A Glass Half Full: The Dubious History of Elder Abuse Policy

The Context of Elder Maltreatment: an Opportunity for Prevention Science

Elder maltreatment (EM) has been understood as a worldwide major public health threat for decades, yet it remains a form of victimization receiving limited attention, resources, and research. EM, which includes caregiver neglect and self-neglect, has far-reaching and long-lasting impacts on older adults, their families, and communities. Rigorous prevention and intervention research has significantly lagged in proportion to the magnitude of this problem. With rapidly growing population aging, the coming decade will be transformative: by 2030, one in six people worldwide will be aged 60 or older, and approximately 16% will experience at least one form of maltreatment (World Health Organization, 2021). The goal of this paper is to raise awareness of the context and complexities of EM, provide an overview of current intervention strategies based on a scoping review, and discuss opportunities for further prevention research, practice, and policy within an ecological model applicable to EM.

Incidents of Sexual Assault Against Older Adults: A Comparison Study

Sexual assault perpetrated against older adults remains understudied. This research examined sexual assault incidents perpetrated against older women and men (aged 60+) reported to law enforcement. It compared these sexual assault incidents with those committed against middle-age (aged 40-59) and younger (aged 18-39) women and men. National Incident-Based Reporting System data (1992-2015) were analyzed using multinomial logistic regression models. Findings showed incidents involving an older woman, relative to a middle-age and/or younger woman, were significantly more likely to involve stranger perpetrators, occur at a private location, and involve additional violent crime or property crime. Incidents involving an older man, relative to a middle-age and/or younger man, were significantly more likely to involve offenders of more than one sex, older offenders, stranger perpetrators, and additional violent crime or property crime. Results are discussed in relation to prior work and future directions.

Comparing older adult and child protection policy in the United States of America

Compared with policy related to child abuse, older adult protection policy developed later and made slower progress in the United States of America. Few studies have addressed older adult protection policy. This paper compares the two policies and provides implications about how to improve older adult protection policy by emulating child protection policy. The Dimensions of Choice Framework was utilised to illuminate the differences between child protection and older adult protection policies (i.e. allocation, provisions, delivery and finance), while Advocacy Coalition Framework theory was used to explain why these differences exist (i.e. the contentions between ally and opposite coalitions). The Dimensions of Choice Framework refined the descriptive comparison of the two policies while the Advocacy Coalition Framework unfolded the efforts and struggles between advocacy coalitions that result in policy changes; and the conceptual combination further provides a cross-disciplinary link between social work and public policy studies. Findings indicated that, compared to child protection policy, older adult protection policy lacked federal legislative and administrative direction, well-developed diagnosis and evaluation tools, a national data system, sufficient federal funds and a comprehensive response mechanism. This was the case because older adult protection advocates presented a more controversial argument regarding the role of government intervention in protecting victims while respecting individual autonomy, lower public and government awareness, and weaker efforts from ally coalitions.

Moving forward: recommendations for advancing late-life polyvictimization practice, policy, and research

This article synthesizes what has been learned from the entire polyvictimization in later-life project and offers five categories of recommendations for addressing polyvictimization and its elderly victims through practice, policy, and research. These five recommendations relate to definitions and frameworks, practice, training and education, research and evidence-based interventions, and prevention. Specifically, this article focuses on changes to improve identification, development of policies and practices, and research priorities.

The shifting conceptualization of elder abuse in the United States: from social services, to criminal justice, and beyond

A variety of forces have shifted the conceptualization of elder abuse over time to where it is almost unrecognizable when compared to its original conceptualization. The field has adopted or embraced whatever social problem is in vogue in an attempt to elevate elder abuse to a recognizable social problem that to date has eluded the field. This paper traces the various influences on the shifting conceptualizations of elder abuse and how those conceptualizations have shaped society's response. The paper concludes by suggesting that multiple conceptualizations can and must co-exist, a framework which is consistent with the multidisciplinary team approach becoming prevalent in the field.

Multidimensional measurement within adult protective services: design and initial testing of the tool for risk, interventions, and outcomes

This study describes the development, field utility, reliability, and validity of the multidimensional Tool for Risk, Interventions, and Outcomes (TRIO) for use in Adult Protective Services (APS). The TRIO is designed to facilitate consistent APS practice and collect data related to multiple dimensions of typical interactions with APS clients, including the investigation and assessment of risks, the provision of APS interventions, and associated health and safety outcomes. Initial tests of the TRIO indicated high field utility, social worker "relevance and buy-in," and inter-rater reliability. TRIO concurrent validity was demonstrated via appropriate patterns of TRIO item differentiation based on the type of observed confirmed abuse or neglect; and predictive validity was demonstrated by prediction of the risk of actual APS recurrence. The TRIO is a promising new tool that can help meet the challenges of providing and documenting effective APS practices and identifying those at high risk for future APS recurrence.

Informing evidence-based practice: a review of research analyzing adult protective services data

The mission of Adult Protective Services (APS) is to protect older and vulnerable adults from abuse, neglect, and exploitation. The complexity of APS cases and the potential for life-changing interventions point to the need for research that examines and evaluates APS practices. A literature review identified 50 studies published during a 16-year period that used APS agencies, clients, data, or resources to test hypotheses regarding elder abuse. The analysis revealed promising efforts toward knowledge development about elder mistreatment and self-neglect. This article provides an overview of salient findings, notes the scarcity of studies that analyze the effectiveness of APS, and highlights the need for additional research. Lessons learned are described, and APS practitioners and researchers are urged to work collaboratively to develop key practice-related questions about APS processes and outcomes that can be tested with appropriate research methodologies.

Analysis of elder abuse statutes across the United States, 2011-2012

The purpose of this article is to describe the state elder abuse statutes in the United States and Washington DC during 2011-2012. The last review of elder abuse statutes occurred in 2001; thus, a reexamination is warranted given the increased awareness of elder abuse at the state and national level and the growing number of older adults in the United States. This descriptive study analyzed the following components of elder or dependent abuse statutes: definitions, reporting requirements, training, and consequences for failure to report. It was determined that differences remain in how states respond to elder abuse at the community-based level.

Nursing homes and the affordable care act: a cease fire in the ongoing struggle over quality reform

Most provisions in the Affordable Care Act that affect nursing homes originated in two earlier attempts at reform, both of which failed multiple times in prior Congressional sessions: the Elder Justice Act and the Nursing Home Transparency and Improvement Act. Both of these earlier efforts focused on improving quality and reducing elder abuse in nursing homes by strengthening oversight and enforcement penalties, expanding staff training, and increasing the information on nursing home quality available to consumers and regulators. Each bill addressed problems that were serious, widespread, and had persisted for years, but each failed to pass on its own. The Affordable Care Act, with its own momentum, became the vehicle for their passage. However, the reasons the bills failed in these earlier efforts suggest implementation challenges now that they have ridden into law on the coattails of the more general effort to reform the health care sector.