National Center for Injury Prevention and Control 

Division of Violence Prevention 

ELDER ABUSE SURVEILLANCE:
 
 


UNIFORM DEFINITIONS AND 

RECOMMENDED CORE DATA ELEMENTS 

ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS

ELDER ABUSE SURVEILLANCE: 

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS 

Version 1.0 

Compiled by 

Jeffrey Hall PhD, MSPH 

Debra L Karch, PhD 

Alex Crosby, MD, MPH 

2016 

Centers for Disease Control and Prevention 

National Center for Injury Prevention and Control 

Division of Violence Prevention 

Atlanta, Georgia 

Uniform Definitions and Recommended Core Data Elements For Use In Elder Abuse Surveillance, 

Version 1.0 is a publication of the National Center for Injury Prevention and Control, 

Centers for Disease Control and Prevention. 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS
ELDER ABUSE SURVEILLANCE:

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National Center for Injury Prevention and Control 

Debra Houry, MD, MPH, Director 

Division of Violence Prevention 

James Mercy, PhD, Director 

Suggested citation: 

Hall, JE, Karch, DL, Crosby, AE. Elder Abuse Surveillance: Uniform Definitions and Recommended Core Data Elements For Use In Elder Abuse 

Surveillance, Version 1.0. Atlanta (GA): National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 2016. 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS

TABLE OF CONTENTS 

EXECUTIVE SUMMARY .......................................................................................................................................... 8



PANEL MEMBERS ................................................................................................................................................... 9



PEER REVIEWERS ................................................................................................................................................. 10



CDC STAFF ............................................................................................................................................................ 11



ACKNOWLEDGEMENTS ....................................................................................................................................... 12



BACKGROUND...................................................................................................................................................... 13



Introduction ...............................................................................................................................................................................................................................14



Public Health Importance of EA.....................................................................................................................................................................................15



The Need for Uniform Definitions ................................................................................................................................................................................15



Rationales for Uniform Definitions and Recommended Core DataElements for Elder Abuse Surveillance..................21



Participatory Process.............................................................................................................................................................................................................21



Purpose and Scope................................................................................................................................................................................................................21



Notes on the Use of Elder Abuse Surveillance Uniform Definitions and Recommended Core Data Elements, Version 1.0...................22



Next Steps....................................................................................................................................................................................................................................23



UNIFORM DEFINITIONS....................................................................................................................................... 25



RECOMMENDED CORE DATA ELEMENTS FOR ELDER ABUSE SURVEILLANCE................................................. 41



Identifying Information For Elder Abuse Surveillance System ..................................................................................................................45



Elder Demographics..............................................................................................................................................................................................................51



Elder Situational Data Elements.....................................................................................................................................................................................67



Perpetrator Demographics...............................................................................................................................................................................................75



Perpetrator Situational Data Elements.......................................................................................................................................................................79



Data Elements For All Abuse Events ...........................................................................................................................................................................83



Physical Abuse Data Elements........................................................................................................................................................................................93



Sexual Abuse Data Elements...........................................................................................................................................................................................99



Psychological/Emotional Abuse Data Elements...............................................................................................................................................105



Neglect Data Elements.....................................................................................................................................................................................................111



Financial Abuse Data Elements...................................................................................................................................................................................115



END NOTES......................................................................................................................................................... 118



REFERENCES....................................................................................................................................................... 119


ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS 8 

EXECUTIVE SUMMARY
 
 


Longstanding divergences in the definitions and data elements used to collect information on Elder Abuse (EA) make it difficult to measure EA nationally, compare the problem across states, counties, and cities, and establish trends and patterns in the 

occurrence and experience of EA. To help remedy these problems and promote public health surveillancei of EA, the Centers 

for Disease Control and Prevention (CDC) and a diverse group of EA experts collaboratively produced version 1.0 of uniform 

definitions and recommended core data elements for possible use in standardizing the collection of EA data locally and 

nationally. Proposed uniform definitions were developed for the following phenomena (and for associated terms or elements 

that could be sources of confusion or disagreement). 

Elder Abuse 

Involved Parties 

Physical Abuse 

Sexual Abuse 

Emotional/Psychological Abuse 

Neglect 

Financial Abuse/Exploitation 

Other Related Phenomena 

Elder Abuse Circumstances or Consequences (associated concepts) 

Subcategories in the Core Data Element set include: 

1) Identifying Information, 

2) Elder Demographics, 

3) Elder Situational Data Elements, 

4) Perpetrator Demographics, 

5) Perpetrator Situational Data Elements, 

6) Data Elements for All Abuse Events, 

7) Physical Abuse Data Elements, 

8) Sexual Abuse Data Elements, 

9) Emotional/Psychological Abuse Data Elements, 

10) Neglect by Caregivers Data Elements, and

 11) Financial Abuse Data Elements. 

The development and use of uniform definitions and recommended core data elements is an important first component of a 

larger process addressing data collection features that cause important discrepancies, gaps, and limitations in what is known 

about EA. Their use may move the EA prevention field closer to obtaining robust epidemiologic estimates which may provide 

a stronger basis for evaluating population level prevention/intervention strategies and setting prevention priorities. 

As with the other CDC guidelines for uniform definitions and recommended data elements, this initial release of Elder Abuse 

Surveillance: Uniform Definitions and Recommended Core Data Elements, Version 1.0 is intended to serve as a starting point. 

Many definitions, data element descriptions, and coding specifications are new, and field testing is necessary to evaluate 

them. Systematic field studies are needed to gauge the usefulness of the content of Version 1.0, identify optimal models, 

methods, and processes of data collection, and specify resource requirements for implementation. Prospective users of Version 

1.0 are invited to contact CDC (via dvpinquiries@cdc.gov ) to discuss their plans for evaluating or using some or all of the 

recommended core data elements. Lessons learned through field use and evaluation will be a valuable source of input for 

subsequent revisions. 
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PANEL MEMBERS
 
 


Ronald Acierno, PhD 

Associate Dean for Research, 

Professor 

Medical University of South Carolina 

Jeannette M. Daly, PhD, RN 

Associate Research Scientist 

Department of Family Medicine 

University of Iowa Carver College of Medicine 

Barbara Dieker 

Former Director, Office of Elder Rights 

Administration on Aging 

Carmel Dyer, MD AGSF, FACP 

Roy M. and Phyllis Gough Huffington Chair in Gerontology,
 
 


Associate Dean for Harris County Programs,
 
 


Professor - Geriatric and Palliative Medicine,
 
 


The University of Texas Health Sciences Center at Houston
 
 


Xin Qi Dong, MD, MPH 

Professor of Medicine 

Rush Institute for Healthy Aging 

Rush University 

Janice A. Green 

Program Specialist 

U.S. Department of Justice 

Office on Violence Against Women 

Gavin Kennedy 

Director, Division of Long Term Care Policy 

Office of the Assistant Secretary for Planning and Evaluation 

Laura Mosqueda, MD, FAAFP, AGSF 

Chair, Department of Family Medicine 

Keck School of Medicine 

University of Southern California 

Carrie Mulford, PhD 

Social Science Analyst 

Violence and Victimization Research 

Division 

Office of Research and Evaluation 

National Institute of Justice 

U.S. Department of Justice 

James G. O’Brien, MD 

Chair and Professor, Geriatric Medicine, Medical Director 

Geriatric Medicine Center 

University of Louisville 

Kathleen Quinn 

Executive Director
 
 


National Adult Protective Services Assn. (NAPSA)
 
 


Lisa Shugarman, PhD 

Director of Policy 

The SCAN Foundation 

Sidney Stahl, PhD 

Former Chief, Individual Behavioral Processes Branch 

Behavioral and Social Research Program 

National Institute on Aging 

National Institutes for Health 

Lori Stiegel, JD, 

Associate Staff Director, Senior Attorney 

Commission on Law and Aging 

American Bar Association (ABA) 

Pamela Teaster, PhD 

Professor, Associate Director for Research 

Center for Gerontology 

Virginia Tech 

Valory Pavlik, PhD, MPH 

Associate Professor 

Department of Family and Community Medicine 

Baylor College of Medicine 

Omar R. Valverde., Esq. 

Aging Services Program Specialist 

Office of Elder Rights 

Administration on Aging 

Stephanie Whittier-Eliason, MSW 

Team Lead 

Office of Elder Justice and Adult Protective Services 

Administration on Aging 

Administration for Community Living 

Helen Lamont, PhD 

Policy Analyst 

Division of Long Term Care Policy 

Office of the Assistant Secretary for Planning and Evaluation 

9 
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PEER REVIEWERS
 
 


Georgia Anetzberger, Ph.D. 

Consultant, Expert on Elder Abuse Prevention 

Scott Beach PhD 

“Associate Director 

University Center for Social and Urban Research (UCSUR)” 

University of Pittsburgh 

Bonnie Brandl, M.S.W. 

Director 

National Clearinghouse on Abuse in Later Life 

Marie-Therese Connolly, JD 

Woodrow Wilson Center Senior Scholar 

Linda Dawson, J.D. 

Elder Justice Coordinator 

National Clearinghouse on Abuse in Later Life 

Terry Fulmer, Ph.D., R.N., FAAN 

President of the John A Hartford Foundation 

Becky Kurtz 

Director of the Office of Long-Term Care Ombudsman 

Programs 

Adminstration on Aging 

Mark Lachs, MD 

Professor of Medicine, Co-Chief of the Division of Geriatrics 

and Gerontology 

Weill Medical College 

Christopher Mikton, PhD 

Technical Officer 

Violence PreventionTeam 

World Health Organization 

Lisa Nerenberg, M.S.W. M.P.H. 

Consultant, Speaker, and Trainer on Elder Abuse Prevention 

Chayo Reyes 

“Retired Los Angeles Police Department Detective 

Elder Financial Protective Services Consultant” 

Debbie Ruggles, MBA 

Violence Prevention Specialist 

Washington State Department of Health 

Dinesh Sethi, MSc MD FFPH 

Technical Officer 

WHO European Regional Office

 European Centre for Environment and Health, Rome 

World Health Organization 

Winsor Schmidt, J.D., L.L.M. 

Endowed Chair/Distinguished Scholar in Urban Health Policy, 

University of Louisville School of Medicine 

Patricia K. Smith, M.S., R.D. 

Violence Prevention Program Coordinator 

Injury & Violence Prevention Section” 

Michigan Department of Community Health 

Randolph “Randy” Thomas, MA 

Former President, National Committee for the Prevention of 

Elder Abuse 

Wendy Verhoek-Oftedahl, Ph.D., M.S. 

Assistant Professor of Community Health (Research) 

Brown Warren Alpert Medical School 

Robert B. Wallace, MD, MSc 

Director, Center on AgingProfessor of Epidemiology, 

College of Public HealthProfessor of Internal Medicine 

University of Iowa Carver College of Medicine 
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CDC STAFF
 
 


Alex Crosby, MD, MPH 

Branch Chief 

Surveillance Branch 

Division of Violence Prevention, 

National Center for Injury Prevention and Control, 

Centers for Disease Control and Prevention 

Kathleen Basile, Ph.D. 

Lead Behavioral Scientist 

Research and Evaluation Branch 

Division of Violence Prevention, 

National Center for Injury Prevention and Control, 

Centers for Disease Control and Prevention 

Sarah Foster, MPH 

Deputy Branch Chief, 

Vaccine Supply and Assurance Branch 

Immunization Services Division 

National Center for Immunization and Respiratory Diseases 

Centers for Disease Control and Prevention 

Jeffrey Hall, Ph.D., M.S.P.H. 

Lead Behavioral Scientist 

Surveillance Branch 

Division of Violence Prevention, 

National Center for Injury Prevention and Control, Centers for 

Disease Control and Prevention 

E. Lynn Jenkins, Ph.D. 

Senior Advisor for Program Integration Division of 

Unintentional Injury Prevention National Center for Injury 

Prevention and Control, 

Centers for Disease Control and Prevention 

Debra Karch, Ph.D. 

Epidemiologist
 
 


HIV Incidence and Case Surveillance Branch 
 
 

Division of HIV Prevention, 
 
 

National Center for HIV/AIDS, Viral Hepatitis, STD and TB 
 
 

Prevention, 
 
 

Centers for Disease Control and Prevention,
 
 


Reshma R. Mahendra, MPH 

Public Health Advisor 

Office of the Director, Division of Violence Prevention 

National Center for Injury Prevention and Control 

Centers for Disease Control and Prevention 

11 
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ACKNOWLEDGEMENTS
 
 


The content of this document reflects the efforts and insights of many professionals working in numerous sectors. These 

professionals willingly shared their expertise as expert panel members and peer reviewers. Despite busy schedules and existing 

commitments, each contributor allocated time and energy, doing their own unique part to assure that the proposed uniform 

definitions and recommended data elements would be precise, clear, and widely relevant. We are grateful for their time, efforts, 

and insights. We also thank our colleagues in the Office of Elder Justice and Adult Protective Services Administration on Aging/ 

Administration for Community Living for their co-sponsorship of preliminary development work and for their abiding support 

over the years. 
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BACKGROUND
 
 


13 
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Introduction 

Older adulthood is often labeled the “Golden Years.” It is a point where many Americans expect to do things that they could 

not do earlier in life due to factors such as family and occupational commitments or financial constraints. It is a time when 

many Americans expect to continue growing as individuals by pursuing personal interests, hobbies, or even second careers, 

as their health permits. At a minimum, most Americans believe that old age should be a time in one’s life that is worry-free, 

peaceful, and stable, where autonomy is retained as long as possible. 

Unfortunately, for persons who experience Elder Abuse (EA),ii, iii old age may be far from “golden.” It can be a sad, stressful time 

filled with pain, poor health, and poverty. It can involve a life that is disconnected from the activities and relationships that one 

finds most meaningful. This disconnection also affects life within the communities surrounding such persons by denying them 

access to these valued older contributors who are important sources of knowledge, expertise, and mentoring. 

EA can be prevented or halted. However, preventing EA at the population level requires data that will support effective action. 

Such data enable the effectiveness of prevention and intervention strategies to be assessed and facilitate decisions regarding 

strategies that should be implemented or further evaluated. The data also inform decisions on how resources should be 

allocated to achieve EA prevention and intervention objectives. 

Numerous organizations and agencies collect EA-related data that could be used for the previous purposes. Unfortunately, 

these data have often been collected for EA cases using different case definitions. Moreover, the frequently used data 

collection instruments, protocols, and systems tend to capture information on persons and incidents that is too often 

incompatible. Such divergences reflect variations in the legislation, statutes or regulations that provide the criteria used to 

identify cases, or variations in the goals, philosophies, or scope of specific studies.1-8 These divergences have made it difficult to 

determine the magnitude of EA nationally, to compare the problems across states, counties, and cities, and to establish trends 

and patterns in the occurrence and experience of EA. 

Given these conditions and consequences, the creation of uniform definitions and data elements for use in collecting EA 

data is essential. To promote national level public health surveillance of EA, the Centers for Disease Control and Prevention’s 

Division of Violence Prevention (CDC/DVP) produced a set of uniform definitions and recommended core data elements. Use 

of uniform definitions and data elements may move the field focused on EA closer to obtaining robust, accurate and reliable 

epidemiologic estimates.1 They may also provide a stronger basis for evaluating the effectiveness of population level strategies 

for prevention and intervention and for setting prevention priorities and objectives. 
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Public Health Importance of EA 

Several factors make EA an important public health issue. First, the growth rate of the older adult population (persons 65 years 

old and over) has greatly exceeded the growth rate of the population of the country as a whole. In 1900 there were 3 million 

older adults, by 1994 there were 33 million, by 2030 the U.S Census Bureau estimates that there will be 71 million. About 1 in 

8 Americans were aged 65 years and older in 1994, but about 1 in 5 would be in that age group by the year 2030 (U.S. Bureau 

of the Census, Jennifer Cheeseman Day, personal communication). These demographic trends indicate that there will be an 

expanded population potentially at-risk for these forms of violence. 

