National Academies Press: OpenBook
Suggested Citation:"Front Matter." National Research Council. 2003. Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Washington, DC: The National Academies Press. doi: 10.17226/10406.
×

ELDER MISTREATMENT

Abuse, Neglect, and Exploitation in an Aging America

Panel to Review Risk and Prevalence of Elder Abuse and Neglect

Richard J. Bonnie and Robert B. Wallace, Editors

Committee on National Statistics and

Committee on Law and Justice

Division of Behavioral and Social Sciences and Education

NATIONAL RESEARCH COUNCIL OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu

Suggested Citation:"Front Matter." National Research Council. 2003. Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Washington, DC: The National Academies Press. doi: 10.17226/10406.
×

THE NATIONAL ACADEMIES PRESS
500 Fifth Street, N.W. Washington, DC 20001

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by Contract/Grant No. N01-0D-4-2139 between the National Academy of Sciences and DHHS/National Institutes of Health. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.

Library of Congress Cataloging-in-Publication Data

Bonnie, Richard J.

Elder mistreatment : abuse, neglect, and exploitation in an aging America / Richard J. Bonnie and Robert B. Wallace, Editors.

p. cm.

Includes bibliographical references and index.

ISBN 0-309-08434-2 (hardback)

1. Aged—Abuse of—United States I. Wallace, Robert B. II. Title.

HV6626.3+

362.6—dc21

2002012762

Additional copies of this report are available from
The National Academies Press,
500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu

Printed in the United States of America

Copyright 2003 by the National Academy of Sciences. All rights reserved.

Suggested citation: National Research Council. (2003). Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Panel to Review Risk and Prevalence of Elder Abuse and Neglect. Richard J. Bonnie and Robert B. Wallace, Editors. Committee on National Statistics and Committee on Law and Justice, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." National Research Council. 2003. Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Washington, DC: The National Academies Press. doi: 10.17226/10406.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation:"Front Matter." National Research Council. 2003. Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Washington, DC: The National Academies Press. doi: 10.17226/10406.
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Suggested Citation:"Front Matter." National Research Council. 2003. Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Washington, DC: The National Academies Press. doi: 10.17226/10406.
×

PANEL TO REVIEW RISK AND PREVALANCE OF ELDER ABUSE AND NEGLECT

RICHARD J. BONNIE (Chair),

Schools of Law and Medicine, University of Virginia

TERRY FULMER,

School of Nursing, New York University

RICHARD A. KULKA,

Research Triangle Institute, Research Triangle Park, NC

EVA KUTAS,

Mental Health and Development Disabilities Service Division, National Association of Adult Protective Administrators, Salem, OR

EDWARD O. LAUMANN,

Department of Sociology, University of Chicago

CONSTANTINE G. LYKETSOS,

Division of Geriatric Psychiatry and Neuropsychiatry, School of Medicine, The Johns Hopkins University, MD

GARY B. MELTON,

Institute on Family and Neighborhood Life, Clemson University, SC

LAURA MOSQUEDA,

Department of Family Medicine, University of California, Irvine

GREGORY PAVEZA,

School of Social Work, University of South Florida

KARL PILLEMER,

Department of Human Development, Cornell University, NY

LORI A. STIEGEL,

Commission on Legal Problems of the Elderly, American Bar Association, Washington, DC

ROBERT B. WALLACE,

Department of Epidemiology and Internal Medicine, University of Iowa Colleges of Public Health and Medicine

EARL S. POLLACK, Study Director

MARISA GERSTEIN, Research Assistant

DANELLE DESSAINT, Senior Project Assistant

TANYA M. LEE, Project Assistant

LORA FLATTUM HAMP, Consultant

Suggested Citation:"Front Matter." National Research Council. 2003. Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Washington, DC: The National Academies Press. doi: 10.17226/10406.
×

COMMITTEE ON NATIONAL STATISTICS

2001-2002

JOHN E. ROLPH (Chair),

Marshall School of Business, University of Southern California

JOSEPH G. ALTONJI,

Department of Economics, Northwestern University, IL

ROBERT BELL,

AT&T Research Laboratories, Florham Park, NJ

LAWRENCE D. BROWN,

Department of Statistics, University of Pennsylvania

ROBERT M. GROVES,

Survey Research Center, University of Michigan

HERMAN HABERMANN,

United Nations Statistical Division, New York, NY

JOEL L. HOROWITZ,

Department of Economics, Northwestern University, IL

WILLIAM KALSBEEK,

Survey Research Unit, Department of Biostatistics, University of North Carolina

ARLEEN LEIBOWITZ,

School of Public Policy and Social Research, University of California, Los Angeles

RODERICK J.A. LITTLE,

School of Public Health, University of Michigan

THOMAS A. LOUIS,

The RAND Corporation, Arlington, VA

DARYL PREGIBON,

AT&T Laboratories-Research, Florham, NJ

NORA CATE SCHAEFFER,

Department of Sociology, University of Wisconsin-Madison

MATTHEW D. SHAPIRO,

Department of Economics, University of Michigan

ANDREW A. WHITE, Director

Suggested Citation:"Front Matter." National Research Council. 2003. Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Washington, DC: The National Academies Press. doi: 10.17226/10406.
×

