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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America
ISSUES RELEVANT TO ASSESSMENT OF VIOLENCE AGAINST OLDER ADULTS
There are two major points to consider when interviewing older adults, relative to younger adults. First, older adults are frequently more reluctant to disclose psychological and interpersonal problems of the past or present. Second, their verbal reports are more affected by physical factors (e.g., fatigue, hearing difficulty) (Ouslander, 1984; Patterson and Dupree, 1994). With respect to the first point, older adults may actually be less likely to disclose abuse than are their abusers (see Homer and Gilleard, 1990, Pillemer and Finkelhor, 1988). Older adults who have been abused or assaulted by family members may be unlikely to report these events for a variety of reasons. Among hypothesized explanations that require further study is the supposition that older adults feel responsible, at least in part, for their children’s abusive behavior because they “taught them to be that way.” That is, they blame their own parenting style for their adult child’s behavior. Another hypothesized explanation is that older adults may also feel extremely embarrassed that their offspring or spouses are abusing them and that they are powerless to stop the abuse. They may be very motivated to hide this powerlessness, both out of pride, and in order to deny any physical or cognitive declines associated with aging. Older and younger adults also report that simply being stigmatized or labeled as a victim is aversive, particularly in instances of sexual assault (Kilpatrick et al., 1992). As with younger victims of domestic violence, abused older adults may fear retribution or more intense assaultiveness from the perpetrator or other abusive parties. Financially or physically dependent older adults also face the very real fear that if the perpetrator is arrested or removed from the household following disclosure, they may be institutionalized or lose other freedoms. Indeed, adults of all ages who have never made or experienced a report of abuse probably do not have information about resources or outcomes of reporting abuse and hence may deny any query, considering truthful responses as potentially damaging but not potentially helpful. Finally, older adult victims may care deeply for or love the perpetrator and may try to avoid hurting or embarrassing the perpetrator in any way through disclosure to epidemiological researchers or authorities.
Physical health barriers to reporting victimization events include deficits in cognitive functioning, hearing loss, increased susceptibility to fatigue, inability to remain sitting for extended durations (e.g., due to arthritis), and effects of medication on concentration and memory. Other factors to consider when assessing older adults include ageism, interview stress, increased somatic presentations that may mirror psychopathological symptoms, increased time needed to build trust and rapport, and increased medication use. Ageism refers to “a personal revulsion to, and distaste for, growing old, and a fear of powerlessness, uselessness, and death” (Patterson