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ELDER MISTREATMENT: ABUSE, NEGLECT, AND EXPLOITATION IN AN AGING AMERICA (2003)


CHAPTER: FRONT MATTER

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Suggested Citation:"Front Matter." National Research Council. 2003. Elder
Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Washington,
DC: The National Academies Press. doi: 10.17226/10406.
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Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Washington,
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Panel to Review Risk and Prevalence of Elder Abuse and Neglect Richard J. Bonnie
and Robert B. Wallace, Editors Committee on National Statistics and Committee on
Law and Justice Division of Behavioral and Social Sciences and Education THE
NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu

THE NATIONAL ACADEMIES PRESS â¢ 500 Fifth Street, N.W. â¢ Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the
Governing Board of the National Research Council, whose members are drawn from
the councils of the National Academy of Sciences, the National Academy of
Engineering, and the Institute of Medicine. The members of the committee respon-
sible for the report were chosen for their special competences and with regard
for appropriate balance. This study was supported by Contract/Grant No.
N01-0D-4-2139 between the National Academy of Sciences and DHHS/National
Institutes of Health. Any opin- ions, findings, conclusions, or recommendations
expressed in this publication are those of the author(s) and do not necessarily
reflect the views of the organizations or agencies that provided support for the
project. Library of Congress Cataloging-in-Publication Data Bonnie, Richard J.
Elder mistreatment : abuse, neglect, and exploitation in an aging America /
Richard J. Bonnie and Robert B. Wallace, Editors. p. cm. Includes
bibliographical references and index. ISBN 0-309-08434-2 (hardback) 1.
AgedâAbuse ofâUnited States I. Wallace, Robert B. II. Title. HV6626.3+
362.6âdc21 2002012762 Additional copies of this report are available from The
National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC
20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area);
Internet, http:// www.nap.edu Printed in the United States of America Copyright
2003 by the National Academy of Sciences. All rights reserved. Suggested
citation: National Research Council. (2003). Elder Mistreatment: Abuse, Neglect,
and Exploitation in an Aging America. Panel to Review Risk and Preva- lence of
Elder Abuse and Neglect. Richard J. Bonnie and Robert B. Wallace, Editors.
Committee on National Statistics and Committee on Law and Justice, Division of
Behavioral and Social Sciences and Education. Washington, DC: The National
Academies Press.

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National Research Council. www.national-academies.org



PANEL TO REVIEW RISK AND PREVALANCE OF ELDER ABUSE AND NEGLECT RICHARD J. BONNIE
(Chair), Schools of Law and Medicine, University of Virginia TERRY FULMER,
School of Nursing, New York University RICHARD A. KULKA, Research Triangle
Institute, Research Triangle Park, NC EVA KUTAS, Mental Health and Development
Disabilities Service Division, National Association of Adult Protective
Administrators, Salem, OR EDWARD O. LAUMANN, Department of Sociology, University
of Chicago CONSTANTINE G. LYKETSOS, Division of Geriatric Psychiatry and
Neuropsychiatry, School of Medicine, The Johns Hopkins University, MD GARY B.
MELTON, Institute on Family and Neighborhood Life, Clemson University, SC LAURA
MOSQUEDA, Department of Family Medicine, University of California, Irvine
GREGORY PAVEZA, School of Social Work, University of South Florida KARL
PILLEMER, Department of Human Development, Cornell University, NY LORI A.
STIEGEL, Commission on Legal Problems of the Elderly, American Bar Association,
Washington, DC ROBERT B. WALLACE, Department of Epidemiology and Internal
Medicine, University of Iowa Colleges of Public Health and Medicine EARL S.
POLLACK, Study Director MARISA GERSTEIN, Research Assistant DANELLE DESSAINT,
Senior Project Assistant TANYA M. LEE, Project Assistant LORA FLATTUM HAMP,
Consultant v

COMMITTEE ON NATIONAL STATISTICS 2001-2002 JOHN E. ROLPH (Chair), Marshall
School of Business, University of Southern California JOSEPH G. ALTONJI,
Department of Economics, Northwestern University, IL ROBERT BELL, AT&T Research
Laboratories, Florham Park, NJ LAWRENCE D. BROWN, Department of Statistics,
University of Pennsylvania ROBERT M. GROVES, Survey Research Center, University
of Michigan HERMAN HABERMANN, United Nations Statistical Division, New York, NY
JOEL L. HOROWITZ, Department of Economics, Northwestern University, IL WILLIAM
KALSBEEK, Survey Research Unit, Department of Biostatistics, University of North
Carolina ARLEEN LEIBOWITZ, School of Public Policy and Social Research,
University of California, Los Angeles RODERICK J.A. LITTLE, School of Public
Health, University of Michigan THOMAS A. LOUIS, The RAND Corporation, Arlington,
VA DARYL PREGIBON, AT&T Laboratories-Research, Florham, NJ NORA CATE SCHAEFFER,
Department of Sociology, University of Wisconsin-Madison MATTHEW D. SHAPIRO,
Department of Economics, University of Michigan ANDREW A. WHITE, Director vi

