Elder abuse is increasing in the United States (US) as more Americans age and become vulnerable to various forms of mistreatment (Chang & Levy, 2021). This kind of abuse can have significant effects on mental health, not only for older victims but for perpetrators of abuse, too.
Identifying elder abuse, who it impacts, and how it intertwines with mental health can be challenging. However, it is the first step in addressing the problem and guiding interventions.
Elder Abuse: A Snapshot
Elder abuse affects about 10 percent of adults over 70 in the US annually, though this is likely an underestimate (Rosay & Mulford, 2017).
Elder abuse can be difficult to recognize and comes in different forms, including physical abuse, emotional or psychological abuse, neglect (including self-neglect), abandonment, sexual abuse, and financial exploitation. Obvious signs that abuse may be occurring include unexplained injuries or bruises, unusual weight loss, or unclean living conditions. However, there can also be more discrete signs, such as unusual changes in sleep and behavior, increased anxiety, or unpaid bills (National Council on Aging (NCOA), 2021).
While abuse can be committed by anyone, family members are often the main perpetrators. Researchers at the University of Southern California found that, among callers to the National Center on Elder Abuse’s resource hotline, nearly 50 percent reported abuse at the hands of a family member (Weissberger et al., 2020).
The Link Between Elder Abuse and Mental Health
Some older adults may be more vulnerable to abuse than others, such as those with cognitive impairment, those experiencing social isolation and depression, and those with small or no social networks (NCOA, 2021; Koga et al., 2020).
Though depression may put older adults at greater risk for abuse, the relationship between mental health and abuse isn’t so simple. In fact, research suggests that depression is both a risk factor and an outcome of elder abuse.
In one study, older adults with existing depression were about two times more likely to experience abuse than counterparts without depression. Concurrently, older adults without mental health concerns who then experienced abuse were about two times more likely to experience depression in the following three years (Koga et al., 2020).
Suicidal ideation can also result from elder abuse. Researchers in China found that older adults who experienced abuse were much more likely to experience suicidal ideation than those who were not abused (almost 18 percent versus two percent) (Wu et al., 2013).
Perpetrators of Elder Abuse Face Their Own Mental Health Challenges
It’s no surprise that victims’ poor mental health outcomes and elder abuse are related. But mental health plays a role for perpetrators of abuse, too.
Chronic physical or mental health conditions, substance or alcohol misuse, and high stress and burnout are risk factors for perpetrators of elder abuse (World Health Organization (WHO), 2022).
The COVID-19 pandemic produced a perfect storm for abuse that reverberates today, as both older adults and perpetrators experienced social isolation, stress, and health problems. One survey of community-based caregivers shows that, post-COVID, they are drinking more alcohol, feeling significantly more socially isolated and lonely, and are more worried about their finances than before the pandemic (Makaroun et al., 2021).
These stressors also impact paid staff in long-term care settings. Self-reports from these staff suggest that the risk of elder abuse is greater when they experience stress from staff shortages and emotional exhaustion, both of which have been exacerbated by the COVID-19 pandemic (Yon et al., 2019).
We Can’t Reduce Elder Abuse Without Awareness
While addressing stressors is important, it’s also crucial to equip our communities to identify abuse and normalize talking about it. Most experts agree that elder abuse is underreported, mainly due to fear of retaliation or shame (RAINN, n.d.).
Research shows that victims of abuse seek help from law enforcement only 15 percent of the time. Older adults are least likely to report abuse to authorities when they depend upon their abuser and when their abuser is well-connected to the community (Burnes et al., 2018).
Older adults often don’t feel empowered or equipped to seek help, and professionals are undertrained to identify abuse or help older victims access care and services they may need.
So, What Can We Do?
To better identify abuse and give older adults a voice, we can look to critical access points in our healthcare system where providers often interact with older adults. One example is the emergency department (ED).
Older adults account for 23 million ED visits each year, yet ED providers say they do not commonly screen for elder abuse and feel that they often miss it (Sheber et al., 2023; Rosen et al., 2018). Reasons for this include time constraints, a lack of training, and a positive screen for elder abuse requiring additional work.
Implementing a multidisciplinary team (MDT) in the ED that specializes in elder abuse is one way to help providers better identify abuse and link patients with resources. Hospital MDTs are made up of social workers, legal experts, and patient services staff, among others. They augment clinical provider care by conducting a comprehensive evaluation of an older patient with suspected abuse and then connecting that patient with necessary services and support.
MDTs are also used outside of hospital settings in towns and districts, staffed by a mix of civic and health professionals, including law enforcement, mental health clinicians, and attorneys. These community-based teams link elder abuse victims to services and resources, provide counseling, and engage in crisis intervention (Office for Victims of Crime, 2023). They also deliver training to government officials, healthcare providers, and courts to identify elder abuse.
MDTs are valuable for victims, but we also need prevention for perpetrators, too.
The American Psychological Association (2022) suggests that education is key to preventing abuse for perpetrators. If perpetrators know what risk factors lead to abuse, how abuse impacts an older adult’s mental health, and what resources are available, they may be less likely to commit abuse and get help.
