Elder Abuse and the Contagion of Violence: One Size Doesn’t Fit All
Elder abuse is a global public health and human rights issue. Elder abuse includes physical, sexual, and emotional abuse, neglect (both caregiver and self-neglect), and financial exploitation. Despite the evidence suggesting that elder abuse is associated with morbidity and mortality, great paucity remains in our understanding of theories, etiologies, and intervention strategies.
The Institute of Medicine Forum on Global Violence Prevention convened a workshop in spring 2012 to explore the contagious nature of violence, with much discussion on the issues of child maltreatment, youth violence, and family violence. Speakers at the workshop discussed how violence leads to other violence, and can spread through individuals, groups, and generations. Although little discussion took place regarding violence against the elderly, some elements of the framework could apply to elder abuse.
Among elder abuse by known perpetrators, family members are the most frequent offenders. Evidence suggests that susceptible victims tend to be women of older age and lower socioeconomic status, and those experiencing cognitive or physical impairment and psychosocial distress. Given that child maltreatment and intimate partner violence occur in homes, it is possible for elder abuse to co-occur within the same families. In addition, because previous victimization is a risk factor for future victimization, one could speculate that elder abuse victims might also have been victims of other types of violence earlier in their lives. And finally, although most abusive acts occur unidirectionally toward older adults, it is possible that older victims could return the violence toward the partner or the child, creating a codependent violent cycle.
Moreover, older adults are at risk of self-neglect and self-violence. Suicide is common in older adults, although there is great cultural variation globally. In addition, older adults often neglect their mental and physical well-being, with a recent study suggesting a prevalence rate of 9 percent (and it is even greater among those of lower socioeconomic status or cognitive or physical frailty). Recent evidence suggests that older adults who neglect themselves are at substantial increased risk for subsequent victimization by known or unknown perpetrators.
However, the contagion of violence only fits some of the characteristics of elder abuse cases. Elder abuse is perpetrated not only by family members, but also by other known persons, as well as strangers. Among abuse by unknown perpetrators, one of the most common cases is financial exploitation, a form of abuse that is unique to elder abuse. Evidence suggests that the risk factors of cognitive and physical impairment tend to predict financial exploitation, rather than physical or sexual abuse. It is not necessarily the case, then, that such forms of elder abuse are contagious, and a different conceptual framework is necessary to explore these different factors.
Theories relating to elder abuse are important for research, education, practice, and policy making. Although the contagion of violence can partly explain certain subtypes of elder abuse within specific settings, cultures, and relationships, there are many other forms of elder abuse that cannot be explained. Further efforts are needed to understand the subtypes of elder abuse and delineate the different risk and protective factors and consequences. Through these approaches, successful intervention and prevention strategies can be tested and implemented in order to reduce suffering, morbidity, and mortality.