COMMITTEE ON LAW AND JUSTICE 2001 CHARLES F. WELLFORD (Chair), Center for
Applied Policy Studies and Department of Criminology and Criminal Justice,
University of Maryland JOAN PETERSILIA (Vice Chair), School of Social Ecology,
University of California, Irvine ALFRED BLUMSTEIN, H. John Heinz III School of
Public Policy and Management, Carnegie Mellon University JEANETTE COVINGTON,
Department of Sociology, Rutgers University RUTH DAVIS, The Pymatuning Group,
Inc., Alexandria, VA JEFFREY FAGAN, Schools of Law and Public Health, Columbia
University DARNELL HAWKINS, Department of African American Studies, University
of Illinois at Chicago PHILIP HEYMANN, Center for Criminal Justice, Harvard Law
School CANDACE KRUTTSCHNITT, Department of Sociology, University of Minnesota
MARK LIPSEY, Department of Psychology and Human Development, Vanderbilt
University COLIN LOFTIN, School of Criminal Justice, State University of New
York at Albany JOHN MONAHAN, School of Law, University of Virginia DANIEL NAGIN,
H. John Heinz III School of Public Policy and Management, Carnegie Mellon
University PETER REUTER, Department of Criminology and Criminal Justice,
University of Maryland WESLEY SKOGAN, Department of Political Science and
Institute for Policy Research, Northwestern University KATE STITH, School of
Law, Yale University MICHAEL TONRY, Institute of Criminology, Cambridge
University CATHY SPATZ WIDOM, Department of Psychiatry, New Jersey Medical
School CAROL PETRIE, Director RALPH PATTERSON, Senior Project Assistant vii



Acknowledgments T he Panel to Review Risk and Prevalence of Elder Abuse and
Neglect wishes to thank the many individuals who contributed to the preparation
to this report. The project was sponsored by the Na- tional Institute on Aging,
National Institutes of Health, U.S. Department of Health and Human Services,
with additional support from the Office of Behavioral and Social Science
Research and the Office of Research on Womenâs Health of the National
Institutes of Health and the Agency for Health Care Research and Quality. Sidney
Stahl served as project officer and was very helpful in orienting the panel to
the major issues on elder abuse and neglect that needed to be considered. The
panel also expresses its appreciation to Laurence Branch, Duke University; Larry
Corder, Duke University; and Brian Kemp, University of California, Irvine, who
prepared background papers in addition to those included in this volume. Thanks
are also due to those who reviewed the papers commissioned by the panel and
provided many helpful commentsâ Barbara Altman, National Center for Health
Statistics; Jack Guralnik, Na- tional Institute on Aging; Jane Tilly, Urban
Institute; Jordan Kosberg, Uni- versity of Alabama; Kenneth Minaker,
Massachusetts General Hospital; Carla VandeWeerd, University of South Florida;
Richard Schulz, University of Pittsburgh; and George Annas, Boston University.
The panel also wishes to thank Marie-Therese Connolly, U.S. Depart- ment of
Justice; Patricia McFeeley, University of New Mexico; Joanne Otto, Colorado
Department of Human Services; and Patsy Klaus, U.S. ix

