Professionals

Elder Abuse
Lonnie L. Fay
January 10, 1993

Abstract:

The subject of elder abuse has in recent years come into focus as a problem of sufficient magnitude to warrant investigation by researchers. It has significant proportions, occurring only slightly less frequently than that of child or spousal abuse. Since the subject of elder abuse has lately come into focus, there has existed a common wisdom regarding the cause and nature of the phenomenon, and this common wisdom itself has only recently come into question as new research has been reviewed. The increase in our elderly population and the resultant current interest in our elders as their numbers increase, has opened new doors for speculation into the causes and nature of elder abuse. This paper will review current knowledge, thoughts and research on the subject.

The Scope and Nature of Elder Abuse:

The age structure of America’s population is moving towards an all time high level of elderly, those 65 years of age or older. The “baby boomers,” those born between 1945 and 1960, will “be retiring beginning in 2010, and by 2030 they will constitute more than 20 percent of the population (Dye, 1990).” This increase in our elder population, and the resultant “gray power” will bring into focus many issues specific to the elderly; one of which is the abuse of the elderly and which has only in recent years become visible to the public eye. Of the 31 million persons over 65 years of age in America’s population today, most of them are women (Dye, 1990) and the aged female is the most likely to suffer at the hands of an abusive caregiver (Sullivan and Thompson, 1991). This paper will attempt to bring to light what appears to be a possible mis-vision in the causal view of elder abuse and will also attempt to illustrate a concept of cause for elder abuse that appears to have a more compelling validity than the current prevailing wisdom.For purposes of this paper, elder abuse will be considered to be physical or psychological abuse, and abuse by neglect of a caregiver. This paper will not consider the abuses that occur as a result of financial manipulation by the caregiver of the elders’ monetary affairs even though this is a common form of abuse of the elderly. If financial abuse were to be considered in this paper, the number of cases discussed would be far greater than those mentioned.

“Understanding elder abuse is of major importance because it is a dilemma which most of us will face: first, as a caregiver, and later when we grow older, as a dependent elder (Steinmetz, 1981).” While most of us will escape individual personal impact by the more sensational social issues like street violence, unemployment, child and spousal abuse … not one of us, if we are lucky enough to live long enough, will escape the reality of aging. A Massachusetts survey of professionals and paraprofessionals noted that fully 55% of the respondents to their survey reported at least one incident of elder abuse in the 18 months immediately prior to the survey (O’Malley, 1979). Thus, it seems almost certain that many of us will become intimately involved either personally or through our family, with an incidence of elder abuse during our lifetime.

“Abuse of the elderly is a growing problem (Rosado, 1991).” Estimates of those elders who suffer at the hands of an abusive caregiver range from 5% (Rosado, 1991) of the general population of elderly, to 55% of at risk contacts from a specific narrow survey of those professionals who deal with the elderly ( O’Malley, 1979).

Elder abuse is a problem of the greatest magnitude; it stretches across all walks of life, across every social group, across every ethnic and cultural group; we will see also that it possesses a unique and sad irony … unless dramatic changes occur, the perpetrator, as he or she ages, is quite likely to become an unwilling victim of his or her own crime.

A Recent Historical Review:

The United States Congress passed the Older Americans Act in 1965; it was amended in 1987 to require State Offices on Aging to identify those agencies that may be involved in identifying and treating abused, neglected, and exploited elders. These state agencies were further mandated the task of determining appropriate services for such individuals (Foelker, et.al., 1990). The last 20 years has witnessed an increasing awareness of the problem of elder abuse as the “baby boomers” reach middle age and are more likely to themselves be involved either directly or indirectly with the elderly. Obviously, over the next twenty years many of these same “baby boomers” will themselves become members of the over 65 age group.”Elder abuse did not exist in the public mind until 1979 (Shapiro, 1992).” Perhaps this is not a completely accurate date to ascribe to a public awareness of elder abuse but it serves to point out the fact that awareness of this problem is a recent social phenomena. In earlier history, until the era when life spans increased because of better medical care and the family structure began to broaden, this country’s population of dependent elders was relatively small. In general, our population worked until they died; today, the elderly constitute the fastest growing segment of our population and according to some studies as many as 1.5 million of them suffer from some kind of mistreatment (Rosado, 1991).

