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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America
the number of APS elder abuse reports substantially increased over the past 10 years, an increase that exceeded the growth in the elderly population during this period (National Center on Elder Abuse, 1998).
FORMS OF ELDER ABUSE
What constitutes elder abuse is defined by state law, and state definitions vary considerably (U.S. General Accounting Office, 1991; Kapp, 1995; National Center on Elder Abuse, 2001; Moskowitz, 1998b; Roby and Sullivan, 2000).4 Not surprisingly, researchers have also used many different definitions in studying the problem (Choi and Mayer, 2000; Kleinschmidt, 1997; Macolini, 1995; National Center on Elder Abuse, 2001; Pillemer and Finkelhor, 1988).5 The variation in definitions has been cited as a significant impediment to elder abuse recognition, management, research, and analysis (U.S. General Accounting Office, 1991; Kleinschmidt, 1997; Lachs and Pillemer, 1995; Moskowitz, 1998b; Nerenberg, 2000a; Roby and Sullivan, 2000; Rosenblatt et al., 1996).
Elder abuse in domestic settings (i.e., within the older person’s own home or in the home of a caregiver) is often differentiated from elder abuse within institutional settings (i.e., within residential facilities for older persons such as nursing homes) (Brandl and Meuer, 2000; National Center on Elder Abuse, 1996, 2001). Domestic elder abuse has been asserted to be more prevalent than institutional elder abuse (Kosberg and Nahmiash, 1996; Marshall et al., 2000; Moskowitz, 1998b), in part because it has been estimated that 80 percent of the dependent elders in this country are cared for at home (National Center on Elder Abuse, 1996). However, research directly substantiating this assertion is lacking.6 Another dichotomy frequently used distinguishes between elder abuse by individuals who have a special relationship with the elder person (e.g., spouses, children, other relatives, friends, or caregivers providing services within the
These variations include whether elder abuse is addressed as a separate category or whether it is grouped with the abuse of adults with a disability of any age, the age cutoff used to define an elder person, the definitions of various types of abuse, and whether elder abuse encompasses self-neglect or sexual abuse (Dessin, 2000; Lachs and Pillemer, 1995; Mehta, 2000).
The little research that has been conducted has been criticized for conceptual and methodological weaknesses, including reliance on underinclusive or nonrepresentative samples of cases brought to the attention of social agencies or reporting authorities, unclear definitions of elder abuse, reliance on professional reports rather than victim interviews, and failure to use rigorous research designs, such as random-sample surveys and case-comparison studies (Pillemer and Finkelhor, 1988; Schiamberg and Gans, 2000).
Data on institutional elder abuse are so scarce that it is not possible to make any national estimates of its incidence or prevalence” (National Center on Elder Abuse, 1996:2).