As we observe World Elder Abuse Awareness Day, it’s hard to acknowledge that we don’t really know how much elder abuse occurs in the United States, or even how many cases are reported to the authorities. Without good numbers, it’s impossible to know if the problem is growing, where to allocate resources, and whether the response is effective.
The most recent national numbers—from a 2009 survey—estimate that 11 percent of older Americans experience abuse, neglect, or exploitation in the community. The true prevalence is certainly higher because abuse that occurs in families, as elder abuse often does, is usually underreported. On top of that, the 11 percent doesn’t account for the most vulnerable people who live in nursing homes and other long-term care facilities because they couldn’t be reliably surveyed.
Why don’t we know more? The answer has to do with how the United States has structured its response to the problem.
What is elder abuse? It depends on where you live
As with crime in general, the primary response to elder abuse occurs at the state and local levels, with each state developing its own legal definitions and investigation mechanisms.
Adult Protective Services (APS) agencies, rather than the police, are often the first responders to elder abuse. The scope of what APS agencies investigate, whom they serve, and even how they count cases can vary substantially across states. You can’t simply sum up the numbers from each APS agency and come up with the number of people who have experienced elder abuse—right now, you’d be comparing apples with oranges.
State laws also regulate when an APS agency can intervene. In many states, APS responds to not only elder abuse, but also to younger disabled adults and people who are self-neglecting through no one’s fault. As a result, states vary with respect to the age at which someone is an “elder,” the types of vulnerabilities they may need to exhibit, and the locations APS may investigate.
Whether there is a caregiver or trust relationship between the elder and the abuser also matters—a family member stealing money from an older person might be elder abuse, but theft by a stranger typically is not.
A uniform way to define elder abuse
The Administration for Community Living and the Bureau of Justice Statistics have been exploring ways to collect and standardize data from APS agencies so we can aggregate it across states in an apples-to-apples manner. The Administration for Community Living is concerned with adult maltreatment more broadly. The Bureau of Justice Statistics focuses on identifying acts severe enough to constitute a crime.
So what might a uniform definition of elder abuse look like? With support from the Bureau of Justice Statistics, the Urban Institute has laid out guidelines for how to define and count reported instances of elder abuse, building on developmental work by the Centers for Disease Control and Prevention. In short, a number of offense, victim, and perpetrator characteristics must come together:
- A broad but consistent array of victimizations falls under the umbrella of elder abuse. To count as “abuse,” these acts must be perpetrated by one person against another. State laws use disparate terms, but acts can generally be categorized into six types of abuse: physical abuse, sexual abuse, emotional or psychological abuse, neglect, abandonment, and financial or material exploitation. Many APS agencies also investigate self-neglect, but we don’t recommend counting these cases as “abuse.”
- Victims of elder abuse are, by definition, older adults, but vulnerability also matters. The Centers for Disease Control, the Elder Justice Act, and many state APS programs set the age threshold as 60 and above. But many people over age 60 are healthy, independent, and don’t need special protection. State elder abuse laws are often oriented toward those who are disabled or lack the ability to protect or care for themselves.
- Perpetrators of elder abuse are people the elder should have been able to trust. State laws concerning the victim-perpetrator relationship haven’t been analyzed as thoroughly, but family members and caregivers often fall under this definition. So do people whom an elder should be able to trust by virtue of their profession, like nursing home employees or financial advisers, even if the victim does not know them well. Strangers who target older people for scams are in a somewhat different category; we don’t recommend classifying these cases with elder abuse.
This definition of elder abuse is necessarily a narrow slice of what APS agencies do. However, by focusing on these elements, we can begin to assemble national data in a comparable way across states.
We need accessible, national data on elder abuse
We are conducting a survey of APS agencies across the country to learn whether they have the data system capacity to report statistics in line with the above definition. We are also finding out whether APS data can provide insights on the amount of abuse occurring in care facilities compared with the community, and the extent to which incidents reported to APS might be criminal in nature. We expect to release the survey’s findings and our recommendations for future data collection at the end of the year.
Our national response to elder abuse has been hindered by a lack of data—the saying that you can’t change what you can’t measure certainly applies—but we are at a point of incredible opportunity. Most APS programs collect and maintain data electronically. This wasn’t the case just a decade ago.
Having electronic data gives APS agencies unprecedented flexibility in reporting information. Between the efforts of local, state, and federal stakeholders, we are now at a point where national information about the extent of elder abuse is within reach.