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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America
have noted that very little is known about the phenomenology, magnitude, etiology, and consequences of elder mistreatment, and that almost nothing is known about the effects of interventions. Although the body of evidence remains sparse, researchers have recently begun to raise doubts about the cost-effectiveness of current interventions (Dyer et al., 1999; Harrell et al., 2002; Pavlik et al., 2001; Hajjar and Duthie, 2001; Wolf and Li, 1999).
Overall, the national response to elder mistreatment still remains weak and incomplete. Adult protection is a poorly funded system, and Congressman Pepper’s single-minded emphasis on the abuse, exploitation, and neglect of vulnerable elderly people has not been sustained by his successors in Congress or by a public preoccupied with youthfulness and ill at ease with aging. As a result, elder mistreatment remains hidden, poorly characterized, and largely unaddressed—more than two decades after the Pepper hearings first exposed it to public view. It is long past time to move the field forward in a careful and systematic way, drawing on the knowledge already generated in the domains of child maltreatment and intimate partner violence, while remedying the weaknesses that have so far plagued the field.
WEAKNESSES IN EXISTING RESEARCH
Although there is a sizable body of unpublished reports and commentary on elder mistreatment, fewer than 50 peer-reviewed articles based on empirical research have been published in the field. (A summary of these studies appears in Appendix A.) Although these studies provide a foundation for further work, it is not a strong one. National Research Council (1993) and Institute of Medicine reports (2001; National Research Council and Institute of Medicine, 1998) and other authoritative reviews (e.g., Pillemer, 2001; National Institute of Justice, 2000) have repeatedly lamented the weakness of the research base for designing programs and informing policy on the wide variety of overlapping problems, ranging from granny battering to neglect by nursing homes, that are grouped under the rubric of elder mistreatment. A systematic program of research is needed to better describe the many facets of the problem and to explore their causes and consequences.
Understanding the nature and scope of the problem is prerequisite to designing and implementing solutions. In the absence of the necessary research, interventions have been designed and implemented in the dark, so to speak. Almost every state has required reporting of suspected cases of elder mistreatment, but little is known about the effects of these requirements (National Research Council and Institute of Medicine, 1998). A few states and localities have mounted some creative interventions, but these few initiatives have been poorly evaluated. It has often been said that elder