Most of the personal wealth of the nation is held by people who are older, to support their retirement years, advanced age, and family legacy. Financial assets, so long accumulated, make older people targets for financial crimes big and small.
Elder abuse is a public health crisis that deserves more attention. According to the National Elder Mistreatment Study (NEMS), one in ten older adults experience abuse, which includes physical, psychological, sexual, and financial abuse, as well as neglect. The impact on older people is profound. The volume Elder Abuse: Research, Practice, and Policy (edited by XinQi Dong) mentions that in addition to loss of life, elder abuse can cause extreme physical deterioration and long-standing decline in emotional health. Elder abuse victims have a higher risk of death than those who have not been mistreated. Victims of abuse are also more likely to be admitted to the hospital or nursing home.
Elder abuse is a first-person and third-person problem. It affects people who are old now, and it is a threat to each of us as we enter old age. Elder abuse exists in the present and will exist in the future. It has the potential to steal what each older person desires and deserves—dignity, autonomy, and good health in the final stages of life.
What should we do? Simply put, more! We need more prevention. We need more response.
The Sunflower Foundation recently awarded a $200,000 grant to the Center for Practical Bioethics to identify strategies for detecting, addressing, and preventing elder abuse in Kansas. I am privileged to oversee this work at the Center, the goal being to develop a set of research-based recommendations to strengthen and advance the work already under way in the state.
Role Of Law Enforcement
Elder abuse initiatives fall roughly into the categories of prevention and response. Like efforts elsewhere, those in Kansas have emphasized effective adult protective services and sufficient law enforcement response. Prosecutors at every level, including the Kansas attorney general, are providing visible leadership and prosecuting elder abuse cases in urban and rural parts of the state. The attorney general is working to improve state law and understands the value of educating the public. While there is always more to do regarding training of prosecutors and cops, Kansas is actively attending to investigating and responding to abuse.
Prosecution of abuse, though, happens too late. We cannot prosecute our way out of the problem of elder abuse. And it is naïve to equate elder abuse response with elder abuse prevention. In the realm of prevention, Kansas, like most states, has much more work to do.
Although screening tools are available, it is not common practice in the US for clinical and social services professionals to proactively look for abuse. Yet, these same professionals acknowledge that they see older adults who are abused. The people most likely to spot abuse are individuals who call upon an older person in their home, be they a neighbor, nurse, or home-meal volunteer.
As we search for opportunities to attend to elder abuse prevention, we must call upon professionals of all types to look for abuse, identify people at risk of being abused, and respond. Some responses necessitate a call to adult protective services. In communities, professionals of all types can, themselves, address victim or caregiver depression, isolation of an older adult, recognition of cognitive or physical impairment, and planning for safety. At the societal level, we need more service options, such as emergency shelters, as well as more service dollars, especially those targeted to people most at risk for abuse or neglect.
Within a state, there are domains of activity that could be better deployed to prevent abuse or reduce risk of abuse. Health care providers of all types can do more. Advocacy organizations and individuals can be called upon to help. Financial services organizations and banks can provide education for their personnel and the public alike.
Researchers can advance the field by studying problems and practical solutions. Kansas, like most states, has not yet conducted a state-specific prevalence study. Funding priorities for government agencies and the private sector should focus on elder abuse prevention by better targeting risk. Perhaps transportation resources should be allotted first to isolated older people at risk for abuse and neglect.
Elder abuse prevention requires multifactorial attention. The complexity of abuse, the disheartening and unsafe conditions in which some older people live, and the breadth and depth of the problem have stymied professionals and the public for too long. Older people die, older people are hurt, older people are neglected. Elder abuse is a threat to health and to life itself.
Ultimately, each of us can do one thing. We can commit to being competent on this issue. Working in service to older people requires knowing of the risk and being alert to the possible presence of abuse. If each of us knew what we could do and what older people need from us, then prevention would be a shared societal endeavor.
Elder abuse victims need law enforcement. They might need their family, friends, and neighbors even more.
To achieve the goals of independent and healthy aging, we must attend to the risks associated with abuse and neglect and intervene before things go wrong.
The Archstone Foundation, based in Long Beach, California, is well known for its past funding of prevention of elder abuse and neglect. As Archstone’s funding priorities have changed, this is now a “legacy” program. This means that Archstone no longer accepts unsolicited proposals in this funding area. Read about its past grant making.
The John A. Hartford Foundation (JAHF) is a national funder of aging programs. Its president, Terry Fulmer, has a long-standing commitment to addressing elder abuse, and she is one of the early pioneers in elder abuse research. As part of its funding priority to create age-friendly health systems, in 2016 the JAHF awarded a grant regarding screening for elder abuse in hospital emergency departments.