Second, the public health impacts of EA may be far-reaching due to the numerous and varied physical and psychosocial 

consequences of being exposed to these phenomena. However, few studies have examined the consequences of EA, and 

even fewer have distinguished the impacts of EA from those linked to normal aging.8-10 The most commonly documented 

physical impacts of EA include: welts, wounds, and injuries (bruises, lacerations, dental problems, head injuries, broken 

bones, pressure sores); persistent physical pain and soreness; nutrition and hydration issues; sleep disturbances; increased 

susceptibility to new illnesses (including sexually transmitted diseases); exacerbation of pre-existing health conditions; and 

increased risks for premature death.11-15 EA is predictive of later disability among persons who initially displayed no disability 

and is associated with increased rates of emergency department utilization, increased risks for hospitalization, and increased 

risk for mortality.16-19 Established psychological impacts of EA include levels of psychological distress, emotional symptoms, and 

depression higher than those observed among elders who have not experienced these exposures.20-26 Potential psychological 

consequences deserving further study are increased risks (relative to younger population of persons who have experienced 

abusive or neglectful behaviors) for developing fear / anxiety reactions, and post- traumatic stress syndrome. Lastly, the social 

consequences of EA may vary from increased social isolation (due to self-withdrawal or perpetrator imposition) to decreased 

social resources (social identities, supports, roles in key networks) and increased expenditures on services to compensate for 

resources lost through exploitation and to identify and rehabilitate EA victims.11,27 The direct medical costs of injuries caused by 

EA are estimated to contribute more than $5.3 billion to the nation’s annual health expenditures,28,29 while financial abuse by 

itself costs older Americans over $2.6 billion dollars annually.30,31 Other societal costs may include expenses associated with the 

prosecution, punishment, and rehabilitation of EA perpetrators. Estimates of such expenses are not currently available. 

The Need for Uniform Definitions and Recommended Data Elements 

Impediments to Data Comparison and Aggregation / Pooling: Administrative Data 

It is difficult to confirm and characterize the true public health burden of EA. This is largely due to the methodological 

problems that definitional variations introduce into efforts to aggregate, compare, and/or interpret data from different sources. 

For example, administrative data sources (e.g., Adult Protective Services, Long-Term Care Ombudsman, state long-term 

care facilities, regulatory, and law enforcement) cannot be readily pooled because they use divergent definitions to define 

cases and collect data.32 Research by Daly et al,33 Joegerst et al.,34 and others (including the CNSTAT of the National Research 

Council of the National Academies of Science) has firmly established that variations in the state or local statutes from which 

operational definitions have been derived introduce comparability problems that cannot always be resolved in a meaningful 

way. Characteristics such as the use of different terms and jargon and behavioral categories that are not conceptually or 

operationally compatible make efforts such as cross-walkingiv for the purpose of data aggregation very difficult. 

The previous problems are further compounded by sector and system specific characteristics that vary the depth, breadth, 

and quality of data elements that are available for comparison. These include intrinsic differences in each data collection 

system’s purpose/objectives, design and infrastructure, or scope of focus and operation. They may also include variations in 

the activities, processes, and procedures by which relevant data are collected, interpreted, or reported. Such system specific 

characteristics are responsible for the presence of unique or specialized data elements, variations in data element properties, 

and differences in the set of data elements comprising the core of data collection efforts. 

Impediments to Comparison and Aggregation/Pooling: Survey Research Data 

Many discussions regarding data on Elder Abuse focus on problems compiling data from administrative data sources. However, 

there also has been some consideration of how definitional issues affect potentials for comparing or pooling of estimates from 

population based studies. Estimate pooling involves producing a common estimate as a function of individual estimates such 

as those obtained in studies of EA’s and prevalence. This methodology could be used to obtain more precise estimates of EA’s 

prevalence if the estimates of different population-based studies could be combined in a statistically valid way. 

15 
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The impediments to pooling estimates from existing population based studies of EA are numerous and diverse. For one, 

relevant studies were conducted at different points in time, using samples that are not directly comparable. Although the 

samples are nationally representative, they capture different cohorts in the national population. This is important because 

studies conducted at different points in history capture groups of older adults whose risks for abuse may be influenced by 

different societal conditions and occurrences that could result in differences in the population exposure to risk factors for EA 

over time. Existing population based studies also differ with regard to the age groups from which data were collected as well 

as the approaches used for sample generation and data collection (e.g., ages 57-85, 60 and older, ages 65 and older). 

More importantly, the studies differ with regard to how EA was measured. For example, some studies examine only physical 

abuse, whereas others examine only psychological abuse. Even the measurement of physical abuse itself varies markedly. 

Different studies measure different types of physical abuse, and varying numbers of abusive behaviors that may be suffered. 

Laumann et al., for instance, measured three forms of physical abuse using a single question— “Is there anyone who hits, 

kicks, slaps, or throws things at you?”35 In contrast, Acierno et al.2 measured multiple forms and aspects physical abuse using 

three questions—“Has anyone ever hit you with their hand or object, slapped you, or threatened you with a weapon?”, 

“Has anyone ever tried to restrain you by holding you down, tying you up, or locking you in your room or house?”, and “Has 

anyone ever physically hurt you so that you suffered some degree of injury, including cuts, bruises, or other marks?” Lastly, the 

measures of abuse themselves also vary in behavioral specificity, with some studies using more general, summary measures 

asking whether elders experienced any one of several behaviors while other studies use greater numbers of questions to 

allow individual experiences to be measured separately. Differences in this area produce substantial variation in the degree of 

measurement overlap across studies and in the validity, sensitivity, and specificity of indicators of abuse. 

Definitions Developed by Agencies, Associations, and Institutions 

As concerned parties have mobilized to confront Elder Abuse, different but related frames have been constructed to define, 

understand, and address it. The definitional activities and products of such stakeholders have shaped ideas about what 

should be considered EA, its constituent elements, dimensions, or types, and the specific populations in which it can occur. 

A cross-section of prominent definitions on Elder Abuse and related constructs is provided in Table 1. Most were developed, 

are supported, or are used by groups whose stature is sufficient to influence practices and policies governing various sectors 

of the field of EA prevention. Others were produced by seminal efforts that have expanded thought about how EA should 

be conceived and measured. All definitions were thoroughly studied in preparation for the definitions development process 

described in the following section. They provided important building blocks for the creation of the proposed uniform 

definitions. 

Although there are some similarities among the provided definitions (and with our proposed uniform definitions), several 

differences are worthy of note. Beyond the most obvious variations in terminology, the definitions vary in their level of 

abstraction (i.e., cover many phenomena very generally in a highly conceptual manner, very concretely address a few 

behaviors in a narrow context/situation specific way, or assume a position somewhere between these poles). They also 

vary in their specificity of behavioral manifestations/indicators and elaboration of definitional elements whose meanings 

might require clarification to assure uniformity in the interpretation and use of the definitions. For example, definitions in 

the Older Americans Act (OAA), on the website of the National Center for Elder Abuse (NCEA), and in definitions from the 

National Research Council (NRC) specify conditions that must be present for EA or a related phenomenon to be present (i.e., 

mistreatment or abuse). They also specify the full range of persons who may be involved. (i.e., older adults/elders, as a result of 

actions/inactions by caregivers and trusted individuals). In contrast, the definition of EA that the American Medical Association 

(AMA) devised during the late 1990s discusses EA more generally. This definition does not state what categories of individuals 

could be considered perpetrators. The AMA definition presented here also differs from the other definitions because it does 

not include some aspect of trust or an anchoring to a trust relationship as a necessary element for distinguishing EA from 

victimization due to the actions of strangers. 
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Table 1. A Cross-Section of Prominent Definitions On Elder Abuse and Related Constructs 

Author / Source / Origin Included Constructs Specified Definitions 

Older Americans Act Of 1965 Older individual: An individual who is 60 years of age or older. 

As Amended In 2006 (Public Abuse: The willful infliction of injury, unreasonable confinement, 

Law 109-365) 

Neglect: 

Self-neglect: 

Exploitation 

Elder abuse 

Elder abuse, neglect, 

and exploitation 

intimidation, or cruel punishment with resulting harm, 

pain, or mental anguish; or deprivation by a person, 

including a caregiver, of goods or services that are 

necessary to avoid physical harm, mental anguish, or 

mental illness. 

The failure of a caregiver or fiduciary to provide the goods 

or services that are necessary to maintain the health or 

safety of an older individual; or Self-neglect. 

An adult’s inability, due to physical or mental impairment 

or diminished capacity, to perform essential self-care tasks 

including-Obtaining essential food, clothing, shelter, and 

medical care; Obtaining goods and services necessary to 

maintain physical health, mental health, or general safety; 

or Managing one’s own financial affairs. 

The fraudulent or otherwise illegal, unauthorized, or 

improper act or process of an individual, including a 

caregiver or fiduciary, that uses the resources of an older 

individual for monetary or personal benefit, profit or gain, 

or that results in depriving an older individual of rightful 

access to, or use of, benefits, resources, belongings, or 

assets. 

The term ‘‘elder abuse’’ means abuse of an older individual. 

The term ‘‘elder abuse, neglect, and exploitation’’ means 

abuse, neglect, and exploitation, of an older individual. 

The American Medical 

Association (1997) 

Elder abuse An act or omission which results in harm or threatened 

harm to the health or welfare of an elderly person. Abuse 

includes intentional infliction of physical or mental injury; 

sexual abuse; or withholding of necessary food, clothing, 

and medical care to meet the physical and mental needs 

of an elderly person by one having the care, custody, or 

responsibility of an elderly person. 

Committee on National 

Statistics, National Research 

Council of The National 

Academies of Sciences, 

Engineering, and Medicine 

(also embraced by the National 

Institute on Justice of the U.S. 

Department on Justice and the 

National Institute on Aging of 

the National Institutes on Health 

(2003) 

Mistreatment Intentional actions that cause harm or create a serious 

risk of harm, whether or not intended, to a vulnerable 

elder by a caregiver or other person who stands in a trust 

relationship to the elder or failure by a caregiver to satisfy 

the elder’s basic needs to protect the elder from harm. 

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Author / Source / Origin Included Constructs Specified Definitions 

NRC continued... Abuse 

Neglect 

Harm 

Caregiver 

Trust relationship 

Vulnerability 

Conduct by responsible caregivers or other individuals 

that constitutes “abuse” under applicable state or federal 

law. 

An omission by responsible caregivers that constitutes 

“neglect” under applicable federal or state law. 

Injuries or unmet basic needs attributable to acts or 

omissions by others. 

A person who bears or has assumed responsibility for 

providing care or living assistance to an adult in need of 

such care or assistance. 

A care giving relationship or other familial, social or 

professional relationship where a person bears or has 

assumed responsibility for protecting the interests of the 

older person or where expectations of care or protection 

arise by law or social convention. 

Financial, physical or emotional dependence on others or 

impaired capacity for self-care or self-protection. 

Department of Justice , Elder Abuse / Elder Any knowing, intentional, or negligent act that causes 

Office of Victims of Crime Mistreatment harm or creates a serious risk of harm to an older person 

by a family member, caregiver, or other person in a 

trust relationship. Elder abuse may include abuse that is 

physical, emotional/psychological (including threats), or 

sexual; neglect (including abandonment); and financial 

exploitation. 

Department of Justice, Office Elder Abuse Intentional actions by a caregiver or other trusted 

of Justice Programs individual that causes harm to an older adult. Elder 

abuse can also include the failure of a caregiver or other 

responsible party to provide for the basic needs of an 

elder. The comprehensive definition of elder abuse 

includes financial exploitation of older people, as well 

as physical abuse, neglect, emotional abuse, and sexual 

abuse. 

Administration on Aging 

National Center on Elder 

Abuse 

Elder Abuse 

Physical Abuse 

Intentional or neglectful acts by a caregiver or “trusted” 

individual that lead to, or may lead to, harm of a vulnerable 

elder. Use of physical force that may result in bodily injury, 

physical pain, or impairment. 

Physical abuse may include but is not limited to such acts 

of violence as striking (with or without an object), hitting, 

beating, pushing, shoving, shaking, slapping, kicking, 

pinching, and burning. In addition, inappropriate use of 

drugs and physical restraints, force-feeding, and physical 

punishment of any kind also are examples of physical abuse. 

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Author / Source / Origin Included Constructs Specified Definitions 

Sexual Abuse 

Emotional or 

psychological Abuse 

Neglect 

Abandonment 

Financial or Material 

Exploitation 

Self-Neglect 

Non-consensual sexual contact of any kind with an elderly 

person. Sexual contact with any person incapable of giving 

consent is also considered sexual abuse. It includes, but is not 

limited to, unwanted touching, all types of sexual assault or 

battery, such as rape, sodomy, coerced nudity, and sexually 

explicit photographing. 

The infliction of anguish, pain, or distress through verbal or 

nonverbal acts. Emotional/psychological abuse includes but 

is not limited to verbal assaults, insults, threats, intimidation, 

humiliation, and harassment. In addition, treating an older 

person like an infant; isolating an elderly person from his/her 

family, friends, or regular activities; giving an older person the 

"silent treatment;" and enforced social isolation are examples 

of emotional/psychological abuse. 

The refusal or failure to fulfill any part of a person's obligations 

or duties to an elder. Neglect may also include failure of a 

person who has fiduciary responsibilities to provide care for 

an elder (e.g., pay for necessary home care services) or the 

failure on the part of an in-home service provider to provide 

necessary care. 

The desertion of an elderly person by an individual who has 

assumed responsibility for providing care for an elder, or by a 

person with physical custody of an elder. 

The illegal or improper use of an elder's funds, property, or 

assets. Examples include, but are not limited to, cashing an 

elderly person's checks without authorization or permission; 

forging an older person's signature; misusing or stealing an 

older person's money or possessions; coercing or deceiving 

an older person into signing any document (e.g., contracts or 

will); and the improper use of conservatorship, guardianship, or 

power of attorney. 

The behavior of an elderly person that threatens his/her 

own health or safety. Self-neglect generally manifests itself 

in an older person as a refusal or failure to provide himself/ 

herself with adequate food, water, clothing, shelter, personal 

hygiene, medication (when indicated), and safety precautions. 

The definition of self-neglect excludes a situation in which 

a mentally competent older person, who understands the 

consequences of his/her decisions, makes a conscious and 

voluntary decision to engage in acts that threaten his/her 

health or safety as a matter of personal choice. 

19 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS

- -

Figure 1. Conceptual Models Underlying Assorted Elder Abuse Definitions 

NRC

CNSTAT

AMA

1997

OAA NCEA

Elder 

Mistreatment 

Abuse Neglect 

by Others 

Abuse Neglect Exploitation Self 

Neglect 

Elder 

Abuse 

Neglect 

by Others Exploitation 

Persons 60+ only 

Elder 

Abuse 

Self 

Neglect 

Physical 

Abuse 

Sexual 

Abuse 

Psych 

Abuse 

Neglect 

by Others 

Financial 

Abuse 

Abandonment 

Elder 

Abuse 

Physical 

Abuse 

Psych 

Abuse 

Sexual 

Abuse 

Neglect 

by Others 

All six definition sets focus on older adults. However, the specific category of persons given attention in the OAA are persons 

age 60 and older while the NRC based definitions focus squarely on persons defined as vulnerable. The AMA definition 

arguably has the broadest focus of all the definition sets in its reference to “elderly persons.” 

