Who Might Live in This House?

The reality is that, in today’s busy world, we often don’t know the stories of those around us…and it’s easy to make assumptions or even look away from what we don’t want to acknowledge.  But the reality is also that there is a high likelihood that each of us interacts regularly with at least one older adult who is experiencing a situation like one of those described above.  Elder abuse (EA) is the term that we use to describe not only abusive treatment, but neglect, financial exploitation, and self-neglect (an inability to meet one’s needs for adequate food, shelter, and safety) that involves an older adult. 

Responding to Elder Abuse and Neglect in Age-Friendly Communities

Friends, neighbors, and service providers are often the people who are best positioned to understand when an older adult might be at risk of or experiencing EA.  They’re the eyes and ears of the community, as they can observe an older individual’s patterns of behavior, living conditions, and interactions with others.  They know when a neighbor hasn’t been outside to collect her mail in days and see when one of their shoppers is confused or dressed inappropriately for the weather.  They know when bills are going unpaid even though the older person has the financial resources to meet their obligations, worry when the ambulance shows up in the night, and may even hear shouts of anger from a caregiver.  

And they’re also the people that older adults often grow to trust.

All of this suggests an opportunity for Age-Friendly Communities to provide resources and support to their volunteers, who are often engaging with older residents, so that concerning issues can be identified and, ideally, addressed.  It also suggests an opportunity to increase awareness of EA among the larger community – the business owners who regularly see older patrons, the librarian who recommends books, the taxi driver that transports a patient to the doctor’s office, the electrician who comes into the home to make a repair.

Most importantly, however, we can help our communities understand Elder Abuse as a social justice issue, show how our current social structure allows Elder Abuse to happen, and work together to change community culture in ways that more effectively prevent and address Elder Abuse.  Age-Friendly Communities provide critical frameworks and resources for building more  just and inclusive communities in which all of us have what we need to thrive.

So, how do we go about addressing Elder Abuse, both to respond effectively to older individuals facing abuse or neglect and to build social structures that promote social engagement, increased access to systems of care and support, and the right to live with dignity, respect, and equality, regardless of age?

We'll start here in Module 1 with a background on EA – what it is, who is at risk, and its consequences – and then turn to how Age-Friendly Communities can overcome some of the challenges inherent in confronting EA.

What Is Elder Abuse?

In short, elder abuse is a term that refers to a “single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person” (World Health Organization, 2022).  Further, elder abuse occurs in a context of an older adult’s “incapacitation” or “dependence” – an incapacitated person is unable to participate meaningfully in some or all decisions about their lives, while a dependent person has a physical or mental condition that substantially impairs their ability to adequately provide for their daily needs and therefore relies on another person for assistance. 

The National Center on Elder Abuse (NCEA) identifies six types of EA: 

What Are the Potential Consequences of Elder Abuse?

The harm of Elder Abuse is not limited to the immediate physical or emotional trauma experienced by the older adult.  Multiple studies have shown that EA is predictive of shorter life spans, with the highest levels of mortality reported for those individuals with the lowest levels of psychological and social well-being (Schofield et al., 2013).  In fact, the Administration for Community Living reports that older adults who experience Elder Abuse die prematurely three times more often than their peers.  Higher levels of disability, more hospitalizations and emergency department visits, and increased use of behavioral health services also follow incidents of Elder Abuse (Yunus et al., 2017).  People who experience EA often report declines in both physical and mental health, including more musculoskeletal pain, gastrointestinal issues, depress and anxiety, and suicidal thoughts (Yunus et al., 2017).

In addition, concerned others - family members, friends, and neighbors - face significant levels of distress associated with knowledge of Elder Abuse.  Research by Breckman et al. (2018) found that being aware of a situation of elder mistreatment is highly distressing for millions of adults in the U.S., especially those who take on a helping role for the older person.  Adult children who live at a distance from their parents may feel guilt or responsibility for not recognizing the signs of Elder Abuse sooner.  Some concerned others may feel frustration at the reluctance or inability of an older individual to share what they've experienced.  And given the reliance on  people who cause harm for caregiving support, family members may often have to work quickly to modify the older person's caregiving routine, often with inadequate resources to address these changing needs.

Why Is Elder Abuse Challenging for Communities to Address?

Let's start with ageism - the stereotypes (how we think), prejudice (how we feel), and discrimination (how we act) towards others or oneself based on age (World Health Organization, 2021).  Because these intersecting factors both justify abusive behavior against older people and lead us to overlook its consequences, one could argue that Elder Abuse is the most harmful expression of ageism in our society.

Social acceptance of negative attitudes and beliefs about the value of people later in their lives heightens the risk of Elder Abuse.  People causing harm to older people use ageist assumptions and beliefs to rationalize abuse, neglect, or exploitation.  It's "OK" because "they're going to die soon anyway" or because they may have dementia and "not know what's happening."  Ageism may lead people to see older adults as less worthy of dignity and respect; rather than seeing them as fully human, people may think of them as "disposable, inconvenient, and irrelevant" (National Clearinghouse on Abuse in Later Life, 2021).

Not only does ageism lead to situations of abuse in a variety of settings, it also contributes to a systemic challenges in protecting older people who are at risk.  Recent research indicates a significant relationship between higher structural ageism and greater violence against older persons across countries (Chang et al., 2021); in Australia, a nationwide survey found that higher levels of ageism are associated with both lower recognition of and a tendency to condone Elder Abuse (Qu et al., 2021).  Ageist views in society make it easier to trivialize or minimize stories of abuse shared by older adults, with the end result that, too often, we dismiss complaints and allow the situation to continue.  The National Clearinghouse on Abuse in Later Life puts it this way:  "When ageism prevents us from ascribing the full range of human experiences to older adults, we limit society's ability to keep older people safe from the harm of abuse and to hold perpetrators accountable."

In addition, because ageism is often internalized, older adults' perspectives of themselves can be affected, leading them to believe that mistreatment is simply an inevitable part of aging.  Ageism creates feelings of powerlessness and resignation for older adults, feelings that can effectively serve as a barrier to reporting the harms they experience or seeking other forms of protection.