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© 2015, Deeanna Hui
Overview of the Prevalence of Elder Abuse and Neglect
Deeanna Hui
Texas Woman’s University
November 24, 2015

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© 2015, Deeanna Hui
Introduction
The term “elder abuse and neglect” has been widely defined as an act of omission that
cause trauma or threatened harm to the health and welfare of an older individual (Kennedy,
2005). Differently speaking, it is a violation of human and civil right of a vulnerable individual
by the person they rely on, or the caregiver (Cooper, Selwood, & Livingston, 2008). Elder
mistreatment is not a new issue in any society as it has occurred around the world for decades;
however, it did not come under the light until the recent decade when people begin to notice and
concern the rising of this issue. In United States, the first major investigation of elder abuse was
conducted two decades ago in the National Elder Abuse Incidence Study. Based on the records
of Adult Protective Service Agency, it found that 45 thousands of people aged 60 years or older
had experienced physical abuse, neglect, or some form of mistreatment in 1996 (Acierno, et al.,
2010). Later, 46 thousands cases were reported in 2004 (Fact Sheet, 2011). Nevertheless, other
researchers found elder abuse has the tendency to be undetected and unreported; only
approximately 1 in 14 cases were reported to authorities. Besides, majority of the studies
precluded the cognitively impaired elderlies from the samples of their inquiry-based method.
Therefore, this data from Adult Protective Service Agency records and professionals reports
underrepresented the victim population (Acierno, et al., 2010). In order to better address the
problem of elder abuse, it is crucial to educate the public and raise their awareness on this issue,
and provide sufficient trainings to health or community professionals on diagnosis of
mistreatment and procedure to report such discovery.
Findings
As many researchers realized the limitation of the records from Adult Protective Service
and authorities, most of the current research redirected their focus onto the older adults to gather

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information and only used these records for comparison purposes. They mostly conducted in-
person interview or telephone interview, where participants could speak privately without fear of
being overheard, to increase the likelihood of self-disclosure and the reliability of the data
(Acierno et al., 2010; Burnes et al., 2015). Yet, the cognitively impaired elderly were still out of
picture because their inability to respond to the interview precisely. From the National Elder
Mistreatment Study (Acierno, et al., 2010), four types of mistreatments were examined:
emotional abuse, physical abuse, neglect, and financial abuse or exploitation. The prevalence of
these abuses since 2008 to 2010 were 0.2-1.8%, 1.1-9%, 0.4-5.4%, and 5-5.2%, respectively
(Acierno et al., 2010; Burnes et al., 2015). Likewise, almost slightly more than 1 in 10
community-residing elderly experienced some form of abuse or neglect (Acierno, et al., 2010).
Acierno and his colleagues (2010) found each type of abuse was associated with
particular factors, for instances: emotional abuse was associated with younger age, employment,
and previous traumatic experience; physical abuse was related to younger age and social support;
sexual abuse was correlated with previous traumatic experience and low social support; neglect
was connected with poor health, low income, minority social status; and financial exploitation
was likely associated with the needs of assistance with daily activities and nonuse of social
services, and mostly done by family members. Specifically, they concluded the factor of low
social support was the most influential and relevant of all as it was shown to triple the occurrence
of any type of abuses. In fact, elderly who reported low social support were also more likely to
experience mental disorders, such as depression, generalized anxiety disorder, and post-traumatic
stress disorder (Acierno, et al., 2010).
On the other hand, Burnes and his team (2015) put the relationship between these risk
factors and mistreatment in a different perspective. They explained seniors with functional

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impairment and poor health were put at greater risk of abuse and neglect were due to diminishing
ability to defend oneself and escape the mistreatments. Thus, physical vulnerability somehow
correlates with the severity of abuse and neglect. Furthermore, they found elders who were under
certain crisis or stress was prone to experience mistreatment as well, for example, compared with
married older adults, separated or divorced older adults were more likely to have conflictive and
unsteady family relationships that lead to lower social support and pose greater risk, as
aforementioned (Burnes, et al., 2015). Additionally, low economic resources also place elderly at
risk because it was often considered as situational stressor contributing to mistreatment (Burnes,
et al., 2015). Even racial status somehow put individual at disadvantage, like Acierno et al
discussed, but the cultural values they embraced could be a protective factor. For example,
Hispanic elders tend to have lower rate of neglect and abuse because Hispanic culture promotes
filial responsibility and family closeness; therefore, cultural values does facilitate protection
against mistreatment (Burnes, et al., 2015).
Despite health condition and available resources are keys that hinder older adults to
abscond from abuse situation, community personnel and health professionals they contact also
take a vital role to prevent and report these happenings. Indeed, the situations escalate because
perpetrators do not feel monitor or unaware of their action is guilty. According to Cooper,
Selwood, and Livingston’s systematic review (2008), “1 in 6 care staffs reported committing
emotional abuse and 1 in 10 physical abuse, and over 80% of care home staffs had observed
abuse,” yet only 2% were reported to home management or authorities. In many cases the
abusive acts were not intentional and the care staffs may not even viewed their own actions in
this light. Often time abusive acts reflected caregiver’s lifelong relationship with past abused
experience, or the stress that he or she encounters in response to care recipient behaviors or