Notable differences in the degree and type of information provided about proposed categories/ constituent elements reflect 

differences in each group’s starting point in the operationalization process. The starting points largely determined the nature 

and content of the underlying conceptual model and will influence any measurement models subsequently developed (see 

Figure 1). For instance, the OAA definitions start with a model including four interrelated global constructs at the highest 

order— abuse, neglect, self-neglect, and exploitation. Subtypes of these constructs were developed by narrowing the focus 

from the universe of experiences with abuse, neglect, and exploitation to only those of persons 60 years of age and older. The 

behavioral content remains unchanged and is fairly abstract in nature due to its political and legal origins and functions. 

In contrast, the NRC definitions reflect a model that includes abuse and neglect as forms of mistreatment. It does not, 

however, distinguish further between abuse and neglect to designate specific behavioral or experiential indicators that can 

be measured or observed. The rationale for this action is straightforward. The CNSTAT’s underlying goal was to provide a viable 

frame for EA related research while allowing researchers to define the specific indicators of abuse and neglect in a manner 

most consistent with the operational definitions present in relevant state and federal laws. 

Of the set of definitions, the NCEA’s are by far the most detailed and operationally specific. However, the usefulness of the 

definitions may be limited by their exclusion of definitions for embedded elements, concepts, and terms that are themselves 

moderately abstract in nature. Terms such as “impairment,”“non-consensual contact,”“harassment,” and “fiduciary responsibility,” 

for instance, may be misunderstood or interpreted in a manner that diverges from the organization’s intention when read 

by persons lacking legal training. This could lead to variations in both clinical judgments and the application of structured 

frameworks for decision making which may rely on EA definitions to provide parameters for case identification, reporting or 

investigation. 

In sum, each of the presented definitions has its own strengths and weaknesses. In their own way, each definition development 

effort has advanced the field of EA prevention by incrementally improving the rigor with which EA is conceptualized. They have 

also helped cultivate data collection and research efforts that are better positioned to capture and distinguish behaviors that 

20 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS

 

should be the foci of systems level prevention efforts. Nevertheless, these definitions cannot be directly and immediately used as 

a basis for data standardization due to the characteristics highlighted in the previous paragraphs. 

The effort described in this document is an attempt to capitalize or build on the gains made in previous work to improve EA’s 

definition and measurement. It incorporates lessons learned in these efforts, integrating the strong points of each definition 

set and attempting to address their limitations with the goal of making further progress towards developing uniform 

definitions and data elements that would be utilized by the widest possible variety of groups working to prevent EA. 

Rationales for Uniform Definitions and Recommended Core Data Elements for Elder Abuse Surveillance 

The development and use of uniform definitions and recommended core data elements is an important first component 

of a larger process a process to improve or standardize the data collection on EA. By developing uniform definitions and 

recommended core data elements, we create a basis from which data standardization work can be initiated. They provide 

a viable mechanism for coordinating, harmonizing, and linking diverse sources of EA data. Use of these definitions could 

increase the comparability and usefulness of administrative and research data. These definitions can make it possible to more 

fully describe EA’s scope and nature, expand knowledge about its developmental history (by allowing individual’s interactions 

with, movement through, or use of different systems to be tracked), and document the outcomes of persons who have 

perpetrated or experienced EA and have interacted with specific systems or received specific services. 

Participatory Process 

CDC facilitated development of the proposed uniform definitions and recommended data elements for EA surveillance via a 

grounded, participatory process. CDC recruited a panel of scientists and practitioners representing multiple disciplines (e.g., 

medicine, psychology, epidemiology, sociology, gerontology), various affiliations (e.g., government, academic institutions), and 

diverse areas of interest (e.g., suicidal behavior, public health surveillance, injury prevention). CDC also established relationships 

with and sought panel participation from staff from other federal agencies focused on EA prevention. The members of the 

panel formed by the two groups of collaborators are listed on page 6 of this document. 

Together, panelists 1) identified concerns associated with defining, applying, and gaining acceptance of uniform definitions; 

2) identified implications, costs, and benefits inherent to various approaches to definition; and 3) developed draft uniform 

definitions and recommended data elements for operationalization. 

They also worked with CDC to develop descriptors for starter data elements and to distinguish Core data elements essential for 

EA surveillance from Supplementary data elements recommended for collection as resources permit. 

CDC staff summarized the recommendations from meetings of the expert panel and incorporated changes recommended 

by the panel members. They also 1) created a list of terms for sub-definition, 2) researched definitions for these terms, 3) 

developed descriptions and criteria for the data elements and 4) produced a document containing all of this information. A 

draft of this document was sent to the expert panel for a final review and then prepped for peer review based on a last set of 

panel suggestions. 

The peer review process was extensive. It involved submission of independent critiques, commentary, and suggestions by the 

eighteen reviewers listed on page 8 of this document. These peer reviewers were nominated by members of the expert panel. 

CDC compiled comments and suggestions submitted by each peer reviewer. CDC staff then integrated and reconciled (in 

cases where opposing perspectives emerged) peer review feedback to produce a next iteration of the draft definitions and 

data elements document. The document incorporating contributions of both the expert panel and the peer review process 

was subsequently critiqued a final time in CDC’s internal scientific review and clearance process. This clearance process ensures 

the scientific quality, integrity, and relevance of CDC documents before they are released to the public. The current document, 

Elder Abuse Surveillance: Uniform Definitions and Recommended Core Data Elements, Version 1.0, and the forthcoming document 

Elder Abuse Surveillance: Supplementary Data Elements reflect these developmental processes, their diverse facets, and their 

assorted contributors. 

Purpose and Scope 

Elder Abuse Surveillance: Uniform Definitions and Recommended Core Data Elements, Version 1.0, is intended for voluntary use 

by individuals and organizations interested in gathering surveillance data on EA. The term “surveillance” is used in the public 

health sense and is defined as the ongoing, systematic collection, analysis, interpretation, and dissemination of data regarding 

21 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS 22 

a health-related event for use in public health action to reduce morbidity and mortality and to improve health. This process 

is explicitly tied to public health action, where existing knowledge is applied to guide authorities to initiate prevention and 

control efforts. It provides answers to essential questions including: 

1. What is the problem? (Who and how many are being injured and in what ways?) 

2. What is the cause? (What are the risks that contribute to injury?) 

3. What works? (How can we intervene and which interventions best reduce the risks and the harm?) 

4. How do we prevent it? (How do we make the best use of available resources to stop people from being injured or to 

reduce the harm done? How do we add to our resources if they are insufficient?) 

Public health surveillance is therefore directly linked to the population’s monitoring and control needs, especially those 

relating to sources of injury such as EA. 

This document is not meant as a set of mandates, but rather is intended to promote and improve consistency of EA 

measurement and surveillance. If the recommended data elements can be uniformly recorded and the data made available 

to numerous users, then better estimates of the incidence and prevalence of EA can be obtained and problems such as data 

incompatibility and high costs of collecting, linking, and using data can be substantially reduced. 

Broad categories of developed recommended data elements included Core Data Elements (units of data that should be 

collected or documented for every case/incident) and Supplementary Data Elements (additional data that can be collected 

to further describe cases/incidents if resources will allow this). The current document only presents content for Core Data 

Elements. The elements included in this set represent the minimum amount of information needed to establish or evaluate 

priorities and strategies for EA prevention and intervention. To promote nation-wide interoperability Core Data Elements 

also include data elements that are critical for record linkage purposes, duplicate record identification/removal, and case 

monitoring. 

The recommended data elements are designed to collect information of value for public health surveillance of EA and to serve 

as a technical reference for automation of the surveillance data. A structured format, modified slightly from Data Elements 

for Emergency Department Systems (DEEDS), Release 1.0(National Center for Injury Prevention and Control, 1997), is used to 

document each data element as follows: 

• Description/Definition of the data element; 

• Description of its Uses; 

• Discussion of conceptual or operational issues; 

• Specification of the Data Type(and maximum allowed Field Length); 

• Indication of when data element Repetition may be necessary to include all answers that may apply; 

• Field values/ coding instructions that designate recommended coding specification and valid data entries; and 

• Where applicable, reference to one or more Data Standards or Guidelines used to define the data element and its field 

values, and Other References considered in developing the data element. 

Data types and field lengths conform to specifications in Health Level7 (HL7), a widely used protocol for electronic data 

exchange (HL7, 1996), and ASTM’s Introduction 5(formerly known as the American Society for Testing and Materials) E1238-94: 

Standard Specification for Transferring Clinical Observations Between Independent Computer Systems (ASTM, 1996). 

Notes on the Use of Elder Abuse Surveillance Uniform Definitions and Recommended Core Data Elements, Version 1.0 

The Uniform Definitions are used throughout the Recommended Core Data Elements. The definitions are likely to be of value 

to policymakers, researchers, public health practitioners, victim advocates, service providers, and media professionals seeking 

to clarify discussions about EA. However, most terms in the “Uniform Definitions” are defined in only a comprehensive sense, 

and practitioners, researchers, and other users may need to further refine and systematically adapt them for use in particular 

professional and practice settings. Such work should ideally occur within a guided adaptation process that will preserve the 

core elements of the Uniform Definitions while achieving relevance, sustainability, and acceptability among specific end-user 

populations. Other terms were not defined by the expert panel and may need to be defined in subsequent versions of the 

“Uniform Definitions.” Examples of specific issues needing further clarification include how to identify victims and perpetrators 

in episodes that appear to be mutually violent, and how to capture important developments such as transitions out of 

victimization or perpetration status. 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS

Elder Abuse (EA), as specified in the “Uniform Definitions” and used throughout 

the “Recommended Core Data Elements,” refers to an intentional act or failure to 

act by a caregiver or another person in a relationship involving an expectation 

of trust that causes or creates a serious risk of harm to an older adult. 

Points to Consider: 

• As with all efforts to collect data on Elder Abuse, ethical and safety issues are paramount. No data should be collected 

or stored that would in any way jeopardize a possible victim’s safety. Those interested in developing a surveillance 

system for EA must be particularly conscious of the need to preserve confidentiality. Confidentiality must be protected 

when planning data linkage across multiple data sources, perhaps through mechanisms such as encryption of unique 

identifiers. 

• No single agency is likely to collect all of the data elements recommended. As a consequence, it is likely that anyone 

setting up a surveillance system will need to combine data from a number of sources (e.g., health care records and 

police records) using a relational database. This will allow information on data elements to be gathered from each 

data source used. The mechanics of how to set up relational databases are not discussed in this document, but 

background information from the CDC’s National Violent Death Reporting System (NVDRS: see http://www.cdc.gov/ 

ViolencePrevention/NVDRS/index.html for more information) should provide information helpful for developing such 

databases. A unique identifier will need to be created to allow for linkage across all data sources included. This identifier 

may or may not be identical to the data element Case ID. 

• The goals of EA surveillance are to obtain an estimate of the number of people who are affected by EA and to describe 

the characteristics of people affected, the number and types of EA episodes, the associated injuries, and other 

consequences. Counting injuries as part of a surveillance system is a common proxy for estimating the number of people 

affected. However, the large number of cases in which multiple forms of violence co-occur and the repetitive nature of 

EA mean that such a proxy may be less accurate than is desired. In addition, it is often difficult to distinguish an injury due 

to a benign cause from one due to abuse, especially in older aged individuals. This is because many common age-related 

conditions may mask or mimic signs of abuse. To obtain more accurate estimates of the number of people affected 

by EA, ultimately we will need to develop mechanisms for linking data, both within and across different data sources, 

through the use of unique identifiers. 

• The elements can be gathered in any order and can be obtained from one or more data sources for any given victim 

of EA. Each data element includes a code set that specifies recommended coding values and instructions for what to 

do when the data element is not applicable for a particular victim. Obviously, the accuracy and completeness of data 

collected on EA victimization depend upon what is documented by the agency providing the information. 

• The mechanics of how to set up a database that accommodates data from multiple sources are not discussed in this 

document. Users should refer to other sources for information on how to set up a database. 

Next Steps 

This initial release of Elder Abuse Surveillance: Uniform Definitions and Recommended Core Data Elements, Version 1.0 is intended 

to serve as a starting point for advancing surveillance, research, and practice aimed at preventing EA. It is our hope that the 

proposed Uniform Definitions will assist the field in 1) further describing and delineating the core constituent elements of 

EA; 2) improving the classification of its behavioral manifestations and its differentiation from other, similar phenomena; 3) 

clarifying and explaining the practical relevance of concepts, terms, or expressions that are often esoteric and abstract; and 4) 

making information and vocabulary regarding EA accessible to and actionable for the widest variety of stakeholders. Through 

such contributions the current effort and any ensuing work will build upon and extend the achievements of earlier definitional 

efforts. 

The developed Supplementary Data Elements will be presented in the forthcoming CDC publication Elder Abuse Surveillance: 

Supplementary Data Elements. The Supplementary Data Elements presented in this companion publication are designed to 

23 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS 24 

augment information provided by the Core Data Elements presented here. The publication will provide practice based and 

research informed guidance regarding additional administrative, clinical, or survey data that would be beneficial to collect 

if resources allow. Such data could provide practitioners and researchers with more extensive opportunities for expanded 

surveillance, etiologic study, and research to inform practice. 

Many of the Recommended Core Data Element definitions and coding specifications are new, and field testing is necessary 

to evaluate them. Systematic field studies are needed to gauge the usefulness of Version 1.0 for EA surveillance, to identify 

optimal methods of data collection, and to specify resource requirements for implementation. Prospective users of Version 

1.0 are invited to contact CDC to discuss their plans for evaluating or using some or all of the Uniform Definitions and 

Recommended Core Data Elements. Lessons learned through field use and evaluation will be a valuable source of input for 

subsequent revisions, but all comments and suggestions for improving this document are welcome. 

Please send questions or suggestions for improving this document to: 

Jeffrey E. Hall, PhD., M.S.P.H., C.P.H. 

