• Section 6 discusses the sample design and data collection issues associated with studies to determine the prevalence of abuse and neglect in nursing homes and residential care facilities;

  • Section 7 discusses what is known about the causes of abuse and neglect and presents the author’s recommendations for additional research.


The definition of physical abuse is the area about which there is the greatest agreement, both in terms of being “wrong” and in terms of what constitutes physical abuse; it involves injury or harm to a person carried out with the intention of causing suffering, pain, or impairment (Clarke and Pierson, 1999; Lachs et al., 1994; Lachs and Pillemer, 1995; Tatara and Kuzmeskus, 1996–1997). The Administration on Aging, in its instructions to long-term care ombudsmen, defines abuse as “the willful infliction of injury, unreasonable confinement, intimidation or cruel punishment with resulting physical harm, pain, or mental anguish or deprivation by a person, including a caregiver, of goods or services that are necessary to avoid physical harm, mental anguish, or mental illness” (1998:13). This is consistent with the definition used by the Centers for Medicare and Medicaid Services (CMS, formerly the Health Care Financing Administration) in its guidelines to the states on reporting of abuse and neglect in nursing homes, as reported below.

Physical abuse is generally thought to include hitting, slapping, pushing, or striking with objects. In nursing homes, other types of actions have been included, such as improper use of physical or chemical restraints. Physical abuse also typically includes sexual abuse or nonconsensual sexual involvement of any kind, from rape to unwanted touching or indecent exposure.2

There is somewhat less agreement about whether verbal or psychosocial abuse should be included in the general category of abuse when applied to older persons. This is generally thought of as “intentional infliction of anguish, pain, or distress through verbal or nonverbal acts” and includes threats, harassment, and attempts to humiliate or intimidate the older person (Clarke and Pierson, 1999:632).

In focus group interviews conducted in 2000 (Hawes et al., 2001),


Clarke and Pierson (1999:635) argue that examples (or possibly indicators of potential abuse and neglect) of abuse are “falls and fracture, physical or chemical restraints, malnutrition, dehydration, bed sores, defective equipment, lack of supervision, weight gain or loss, theft of money and personal property, unexpected or wrongful death, unsanitary conditions, untrained or insufficient staff, over-sedation, substandard medical care, and poor personal hygiene.”

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