Developing a Service Response to Elder Abuse

Challenges in defining abuse and crafting effective prevention, intervention, and public policy. Since the late 1970s, when elder abuse first emerged in the public's consciousness, the question of what actually constitutes abuse has stimulated ongoing and often heated debate. The disagreement has focused on what should and should not be included under the rubric of elder abuse. In defining the scope of the professional enterprise that studies elder abuse and provides services related to it, researchers, policy makers, and practitioners have attempted to tease out the common threads that connect such disparate acts as neglect by well-meaning caregivers, flagrant acts of physical cruelty, and exploitation by predatory strangers. The goal is to explain the underlying causes or motives for abuse and to shed light on victims' service needs. Narrowly defined, elder abuse is harmful or hurtful conduct that is willfully inflicted upon an older person. This shorthand definition seems straightforward, yet each element has been challenged and disputed. Some have rejected the requirement that there be a perpetrator, arguing that self abuse and self neglect, which range from non-compliance with medical advice to an individual's refusal to accept basic care or necessities, are variants of elder abuse. The requirement that abuse be intentional or willful has also come into question. Many believe that when well-meaning but untrained, unqualified, or overburdened caregivers provide inadequate care, the conduct is not abusive because these caregivers lack malice or motive. It can further be argued that attaching the stigmatizing label of abuse to these situations is both damaging and counterproductive since it is likely to discourage these deficient caregivers from seeking and receiving the help they need. Those who favor including unintentional abuse and neglect within the framework of elder abuse argue that determining perpetrators' intentions or underlying motivations is virtually impossible anyway, rendering the distinction between willful and unintentional or inadvertent conduct meaningless. There has even been debate as to whether the elder-abuse services should be extended to include nonelderly victims. Proponents of this view argue that age is an arbitrary proxy for vulnerability and that it is disability, illness, and dependency, rather than age alone, that dictate the need for protective services. Further straining the boundaries of the field is the fact that new forms of abuse are continually being posited, revealed, or defined. An example is "undue influence," the often subtle and sustained manipulation of vulnerable people by predatory individuals. This complex form of abuse, which has led some elders to give away their principal assets or life savings, has been largely overlooked until fairly recently because victims often appear to be competent and assenting. It is often only after the ties to those who have exploited them have been severed that many of these victims, or people around them, recognize that exploitation has taken place. Others never come to this realization. Even sexual assault, which includes sexual contact with people who lack the mental capacity to meaningfully exercise consent, may not be recognized as abusive when it does not involve physical force or violence, particularly if the victim appears to be a willing participant (Nerenberg, 1998). Further blurring the distinction between abusive and nonabusive conduct is the subjective quality of this determination. With some forms of mistreatment, particularly psychological abuse, that which some perceive as abusive may not seem so to others. In one family, for example, members may threaten or insult one another, and the behavior is not taken seriously by any of the parties involved. In another family, however, the same behavior may be extremely damaging, provoking anguish or terror in the person toward whom it is directed. …