Lead Behavioral Scientist 

Surveillance Branch 

Division of Violence Prevention 

National Center for Injury Prevention and Control 

Centers for Disease Control and Prevention 

4770 Buford Highway, NE, MS F63 

Atlanta, GA 30341 

dvpinquiries@cdc.gov 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS

UNIFORM DEFINITIONS



25 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS 26 

Defined Terms 

ELDER ABUSE ............................................................................................................................................................................ 28



Intentional / Intentionally ......................................................................................................................................................................................................................................................28



Expectation of Trust....................................................................................................................................................................................................................................................................28



Risk...........................................................................................................................................................................................................................................................................................................28



Harm.......................................................................................................................................................................................................................................................................................................28



INVOLVED PARTIES .................................................................................................................................................................. 30



Older Adult / Elder.......................................................................................................................................................................................................................................................................30



Victim.....................................................................................................................................................................................................................................................................................................30



Perpetrator / Offender..............................................................................................................................................................................................................................................................30



Current or Former Legal Spouse ......................................................................................................................................................................................................................................30



Intimate Partner.............................................................................................................................................................................................................................................................................30



Child........................................................................................................................................................................................................................................................................................................30



Family Member/Relative.........................................................................................................................................................................................................................................................30



Caregiver .............................................................................................................................................................................................................................................................................................30



Care Custodian...............................................................................................................................................................................................................................................................................30



Legal Guardian................................................................................................................................................................................................................................................................................31



Other Person in Position of Power or Trust...............................................................................................................................................................................................................31



Friend.....................................................................................................................................................................................................................................................................................................31



Acquaintance / Persons of Casual Acquaintance ...............................................................................................................................................................................................31



Stranger................................................................................................................................................................................................................................................................................................31



PHYSICAL ABUSE...................................................................................................................................................................... 31



Illness......................................................................................................................................................................................................................................................................................................31



Bodily / Physical Injury..............................................................................................................................................................................................................................................................31



Physical Pain .....................................................................................................................................................................................................................................................................................31



Functional Impairment............................................................................................................................................................................................................................................................32



Distress..................................................................................................................................................................................................................................................................................................32



Inappropriate use of Drugs...................................................................................................................................................................................................................................................32



Inappropriate use of Physical Restraints.....................................................................................................................................................................................................................32



Physical Punishment..................................................................................................................................................................................................................................................................32



SEXUAL ABUSE.......................................................................................................................................................................... 32



Forced....................................................................................................................................................................................................................................................................................................33



Unwanted ..........................................................................................................................................................................................................................................................................................33



Sexual Interaction.........................................................................................................................................................................................................................................................................33



Noncontact.......................................................................................................................................................................................................................................................................................33



Voyeurism...........................................................................................................................................................................................................................................................................................33



Sexual Harassment......................................................................................................................................................................................................................................................................33



Incapacitated Person.................................................................................................................................................................................................................................................................33



Competent / Competence (mental and legal).....................................................................................................................................................................................................33



EMOTIONAL / PSYCHOLOGICAL ABUSE ................................................................................................................................ 33



Fear..........................................................................................................................................................................................................................................................................................................34



Infantilize.............................................................................................................................................................................................................................................................................................34



NEGLECT.................................................................................................................................................................................... 34



Failure to Meet Needs for Essential Medical Care................................................................................................................................................................................................34



Nutrition...............................................................................................................................................................................................................................................................................................34



Hydration............................................................................................................................................................................................................................................................................................35



Hygiene................................................................................................................................................................................................................................................................................................35



Clothing...............................................................................................................................................................................................................................................................................................35



Shelter ...................................................................................................................................................................................................................................................................................................35


ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS

FINANCIAL ABUSE / EXPLOITATION ....................................................................................................................................... 35



Fraud.......................................................................................................................................................................................................................................................................................................35



Misappropriation..........................................................................................................................................................................................................................................................................35



Power of Attorney........................................................................................................................................................................................................................................................................36



Undue Influence...........................................................................................................................................................................................................................................................................36



Conservatorship............................................................................................................................................................................................................................................................................36



Trust.........................................................................................................................................................................................................................................................................................................36



Fiduciary ..............................................................................................................................................................................................................................................................................................36



Fiduciary Duty.................................................................................................................................................................................................................................................................................36



OTHER RELATED PHENOMENA APPEARING IN THE LITERATURE AND REPORTING LAWS ........................................... 36



Abandonment................................................................................................................................................................................................................................................................................37



Abduction..........................................................................................................................................................................................................................................................................................37



Criminal Record Identity Theft............................................................................................................................................................................................................................................37



Medical Abuse................................................................................................................................................................................................................................................................................37



Resident-to-Resident Abuse/Aggression..................................................................................................................................................................................................................37



Self-Neglect.......................................................................................................................................................................................................................................................................................37



Violation of Rights........................................................................................................................................................................................................................................................................38



TERMS ASSOCIATED WITH THE CIRCUMSTANCES AND CONSEQUENCES OF ELDER ABUSE......................................... 38



Incident................................................................................................................................................................................................................................................................................................38



Activities of Daily Living (ADLs)..........................................................................................................................................................................................................................................38



Instrumental Activities of Daily Living (IADLs)........................................................................................................................................................................................................38



Capacity...............................................................................................................................................................................................................................................................................................38



Economic or Financial Dependency/Dependence..........................................................................................................................................................................................38



Report / Reported........................................................................................................................................................................................................................................................................38



Investigation / Investigated..................................................................................................................................................................................................................................................39



Substantiated Report................................................................................................................................................................................................................................................................39



Disability ..............................................................................................................................................................................................................................................................................................39



Disease..................................................................................................................................................................................................................................................................................................39



27 
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ELDER ABUSE


An intentional act or failure to act by a caregiver or another person in a relationship involving an expectation of trust that 

causes or creates a risk of harm to an older adult. 

Sub-definitions: 

Intentional / Intentionally 

Intended or planned; done deliberately, knowingly, willfully, or voluntarily. 

The term “intentional” limits EA to acts purposefully, deliberately, and consciously taken by another or others. Consistent 

with other World Health Organization and CDC work on interpersonal violence, intentionality is tied to actions taken 

regardless of the possible or actual outcomes of the action. In other words, actions should be classified not on the 

consequences of the act, but on the nature of/motives for the act itself. This classification approach is important. The harm 

or injuries produced intentionally and unintentionally may be nearly indistinguishable. However, the approaches required 

to prevent or halt processes leading to intentional injuries and to limit their adverse effects may be wholly different from 

those needed to address processes that may lead to unintentional injuries. Determining and understanding intent is an 

indispensable prerequisite for the design of prevention and intervention strategies that are appropriate and effective. 

It is acknowledged that (1) acts by caregivers and others in relationships involving expectations of trust may be deliberate 

and intentional; however, harm to an older adult might not be the intended consequence; (2) harm to an older adult 

may not be the intended consequence of a failure to act; (3) individual incidents may involve mixtures of intentional 

and unintentional acts; (4) determining intent is often difficult and in many cases depends on the amount and quality of 

available evidence, how such evidence is interpreted, and perceptions regarding intent and motives. 

Expectation of Trust 

The rational expectation or belief that a relative, friend, caregiver, or other person with whom a legally defined professional 

relationship exists can or should be relied upon to protect the interests of an older adult and/or provide for an older adult’s 

care. This expectation is based on either the willful assumption of responsibility or expectations of care or protection arising 

from legal or social conventions. The expectation that the aforementioned persons will perform actions that benefit the older 

adult, regardless of whether the behaviors are controlled or monitored, creates a condition of vulnerability. 

Persons such as estranged relatives with whom there is neither affection nor trust would be excluded. In addition, the 

expectation of trust generally does not extend to strangers or persons of casual acquaintance. The exception is when 

strangers or casual acquaintances are embraced by older adults as family members, friends, or caregivers. With this transition 

the former strangers/acquaintances become subject to the same expectations governing the behaviors of others in a 

position of trust. 

Risk 

The possibility that an individual will experience an event, illness, condition, disease, disorder, injury or other outcome that 

is adverse or detrimental and undesirable. 

Harm 

Immediate or delayed disruptions to an individual’s physical, cognitive, emotional, social, or financial health. 

1. Disruption of physical health includes, but is not limited to physical injuries, preventable illnesses, and inadequate 

nutrition. 

– Physical injuries are physical disruptions, including those that may result in death, occurring to the body due 

to exposure to thermal, mechanical, electrical, or chemical energy interacting with the body in amounts or 

rates that exceed the threshold of physiological tolerance, or from the absence of such essentials as oxygen or heat.36 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS

Physical injuries can include physical marks, burns, lacerations, contusions, abrasions, broken bones, internal injuries, 

organ damage, poisoning, asphyxiation. 

– Preventable illnesses are those illnesses and diseases that can be avoided by initiating preventive health behaviors or 

using preventive health care services. Examples include pneumococcal diseases, influenza, and tetanus. Preventable 

illnesses can increase morbidity and mortality among older adults because, relative to younger populations, older 

adults, on average, tend to experience more co-occurring medical conditions, may be more susceptible to serious 

conditions associated with preventable illnesses, and are at higher risk for complications. They may result from a 

denial of medical care, withholding of medication, or failure to immunize medically vulnerable or frail older adults 

against diseases. 

By itself failure to assure that an older adult is vaccinated is not considered abuse. However, this failure can be 

interpreted as an element of neglect when combined with other negligent behaviors. While this action alone could 

not be considered sufficient evidence of neglect, it is often observed in combination with other conditions such as 

malnutrition, wasting, etc. This is an issue of particular relevance to older adults who are medically vulnerable or frail. 

Their compromised health states make it extremely vital that steps be taken to avoid preventable illnesses which 

could spiral into significant, life-threatening conditions. 

– Inadequate nutrition refers to imbalances in needed nutrients and energy from food that may increase an older 

adult’s risks for adverse health outcomes, poor health, and impaired functioning. 

2. Disruption of cognitive health may include changes in cognitive performance (e.g., impaired decision making and 

problem solving, poor memory performance, and stress-related cognitive interference) or changes in the brain’s 

structural or functional integrity. 

3. Disruption of emotional health may involve problems with emotional regulation (the ability to determine what 

emotions once has, when one has them, and how often one experiences or expresses emotions) or emotional 

intelligence (the ability to perceive and express emotions, understand affect-laden information, use emotional 

knowledge, and regulate conditions to foster intellectual growth and well-being). 

4. Disruptions of social health may include damaged or severed social bonds, relationships, or social ties, loss of social 

identities, social positions and social roles, or loss of access to vital social resources, networks, and institutions. 

5. Disruptions of financial health or standing may include accrual of new liabilities (e.g., health care costs, loans, credit 

lines, overdraft or interest fees), net income reductions or potential earnings losses, losses of tangible personal property 

(e.g., automobiles, houses, art/antiques etc.) reduced or depleted assets (e.g., savings, checking or investment accounts), 

or reduced availability of funds to cover obligatory (e.g., living expenses, loans or mortgages, medications and required 

medical care or services) and discretionary (hobbies, leisure, and entertainment) expenses. Such changes may limit or 

remove options for ensuring satisfaction of one’s physiological, psychological and social needs. 

29 
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INVOLVED PARTIES
 

Older Adult / Elder 

Any person whose chronological age is 60 years or older. Age 60 was selected as the lower boundary for classification as 

an older adult because it is the age of first eligibility for services furnished under the Older American’s Act and for inclusion 

in activities and programs covered in the Elder Justice Act. 

Victim 

Person on whom the abuse is inflicted or who experiences abuse. Survivor is often used as a synonym for victim. 

Perpetrator / Offender 

Person or persons who inflicts or causes the victim to experience abuse. Such persons must be in a relationship involving 

an expectation of trust. 

Current or Former Legal Spouse 

Someone to whom the victim is or was legally married, as well as a separated legal spouse. 

Other Intimate Partner 

Current common-law spouses, current boyfriends/girlfriends/partners (opposite or same sex), former commonlaw spouses, or former boyfriends/girlfriends/partners (opposite or same sex). Intimate partners may or may not be 

cohabiting. Intimate partners may or may not have an existing sexual relationship. States differ as to what constitutes a 

common-law marriage. Users of the Recommended Core Data Elements will need to know what qualifies as a commonlaw marriage in their state. 

Child 

A person’s biological or legally adopted offspring, including a son or daughter. May also include step children and foster 

children. 

Other Family Member/Relative 

Someone sharing a relationship by blood or marriage, or other legal contract or arrangement (i.e., legal adoption, 

foster parenting). This includes current as well as former family relationships. Therefore, though not an exhaustive list, 

stepparents, parents, siblings, grandchildren, former in-laws, and adopted family members are included in this category. 

This category excludes the victim’s children. 

Caregiver 

1. Family (Informal) Caregiver: any relative, partner, friend or neighbor who has a significant personal relationship with, 

and provides a broad range of Instrumental Activities of Daily Living (ADL) /Activities of Daily Living(ADL) (defined 

below) assistance for an older adult. These individuals may be primary or secondary caregivers (i.e., persons who assist a 

primary caregiver) and live with, or separately from, the person receiving care. 

2. Formal Caregiver: a provider associated with a formal service system, whether a paid worker or a volunteer. 

Care Custodian 

An individual entrusted with the care and maintenance of another person. 
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UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS

Legal Guardian 

A person who has been appointed by a court to possess the power and obligation to take care of and manage the 

property, well-being and/or rights of a person who, because of status as a minor, understanding, or self-control, is 

considered incapable of administering his or her own affairs. 

Other Person in Position of Power or Trust 

Someone such as a religious leader, advisor, or employer (not an exhaustive list). 

Friend 

Someone with whom the victim shares a substantial personal relationship but who is not related to the victim by blood or 

marriage, and is not a current or former spouse, another current or former intimate partner, another family member, or a 

person in an official position of power or trust. 

Acquaintance / Persons of Casual Acquaintance 

Someone who is known casually to or recognized by the victim, with whom no substantial personal relationship exists, 

who is not related to the victim by blood or marriage, and is not a current or former spouse, another current or former 

intimate partner, another family member, a friend, a person in an official position of power or trust, or a stranger. 

Stranger 

Someone who is not known to the victim and with whom no substantial personal, pre-existing relationship exists. 

PHYSICAL ABUSE 

The intentional use of physical force that results in acute or chronic illness, bodily injury, physical pain, functional impairment, 

distress, or death.* Physical abuse may include but is not limited to such acts of violence as striking (with or without an object 

or weapon), hitting, beating, scratching, biting, choking, suffocation, pushing, shoving, shaking, slapping, kicking, stomping, 

pinching, and burning. In addition, inappropriate use of medications and physical restraints, pinning in place, arm twisting, hair 

pulling, force-feeding, and physical punishment of any kind also are examples of physical abuse. 

* The threat of force with or without a weapon should be considered emotional abuse. 

Sub-definitions: 

Illness 

An acute or chronic condition of poor health that may affect the body or mind. 

Bodily / Physical Injury 

Any physical damage or hurt occurring to the body. 

Physical Pain 

A state of physical uneasiness that ranges from mild discomfort or dull distress to acute, often unbearable, agony. May 

be generalized or confined to a specific area of the body; is typically the consequence of being injured or hurt physically 

or as a result of illness. Pain characteristics include the site (localization), onset and offset, character, radiation, associated 

symptoms, time pattern, exacerbating and ameliorating factors, and severity. Usually produces a reaction of wanting to 

avoid, escape, yield to, or eliminate the causative factor and its effects. 

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Functional Impairment 

The inability to perform routine and age-appropriate tasks in the domains of work, home, and social activities, as indicated 

by threshold tests. 

Distress 

Mental or physical suffering or anguish of the body and/or mind. 

Inappropriate Use of Medications 

Use of medications in a way that causes bodily injury, physical pain, functional impairment, extreme distress, or death. 

May involve the use of prescribed drugs as well as those for which a prescription has not been provided. Examples 

include but are not limited to: administration of medication for the correct indication but at doses that are too high 

or too low; over-medication, especially over–sedation; under-medication, especially analgesia; administration of the 

wrong medication; administration of medication for a purpose for which it was not intended; bartering or exchange of 

medications for coercive purposes. 

Inappropriate Use of Physical Restraints 

Physical restraints include any device, material or equipment attached to or near a person’s body, which cannot be 

controlled or easily removed by the person. Such restraints deliberately prevent or are deliberately intended to prevent 

a person’s free body movement to a position of choice and/or a person’s normal access to their body. The inappropriate 

use of physical restraints refers to use of such devices, materials, or equipment in a way that causes bodily injury, physical 

pain, functional impairment, extreme distress, or death or for purpose of punishment. Does not include situations where 

restraint use has been medically authorized for a legitimate purpose (e.g., managing behavioral aggression associated 

with acute or chronic psychiatric conditions) and harm is caused by a person’s own behaviors or status. 

Physical Punishment 

The direct or indirect infliction of physical discomfort or pain for the purpose of (1) stopping unwanted behavior, (2) 

preventing the recurrence of unwanted behavior, or (3) because of a failure to perform a required, requested, or desired 

activity. 