Who Are the Abused?

By the end of this century, the greatest increase in the elderly population is estimated to be among those elders in the 75 years and over age bracket (Steinmetz, 1981). This has important implications since this is also the age group which faces the most severe financial, emotional, and physical crises which may require the care of their family and society. The disengagement theorists argue “that as older adults slow down they gradually withdraw from society ….” (Santrock, 1992), they “disengage,” becoming less involved with society’s affairs; this act of disengagement tends to isolate the elderly from the controlling sanctions of the population at large; a sort of “out of sight, out of mind” relationship occurs. It appears probable that a large segment of our population, which is the most likely to require caregiver assistance, is also the segment most likely to become least visible; this combination of need and lack of visibility may help to establish a societally unsanctioned realm of opportunity for the possible abuse of the elderly by the caregiver.Labeling theory, the idea that people tend to behave in a fashion in which they have been defined by or imagine they are perceived by others, may further add to the potential for an abusive situation. In Western culture our elders are many times perceived or “labeled,” as ” … sick, ugly, and parasitic. … incapable of thinking clearly, learning new things, enjoying sex … inhumane perceptions to be sure, but often painfully real (Santrock, 1992).” Speculation may allow us to view the imagined truth of this kind of labeling of our elders to result in a general sense of ageism, or prejudice against our elders, and it may be that this implants a view of worthlessness of the elder in the mind of the caregiver. Our exposure to this sort of labeling and the resulting ageism is life long, beginning at early childhood through our fairy tale stereotypes of the elderly. Since ” … in the vast majority of children’s classics, old equals ugly and evil. … like the old witch who tries to bake and eat Hansel and Gretel (Beck, 1992).”

Elder abuse is certainly not an isolated occurrence; it involves an “estimated 1.5 million … elderly in the United States, most {sic., of which} are women over the age of 75 years (Sullivan and Thompson, 1991). It thus may have an impact on many of us during our lifetimes. In fact, abuse of the elderly by loved ones and caregivers exists with a frequency few dare to imagine, occurring with a frequency only slightly less than that of child abuse (Quinn and Tomita, 1986).

Elder abuse is many times a continuation of family violence which has been passed on from generation to generation (Hutchinson, 1988); earlier spousal or child abuse may be involved in many cases and so it may be that earlier poor family dynamics involving spousal or child abuse creates an environment leading to a generationally inverted, or retaliatory abuse. That is, the earlier abused becomes the abuser. Some Canadian studies reveal that between 75%-85% of abusers themselves come from abusive environments (Hutchinson, B., 1988). The circle of family violence then may remain unbroken and in fact, may surround the generation gap between both the young and the old.

The elder’s need for physical assistance in their daily living activities, their disengagement from society’s affairs, Western culture’s labeling of the elderly as sick and parasitic, along with their lack of visibility to our population at large provides the kindling from which an abusive relationship may erupt.

Who Are the Abusers?

Common wisdom has held that the elder abuser was a caregiver suffering from the stress and resentment created by generational inversion and the dependence of the older person. It has been held that these caregivers simply could not cope any longer and “cracked” in an isolated instance and were somewhat “forgiven” by law enforcement officials; they were rarely ever prosecuted. The subject was swept back under the rug and in all but the most sensational cases, forgotten very much like earlier mentions of child and spousal abuse.Terms were invented to help describe this phenomenon such as “generational inversion” where the cause was seen as a matter of fairness and unfairness; the blame for abuse was thus laid with the elder who had become more childlike, and not with the caregivers, who were thought by many to be kindly unfortunates. Society’s view has been one of forgive and forget … and the sooner forgotten the better.

