on the health of women, and that they make up a good proportion of emergency room admissions. But research on the effects of elder abuse has been inhibited because of the complexity of untangling the synergistic effects of aging, and disease in old age from the impact of abuse or neglect.

There is only one study on the consequences of abuse on physical health. Lachs and colleagues (1998) used an existing National Institute on Aging cohort study that looked at the status of the abused elders over a period of 13 years, examining statistics of physical health, mental health, social situations, even religious habits, and so forth. They merged that dataset with one from the adult protective services unit serving New Haven, Connecticut. That unit, which is in a mandatory reporting state, has been collecting data since 1978. There were 7 cases of abuse that had been investigated for corroboration, 57 cases of neglect, and 2,608 cases not reported but investigated by researchers. They looked at the rate of mortality and found there was no difference in the first few years, but by the 13th year there was a decided difference in outcomes: 40 percent of the nonreported elders were still alive, 13 percent of the “self-neglect” category were still alive, and 9 percent of the “reported abused” category were still alive.

What was interesting is how closely this followed the Blenkner results, from 30 years earlier. Both showed a higher rate of institutionalization and a higher rate of nursing home placement. It suggests to me that the intervention itself may be a factor. This would be an important area for research.

Let me go back to depression. Depression is the only aspect of psychological abuse that has been explored by researchers at all, and those studies are very small and the methodology is subject to question. But indeed, if you look at groups of elders who have been abused, neglected, and exploited, you find more depression in this group. Commentators have suggested that other causes of emotional distress are also provoked by the acts of elder abuse or exploitation—depression, fear, guilt, shame, stress, learned helplessness, and post-traumatic stress syndrome (see, for example, Goldstein, 1996).

PREVALENCE AND INCIDENCE

Five studies have been done on prevalence in five different countries, using three or four or five different methodologies, some better than others.

The first was the Pillemer and Finkelhor (1988) study of the metropolitan Boston area. A representative sample of elders was interviewed over the telephone, or if the older person was unable to respond on the telephone, they conducted face-to-face interviews. They found that 3.2 percent of that sample was abused or neglected. However, they did not include financial



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