SEXUAL ABUSE 

Forced and/or unwanted sexual interaction (touching and non-touching acts) of any kind with an older adult. This may include 

but is not limited to forced and/or unwanted completed or attempted contact between the penis and the vulva or the penis 

and the anus involving penetration, however slight; forced and/or unwanted contact between the mouth and the penis, 

vulva, or anus; forced and/or unwanted penetration of the anal or genital opening of another person by a hand, finger, or 

other object; forced and/or unwanted intentional touching, either directly or through the clothing, of the genitalia, anus, groin, 

breast, inner thigh, or buttocks; unwarranted, intrusive, and/or painful procedures in caring for genitals or rectal area; or forced 

and/or unwanted non-contact acts of a sexual nature such as forcing a victim to view pornographic materials, photographing 

an elder for sexual gratification, voyeurism and verbal or behavioral sexual harassment. 

All the above acts also qualify as sexual abuse if they are committed against an incapacitated person who is not 

competent to give informed approval, indicating a freely given agreement to have sexual intercourse or sexual contact. 

Sub-definitions: 

Forced 

Obtained through the use of physical power or the use of express or implied threats of violence, reprisal or other 

intimidating behavior that puts a person in immediate fear of the consequences in order to compel that person to act 

against his or her will. 
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UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS

Unwanted 

Not wanted, desired, requested, or consented to. 

Sexual Interaction 

Any of numerous ways by which people experience and express themselves as sexual beings, as influenced and defined 

by personal preferences and/or social or cultural conventions (religious or legal, according to federal, state, or local law). 

Contact Acts 

Sexual acts wherein a person physically touches or connects with another person’s body using his or her appendages, 

other body parts, or physical objects. 

Non-contact Acts 

Sexual acts that do not involve physical contact such as forcing a victim to view pornographic materials, photographing 

an elder for sexual gratification, voyeurism and verbal or behavioral sexual harassment. 

Voyeurism 

Deriving sexual satisfaction by secretly watching others undress or engage in sexual activity. May also involve watching to 

derive satisfaction from another’s distress, discomfort, or anxiety. 

Sexual Harassment 

Any form of unwanted sexual attention (e.g., sexual advances, suggestions, requests or threats) that is deemed 

inappropriate, offensive, intimidating or humiliating. Harassment includes contact and non-contact acts as defined above. 

Incapacitated Person 

An individual who is unable to receive and evaluate information or make or communicate decisions to such an extent that 

the individual lacks the ability to meet essential requirements for physical health, safety, or self-care, even with appropriate 

technological assistance.37 Incapacitation may be isolated in nature involving a single acute experience, intermittent in 

nature occurring unpredictably or at irregular intervals, or ever-present affecting a person’s life on a daily basis. Sources of 

incapacitation may include but not be limited to illnesses, diseases, or injuries (including those that may become more 

prevalent or more severe as one ages), mental or physical disability, being asleep or unconscious (e.g., due to the effects 

of medications), or intoxication (e.g., incapacitation, lack of consciousness, or lack of awareness) through the voluntary or 

involuntary use of alcohol or drugs. 

Competence (mental and legal) 

The ability to understand the nature and effect of the act in which an individual is engaged. An individual’s status where 

competence is concerned is jointly influenced by their own characteristics as a decision maker (e.g., intelligence, age, 

education, health status) as well as the characteristics of the task (e.g., the complexity, familiarity, or clarity of framing) and 

the setting, circumstances, or context of decision making (e.g., stress or pressure level, relationship dynamics such as the 

distribution of power among participants in the interaction). 

EMOTIONAL / PSYCHOLOGICAL ABUSE 

Verbal or nonverbal behavior that results in the infliction of anguish, mental pain, fear, or distress, that is perpetrated by a caregiver 

or other person who stands in a trust relationship to the elder. Such behaviors may have immediate effects or delayed effects that 

are short or long-term in nature that may or may not be readily apparent to or acknowledged by the victim. May include any of 

the following and vary according to cultural norms: 

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1. Humiliation/Disrespect 

– Behaviors intended to be, or clearly perceived to be humiliating, degrading, insulting or devaluing the older person. 

Examples: verbal insults, insults in public, infantilizing comments, calling the older adult stupid, worthless, foolish, etc. 

2. Threats 

– Verbal or non-verbal gestures or suggestions of intended physical, sexual, or psychological mistreatment; neglect; 

abandonment; or financial exploitation with the intent of changing or manipulating the behavior of the older person in 

response. Communication of plans to take a harmful action against the older adult if he or she will not perform desired 

activities or behaviors, including, for example, plans to leave and never return, claiming that one will stop provision of care, 

plans of institutionalization or homelessness; threatening to harm other family members, friends or pets or to damage 

prized possessions; plans to use force with or without a weapon. 

3. Harassment 

– Behaviors that are repeated in such a manner as to be intended or perceived as hostile, coercing, or manipulating the elder 

adult to do or not do something against their will. Examples: repeatedly following, watching, or tracking an older adult and 

doing so in a manner that lets the person know that this is occurring; repeated unwanted telephone calls, letters, or other 

communications that are hostile or coercive; showing up uninvited at places frequented by an older adult.. 

4. Isolation/Coercive Control 

– Verbal or physical behaviors resulting in either geographic or interpersonal isolation of the older adult. Examples: silent 

treatment; restriction of phone or car use; intentional seclusion of older adult from family, friends, or other social outlets; 

relocation to a remote location; withholding assistive devices like a walker, wheel chair, hearing aide, etc; or locking an older 

adult in a room. All of these behaviors have the effect of disconnecting the older adult from others. Behaviors can also 

involve ignoring the elder’s attempts and needs to interact. 

Sub-definitions: 

Fear 

An unpleasant often strong emotion caused by anticipation or awareness of danger 

Infantilize 

The act of treating an adult as if he or she were an infant or young child 

NEGLECT 

Failure by a caregiver or other person in a trust relationship to protect an elder from harm or the failure to meet needs for 

essential medical care, nutrition, hydration, hygiene, clothing, basic activities of daily living or shelter, which results in a serious 

risk of compromised health and/or safety, relative to age, health status, and cultural norms. 

Sub-definitions: 

Failure to meet needs for: 

Essential medical care 

Failure to provide for or seek proper medical and/or dental care that affects adversely, or might affect adversely the 

physical, mental and/or psychological well-being of the older adult. 

Nutrition 

Failure to provide, assure, or seek adequate food intake, failure to provide or make food choices that promote 

health/avoid nutritional deficiencies 
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Hydration 

Failure to provide, assure, or seek sufficient fluid intake or adequate water consumption. 

Hygiene 

Failure to provide or to engage in: regular baths/showers; normal grooming practices such as caring for one’s skin, hair, 

teeth, or nails; proper disposal of urine, feces, and other bodily waste. (Must account for normative standards for hygiene 

set by specific communities and/or subcultures) 

Clothing 

Failure to provide or wear adequate or proper clothing suitable for the weather, cleanliness, or custom and culture of the area. 

Shelter 

Failure to provide or maintain a living environment which is safe; free of overcrowding, unsanitary conditions, and 

structural hazards; and provides proper protection against the elements. (Must account for normative standards for 

appropriate shelter set by specific communities and/or subcultures) 

FINANCIAL ABUSE / EXPLOITATION 

The illegal, unauthorized, or improper use of an older individual’s resources by a caregiver or other person in a trusting 

relationship, for the benefit of someone other than the older individual. This includes, but is not limited to, depriving an older 

individual of rightful access to, information about, or use of personal benefits, resources, belongings, or assets. 

Examples include but are not limited to: Taking money or items from an older adult’s home or accounts without proper 

authority or approval; occupying, selling, or transferring property against an older adult’s wishes or best interests; unauthorized 

credit or debit card use; opening credit accounts in an older adult’s name using their good credit or using an elder’s personal 

information to obtain services (telephone, cable, basic utilities etc.), rent, lease, or buy properties(identity theft); cashing checks 

without permission or authorization; use of insurance information to obtain medical services; creating or changing insurance 

policies to benefit another; changing wills, trusts, or inheritance arrangements for another’s benefit without an older adult’s 

knowledge or permission; forgery; forcing an older adult to sign a document; abusing joint signature authority on a bank 

account; misappropriation of funds from a pension; getting an older adult to sign a deed, will, contract, or power of attorney 

through deception, coercion, or undue influence; using a power of attorney, including a durable power of attorney, for purposes 

beyond those for which it was originally executed; taking advantage of an elder’s lack of capacity to initiate financial transactions, 

instruments, or documents; improperly using the authority provided by a conservatorship (or guardianship), trust, etc.; negligently 

mishandling assets, including misuse by a fiduciary or caregiver; denying elder persons access to their money or preventing them 

from controlling their assets; withholding care for financial gain (e.g. preventing funds to be used for needed care by someone 

who stands to inherit). 

Sub-definitions: 

Fraud 

Deception carried out for the purpose of achieving personal gain while causing injury to another party. An intentional 

distortion of truth initiated to convince another to part with something of value or to surrender a legal right. 

Misappropriation 

The intentional, illegal use of the property or funds of another person for one’s own use or other unauthorized purpose, 

particularly by any person with a responsibility to care for and protect another’s assets (a fiduciary duty). 

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Power of Attorney 

A written document in which one person (the principal) appoints another person to act as an agent on his or her behalf, 

thus conferring authority on the agent to perform certain acts or functions on behalf of the principal. The certain acts may 

include signing papers, checks, title documents, contracts, handling bank accounts and other activities in the name of the 

person granting the power. 

Undue Influence 

Use of one’s role and power to exploit the trust, dependency, and fear of another. The exploiter’s role and power are used 

in ways that deceive or mislead to gain control over the decision making of the person being exploited. 

Conservatorship 

A conservatorship is created by the appointment of a conservator, also sometimes called a guardian. A conservator or 

guardian is a person or entity appointed by a court to manage the property, daily affairs, health, and/or financial affairs of 

another person (called the conservatee or ward), usually someone who is legally incapacitated. 

Trust 

An entity created to hold assets for the benefit of certain persons or entities, with a trustee managing the trust (and often 

holding title on behalf of the trust). 

Fiduciary 

A person (or a business like a bank or stock brokerage) who has the power and obligation to act for another (often called 

the beneficiary) under circumstances which require total trust, good faith and honesty. 

Fiduciary Duty 

A duty to act for someone else’s benefit, while subordinating one’s personal interests to that of the other person. It is the 

highest standard of duty implied by law (e.g. trustee, guardian). 

OTHER RELATED PHENOMENA 

While this document focuses on five types of EA, other related phenomena are defined in the literature and state EA statutes. 

These include abandonment, abduction, medical abuse, resident-to-resident abuse/aggression, and the broad category of rights 

violations. Examples of definitions for these phenomena are presented below. 

There is a fair degree of agreement in the EA field about what constitutes abandonment. Abandonment is included in this 

section because opinions diverge sharply on the issue as to whether it is a subtype of neglect or a wholly separate phenomenon. 

This is also the case for medical abuse; while some argue that it is a subtype of physical abuse, others emphasize its overlap 

with neglect, and still others assert that it be addressed as a distinct problem. In producing the content for this document, the 

expert panel embraced the first and second arguments and determined that the behaviors of medical abuse could be captured 

by the combination of the proposed EA types and definitions. Subsequent editions of this document should evaluate shifts in 

perspectives about this and other related phenomena and reconsider the classifications assigned here. 

In contrast, there is considerably less consensus about either the scope of definitions for the remaining phenomena or their 

relationship to EA. Abduction is one example where numerous definitions coexist. There is disagreement on whether abduction 

should include removals that only involve movement of an individual across state lines or refer more broadly to removals 

crossing local boundaries. There is also disagreement regarding whether definitions for abduction should incorporate or exclude 

competence requirements. Lastly, some conceptualizations of violations of rights consider abduction to be a specific member of 

a broader, more amorphous class of infringements. 
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Our decision to classify self-neglect as a distinct but related construct is consistent with the World Health Organization’s 

typology of violence. This typology differentiates between violence a person inflicts upon himself or herself (Self-directed 

violence) and violence inflicted by another individual (Interpersonal violence). Self-neglect is considered a form of self-harm or 

self-abuse that may co-occur alongside or be triggered by elder abuse. Strategies for self-neglect prevention may differ from 

those for elder abuse due to important differences in associated risk factors and differences in applicable ethical and legal 

considerations that must be addressed (e.g., rights to self-determination when indicators of self-neglect are observed in a 

competent elder). Our decision is also consistent with conclusions drawn in other initiatives in the field of EA prevention which 

argue that self-neglect is an important phenomena, deserves its own research, and should be the central focus of a separate 

effort to achieve uniformity in its definition, measurement, and documentation (e.g., National Committee for The Prevention of 

Elder Abuse 2008 Symposium on Self-Neglect ). 

Finally, the amount of attention given to phenomena such as resident-to-resident aggression has increased tremendously 

over the last decade. Resident-to-resident aggression is not a form of elder abuse. However, its occurrence produces injuries 

and wounds identical to those resulting from abuse and may result when institutions fail to take action to prevent or manage 

aggression or take actions that are not sufficient to assure resident health and safety. Both of these phenomena may produce 

outcomes as harmful as those of elder abuse. They may also intensify the impacts of abuse if they are experienced concurrently. 

Abandonment 

The desertion or willful disregard of an older adult by anyone having care or custody of that person under circumstances 

in which a reasonable person would continue to provide care and custody. 

Abduction 

– Removal from the documented state of residence of any older adult who does not have the capacity to consent to such 

removal and/or preventing such persons from returning to their state of residence. Abduction may also include restraint 

of any conservatee (ward) without the consent of the conservator (guardian) or the court. 

Criminal Record Identity Theft 

Occurs when a caregiver or other person in a relationship where there is an expectation of trust gives an elder’s name and 

personal information such as a drivers’ license, date of birth, or Social Security number (SSN) to a law enforcement officer 

during an investigation or upon arrest, or presents to law enforcement a counterfeit license containing another person’s 

data. Involves posing as another person when apprehended for a crime. 

Medical Abuse 

Conceptual definitions for this term could not be found. Behaviors typically connected to the term include: inappropriate 

use of restraints; neglect leading to bedsores, unsanitary conditions, malnutrition, insufficient pain management, 

untreated medical conditions and poor personal hygiene; intentional recommendation or use of unnecessary medical 

procedures; causing illness in a person for the purpose of receiving attention or resources; forced feeding. 

Resident-to-Resident Abuse/Aggression 

Negative and aggressive physical, sexual or verbal interactions between residents of a long-term care facility that is 

unwelcomed by the recipient(s) and that have high potential to cause physical or psychological distress. 

Self-Neglect 

A nationally accepted, uniform definition of self-neglect has not been developed. Examples of existing definitions include: 

– The behavior of an elderly person that threatens his/her own health and safety. This behavior generally manifests itself 

in an older person as a refusal or failure to provide himself/herself with adequate food, water, clothing, shelter, personal 

hygiene, and safety precautions. This excludes situations in which a mentally competent older person, who understands 

the consequences of his/her decisions, makes a conscious and voluntary decision to engage in acts that threaten his/her 

health or safety as a matter of personal choice. (National Association of Adult Protective Service Administrators and the 

National Center on Elder Abuse) 

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– Meeting one or more of the following: 

• Persistent inattention to personal hygiene and/or environment 

• Repeated refusal of some/all indicated services which can reasonably be expected to improve quality of life 

• Self-endangerment through the manifestation of unsafe behaviors(e.g., persistent refusal to care for a wound, creating 

fire-hazards in the home) (Pavlou & Lachs, 2008) 

– Lack of self-care and inattention to personal hygiene, domestic squalor, hoarding, apathy and disinterest for [one’s] 

condition, social withdrawal, and stubborn refusal of help. (Clark et al., 1975) 

– The inability of a person to understand the consequences of his or her actions or inaction when the inability leads to or 

may lead to harm. There are two components to self-neglect: 

• The failure to provide for oneself the basic needs to avoid physical harm or suffering. 

