Where Mental Health and Elder Abuse Intersect

As the aging population has increased, so too has the incidence of elder abuse. Elder abuse is intentional physical, emotional, sexual, or financial harm, by a caregiver or any other person, that causes harm or a serious risk of harm to a vulnerable older adult (Administration on Aging, 2014). Current literature suggests a complex link between elder abuse and vulnerability of the victim, particularly cognitive impairment, as well as stress of caregivers, a history of domestic violence between partners, mental illness, substance abuse, and financial troubles in abusers (National Center for Elder Abuse [NCEA], n.d.[a]); MacNeil, 2010). Though elder abuse has become a significant public health issue, it still often goes undetected and untreated (Dong, 2012). As the NCEA describes it, "Elder Abuse can be an older parent isolated and neglected by an adult child or caregiver; domestic violence by a partner (long-term or new), adult child, or caregiver; sexual assault by a stranger, caregiver, or family member; abuse or neglect by a partner with advancing dementia; financial exploitation by a stranger, trusted family member, or professional; or, systemic neglect by a long-term-care provider that hires too few staff members, provides insufficient training to its staff, and expends too few resources on resident care" (NCEA, 2014). Current estimates suggest that 5 million or more older Americans have been abused, neglected, or exploited, and at a minimum, only one in fourteen cases are reported (NCEA, n.d.[b]). Of the most vulnerable elders-those who suffer from physical, mental, or cognitive impairments-it is estimated that one in four are at risk of abuse, with only a small proportion of that abuse ever detected (Cooper, Selwood, and Livingston, 2008). And these numbers stand to grow, as research suggests that dementia increases the risk of elder abuse by creating an environment that can more easily invite abuse from friends, family, caregivers, and others (Cooney, Howard, and Lawlor, 2006). The Alzheimer's Association estimates that 13.9 percent of those ages 70 and older in the United States have dementia. By 2050, the number of people ages 65 and older with Alzheimer's Disease may nearly triple, from 5 million to as many as 16 million (Alzheimer's Association, 2012). Elder abuse largely takes place in the community, though it can occur in nursing facilities and in assisted living facilities. It is a serious, complex, and growing problem that is under-reported, untreated and undertreated, and misunderstood (American Psychological Association [APA], n.d.). Elder abuse is not an easy problem to address, for multiple reasons. There is a lack of national guidelines for describing abuse, myriad uncoordinated state and local laws for reporting and intervening in abusive situations, and poor education, training, and support for professional service workers, family caregivers, and community volunteers. Limited data and research on risk, assessment, and intervention outcomes are also a challenge. In addition, the public is ill-informed about the issue.Profiling Elder Abusers and VictimsAccording to the NCEA (n.d.[a]), the majority of abusers are family members or people known to the victim. Family members with mental illness or substance abuse issues, or those stressed by caregiving burden, perpetrate abuse at higher rates than other family members.The Centers for Disease Control and Prevention (CDC), reports there are a number of individual, relational, community, and societal issues that may directly or indirectly make someone an abuser. The major individual and relational risk factors are the following: current diagnosis of mental illness; current abuse of alcohol; high levels of hostility; inadequate preparation or training for caregiving responsibilities; inadequate coping skills; exposure to abuse as a child; past experience of disruptive behavior and lack of social support; and, high financial and emotional dependence upon a vulnerable elder (CDC, n. …