COMMITTEE ON LAW AND JUSTICE

2001

CHARLES F. WELLFORD (Chair),

Center for Applied Policy Studies and Department of Criminology and Criminal Justice, University of Maryland

JOAN PETERSILIA (Vice Chair),

School of Social Ecology, University of California, Irvine

ALFRED BLUMSTEIN,

H. John Heinz III School of Public Policy and Management, Carnegie Mellon University

JEANETTE COVINGTON,

Department of Sociology, Rutgers University

RUTH DAVIS,

The Pymatuning Group, Inc., Alexandria, VA

JEFFREY FAGAN,

Schools of Law and Public Health, Columbia University

DARNELL HAWKINS,

Department of African American Studies, University of Illinois at Chicago

PHILIP HEYMANN,

Center for Criminal Justice, Harvard Law School

CANDACE KRUTTSCHNITT,

Department of Sociology, University of Minnesota

MARK LIPSEY,

Department of Psychology and Human Development, Vanderbilt University

COLIN LOFTIN,

School of Criminal Justice, State University of New York at Albany

JOHN MONAHAN,

School of Law, University of Virginia

DANIEL NAGIN,

H. John Heinz III School of Public Policy and Management, Carnegie Mellon University

PETER REUTER,

Department of Criminology and Criminal Justice, University of Maryland

WESLEY SKOGAN,

Department of Political Science and Institute for Policy Research, Northwestern University

KATE STITH,

School of Law, Yale University

MICHAEL TONRY,

Institute of Criminology, Cambridge University

CATHY SPATZ WIDOM,

Department of Psychiatry, New Jersey Medical School

CAROL PETRIE, Director

RALPH PATTERSON, Senior Project Assistant

Page viii Cite
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Suggested Citation:"Front Matter." National Research Council. 2003. Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Washington, DC: The National Academies Press. doi: 10.17226/10406.
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Acknowledgments

The Panel to Review Risk and Prevalence of Elder Abuse and Neglect wishes to thank the many individuals who contributed to the preparation to this report. The project was sponsored by the National Institute on Aging, National Institutes of Health, U.S. Department of Health and Human Services, with additional support from the Office of Behavioral and Social Science Research and the Office of Research on Women’s Health of the National Institutes of Health and the Agency for Health Care Research and Quality. Sidney Stahl served as project officer and was very helpful in orienting the panel to the major issues on elder abuse and neglect that needed to be considered.

The panel also expresses its appreciation to Laurence Branch, Duke University; Larry Corder, Duke University; and Brian Kemp, University of California, Irvine, who prepared background papers in addition to those included in this volume. Thanks are also due to those who reviewed the papers commissioned by the panel and provided many helpful comments— Barbara Altman, National Center for Health Statistics; Jack Guralnik, National Institute on Aging; Jane Tilly, Urban Institute; Jordan Kosberg, University of Alabama; Kenneth Minaker, Massachusetts General Hospital; Carla VandeWeerd, University of South Florida; Richard Schulz, University of Pittsburgh; and George Annas, Boston University.

The panel also wishes to thank Marie-Therese Connolly, U.S. Department of Justice; Patricia McFeeley, University of New Mexico; Joanne Otto, Colorado Department of Human Services; and Patsy Klaus, U.S.

Suggested Citation:"Front Matter." National Research Council. 2003. Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Washington, DC: The National Academies Press. doi: 10.17226/10406.
×

Department of Justice, for their presentations of background information to the panel.

The panel is also grateful to the staff of the National Research Council for its superb support throughout the course of the study. Study Director Earl Pollack, ably assisted by Marisa Gerstein, Danelle Dessaint, and Tanya Lee, helped the panel stay well-informed, on track, and on time. Constance Citro, senior project officer, provided many helpful suggestions. Lora Hamp, a third-year student at the University of Virginia Law School, provided valuable research assistance on elder mistreatment legislation and on legal and ethical issues in elder mistreatment research.

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the Report Review Committee of the National Research Council. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making the published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

We thank the following individuals for their participation in the review of this report: Ira Ralph Katz, Institute on Aging, University of Pennsylvania; Jennifer M. Kinney, Department of Sociology, Gerontology, and Anthropology, Miami University; Jill E. Korbin, Office of the Dean, College of Arts and Sciences, Case Western Reserve University; Kenneth Minaker, Massachusetts General Hospital, Boston; Becky Morgan, Stetson College of Law; and Stephen Zarit, Gerontology Center, Pennsylvania State University.