• The inability to understand the consequences of that failure. (Oregon Department of Human Services) 

Violation of Rights 

The deprivation of any inalienable right, such as personal liberty/freedom of choice, assembly, speech, privacy, confidentiality, 

religious freedom, the right to vote. In long term care facilities, this term can be very broad, based on applicable state and/ 

or federal regulations, and can include the right to medical services, choice of physician, freedom to refuse psychotropic 

medications, right to remain in the facility, and freedom from physical restraint or involuntary seclusion. 

TERMS ASSOCIATED WITH THE CIRCUMSTANCES AND CONSEQUENCES OF ELDER ABUSE 

Incident 

A single act or series of acts that are connected to one another and that may persist over a period of minutes, hours, or 

days. One perpetrator or multiple perpetrators may commit an incident. 

Activities of Daily Living (ADLs) 

Everyday tasks related to personal care usually performed for oneself in the course of a normal day, including bathing, 

dressing, grooming, eating, walking, taking medications, eliminating, and other personal care activities. 

Instrumental Activities of Daily Living (IADLs) 

Activities related to independent living, such as preparing meals, managing money, shopping for groceries or personal 

items, performing light or heavy housework, and using a telephone. 

Capacity 

The ability, as defined by statute, courts, or clinicians, to perform specific tasks 

Economic or Financial Dependency / Dependence 

The degree to which one person relies on another person for direct or indirect monetary assistance or support to meet 

basic needs for food, water, shelter, clothing, or health care. 

Report/Reported 

A formal or official account or statement regarding an alleged incident of Elder Abuse, made to the appropriate 
 
 

authorities and agencies. 
 
 
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UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS

Investigation / Investigated 

An evaluation of the potential victim after a report has been filed to appropriate authorities. Also more broadly involves 

collection of information regarding the circumstances of a reported incident. Can be initiated or carried out by numerous 

agencies including, but not limited to Adult Protective Services, Law Enforcement, or Long Term Care Ombudsmen. 

Substantiated/Validated Report 

A report that has been investigated and subsequently supported by proof, evidence, or corroborating information. 

Disability 

A physical or mental impairment that substantially limits one or more major life activities of such individual; a record 

of such an impairment; or being regarded as having such an impairment (Americans With Disabilities Act Of 1990, As 

Amended). 

Disease 

A pathological condition of a body part, an organ, or a system resulting from various causes, such as infection, genetic 

defect, or environmental stress, and characterized by an identifiable group of signs or symptoms.38 

39 
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ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS

RECOMMENDED 
 
 

CORE DATA ELEMENTS 
 
 

FOR ELDER ABUSE 
 

SURVEILLANCE
 
 


Overview 

Introduction .................................................................................................................42
 
 


Core Data Elements (List).....................................................................................43
 
 


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Introduction 

Each section describes the Recommended Core Data elements that can be included in a surveillance system designed to 

collect information on Elder Abuse. The order in which the data elements are presented is not intended to suggest a hierarchy; 

users may select data elements that best fit their surveillance needs. 

Depending on the applicability of the information, some or all of the following categories of information are listed for each 

data element: 

• Description or definition of the data element; 

• Uses/data element type describes how the data element should be used and whether it can most feasibly be collected by 

extracting and analyzing Administrative and Clinical Records or carrying out Probability-Based Surveys. 

– Administrative and Clinical Records 

• Contain data that were originally collected in the course of clinical or programmatic activity for a specific, frequently 

non-research purpose such as organizational practice documentation, payment acquisition, or client/case 

management. 

• Administrative and/or regulatory requirements and statutes specify definitions for key phenomena and influence the 

scope and quality of the data collected. 

• Accessibility is limited and governed by legal prescriptions and privacy laws 

• Include but are not limited to health, social services, legal, and financial records 

– Probability-Based Surveys 

• Surveys systematically administered to a randomly selected, representative sample of the target population 

• Survey data are collected directly from individuals affected by the condition under surveillance 

• Typically allow flexibility in the types of data elements that can be captured and the level of detail of information that 

can be collected 

• Discussion of relevant conceptual or operational issues; 

• Data type (and field length) indicates in what format (e.g., text, numeric, date) the data element should be coded including 

the length of the data field; 

• Allow for multiple responses indicates when it is appropriate to include all applicable answers or response options; 

• Field values/coding instructions indicate how to enter data in the field and what each represents; 

• Data standards or guidelines used to define the data elements and its field values. 
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UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS

Core Data ElementsFor Elder Abuse Surveillance (List) 

Identifying Information 

Case id 

Data source 

Date of first agency documentation 

Elder Demographics 

Name 

Social security number 

Date of birth 

Sex 

Sexual orientation 

Race 

Ethnicity 

Marital status 

State, county, city, zip code and address of residence 

Education 

Employment status 

Elder Situational Data Elements 

Incident id 

Place of residence 

Primary caregiver relationship 

Primary caregiver lives in place of residence 

Perpetrator Demographics 

Perpetrator id 

Name 

Social security number 

Date of birth 

Sex 

Race 

Ethnicity 

Marital status 

State, county, city, zip code and address of residence 

Education 

Employment status 

Relationship of the perpetrator to the elder 

Perpetrator Situational Data Elements 

Types of abuse perpetrated 

Home setting of the perpetrator at the time of the incident 

Perpetrator has previously abused elder 

Data Elements for All Abuse Events 

Types of abuse experienced 

Approximate date of abuse onset 

Date of incident 

Location(s) where abuse occurred 

Number of incidents of abuse in past 12 months 

Number of perpetrators involved in most recent incident 

Abuse reported 

Abuse substantiated 

Case investigated by a regulatory agency 

Result of investigation by the regulatory agency 

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Physical Abuse Data Elements 

Type of injury from physical abuse 

Weapon type for physical abuse 

Medical required and care received as a result of physical abuse 

Physical health outcome for elder after physical abuse 

Psychosocial outcome for elder after physical abuse 

Sexual Abuse Data Elements 

Type of injury from sexual abuse 

Weapon type for sexual abuse 

Activity at time of sexual abuse 

Medical care required and received after sexual abuse 

Physical health outcome for elder after sexual abuse 

Psychosocial outcome for elder after sexual abuse 

Psychological/Emotional Abuse Data Elements 

Activity at time of psychological/emotional abuse 

Medical care required and received after psychological/emotional abuse 

Physical health outcome for elder after psychological/emotional abuse 

Psychosocial outcome for elder after psychological/emotional abuse 

Neglect By Caregivers Data Elements 

Medical care received after neglect 

Health outcome for elder after neglect 

Financial Abuse Data Elements 

Other outcome to elder 

Duration of financial abuse 
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Identifying Information 
 
 

For Elder Abuse 
 
 

Surveillance System
 
 


Data Elements 

Case ID.....................................................................................................................................46



Data Source...........................................................................................................................47



Date of First Agency Documentation...................................................................49



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Case ID 

Description/Definition 

A required, unique identification code used by the agency compiling Elder Abuse surveillance data. 

Uses/Data Element Type 

Ensures that entered or accessed records correspond with the proper elder. It also facilitates data linkage for administrative and 

research purposes. 

Data element type: Core. 

Discussion 

Case ID may be assigned by the agency compiling Elder Abuse (EA) surveillance data, or it may be an identifier previously assigned 

by the contributing data source. Case ID can be identical to the identifier created to allow linkage across multiple sources. 

Because identification and documentation of EA is not standard across the many sources that collect data on abuse and neglect, 

data from multiple sources may be needed to better estimate the number of elders who experience abuse. As such, developers 

of surveillance systems may want to explore the viability of a variety of approaches to Elder Abuse surveillance. One method is to 

include data from multiple sources (e.g., APS records, police records and emergency room records) when designing surveillance 

systems. If surveillance system developers choose to use data from multiple sources, a unique identifier should be created for 

linkage across data sources. 

Data Type (and Field Length) 

Text (25). 

Allow for Multiple Responses 

No. 

Field Values/Coding Instructions 

Enter the actual case identification number. 

Data Standards or Guidelines 

Health Level 7 (HL7) (1996). 
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Data Source 

Description/Definition 

Agency or data source from which Elder Abuse surveillance data is received. 

Uses/Data Element Type 

Identifies the agency or organization that supplied data for this victim. It will enable linkage of multiple agency contacts for 

the same victim. 

Data element type: Core. 

Discussion 

No single agency is likely to collect all of the data elements recommended. As a consequence, it is likely that anyone setting up 

a surveillance system will need to combine data from a number of sources (e.g., health care records and police records) using a 

relational database. This will identify data elements gathered from each data source used. 

Data Type (and Field Length) 

Numeric (2). 

Allow for Multiple Responses 

No. 

Field Values/Coding Instructions 

Code Description 

01 Emergency department 

02 Other hospital department (non-psychiatric) 

03 Mental health or psychiatric hospital or department 

04 Other non-hospital health care, including mental health 

05 Police/Sheriff/Law enforcement 

06 Prosecutor/District attorney 

07 Probate court investigator 

08 Public guardian 

09 Legal aid program 

10 Other court-related or criminal justice-related agency 

11 Shelter for abused elders 

12 Domestic violence program 

13 Rape crisis center 

14 Telephone hotline for victim services, other than those provided by a shelter or rape crisis center 

15 Victim-witness assistance programs 

16 Other victim service agencies 

17 Other social service agencies, other than victim service agencies 

18 Coroner or medical examiner 

19 Vital statistics office within state health department 

20 Adult Protective Services 

21 Area Agency on Aging 

22 Case management program 

23 Senior centers 

24 Meal programs 

25 Transportation services 

26 Assisted living/Board and care facility 

27 Home health care agency 

28 Nursing home/skilled nursing facility 

29 Rest homes 

29 Boarding home/group home 

30 Foster home 

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31 Ombudsman Services 

32 Other agency or data source 

88 Not applicable 

99 Unknown 

Data Standards or Guidelines 

None. 
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Date of First Agency Documentation 

Description/Definition 

Date when the agency providing data to the Elder Abuse surveillance system first documented elder victimization for this 

person. 

Uses/Data Element Type 

Can be used in conjunction with date of birth to calculate the victim’s age at the time of first agency documentation of 

victimization for this person. It can also be used in conjunction with the date of the most recent abuse episode to determine if 

agency documentation of any elder victimization preceded agency documentation of most recent violent episode. 

Data element type: Core. 

Discussion 

It is possible that the victim will have contacts with an agency that precede agency recognition or documentation of elder 

victimization or that precede other disclosure of abuse (e.g., elders often wait to disclose violence to health care practitioners 

until they trust and feel comfortable with their providers). This data element reflects the date when the victimization was 

first documented in the records of the agency providing data to the Elder Abuse surveillance system. If documentation of 

Elder Abuse results from routine screening or other disclosure, there may be no specific violent episode related to the date of 

documentation. If there has been no agency documentation of elder victimization prior to the most recent violent episode, 

then this data element will be identical to the date of agency documentation of most recent violent episode. 

Data Type (and Field Length) 

Date (10). 

Allow for Multiple Responses 

No. 

Field Values/Coding Instructions 

MM/DD/YYYY format 

9’s for any unknown date elements: 

06/99/2007for June 2007 with the day unknown 

99/99/2007 for 2007 with the month and day unknown 

99/99/9999for the year, month and day unknown 

Data Standards or Guidelines 

None. 

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Elder Demographics
 
 


Data Elements 

Name .................................................................................................................................................................. 52

 


Social Security Number........................................................................................................................... 53

 


Date of Birth.................................................................................................................................................... 54

 


Sex ........................................................................................................................................................................ 55

 


Sexual Orientation...................................................................................................................................... 56

 


Race ..................................................................................................................................................................... 57

 


Ethnicity ............................................................................................................................................................ 59

 


Marital Status ................................................................................................................................................. 60

 


State, County, City, Zip Code and Address of Residence.................................................... 61

 


Education......................................................................................................................................................... 64

 


Employment Status ................................................................................................................................... 65

 


Discussion 

The data elements in this section relate directly to information about the elder. Creators of surveillance systems should be 

mindful of confidentiality and safety issues as they develop and use their system. No data should be collected or stored 

that could potentially jeopardize an elder’s safety. When developing a surveillance system for Elder Abuse, the issue of 

confidentiality must be balanced with the need for data linkage across multiple data sets. Data elements containing 

identifying information may be stripped once data from all records related to the elder have been identified and entered into 

the surveillance system. 

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Name 

Description/Definition 

First, middle, and last name. 

Uses/Data Element Type 

Allows for linking data on a particular person across records, thus reducing the chance of duplicate records on the same 

person. 

Data element type: Core. 

Discussion 

The practice of including names in public health surveillance systems is not uncommon. Most surveillance systems for 

infectious diseases include names, as do some injury surveillance systems. Additionally, inclusion of name(s) in a surveillance 

system to track events allows for a unique identifier that can facilitate data linkage across sources. 

These data are not intended for tracking victims or perpetrators. Protection of individuals’ privacy is paramount; to protect 

privacy and confidentiality, access to this data element should be limited to authorized personnel. 

Data Type (and Field Length) 

Lastname Text (20). 

Firstname Text (20). 

Middle name Text (20). 

Allow for Multiple Responses 

No. 

Field Values/Coding Instructions 

Record name in three separate data elements corresponding to last, first and middle name or initial. 

Data Standards or Guidelines 

None. 
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Social Security Number 

Description/Definition 

Social security number. 

Uses/Data Element Type 

Personal identifiers are used to uniquely identify an individual for linking data across data sources, to distinguish between 

persons with the same name, and for identifying duplicate records. See the Introduction section of this manual for a discussion 

about handling data elements that can identify individual persons or agencies. 

Data element type: Core. 

Discussion 

If the social security number is blank or unknown in the source document, enter 999999999. 

Data Type (and Field Length) 

Numeric (9). 

Allow for Multiple Responses 

No. 

Field Values/Coding Instructions 

Actual social security number 

888888888 Not applicable 

999999999 Unknown 

Data Standards or Guidelines 

None. 

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Date of Birth 

Description/Definition 

Date of birth. 

Uses/Data Element Type 

Can be used to calculate age and to distinguish between persons with the same name. 

Data element type: Core. 

Discussion 

If date of birth is not known, the year can be estimated. The date of birth can be used with date of incident to calculate the age 

at the time of the current incident. 

Data Type (and Field Length) 

Date (10). 

Allow for Multiple Responses 

No. 

Field Values/Coding Instructions 

MM/DD/YYYY format 

9’s for any unknown date elements: 

06/99/2007for June 2007 with the day unknown 

99/99/2007 for 2007 with the month and day unknown 

99/99/9999for the year, month and day unknown 

Data Standards or Guidelines 

None. 
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Sex 

Description/Definition 

Sex of person. 

Uses/Data Element Type 

Standard demographic and identifying information. 

Data element type: Core. 

Data Type (and Field Length) 

Numeric (1). 

Allow for Multiple Responses 

No. 

