Added value of elder abuse definitions: A review

Abstract

Elder abuse has devastating consequences for older persons such as a poor quality of life, psychological distress, and loss of property and security. It is also associated with increased mortality and morbidity. Elder abuse is a problem that manifests itself in both rich and poor countries and at all levels of society. It is timely to discuss one of the basic problems that has hampered the study, detection and intervention of elder abuse as the variety of definitions that exist now produce a definitional chaos for researchers, practitioners, and policy makers.

In this article we trace the elements of “how to define elder abuse” and situate them in their socio-historical context. We also analyze the purposes of these different definitions to assess their appropriateness in different settings concerned with elder abuse. Our analysis shows that elder abuse mirrors the societal arrangements which gave rise to them. It also highlights that it is a complex problem that is difficult to define. The central question is whether we need a common definition of elder abuse or different definitions that can be used in different settings. By evidence of our analysis we can see that there is a need for a sufficiently broad and flexible definition in order to cover different behaviors that can constitute abuse and the various settings in which it may occur. On the other hand, the definition needs to be specific and concrete to be useful in professional contexts.

To take a further step forward for both research and practice of elder abuse, we propose to consistently adhere to the WHO definition that leads the enquirer towards a better understanding of the problem and helps to distinguish it from other phenomena; and to a simplified definition for professional practice that sets boundaries to the phenomena and is appropriate for effective prevention and intervention measures.

Introduction

Elder abuse remained hidden and taboo until quite recently. After child abuse and domestic violence were discussed publicly in the 1970s, elder abuse emerged as a form of family violence. During the early 1980s more public and professional interest was given to the issue of elder abuse (McCreadie, 1996, McCreadie, 2003, Pritchard, 1995). What exactly constituted elder abuse, however, was at that time less at the center of attention. Despite the fact that the problem of elder abuse has gained more public attention and quite some research was conducted, global statistics are still lacking, in many instances health care professionals still ignore it, and even now not enough action is taken to protect the individuals subjected to abuse. Moreover cases are often not recorded and unreported (Perel-Levin, 2008). Part of this underreporting is due to the complexity of and unequivocality inherent in the phenomenon itself: abuse can take place in a whole range of settings, including hospitals, nursing homes, residential care homes, day centers and even the person's own home, perhaps the one place where the older person might feel safest (Abbey, 2009, Ansello and O’Neill, 2010, Arai, 2006). Family members, adult children, or spouses are implicated in 90% of the cases of elder abuse. Other abusers include care professionals such as health or social workers, friends, or neighbors. Sometimes the abusers do not recognize what they are doing as a form of abuse; they, and at times their victims, do not know what constitutes abuse and what not, different organizations and professionals still use different terminology, adhere to different definitions and thus perceive abuse differently. This causes significant issues for research as it makes it more difficult to compare the outcomes of various reports as the result of the inconsistencies in the definitions of elder abuse (Pillemer and Wolf, 1986, Pillemer and Prescott, 1989, Newton, 2010).

Lack of agreement about the definition and its parameters has made the assessment of prevalence and incidence problematic from an empirical perspective (Harbison and Morrow, 1998). It makes it especially difficult to determine the extent of the problem of elder abuse. Prevalence rates of elder abuse of between 4 and 6% were found in Canada, Great Britain, Finland and a prevalence rate of between one and ten percent was estimated in the USA (Griffin, 1994, Pillemer and Finkelhor, 1988). In the Netherlands one prevalence study on elder abuse showed a 5.6% prevalence rate (Comijs et al., 1998, Comijs et al., 2000, Comijs, 1999). Inadequate knowledge and training in how to detect abuse and a lack of staff awareness of what constitutes abuse can lead to underreporting of cases of abuse, underestimation and imprecise prevalence rates (Anetzberger, 2004, Griffin, 1994, Kivela et al., 1992, Ogg and Bennett, 1992, Podnieks, 1992). Some prevalence studies include only one form of elder abuse, such as solely physical abuse and others more than one, for example, physical and psychological abuse. As a result, prevalence rates are inconsistent and incomparable. On top of this, the studies involved provide different interpretations of elder abuse, this makes it confusing to analyze and understand the phenomenon in a comparative way and it also has an impact on further research, and thus for the development of policies, prevention and intervention programmes.

As a first step towards further developing the field of elder abuse in a comparative way, this article reviews definitions of elder abuse taking into account different aspects of these definitions and effects they can have on research and professional practice. The purpose of this analysis is to come to an understanding of the development of research and practice in elder abuse. By enabling comparative understanding it hopes to contribute to a comprehensive approach towards elder abuse.