“It is held that … as the costs of the relationship {sic., both financial and emotional} grow for the caregiver while the rewards diminish, the exchange becomes perceived as unfair. If the caretaker feels unable to escape the situation, he or she may become abusive (Pillemer and Finkelhor, 1989).” While this argument is pervasive, expert review of the existing literature by Pillemer and Finkelhor failed to find any empirical confirmation. The victim blaming overtones of this explanation are particularly reprehensible; the implication is that elder abuse is forgivable and somehow understandable given that elders are so difficult to care for. “Similar explanations were used in the early stages of {sic., the research of} child abuse and wife abuse … when victims were held to be responsible for the maltreatment (Pillemer and Finklehor, 1989).” The truth seems to be that while caregiver stress may relate to negative feelings between the people invloved, “it has not been found to be related to serious family conflict or abuse (Pillemer and Finkelhor, 1989).” Current evidence, in fact, seems to support quite the opposite of this prevailing common wisdom.

The reverse of the caregiver stress theory is supported by much of the recent research; “that is, the {sic., primary} risk factor is not the dependence of the victim, but of the abuser (Pillemer and Finkelhor, 1989).” Several recent studies have reached similar conclusions; in one such study (Wolf, Strungnell, and Godkin, 1982) the researchers noted that in two-thirds of the cases, the perpetrator was found to be financially dependent on the victim; another (Hwalek, Sengstock, and Lawrence, 1984) found that 64% were dependent on the victim. An important issue in assessing risk factors for elderly abuse seems to be the financial dependency of the abuser on the potential abused party. “In general, Pillemar found the abusers to be heavily dependent individuals; they included spouses and children who were disabled, cognitively impaired, or mentally ill ( Pillemar and Finkelhor, 1989).” It is important to note that in the largest number of cases they were members of the victims’ family ( Pillemar and Finkelhor, 1989).

The question remains definitively unanswered as to why this might be; however, one theoretical explanation may be found in social exchange theory. The concept of power is fundamental in this examination of cause; one researcher while attempting to identify common features of family violence, “noted that spouse abuse and child abuse frequently occur as a response to a ‘perceived lack or loss of power.’ In the case of elder abuse, it is likely that the feeling of powerlessness experienced by an adult child is especially acute because it so strongly violates society’s expectations for normal adult behavior (Pillemar and Finkelhor, 1989)” and its view that the family should perform in certain basic fashions (Sullivan and Thompson, 1991). It may be that this mental image of the common function of the family is deeply ingrained in the caregiver and further adds to the confusion and frustration of an individual that, many times, is already marginally psychologically unstable.

Sullivan and Thompson, in their text Introduction to social problems, voice their belief that much elder abuse stems from the stress and frustrations of caring for an older adult, and then later state that “…caregiver abuse is more likely to occur when the caregiver is dependent on the elderly person ….” The dependence of the caregiver on the abused in their opinion, seems to be heavily weighted as an important factor when assessing potential risk to an elder. The common wisdom being the first thought mentioned in their text, and then later seemingly rebutted by themselves.

Another key factor in assessing a risk of elder abuse seems to be the state of mind of the caregiver. Substantial evidence points to the abuser as an emotionally dependent individual. Higher rates of alcoholism, arrest, and other deviant behavior are prevalent in the various studies of control groups of abusers. Thus, it may be that the abusers dependence on the elder is a symptom of his or her common dependent behavior in life situations outside the caregiver relationship. The abusers dependence on the elder for financial assistance, housing, and social support ” … appears to result from these characteristics (Pillemer and Finkelhor, 1989).” Perhaps the abuser is responding to these stressful life situations which are unconnected to the caregiver-elderly relationship when neglect occurs or violence erupts in the caregiver-elder relationship? In fact, Pillemar and Finkelhor concluded on the basis of their review of the literature, that the dysfunctional caregiver explanation has more compelling validity, than does the idea of abuse being caused by caregiver stress.