Field Values/Coding Instructions 

Code Description 

1 Male 

2 Female 

3 Transgender 

4 Other 

9 Unknown 

Data Standards or Guidelines 

U.S. Department of Health and Human Services Implementation Guidance on Data Collection Standards for Race, Ethnicity, 

Sex, Primary Language, and Disability Status; http://aspe.hhs.gov/datacncl/standards/ACA/4302/index.shtml. 

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Sexual Orientation 

Description/Definition 

Sexual orientation of the person as self-reported or described by others. 

Uses/Data Element Type 

Standard demographic and identifying information. 

Data element type: Core. 

Data Type (and Field Length) 

Numeric (1). 

Allow for Multiple Responses 

No. 

Field Values/Coding Instructions 

Code Description 

1 Heterosexual or straight 

2 Homosexual, Gay, or lesbian 

3 Bisexual 

4 Other 

9 Unknown 

Data Standards or Guidelines 

None. 
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Race 

Description/Definition 

Race of person. 

Uses/Data Element Type 

Although the biological significance of race has been questioned, data on race are used in public health surveillance and in 

epidemiologic, clinical, and health services research. 

Data element type: Core. 

Discussion 

The categories below represent a social-political construct designed for collecting data on the race and ethnicity of broad 

population groups in the United States. For more than 20 years, the Federal government has promoted the use of a common 

language to ensure uniformity and comparability of data on race and ethnicity. Development of the data standards stemmed 

in large measure from new responsibilities to enforce civil rights laws. Data were needed to monitor equal access in housing, 

education, employment, and other areas for populations that historically had experienced discrimination and differential 

treatment because of their race or ethnicity. The standards are used not only in the decennial census (which provides data for 

the “denominator” for many measures), but also in household surveys, on administrative forms (e.g., school registration and 

mortgage-lending applications), and in medical and other research. 

Race is a concept used to differentiate population groups largely by physical characteristics transmitted by descent. This 

concept lacks clear scientific definition, as racial categories are neither precise nor mutually exclusive. The common use of race 

in the United States draws upon differences not only in physical attributes, but also in ancestry and geographic origins. 

HHS on Oct. 31, 2011, published final standards for data collection on race, ethnicity, sex, primary language and disability 

status, as required by Section 4302 of the Affordable Care Act. The law requires that data collection standards for these 

measures be used, to the extent practicable, in all national population health surveys. They will apply to self-reported 

information only. The law also requires any data standards published by HHS comply with standards created by the Office of 

Management and Budget (OMB). 

Proposed standards were published on June 29, 2011, and public comments were accepted until August 1, 2011. The 

standards, which were effective upon publication. 

Data Type (and Field Length) 

Numeric (1). 

Allow for Multiple Responses 

Yes. If the agency providing the data to the surveillance system uses multiple racial categories, the surveillance system should 

capture multiple responses. 

Field Values/Coding Instructions 

Code Description 

1 White 

2 Black or African American 

3 American Indian or Alaska Native 

4 Asian Indian 

5 Chinese 

6 Filipino 

7 Japanese 

8 Korean 

9 Vietnamese 

10 Other Asian 

11 Native Hawaiian 

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12 Guamanian or Chamorro 

13 Samoan 

14 Other Pacific Islander 

15 Other (Specify) ______________ 

99 Unknown—a person’s race is unknown 

Data Standards or Guidelines 

Office of Minority Health. Final data collection standards for race, ethnicity, primary language, sex, and disability status required 

by section 4302 of the Affordable Care Act. US Dept of Health and Human Services Web site. http: I /minorityhealth.hhs.gov/ 

templates/browse.aspx?lvl=2&1vlid=208. Accessed September 11, 2012. 
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Ethnicity 

Description/Definition 

Ethnicity of the person. A person of Mexican, Puerto Rican, Cuban, South or Central American, or other Spanish culture or 

origin, regardless of race. The term “Spanish origin” can be used in addition to “Hispanic or Latino.” 

Uses/Data Element Type 

Data on ethnicity are used in public health surveillance and in epidemiologic, clinical, and health services research. 

Data element type: Core. 

Discussion 

Ethnicity is a concept used to differentiate population groups by shared cultural characteristics or geographic origins. Many 

cultural attributes contribute to ethnic differentiation (e.g., religion, language, styles of dress, and patterns of social interaction). 

Ethnic differentiation is fluid, imprecise, and contingent on a sense of group identity that can change over time and that 

involves subjective and attitudinal influences. Since 1977, the Federal government has sought to standardize data on race and 

ethnicity among its agencies. HHS on Oct. 31, 2011, published final standards for data collection on race, ethnicity, sex, primary 

language and disability status, as required by Section 4302 of the Affordable Care Act. The law requires that data collection 

standards for these measures be used, to the extent practicable, in all national population health surveys. They will apply to 

self-reported information only. The law also requires any data standards published by HHS comply with standards created by 

the Office of Management and Budget (OMB). 

Proposed standards were published on June 29, 2011, and public comments were accepted until August 1, 2011. 

Data Type (and Field Length) 

Numeric (1). 

Allow for Multiple Responses 

No. 

Field Values/Coding Instructions 

Code Description 

1 Not Hispanic or Latino/a or Spanish origin 

2 Yes, Mexican, Mexican American, Chicano/a 

3 Yes, Puerto Rican 

4 Yes, Cuban 

5 Yes, another Hispanic, Latino, or Spanish origin 

9 Unknown if elder is of Hispanic or Latino origin 

Data Standards or Guidelines 

Office of Minority Health. Final data collection standards for race, ethnicity, primary language, sex, and disability status required 

by section 4302 of the Affordable Care Act. US Dept of Health and Human Services Web site. http: I /minorityhealth.hhs.gov/ 

templates/browse.aspx?lvl=2&1vlid=208. Accessed September 11, 2012 

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Marital Status 

Description/Definition 

Person’s legal marital status at the time of the incident for which data are being collected. 

Uses/Data Element Type 

Risk of violence may vary by legal marital status. Marital status may change over the course of a relationship, particularly a 

violent relationship. For consistency, we recommend recording the person’s marital status at the time of the incident for which 

the data are being collected. 

Data element type: Core. 

Discussion 

Some unmarried partners may be cohabiting. In some states this may qualify as common-law marriage. Classify common-law 

marriage as married. 

Data Type (and Field Length) 

Numeric (1). 

Allow for Multiple Responses 

No. 

Field Values/Coding Instructions 

Code Description 

1 Married – person currently married. (includes living together and not living together) 

2 Separated – person legally separated 

3 Divorced – person divorced and not remarried 

4 Partnered–no legal relationship but shares housing as intimate partners 

5 Single/never married – person who has never been married or whose only marriages have been annulled 

6 Widowed – person widowed and not remarried 

9 Unknown 

Data Standards or Guidelines 

CDC HISSB Common Data Elements Implementation Guide available at 

http://www.cdc.gov/data/index.htm. 
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State, County, City, Zip Code and Address of Residence 

Description/Definition 

State, county, city, zip code and street address of residence at the time of the incident for which data are being collected. 

Uses/Data Element Type 

Allows examination of the correspondence between the location of the elder’s residence, location of the perpetrator’s 

residence and the location of the most recent violent episode. The address is also useful to determine the agency responsible 

for potential public health interventions, to undertake geo-coding, and to calculate population-based injury rates. The address 

can also be used to gain access to U.S. Census information about the socioeconomic status. Locations may have implications 

for intervention strategies. 

Data element type: Core. 

Discussion 

To protect privacy and confidentiality, access to this level of detail must be limited to authorized personnel. The need for 

confidentiality must be taken into account if the full version of this data element is used. 

American National Standards Institute codes (ANSI codes) are a standardized set of numeric or alphabetic codes issued by 

the American National Standards Institute (ANSI) to ensure uniform identification of geographic entities through all federal 

government agencies. These standards replace the Federal Information Processing Standards (FIPS) codes previously issued by 

the National Institute of Standards and Technology (NIST). 

State codes are provided below. The extensive list of county and city codes makes it imprudent to display them. However, at 

the ANSI website, county and city codes are available for look up. A printable list of county and city codes with a state is also 

available. In addition, data collection systems can be enhanced via an ANSI lookup table so that once a state is selected, only 

counties in that state are listed under a county code drop down variable, and only cities within the selected county are listed 

in the a city drop down variable. 

Data Type (and Field Length) 

State Numeric (2). 

County Numeric (3). 

City Numeric (5). 

Zip Code Numeric (5). 

Street Address Text (50). 

Repetition 

No. 

Field Values/Coding Instructions 

Code Description 

State 

01 Alabama 

02 Alaska 

04 Arizona 

05 Arkansas 

06 California 

08 Colorado 

09 Connecticut 

10 Delaware 

11 District of Columbia 

12 Florida 

13 Georgia 

15 Hawaii 

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16 Idaho 

17 Illinois 

18 Indiana 

19 Iowa 

20 Kansas 

21 Kentucky 

22 Louisiana 

23 Maine 

24 Maryland 

25 Massachusetts 

26 Michigan 

27 Minnesota 

28 Mississippi 

29 Missouri 

30 Montana 

31 Nebraska 

32 Nevada 

33 New Hampshire 

34 New Jersey 

35 New Mexico 

36 New York 

37 North Carolina 

38 North Dakota 

39 Ohio 

40 Oklahoma 

41 Oregon 

42 Pennsylvania 

43 Puerto Rico 

44 Rhode Island 

45 South Carolina 

46 South Dakota 

47 Tennessee 

48 Texas 

49 Utah 

50 Vermont 

51 Virginia 

53 Washington 

54 West Virginia 

55 Wisconsin 

56 Wyoming 

60 American Samoa 

64 Federated States of Micronesia 

66 Guam 

68 Marshall Islands 

69 Northern Mariana Islands 

70 Palau 

74 U.S. Minor Outlying Islands 

78 Virgin Islands of the U.S. 

88 Outside the United States 

99 Unknown 

County 

See county codes by state at the link below 

888 Not applicable 

999 Unknown 
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City 

See city codes by state at the link below. 

88888 Not applicable 

99999 Unknown 

Zip Code 

Actual zip code 

88888 Not applicable 

99999 Unknown 

Street Address 

Actual street address 

Data Standards or Guidelines 

http://www.census.gov/geo/www/ansi/ansi.html. 
 

Please note that state codes are not chronological in all cases (i.e., 03 and 07 have no states associated with them). This is not 
 
 

an error but reflects actual census codes.
 
 


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Education 

Description/Definition 

Highest education level/degree achieved. 

Uses/Data Element Type 

Education level is an important indicator of socioeconomic status and is used in epidemiologic and other scientific analyses. 

Data element type: Core. 

Discussion 

None. 

Data Type (and Field Length) 

Numeric (1). 

Allow for Multiple Responses 

No. 

Field Values/Coding Instructions 

Code Description 

0 8th grade or less 

1 9th to 12th grade; no diploma 

2 High school graduate or GED completed 

3 Some college credit, but no degree 

4 Associate’s degree (e.g., AA, AS) 

5 Bachelor’s degree (e.g., BA, AB, BS) 

6 Master’s degree (e.g., MA, MS, Mend, Med, MSW, MBA) 

7 Doctorate (e.g., PhD, EdD) or Professional degree (e.g., MD, DDS, DVM, JD) 

8 Not applicable 

9 Unknown/not applicable 

Data Standards or Guidelines 

National Violent Death Reporting System available at 

http://www.cdc.gov/ViolencePrevention/NVDRS/index.html. 
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Employment Status 

Description/Definition 

Current employment status at the time of the incident. 

Uses/Data Element Type 

Employment status can alter the relationships between elders and perpetrators. Time out of the place of residence, financial 

independence, social activity, and self-worth may be related to employment. 

Data element type: Core. 

Discussion 

None. 

Data Type (and Field Length) 

Numeric (1). 

Allow for Multiple Responses 

No. 

Field Values/Coding Instructions 

Code Description 

1 Employed or self-employed full time 

2 Employed or self-employed part time 

3 Retired and not working by choice 

4 Disabled or too ill to work 

5 Unemployed and looking for work 

6 Other such as homemaker 

8 Not applicable 

9 Unknown 

Data Standards or Guidelines 

None. 

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Elder Situational 
 
 

Data Elements
 
 


Data Elements 

Incident ID.............................................................................................................................................68



Place of Residence............................................................................................................................69



Primary Caregiver Relationship ................................................................................................70



Primary Caregiver Lives in Place of residence .................................................................72



Disabilities in Major Functional Domains...........................................................................73



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Incident ID 

Description/Definition 

Identifier used to identify and distinguish specific incidents that may involve elder abuse. 

Uses/Data Element Type 

Used together, the Participant ID and the Incident ID uniquely identify each incident in the database. The Participant and 

Incident ID can be used to link data from different sources and to define different incidents for individuals with multiple 

records corresponding to discrete abuse incidents. 

Data element type: Core. 

Discussion 

Incident ID may be assigned by the agency compiling Elder Abuse (EA) surveillance data, or it may be an identifier previously 

assigned by the contributing data source. There are no provisions for missing or unknown information for this data element. 

Data Type (and Field Length) 

Text (25). 

Allow for Multiple Responses 

Yes 

Field Values/Coding Instructions 

Code Description 

Enter the actual incident identification number. 

Data Standards or Guidelines 

None. 
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Place of Residence 

Description/Definition 

Type of residence or living arrangement in which the elder resides at the time of the incident. 

Uses/Data Element Type 

Provides information on the context and environment in which the elder lives at the time of the incident. Type of residence is 

the place where the victim lived the majority of the time when the incident occurred. 

Data element type: Core. 

Discussion 

Examples of use and application guidance: If an elder is injured at their place of residence and dies four months later in a 

nursing home, answer questions regarding his or her own family residence. If the elder splits time equally between two or 

more residences, code the residence in which the incident took place. 

Data Type (and Field Length) 

Numeric (2). 

Allow for Multiple Responses 

No. 

Field Values/Coding Instructions 

Code Description 

01 Elder lives alone in a home/apartment 

02 Elder lives with family members only in a home/apartment 

03 Elder lives with non-family members only in a home/apartment 

04 Elder lives with both family and non-family members in a home/apartment 

05 Elder lives in an independent living setting for seniors that does not provide long-term care services 

06 Elder lives in assisted living, board and care home, or similar long-term care facility other than a nursing home 

07 Elder lives in a nursing home 

08 Other 

88 Not applicable 

99 Unknown/not applicable 

Data Standards or Guidelines 

None. 

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Primary Caregiver Relationship 

Description/Definition 

Relationship of the primary caregiver to the elder. 

Uses/Data Element Type 

Allows for examination of the extent to which risk of Elder Abuse increases by the relationship of the caregiver. 

Data element type: Core. 

Discussion 

To be included in this category, the person must provide at least 50% of the caregiving needs of the elder. 

Use the following sentence as a guide for selecting the appropriate description of the relationship: the caregiver is the 

____________ of the elder. For example, when a child is the caregiver of an elder parent, the relationship is “Son or Daughter” 

not “Parent.” (“The caregiver is the child of the elder”). 

Data Type (and Field Length) 

Numeric (2). 

Allow for Multiple Responses 

No. 