Digging deeper into societal-level stressors that may lead to elder abuse is another avenue for change. Experts say that providing financial relief in the form of tax credits and other similar policies that can help reduce stress, burnout, and strain on caregivers would reduce abuse (Marshall et al., 2020).
These interventions are springboards for change, but we have much more research and work to do to prevent abuse and empower older adults. Importantly, interventions to address abuse must incorporate mental health for both victims and perpetrators. With a growing proportion of older adults in America, the time to tackle elder abuse is now.
Katherine O’Malley, MPH, is Policy Analyst at Boston University School of Public Health. She may be reached for comment at keomall@bu.edu.
References
American Psychological Association. (2022, November 10). Elder abuse: How to spot warning signs, get help, and report mistreatment. https://www.apa.org/topics/aging-older-adults/elder-abuse
Burnes, D., Acierno, R., & Hernandez-Tejada, M. (2019). Help-Seeking Among Victims of Elder Abuse: Findings From the National Elder Mistreatment Study. The Journals of Gerontology, 74(5), 891–896, https://doi.org/10.1093/geronb/gby122
Chang, E.S., & Levy, B.R. (2021). High Prevalence of Elder Abuse During the COVID-19 Pandemic: Risk and Resilience Factors. American Journal of Geriatric Psychiatry, 29(11), 1152-1159. https://doi.org/10.1016/j.jagp.2021.01.007
Koga, C., Tsuji, T., Hanazato, M., Suzuki, N., & Kondo, K. (2022). Elder Abuse and Depressive Symptoms: Which is Cause and Effect? Bidirectional Longitudinal Studies From the JAGES. Journal of Interpersonal Violence, 37, 11-12. https://doi.org/10.1177/0886260520967135
Makaroun, L.K., Beach, S., Rosen, T., Rosland, A.M. (2021). Changes in Elder Abuse Risk Factors Reported by Caregivers of Older Adults during the COVID-19 Pandemic. Journal of American Geriatric Society, 69(3), 602-603. https://doi.org/10.1111/jgs.17009
National Council on Aging (NCOA). (2021, February 23). Get the Facts on Elder Abuse. https://www.ncoa.org/article/get-the-facts-on-elder-abuse
Office for Victims of Crime. (2023). Elder Abuse and Financial Exploitation. https://ovc.ojp.gov/2023-report-nation/elder-abuse-financial-exploitation
RAINN. (n.d.). Elder Abuse. https://rainn.org/articles/elder-abuse#:~:text=Even%20with%20mandatory%20reporting%20laws,for%20care%20and%20basic%20needs
Rosay, A. B., & Mulford, C. F. (2016). Prevalence estimates and correlates of elder abuse in the United States: The National Intimate Partner and Sexual Violence Survey. Journal of Elder Abuse & Neglect, 29(1), 1–14. https://doi.org/10.1080/08946566.2016.1249817
Rosen, T., Stern, M.E., Mulcare, M.R., Elman, A., McCarthy, T.J., LoFaso, V.M., Bloemen, E.M., Clark, S., Sharma, R., Breckman, R., & Lachs, MS (2018). Emergency department provider perspectives on elder abuse and development of a novel ED-based multidisciplinary intervention team. Emergency Medicine Journal, 35(10), 600-607. doi: 10.1136/emermed-2017-207303
Sheber, M., McKnight, M., Liebzeit, D., Seaman, A., Husser, E.K., Buck, H., Reisinger, H.S., & Lee, S. (2023). Older adults’ goals of care in the emergency department setting: A qualitative study guided by the 4Ms framework. Journal of American College of Emergency Physicians Open. https://doi.org/10.1002/emp2.13012
Weissberger, G.H., Goodman, M.C., Mosqueda, L., Schoen, J., Nguyen, A.L., Wilber, K.H., Gassoumis, Z.D., Nguyen, C.P., & Han, S.D. (2020). Elder Abuse Characteristics Based on Calls to the National Center on Elder Abuse Resource Line. Journal of Applied Gerontology, 39(10), 1078-1087. https://doi.org/10.1177/0733464819865685
World Health Organization (WHO). (2022, June 13). Abuse of older people. https://www.who.int/news-room/fact-sheets/detail/abuse-of-older-people
Wu, L., Shen, M., Chen, H., Zhang, T., Zhongqiang, C., Xiang, H., & Wang, Y. (2013). The Relationship Between Elder Mistreatment and Suicidal Ideation in Rural Older Adults in China. American Journal of Geriatric Psychiatry, 21(10), 1020-1028. https://doi.org/10.1016/j.jagp.2013.01.036
Yon, Y., Ramiro-Gonzalez, M., Mikton, C.R., Huber, M., & Sethi, D. (2019). The prevalence of elder abuse in institutional settings: a systematic review and meta-analysis, European Journal of Public Health, 29(1), 58–67. https://doi.org/10.1093/eurpub/cky093