x ACKNOWLEDGMENTS Department of Justice, for their presentations of background
information to the panel. The panel is also grateful to the staff of the
National Research Council for its superb support throughout the course of the
study. Study Director Earl Pollack, ably assisted by Marisa Gerstein, Danelle
Dessaint, and Tanya Lee, helped the panel stay well-informed, on track, and on
time. Constance Citro, senior project officer, provided many helpful
suggestions. Lora Hamp, a third-year student at the University of Virginia Law
School, pro- vided valuable research assistance on elder mistreatment
legislation and on legal and ethical issues in elder mistreatment research. This
report has been reviewed in draft form by individuals chosen for their diverse
perspectives and technical expertise, in accordance with proce- dures approved
by the Report Review Committee of the National Research Council. The purpose of
this independent review is to provide candid and critical comments that will
assist the institution in making the published report as sound as possible and
to ensure that the report meets institutional standards for objectivity,
evidence, and responsiveness to the study charge. The review comments and draft
manuscript remain confidential to protect the integrity of the deliberative
process. We thank the following individuals for their participation in the
review of this report: Ira Ralph Katz, Institute on Aging, University of
Pennsylva- nia; Jennifer M. Kinney, Department of Sociology, Gerontology, and
An- thropology, Miami University; Jill E. Korbin, Office of the Dean, College of
Arts and Sciences, Case Western Reserve University; Kenneth Minaker,
Massachusetts General Hospital, Boston; Becky Morgan, Stetson College of Law;
and Stephen Zarit, Gerontology Center, Pennsylvania State Univer- sity. Although
the reviewers listed above have provided many constructive comments and
suggestions, they were not asked to endorse the conclusions or recommendations;
nor did they see the final draft of the report before its release. The review of
this report was overseen by Robert Butler, Interna- tional Longevity Center-USA,
Ltd., New York City. Appointed by the National Research Council, he was
responsible for making certain that an independent examination of this report
was carried out in accordance with institutional procedures and that all review
comments were carefully con- sidered. Responsibility for the final content of
this report rests entirely with the authoring committee and the institution.

Contents Preface xiii Executive Summary 1 PART I: PANEL REPORT 1 Introduction 9
2 Concepts, Definitions, and Guidelines for Measurement 34 3 A Theoretical Model
of Elder Mistreatment 60 4 The Occurrence of Elder Mistreatment 71 5 Risk
Factors for Elder Mistreatment 88 6 Screening and Case Identification in
Clinical Settings 104 7 Evaluating Interventions 121 8 Research Ethics 140 9
Moving Forward 150 References 153 Appendices A Elder Mistreatment Measures and
Studies 165 B Analysis of Elder Abuse and Neglect Definitions Under State Law
181 Lora Flattum Hamp xi

xii CONTENTS C Elder Abuse and Neglect: History and Concepts 238 Rosalie Wolf D
Biographical Sketches 249 PART II: BACKGROUND PAPERS 10 Elder Mistreatment:
Epidemiological Assessment Methodology 261 Ron Acierno 11 Ethical and Policy
Issues in Research on Elder Abuse and Neglect 303 Rebecca Dresser 12 The
Clinical and Medical Forensics of Elder Abuse and Neglect 339 Carmel Bitondo
Dyer, Marie-Therese Connolly, and Patricia McFeeley 13 Financial Abuse of the
Elderly in Domestic Settings 382 Thomas L. Hafemeister 14 Elder Abuse in
Residential Long-Term Care Settings: What Is Known and What Information Is
Needed? 446 Catherine Hawes 15 Elder Abuse Intervention: Lessons from Child
Abuse and Domestic Violence Initiatives 501 David A. Wolfe Index 527

Preface R eports of this kind typically begin by calling at- tention to the
magnitude and social cost of the problem being explored. The fact that
equivalent statements cannot be made with any confidence about elder
mistreatment is a telling indication of the need for the report, as well as for
an intensified program of research. No survey of the U.S. population has ever
been undertaken to provide a national estimate for the occurrence of any form of
elder mistreatment; the magnitude of the prob- lemâamong community-dwelling
elders, as well as those residing in long- term care facilitiesâis basically
unknown. The best estimates, based on figures extrapolated from local studies,
suggest that the national prevalence of elder mistreatment (including physical
abuse, psychological abuse, and neglect) is between 1 and 2 million. The
occurrence and severity of elder mistreatment are likely to increase markedly
over the coming decades, as the population ages, caregiving re- sponsibilities
and relationships change, and increasing numbers of older persons require
long-term care. Although the magnitude of elder mistreatment is unknown, its
social and moral importance is self-evident. However, there is no solid under-
standing of the nature, causes, and consequences of elder mistreatment, the
effectiveness and cost of current interventions, or measures that could suc-
cessfully be taken to prevent it or to ameliorate its effects. The purpose of
this report is to help the nation remedy this deficiency. In Understanding Child
Abuse and Neglect (1993) and Violence in Families (1998), the National Research
Council was able to map out a xiii