Summary and Discussion:

Congressman Claud Pepper as Chairman of the Subcommittee on Health and Long Term Care, said , “Most {sic., Americans} would prefer not to acknowledge that elder abuse, which flies in the face of traditional American ideals, exists.” Like the earlier investigations of child and spousal abuse, we deny its existence and when we do find ourselves confronted with the reality of elder abuse, we attempt to gloss it up by pretending to understand the matter as an isolated event. “… one assumption underlying social science is that the world is not always as it appears or as we are told it is (Friedman and Steinberg, 1989).” We want it to be an isolated event and so it must be an isolated event! The common wisdom of the matter insists that stress and unfairness is the culprit and attempts to lay blame on the elder. “Not me! Not us!” we whisper, and close our eyes to the truth because the truth is too ugly to believe; a real life nightmare we would rather forget.Perhaps the truth is a simple one. Perhaps those that have been abused simply become the abusers in time, as a retaliation against those who have abused them; the golden rule in morbid reverse. Perhaps stress and the unfairness of having to care for our elders is a common justification for abuse … but can there ever be a legitimate justification for abuse of any sort? While these thoughts illustrate much of the common wisdom’s views of the matter, existing research seems to indicate that this is not the whole story.

Current research sees the abuser as a deviant family member dependent on the elder for social, physical, and financial security. It is this sense of dependence by the caregiver and not the stress of caring for the elder that is the major causal factor in elder abuse. Many times the abuser is depicted as the unfortunate driven by the elder to this violence or neglect and society hangs its head and nods silent forgiveness thus, laying the blame on the elder.

Perhaps in many families, earlier child or spousal abuse has caused some family members to overcompensate and drive themselves to superior business or professional successes; academic successes or one of many other higher callings. Perhaps some of the members of the earlier abused family turned to drugs, antisocial behavior or a life pattern of simple mischief for relief. Perhaps, of the hypothetical family members just mentioned, it is many times the one least capable that is entrusted with the care of the elderly, and is placed in a position to do the most harm. Perhaps the perceived successful members are too busy and too occupied with many important things to do; the family member who has had the drug experience, the street experience, or the antisocial experience is thus, placed in the caregiver position to ease two burdens on this hypothetical family. One, care is provided for the elderly family member, and second, a rebel family member is taken out of the realm of concern; the sad truth is that when this happens, the elder is placed at great risk.

This hypothetical family situation is not always the case of course, but, in a great number of instances, current research suggests the elder abuser is a family member who has quite likely been abused him or herself; socially dysfunctional, financially and emotionally dependent on the elder, and perhaps mentally impaired in some way. One may only speculate as to how this family member is chosen to care for its elderly, but it seems that for what ever reason or reasons this person is chosen, the choice is many times dangerous to the elder.

Works Cited:

  • Beck, M., 1992. Through grandpa’s eyes. Newsweek, December 28, 1992, p. 54.
  • Dye, T. R., 1990. Power and society, 3rd Ed., 1990. Pacific Grove: Brooks/Cole.
  • Foelker, G. A., Holland, J., Marsh, M., and Simmons, B. A., 1990. A community response to elder abuse. The gerontologist, V30, N4, p. 560- 562.
  • Friedman, S., and Steinberg, S., 1989. Writing and thinking in the social sciences. Englewood Cliffs: Prentice Hall.
  • Hutchinson, B., 1988. Breaking the cycle of family violence. The correctional service of Canada, Camrose, Alberta.
  • O’Malley, H., et al., 1979. Elder abuse in Massachusetts: A survey of professionals and paraprofessionals. Legal research and services for the elderly, p. 10-12.
  • Pillemer, K., and Finkelhor, D., 1989. Causes of elder abuse: Caregiver stress versus problem relatives. American journal of orthopsychiatry, V59, N2, p. 179-187.
  • Quinn, M.J., and Tomita, S.K., 1986. Elder abuse and neglect, causes, diagnosis, and intervention strategies. New York: Springer Publishing.
  • Rosado, L., 1991. Who’s caring for grandma? Newsweek, July 29, 1991, p.47.
  • Santrock, J.W., 1992. Life-span development, 4th Ed. Dubuque: Wm. C. Brown.
  • Shapirio, J.P., 1992. The elderly are not children. U.S. news and world report , January 13, 1992, p. 26-28.
  • Steinmetz, S. K., 1981. Elder Abuse. Social issues resources series, V2,N3 (4).
  • Sullivan, T.J., and Thompson, K.S., 1991. Introduction to social problems, 2nd Ed. New York: Macmillan Publishing.

Lonnie L. Fay, Elder Abuse, January, 1993.