Power and Exchange Dynamics. Abuser dependency, victim dependency/caregiver stress.
For the purposes of this chapter, we review these risk factors based on the supporting evidence. It is possible to categorize risk factors for elder abuse into three general groups:
Risk factors validated by substantial evidence, for which there is unanimous or near-unanimous support from a number of studies.
Possible risk factors, for which the evidence is mixed or limited.
Contested risk factors, for which potential for increased risk has been hypothesized, but for which there is a lack of evidence.
As the earlier discussion makes clear, however, these categories are only loosely constructed. All findings should be taken with caution, due to methodological shortcomings in the studies. Furthermore, the evidence is generally too limited to make clear distinctions among abuse types. When such information is available and relevant, it is mentioned below.
Both clinical accounts and limited empirical research suggest that a shared living situation is a major risk factor for elder mistreatment, with older persons living alone at lowest risk (Pillemer and Finkelhor, 1988). Paveza et al. (1992) found that risk of mistreatment of Alzheimer’s disease patients by caregivers was greatest when the patient resided with immediate family members (other than the spouse). Lachs et al. (1997a) found living alone to be an important protective factor against mistreatment. Pillemer and Suitor (1992) also found a shared living arrangement to be a risk factor for violence by Alzheimer’s disease caregivers.
The mechanisms for the effect of living arrangement are straightforward. A shared residence increases the opportunities for contact, and thus conflict and mistreatment. Furthermore, tensions that may be relieved by simply leaving the immediate situation can escalate into mistreatment (see Wolf and Pillemer, 1989). Exploration of the differential role of living arrangement according to type of elder mistreatment needs to be conducted. For example, neglect (as the panel has defined it) by its very nature suggests a shared living situation, but financial exploitation may occur even when abuser and victim live apart.