Elder Abuse and Its Prevention: Workshop Summary (2014)

Violence and related forms of abuse against elders is a global public health and human rights problem with far-reaching consequences, resulting in increased death, disability, and exploitation with collateral effects on well-being. Data suggest that at least 10 percent of elders in the United States are victims of elder abuse every year. In low- and middle-income countries, where the burden of violence is the greatest, the figure is likely even higher. In addition, elders experiencing risk factors such as diminishing cognitive function, caregiver dependence, and social isolation are more vulnerable to maltreatment and underreporting. As the world population of adults ages 65 and older continues to grow, the implications of elder abuse for health care, social welfare, justice, and financial systems are great. However, despite the magnitude of global elder maltreatment, it has been an underappreciated public health problem.

This workshop will illuminate the burden of elder abuse around the world and the evidence base for its detection and prevention. Occurrences and co-occurrences of different types of abuse—including physical, sexual, and emotional violence; neglect; and financial exploitation—will be addressed. Promising innovative approaches to intervention and prevention will be explored, as well as opportunities for scalability and cross-sectoral collaboration.

This panel will address the global perspectives of elder abuse and the growing international recognition of its impacts on individuals, families, communities, and societies. Panelists will illuminate different types of maltreatment and their common co-occurrences, including abuse, neglect, and financial exploitation.

This session will aim to describe the diverse conceptual frameworks proposed to examine the issues of elder abuse. Based on the literature and work of the National Academy of Sciences (NAS), Pamela Teaster will summarize key conceptual frameworks with relevance to elder abuse: ecological framework, cycle of violence framework, NAS sociocultural context framework, and lifecourse framework.

The objectives of this session are to describe the status of evidence regarding (1) factors influencing the likelihood of elder abuse (risk factors, protective factors, correlates/comorbid conditions, etc., for victimization and perpetration, according to elder abuse type, setting, and ecological level); (2) adverse outcomes stemming from experiences that are abusive, neglectful, or exploitative; and (3) scope and factors associated with elder abuse in assisted living and long-term care settings.

The goals of the session are to (1) review what we know about caregiver neglect and self-neglect as a subset of elder abuse; (2) examine how caregiver neglect is distinctly different from self-neglect; (3) explore what research is crucial for future progress; and (4) determine possible ways to prepare the workforce to detect, treat, and prevent caregiver neglect and self-neglect.

What are the challenges and ethical issues in measuring and conducting research on elder abuse and implementing interventions? Panelists will discuss issues of informed consent and human subject protection, certificate of confidentiality, decisional capacity issues, lack of reporting, stigma and discrimination, and how to approach victims who refuse needed services. Consideration will be given to challenges within the United States and globally.

The goals of this session are to (1) understand the scope of elder abuse in diverse communities; (2) explore in depth the sociocultural context (measurement, detection, treatment, and help seeking) for elder abuse in diverse communities; (3) examine the role of grassroots community organization in prevention of elder abuse; and (4) explore the role of Community Based Participatory Research (CBPR) methodology in advancing the field of elder abuse and its prevention.

This panel will discuss the measurement development, screening, and prevention of elder abuse across varied settings and providers. This panel will open up with a discussion about elder maltreatment measurement work with the Centers for Medicare & Medicaid Services. Other panel discussions will explore what screening and prevention are and how to improve these processes, led by researchers in the field of elder abuse.

Panelists will present intervention models and strategies that target different forms of elder abuse and their evidence of effectiveness and success. A moderated panel discussion will focus on opportunities for cross-sector collaboration, and adaptation and scalability of promising approaches.

The purpose of the breakout sessions is to explore primary, secondary, and tertiary prevention strategies in different settings, as well as challenges and barriers to implementing such strategies. Specific focus will be given to opportunities for cross-sector collaboration and issues of potential scalability and transferability.

Often compared to the campaigns against domestic violence and child abuse, relative to incidence data and estimates, efforts to combat elder abuse are far behind the curve when it comes to development and implementation of efficient and effective responses. In the United States, passage of the Elder Justice Act as part of the Patient Protection and Affordable Care Act was a first step in solidifying federal activities dedicated to the eradication of elder abuse. This panel will address opportunities, both in the United States and globally, for policy makers and a wide range of stakeholders to identify the variety of ways that elder abuse cuts across sectors and how to promote awareness and prevention.