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condition (Cooper et al., 2008). The study result showed frequently asking both elderly and
caregivers about abuse can lead to better detection and higher sensitivity to the subject, which
may reduce the abusive act and increase inclination to report such incidence (Cooper et al., 2008).
In contrast, even physicians agreed the importance of elder abuse and believed primary care
physicians were best able to assist the victims, they were lack of experience and knowledge to
handle the situation, as familiar as child abuse and spousal abuse (Kennedy, 2005). Kennedy’s
research (2005) revealed 72% of physicians were minimally exposed to abused elders and more
than 80% of the responded physicians felt they had not been trained as much as child and spousal
abuse to diagnose elder mistreatment. For those that reported dealing with suspected cases, 94%
of them could not prove if mistreatment had taken place for some major reasons: the abuse
involved subtle signs, the victims denied mistreatment, unclear about the laws, definitions or
community resources, and unsure the reporting procedure (Kennedy, 2005). Hence, they had
chosen not to report the cases to neither authorities nor Adult Protective Service Agency. In sum,
these statistics demonstrated the significance to educate the public and professional the definition
of elder mistreatment and its law and procedure to report.
Implications
Knowing one’s parent or close relative suffering under the agony of abuse is a
heartbreaking truth to confront, especially when research shown that care staffs have the
tendency to commit abuses and only very few witnesses ever attempt to report (Cooper et al.,
2008). Families who are navigating this issue may experience mix feeling of guilt and conflict;
they may self-blamed the decision and choice they had made or their delayed detection of the
problem to cause torture of their love ones. Depending on the extent of the situation, families
may encounter stresses such as fear of rehiring a caregiver or relocating their elderly to a

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different facility, struggle to care and understand their traumatized elder along with other daily
stresses, or feel more obligated to care for the elder than they ever do. Some families may even
face crisis in serious cases, like death of the love one or some psychological effects that
remained to influence younger family members from wanting to leave their love ones for other to
care, or fear of aging and being in the same situation. This also places mental strain and inputs
the thought into the younger generation that caring for their elders by themselves is an
unavoidable responsibility or else their love ones will be put in jeopardy.
In addition, bringing lawsuit against a facility or caregiver for the mistreatment can be a
stress and a crisis to families at the same time. It is an undeniably long and complicated process
that families need to engage mentally and physically to fight for this unethical act for their love
ones and other elders that are possibly involved. Besides, seeking evidence and witness can be
difficult to take place when 80% of the people that witness the abuse chose not to report and
physicians are not well trained to diagnose elder mistreatment (Cooper et al., 2008; Kennedy,
2005). Moreover, filing a lawsuit without prior knowledge and solely relying on the professional
can be a stressful event, and this may become a crisis over time as it creates financial strain on
the families and strongly affects their emotional state when they are engaging in the process.
As a family professional, one not only can utilize this available data to raise awareness of
elder mistreatment when working with families, but can also provide more guidelines regarding
the early detection of elder abuse, the law and reporting procedure of such incidence, and the
evaluation of facilities or caregivers. Like Cooper and his researchers mentioned (2008),
constantly discussing the topic often helps individuals become more sensitive to the issue and
lead to its detection. Thence, this may reduce or even prevent the happening of elder abuse. But

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if the abuse actually takes place, one can still direct families to appropriate resources and assist
them through the process of reporting and prosecution.
Conclusions
Elder abuse and neglect is a type of violation of human and civil right. Even though it has
been a prevalent issue for decades, it did not gain attention until the recent years when the
number of cases and severity escalated, yet more in depth research are required to obtain
comprehensive overview. Sadly, many of the cases were undetected and unreported to agency
and authorities, so the data from these resources has underestimated the victim population. With
the awareness of this limitation, majority of the current research decided to solicit data directly
from older adults; however, because they required participants to answer series of questions, they
excluded the cognitively impaired elders, which still underrepresented the population but has
certainly improved from the existing data.
The research from Acierno et al (2010) and Burnes et al (2015) summarized some
significant factors, in a biopsychosocial perspective, that place elders at risk of abuse, they
included: age, employment, racial status, previous traumatic experience, health condition,
income, etc. Both directly and indirectly suggested low social support is the factor that strongly
correlates to the chances of being abused. Aside the difficulty for the victim to report their
experience, care staffs and primary care professionals were also vital to help report and prevent
such events, but unfortunately, they did not receive sufficient education to identify and realize
the seriousness of elder mistreatment. For families that undergo this challenge may encounter
stress and crisis, such as emotional and financial strain, loss of love, filing lawsuit, etc., that
require them to cope with. Overall, family professionals are crucial in promoting the importance
of elder mistreatment and providing supports to those who are going through the process.

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Reference
Acierno, R., Hernandez, M. A., Amstadter, A. B., Resnick, H. S., Steve, K., Muzzy, W., &
Kilpatrick, D. G. (2010). Prevalence and correlates of emotional, physical, sexual, and
financial abuse and potential neglect in the United States: The national elder mistreatment
study. American Journal of Public Health, 100(2), 292-297.
Burnes, D., Pillemer, K., Caccamise, P. L., Mason, A., Henderson, C. R., Berman, J., . . . Lachs,
M. S. (2015). Prevalence of and risk factors for elder abuse and neglect in the community:
A population-based study. Journal of American Geriatrics Society, 63, 1906-1912.
Cooper, C., Selwood, A., & Livingston, G. (2008). The prevalence of elder abuse and neglect: A
systematic review. Age and Aging, 37, 151-160. doi:10.1093/ageing/afm194
Fact Sheet. (2011). Retrieved from Center of Excellence on Elder Abuse and Neglect:
http://www.centeronelderabuse.org/docs/ea_stats_fact_sheet_2011.pdf
Kennedy, R. D. (2005). Elder abuse and neglect: The expereince, knowledge, and attitudes of
primary care physicians. Family Medicine, 37(7), 481-486.