xiv PREFACE comprehensive blueprint for research in the adjacent domains of
child mis- treatment and intimate partner violence. However, so little is now
known about elder mistreatment that it would be premature to draw up a detailed
research agenda for this nascent field. Instead, this report is best seen as
laying the foundation for a much-needed scientific effort. The panel em-
phasizes the need to develop a better understanding of elder mistreatment in its
different forms, to develop better measures for it, and to undertake a variety
of population-based studies to ascertain prevalence and risk factors. Several
priorities for research are identified in relation to the determinants of elder
mistreatment, clinical screening and case identification, and pre- ventive
interventions. We are not the first to lament the poor state of knowledge about
elder mistreatment. In 1986, a consensus conference of leading researchers (in-
cluding two of our panel members) was convened at the University of New
Hampshire to point the way toward advancing knowledge. The conclu- sions and
recommendations reached at that conference are strikingly simi- lar to those
appearing in this report. One of the participants at the New Hampshire
conference was Rosalie Wolf, by all accounts one of the founding leaders of the
elder mistreatment field. The panel expressed its deep gratitude to Dr. Wolf for
presenting her views at our initial meeting, despite her poor health, and was
devastated when she passed away within weeks of her appearance at our meeting.
We are publishing the remarks that she delivered at that meeting as an appen-
dix to this report. Indeed, our report is in many ways a tribute to Dr. Wolfâs
heroic efforts over three decades to nurture the field of elder mis- treatment
research. Abuse and neglect of older individuals in society breaches a widely
embraced moral commitment to protect vulnerable people from harm and to ensure
their well-being and security. To carry out this commitment, one cannot rely on
good intentions alone. A substantial investment in scientific research along the
lines outlined in this report is imperative to enable society to enhance its
understanding of elder mistreatment and to mount an effective response to it in
the 21st century. Richard J. Bonnie, Chair Panel to Review Risk and Prevalence
of Elder Abuse and Neglect





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Since the late 1970s when Congressman Claude Pepper held widely publicized
hearings on the mistreatment of the elderly, policy makers and practitioners
have sought ways to protect older Americans from physical, psychological, and
financial abuse. Yet, during the last 20 years fewer than 50 articles have
addressed the shameful problem that abusers—and sometimes the abused
themselves—want to conceal.

Elder Mistreatment in an Aging America takes a giant step toward broadening our
understanding of the mistreatment of the elderly and recommends specific
research and funding strategies that can be used to deepen it. The book includes
a discussion of the conceptual, methodological, and logistical issues needed to
create a solid research base as well as the ethical concerns that must be
considered when working with older subjects. It also looks at problems in
determination of a report's reliability and the role of physicians, EMTs, and
others who are among the first to recognize situations of mistreatment.

Elder Mistreatment in an Aging America will be of interest to anyone concerned
about the elderly and ways to intervene when abuse is suspected, including
family members, caregivers, and advocates for the elderly. It will also be of
interest to researchers, research sponsors, and policy makers who need to know
how to advance our knowledge of this problem.

READ FREE ONLINE


CONTENTS

 * 
 * Front Matter i–xvi
 * Executive Summary 1–8
 * 1 Introduction 9–33
 * 2 Concepts, Definitions, and Guidelines for Measurement 34–59
 * 3 A Theoretical Model of Elder Mistreatment 60–70
 * 4 The Occurrence of Elder Mistreatment 71–87
 * 5 Risk Factors for Elder Mistreatment 88–103
 * 6 Screening and Case Identification in Clinical Settings 104–120
 * 7 Evaluating Interventions 121–139
 * 8 Research Ethics 140–149
 * 9 Moving Forward 150–152
 * References 153–164
 * APPENDIX A Elder Mistreatment Measures and Studies 165–180
 * APPENDIX B Analysis of Elder Abuse and Neglect Definitions Under State Law
   181–237
 * APPENDIX C Elder Abuse and Neglect: History and Concepts 238–248
 * APPENDIX D Biographical Sketches 249–260
 * 10 Elder Mistreatment: Epidemiological Assessment Methodology 261–302
 * 11 Ethical and Policy Issues in Research on Elder Abuse and Neglect 303–338
 * 12 The Clinical and Medical Forensics of Elder Abuse and Neglect 339–381
 * 13 Financial Abuse of the Elderly in Domestic Settings 382–445
 * 14 Elder Abuse in Residential Long-Term Care Settings: What Is Known and What
   Information Is Needed? 446–500
 * 15 Elder Abuse Intervention: Lessons from Child Abuse and Domestic Violence
   Initiatives 501–526
 * Index 527–552

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