Caregiving: Primary Cause of Elder Abuse?

An alternative explanatory model. From the first recognition of elder abuse as a problem widespread enough to require systemic attention, caregiver stress and burden have been regarded as the major precipitory factors. To policy makers, practitioners, and the media alike, elder abuse in its various forms has seemed to originate in the difficulties associated with family members, usually adult children, assisting impaired, dependent older people with daily tasks. Caregiver stress and burden were said to arise from such sources as the necessity to juggle multiple, conflicting roles or the lack of resources to successfully accomplish caregiving functions. Regarding elder abuse as a by-product of caregiver stress and burden served to justify adult protective services as the primary professional intervention for addressing the problem. It could have been otherwise. The earliest discussions of elder abuse arose out of diverse fields: medicine (a "battered old person syndrome" [Butter,1975]), family violence research ("battered parents" [Steinmetz, 1978]), and social work ("abuse of the elderly by informal care providers" [Lau and Kosberg,1978). Social work in the guise of adult protective services succeeded over other possible modes of intervention because (i) abused elders initially were viewed in the same light as abused children, (2) elder abuse was defined as a social problem instead of a public health concern or a crime, and (3) adult prote se ices had already been established nationwide as a result of funding through Title XX of the Social Security Act of 1974. Association of adult protective services with elder abuse also helped to bolster the status of this service system and give it added purpose, struggling as protective-services programs were during the late 1970s in the wake of evaluative research that raised questions about their outcomes (Burr, 1971; Blenkner et al.,1974) and of criticism over their alleged abridgement of individual liberties (Regan, 1978, 1979). As with child protective services, the main functions of adult ptt services are to receive and investigate reports of abuse, to assess client need, to coordinate or provide services to victims, and to pursue legal action against offenders, if indicated. The focus of intervention efforts remains on the victim throughout the process. Attention given to the perpetrator, even when that person is viewed sympathetically as a stressed and burdened caregiver, tends to be minimal, peripheral, or supplemental to the case plan for the victim. The concept of parens patriae forms the philosophical basis of protective-services law in that it supports the focus on the victim, who is seen as vulnerable to harm and in need of intervention by the state to provide protecion. The prevailing view of elder abuse as a byproduct of caregiver stress and burden and reliance on adult protective services as the intervention of choice in elder-abuse cases have always been problematic: Both perspectives are too simplistic for so complex a phenomenon, and they hold up poorly under close examination and extensive use. As early as the mind i98os, empirical studies suggested that the etiology of elder abuse was multifaceted; differences in form of abuse, setting, and victim-perpetrator relationship were identified (Wolf, Godkin, and Pillemer, 1984; Anetzberger, 1987; Steinmetz, 1988; Pillemer and Finkelhor, 1988). These studies also revealed that caregiver stress and burden were not dominant risk factors. Using various methodologies and samples, researchers uncovered evidence that the impairment levels of abused elders could not be distinguished from those of nonabused elders nor could the health status and amount of "interpersonal conflict" of abusing caregivers be distinguished from those of nonabusing caregivers (Phillips, 1983; Pillemer,1985; Suiter and Pillemer, 1988; Bristowe and Collins, 1989). What is more, adult protective services programs on their own have proven incapable of dealing with all the variations in the circumstances surrounding elder abuse, resulting in large numbers of situations wherein reports are never made, victims refuse help, abuse reoccurs after intervention, or practitioners determine that the intervention has had a negative impact (Wolf, Godkin, and Pillemer, 1984; Simon, 1992; Anetzberger,1995). …