospitalizations, nursing home placement, and death. In the Chicago Health and Aging Project, a prospective cohort of community-dwelling older adults, those with confirmed mistreatment were two to three times more likely to be hospitalized and to die than those without a report of mistreatment. Elder mistreatment also causes emotional trauma for nonabusing loved ones, friends, and caregivers, with over two-thirds reporting personal distress related to knowing about the mistreatment.

Despite the high prevalence and health impacts of elder mistreatment, it remains underidentified and underreported. A comprehensive survey of elder mistreatment in New York State found that only 1 of every 24 cases of self-reported elder mistreatment had been reported to authorities. The information that follows will help clinicians identify, document, manage, and report suspected cases of elder mistreatment.