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations; nor did they see the final draft of the report before its release. The review of this report was overseen by Robert Butler, International Longevity Center-USA, Ltd., New York City. Appointed by the National Research Council, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." National Research Council. 2003. Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Washington, DC: The National Academies Press. doi: 10.17226/10406.
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Suggested Citation:"Front Matter." National Research Council. 2003. Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Washington, DC: The National Academies Press. doi: 10.17226/10406.
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Page xiii Cite
Suggested Citation:"Front Matter." National Research Council. 2003. Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Washington, DC: The National Academies Press. doi: 10.17226/10406.
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Preface

Reports of this kind typically begin by calling attention to the magnitude and social cost of the problem being explored. The fact that equivalent statements cannot be made with any confidence about elder mistreatment is a telling indication of the need for the report, as well as for an intensified program of research. No survey of the U.S. population has ever been undertaken to provide a national estimate for the occurrence of any form of elder mistreatment; the magnitude of the problem—among community-dwelling elders, as well as those residing in long-term care facilities—is basically unknown. The best estimates, based on figures extrapolated from local studies, suggest that the national prevalence of elder mistreatment (including physical abuse, psychological abuse, and neglect) is between 1 and 2 million.

The occurrence and severity of elder mistreatment are likely to increase markedly over the coming decades, as the population ages, caregiving responsibilities and relationships change, and increasing numbers of older persons require long-term care.

Although the magnitude of elder mistreatment is unknown, its social and moral importance is self-evident. However, there is no solid understanding of the nature, causes, and consequences of elder mistreatment, the effectiveness and cost of current interventions, or measures that could successfully be taken to prevent it or to ameliorate its effects. The purpose of this report is to help the nation remedy this deficiency.

In Understanding Child Abuse and Neglect (1993) and Violence in Families (1998), the National Research Council was able to map out a

Suggested Citation:"Front Matter." National Research Council. 2003. Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Washington, DC: The National Academies Press. doi: 10.17226/10406.
×

comprehensive blueprint for research in the adjacent domains of child mistreatment and intimate partner violence. However, so little is now known about elder mistreatment that it would be premature to draw up a detailed research agenda for this nascent field. Instead, this report is best seen as laying the foundation for a much-needed scientific effort. The panel emphasizes the need to develop a better understanding of elder mistreatment in its different forms, to develop better measures for it, and to undertake a variety of population-based studies to ascertain prevalence and risk factors. Several priorities for research are identified in relation to the determinants of elder mistreatment, clinical screening and case identification, and preventive interventions.

We are not the first to lament the poor state of knowledge about elder mistreatment. In 1986, a consensus conference of leading researchers (including two of our panel members) was convened at the University of New Hampshire to point the way toward advancing knowledge. The conclusions and recommendations reached at that conference are strikingly similar to those appearing in this report.

One of the participants at the New Hampshire conference was Rosalie Wolf, by all accounts one of the founding leaders of the elder mistreatment field. The panel expressed its deep gratitude to Dr. Wolf for presenting her views at our initial meeting, despite her poor health, and was devastated when she passed away within weeks of her appearance at our meeting. We are publishing the remarks that she delivered at that meeting as an appendix to this report. Indeed, our report is in many ways a tribute to Dr. Wolf’s heroic efforts over three decades to nurture the field of elder mistreatment research.

Abuse and neglect of older individuals in society breaches a widely embraced moral commitment to protect vulnerable people from harm and to ensure their well-being and security. To carry out this commitment, one cannot rely on good intentions alone. A substantial investment in scientific research along the lines outlined in this report is imperative to enable society to enhance its understanding of elder mistreatment and to mount an effective response to it in the 21st century.

Richard J. Bonnie, Chair

Panel to Review Risk and Prevalence of Elder Abuse and Neglect

Suggested Citation:"Front Matter." National Research Council. 2003. Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Washington, DC: The National Academies Press. doi: 10.17226/10406.
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ELDER MISTREATMENT

Suggested Citation:"Front Matter." National Research Council. 2003. Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Washington, DC: The National Academies Press. doi: 10.17226/10406.
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Since the late 1970s when Congressman Claude Pepper held widely publicized hearings on the mistreatment of the elderly, policy makers and practitioners have sought ways to protect older Americans from physical, psychological, and financial abuse. Yet, during the last 20 years fewer than 50 articles have addressed the shameful problem that abusers—and sometimes the abused themselves—want to conceal.

Elder Mistreatment in an Aging America takes a giant step toward broadening our understanding of the mistreatment of the elderly and recommends specific research and funding strategies that can be used to deepen it. The book includes a discussion of the conceptual, methodological, and logistical issues needed to create a solid research base as well as the ethical concerns that must be considered when working with older subjects. It also looks at problems in determination of a report’s reliability and the role of physicians, EMTs, and others who are among the first to recognize situations of mistreatment.

Elder Mistreatment in an Aging America will be of interest to anyone concerned about the elderly and ways to intervene when abuse is suspected, including family members, caregivers, and advocates for the elderly. It will also be of interest to researchers, research sponsors, and policy makers who need to know how to advance our knowledge of this problem.

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