Field Values/Coding Instructions 

Code Description 

01 Husband (current or ex) 

02 Wife (current or ex) 

03 Boyfriend (current or ex) 

04 Girlfriend (current or ex) 

05 Son (biological child) 

06 Son (step/foster/adopted child) 

07 Son-in-law 

08 Daughter (biological child) 

09 Daughter (step/foster/adopted child) 

10 Daughter-in-law 

11 Brother (biological sibling) 

12 Brother (step/foster/adopted sibling) 

13 Brother-in-law 

14 Sister (biological sibling) 

15 Sister (step/foster/adopted sibling) 

16 Sister-in-law 

17 Father (biological parent) 

18 Father (step/foster/adopted parent) 

19 Father-in-law 

20 Mother (biological parent) 

21 Mother (step/foster/adopted parent) 

22 Mother-in-law 

23 Grandson (biological) 

24 Grandson (step/foster/adopted) 

25 Granddaughter (biological) 

26 Granddaughter (step/foster/adopted) 

27 Aunt 

28 Uncle 

29 Cousin (male) 

30 Cousin (female) 
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31 Other in-law (male) 

32 Other in-law (female) 

33 Other male relative 

34 Other female relative 

35 Friend/acquaintance (non-relative) 

36 In-home full time nurse/attendant (non-relative) 

37 For residents of nursing homes or other long-term care facilities, a caregiver working for the facility as an employee, 

contractor, or volunteer 

38 Other non-relative 

88 Not applicable 

99 Unknown 

Data Standards or Guidelines 

None. 

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Primary Caregiver Lives in Place of residence 

Description/Definition 

Denotes if the caregiver lives in the elder’s place of residence, with the residence being the place where the caregiver lives and 

sleeps most of the time. 

Uses/Data Element Type 

Allows for examination of the extent to which risk of Elder Abuse increases when the primary caregiver lives with or without 

the elder. 

Data element type: Core. 

Discussion 

To be included in this category, the person must live at least 50% of the time in the same residence as the elder. 

Data Type (and Field Length) 

Numeric (1). 

Allow for Multiple Responses 

No. 

Field Values/Coding Instructions 

Code Description 

0 No 

1 Yes 

8 Not applicable 

9 Unknown 

Data Standards or Guidelines 

None. 
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Disabilities in Major Functional Domains 

Description/Definition 

These data can be used to assess increased risk of Elder Abuse for elders experiencing disabilities in one or more major 

functional domains. 

Data element type: Core. 

Discussion 

Disability is a state of decreased functioning associated with disease, disorder, injury, or other health conditions, which in 

the context of one’s environment is experienced as an impairment, activity limitation, or participation restriction. Code if the 

elder has been formally recognized as having a disability due the presence of a specific form of impairment, activity limitation, 

or participation restriction and the disability was not a result of the most recent incident of abuse. Formal recognition of 

disability status is indicated by an elder’s possession of official documentation of disability such as medical records; paperwork 

establishing eligibility to receive disability benefits from the Social Security Administration or State Disability Programs, or 

verifying military discharge due to disability incurred during service, following the conclusion of a disability determination 

process; or official rulings classifying an elder as an individual covered by the protections of the American’s with Disabilities Act 

of 1990 (and its subsequent amendments). 

Data Type (and Field Length) 

Numeric (2). 

Allow for Multiple Responses 

Yes. 

Field Values/Coding Instructions 

Code Description 

0 No 

1 Yes 

8 Not applicable 

9 Unknown 

Data Standards or Guidelines 

None. 

Other References: 

Leonardi M et al. Measuring Health and Disability in Europe(MHADIE) Consortium. The definition of disability: what is in a 

name? Lancet, 2006,368:1219-1221. Americans with Disabilities Act of 1990 (ADA) [42 U.S.C. 12101 et seq.] ADA Amendments 

Act of 2008 (S. 3406), Pub. L. 110-325 

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Perpetrator Demographics
 
 


Data Elements 

Perpetrator ID ................................................................................................................................................76
 
 


Relationship of the Perpetrator to the Elder ..............................................................................77
 
 


NOTE: A unique record should be created for each perpetrator. It is recommended that the same demographic data 

elements collected for the victim be collected for each perpetrator. Two additional data elements, “Perpetrator ID” and 

“Relationship of the elder to the perpetrator” are described below. 

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Perpetrator ID 

Description/Definition 

A required, unique identification code used by the agency compiling Elder Abuse surveillance data. Provides a means of 

identifying and distinguishing multiple perpetrators involved in a single case. 

Uses/Data Element Type 

Provides a means of identifying and distinguishing multiple perpetrators involved in a single case. If there is more than one 

perpetrator, create a separate perpetrator ID for each. 

Data element type: Core. 

Discussion 

Perpetrator ID may be assigned by the agency compiling Elder Abuse (EA) surveillance data, or it may be an identifier 

previously assigned by the contributing data source. Perpetrator ID can be identical to the identifier created to allow linkage 

across multiple sources. 

Because identification and documentation of EA is not standard across the many sources that collect data on abuse and 

neglect, data from multiple sources may be needed to better estimate the number of elders who experience abuse. As such, 

developers of surveillance systems may want to explore the viability of a variety of approaches to Elder Abuse surveillance. 

One method is to include data from multiple sources (e.g., APS records, police records and emergency room records) when 

designing surveillance systems. If surveillance system developers choose to use data from multiple sources, a unique identifier 

should be created for linkage across data sources. 

The mechanics of how to set up a database that accommodates data from multiple sources are not discussed in this 

document. Users should refer to other sources for information on how to set up a database. 

Data Type (and Field Length) 

Text (25). 

Allow for Multiple Responses 

No. 

Field Values/Coding Instructions 

Enter the actual case identification number. 

Data Standards or Guidelines 

None. 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS

Relationship of the Perpetrator to the Elder 

Description/Definition 

Describes the perpetrator’s relationship to the elder. 

Uses/Data Element Type 

Data describing the relationship between the elder and the perpetrator are useful for developing and evaluating prevention 

programs and for characterizing various forms of family and caregiver violence. 

Use the following sentence as a guide for selecting the appropriate description of the relationship: the perpetrator is the 

____________ of the elder. For example, when a child abuses an elder parent, the relationship is “Son” or “Daughter” not 

“Parent.” (“The perpetrator is the child—son or daughter of the elder”). If there is more than one perpetrator, create a separate 

perpetrator record for each. 

Data element type: Core. 

Data Type (and Field Length) 

Numeric (2). 

Discussion 

None. 

Allow for Multiple Responses 

No. 

Field Values/Coding Instructions 

Code Description 

01 Husband (current or ex) 

02 Wife (current or ex) 

03 Boyfriend (current or ex) 

04 Girlfriend (current or ex) 

05 Son (biological child) 

06 Son (step/foster/adopted child) 

07 Son-in-law 

08 Daughter (biological child) 

09 Daughter (step/foster/adopted child) 

10 Daughter-in-law 

11 Brother (biological sibling) 

12 Brother (step/foster/adopted sibling) 

13 Brother-in-law 

14 Sister (biological sibling) 

15 Sister (step/foster/adopted sibling) 

16 Sister-in-law 

17 Father (biological parent) 

18 Father (step/foster/adopted parent) 

19 Father-in-law 

20 Mother (biological parent) 

21 Mother (step/foster/adopted parent) 

22 Mother-in-law 

23 Grandson (biological) 

24 Grandson (step/foster/adopted) 

25 Granddaughter (biological) 

26 Granddaughter (step/foster/adopted) 

27 Aunt 

28 Uncle 

77 
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29 Cousin 

30 Other in-law 

31 Other male relative 

32 Other female relative 

33 Friend/acquaintance (non-relative) 

34 In-home full time nurse/attendant (non-relative) 

35 For individuals living in assisted living, a nursing home, or other long-term care facility, an employee, contractor or 

volunteer of the facility. 

36 Other non-relative 

88 Not applicable (e.g., retirement village, assisted living, nursing home, etc.) 

99 Unknown 

Data Standards or Guidelines 

None. 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS

Perpetrator Situational 
 
 

Data Elements
 
 


Data Elements 

Types of Abuse Perpetrated................................................................................................................80



Home Setting of the Perpetrator at Time of the Incident................................................81



79 
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Types of Abuse Perpetrated 

Description/Definition 

Describes the type of abuse perpetrated. 

Uses/Data Element Type 

Allows determination of the types of abuse perpetrated by each perpetrator. 

Data element type: Core. 

Discussion 

None. 

Data Type (and Field Length) 

Numeric (1). 

Allow for Multiple Responses 

Yes. 

Field Values/Coding Instructions 

Code Description 

1 Physical Abuse 

2 Sexual Abuse 

3 Emotional / Psychological Abuse 

4 Neglect 

5 Financial Abuse/Exploitation 

8 Not applicable 

9 Unknown 

Data Standards or Guidelines 

None. 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS

Place of Residence of the Perpetrator at Time of the Incident 

Description/Definition 

Type of residence or living arrangement in which the perpetrator resides at the time of the incident. 

Uses/Data Element Type 

Provides information on the context and environment in which the perpetrator lives at the time of the incident. 

Data element type: Core. 

Discussion 

Note that the place of residence of the elder asked for the setting in which the elder lived the majority of the time. Place of 

residence of the perpetrator is not where the person lived the majority of the time but the home setting at the time of the 

incident. For example, if a perpetrator was living in his or her own apartment but moved in with the elder two weeks prior, the 

place of residence is the elder’s residence. 

Data Type (and Field Length) 

Numeric (1). 

Allow for Multiple Responses 

No. 

Field Values/Coding Instructions 

Code Description 

Perpetrator did not live with elder 

Perpetrator lived with elder only in perpetrators home 

Perpetrator lived with elder only in elder’s home 

Perpetrator lived with elder and other family members in perpetrator’s home 

Perpetrator lived with elder and other family members in elder’s home 

Perpetrator lived with elder and other family and non-family members 

Other (specify) 

Not applicable 

Unknown 

Data Standards or Guidelines 

None. 

81 
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ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS

Data Elements 
 
 

For All Abuse Events
 
 


Data Elements 

Type of Abuse Experienced ....................................................................................................................... 84



Approximate Date of Abuse Onset....................................................................................................... 85



Date of Incident................................................................................................................................................. 86



Location(s) where Abuse Occurred ...................................................................................................... 87



Number Of Incidents of Abuse In Past 12 Months...................................................................... 88



Number of Perpetrators Involved in Most Recent Incident................................................... 89



Abuse Reported ................................................................................................................................................ 90



Abuse Substantiated...................................................................................................................................... 91



83 
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UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS 84 

Types of Abuse Experienced 

Description/Definition 

Describes the type of abuse experienced by an older adult. 

Uses/Data Element Type 

Allows determination of the types of experienced by each older adult. 

Data element type: Core. 

Discussion 

None. 

Data Type (and Field Length) 

Numeric (1). 

Allow for Multiple Responses 

Yes. 

Field Values/Coding Instructions 

Code Description 

1 Physical Abuse 

2 Sexual Abuse 

3 Emotional / Psychological Abuse 

4 Neglect 

5 Financial Abuse/Exploitation 

8 Not applicable 

9 Unknown 

Data Standards or Guidelines 

None. 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS

Approximate Date of Abuse Onset 

Description/Definition 

Approximated date when the victim first experienced abuse/when abuse was first perpetrated. 

Uses/Data Element Type 

Can be used in conjunction with date of birth to calculate the victim’s age at the time when abuse began. It can also be 

used in conjunction with the date of the most recent violent episode to determine time since the beginning of the abuse 

experience. 

Data element type: Core 

Discussion 

It is possible that the victim will have multiple incidents of victimization reported over time. This data element reflects the date 

when the victimization actually began and allows for an understanding of the time lag between victimization and reporting 

or detection. The approximate date of victimization/perpetration onset and the date of reporting may be identical if the 

experience started and was reported the same day. 

Data Type (and Field Length) 

Date (10). 

Allow for Multiple responses 

No. 

Field Values/Coding Instructions 

MM/DD/YYYY format 

9’s for any unknown date elements: 

06/99/2007for June 2007 with the day unknown 

99/99/2007 for 2007 with the month and day unknown 

99/99/9999for the year, month and day unknown 

88/88/8888 Not applicable 

Data Standards or Guidelines 

None. 

85 
ELDER ABUSE SURVEILLANCE:

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Date of Incident 

Description/Definition 

Date when the abuse incident being reported actually occurred. 

Uses/Data Element Type 

Can be used in conjunction with date of birth to calculate the victim’s age at the time of the incident. It can also be used in 

conjunction with the date of the most recent violent episode to determine since the last reported incident. 

Data element type: Core 

Discussion 

It is possible that the victim will have multiple incidents of victimization reported over time. This data element reflects the date 

when the victimization actually occurred and allows for an understanding of the time lag between victimization and reporting. 

The date of victimization and the date of reporting may be identical if the event was reported on the same day. 

Data Type (and Field Length) 

Date (10). 

Allow for Multiple responses 

No. 

Field Values/Coding Instructions 

MM/DD/YYYY format 

9’s for any unknown date elements: 

06/99/2007for June 2007 with the day unknown 

99/99/2007 for 2007 with the month and day unknown 

99/99/9999for the year, month and day unknown 

88/88/8888 Not applicable 

Data Standards or Guidelines 

None. 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS

Location(s) where Abuse Occurred 

Description/Definition 

Describes the type of locations where the abuse of the elder occurred for the current incident. 

Uses/Data Element Type 

Data on the type of places where abuse occurred help to describe the injury or illness producing event and are valuable for 

planning and evaluating prevention programs. 

Data element type: Core. 

Data Type (and Field Length) 

Numeric (2). 

Allow for Multiple Responses 

Yes. 

Field Values/Coding Instructions 

Code Description 

01 House, apartment, including driveway, porch, yard 

02 Street/road, sidewalk, alley 

03 Highway, freeway 

04 Motor vehicle (inside a private vehicle) 

05 Facility/social service agency vehicle (inside an agency vehicle) 

06 Public transportation or station (bus, train, plane, airport, depot, taxi) 

07 Bank/credit union 

08 Retail/commercial establishment (including parking lot) 

09 Office building (lawyer) 

10 Social service office (social security, public assistance) 

11 Senior center/community center 

12 Adult daycare facility 

13 Assisted living facility, board and care home, or similar long-term care facility (other than a nursing home) 

14 Supervised residential facility (e.g., shelter, halfway house, group home) 

15 Outpatient/medical office 

16 Hospital 

17 Nursing home 

18 In-patient Hospice Facility 

19 Synagogue, church, temple, mosque or other building used for religious services 

20 Jail, prison, detention facility 

21 Park, natural or public use area (beaches, forest, river) 

22 Hotel/motel 

23 Other (specify) 

88 Not applicable 

99 Unknown/not applicable 

Data Standards or Guidelines 

National Violent Death Reporting System available at 

http://www.cdc.gov/ViolencePrevention/NVDRS/index.html. 

87 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS 88 

Number of Incidents of Abuse In Past 12 Months 

Description/Definition 

Number of incidents or episodes of abuse that occurred in the 12 months prior to the date of contact with the entity providing 

data. Allows an estimation of the frequency of elder abuse within the last year by any perpetrator. 

Uses/Data Element Type 

Allows an estimation of the frequency of abuse within the last year by any perpetrator. 

Data element type: Core. 

Discussion 

Code this data element based on the specific type of abuse that occurred. For example, if an elder was a victim of both 

physical and sexual abuse, a record should be created for physical abuse and a second record for sexual abuse. The physical 

abuse record should be coded to reflect the single or series of events for physical abuse only. The second record should reflect 

the single or series of events for sexual abuse only. Understanding the frequency of each type of abuse in the last 12 months 

provides a measure of the immediate context for the occurrence of abuse. 

Allow for Multiple Responses 

No. 

Field Values/Coding Instructions 

Code Description 

0 0 incidents of abuse 

1 1 incident of abuse 

2 2-5 incidents of abuse 

3 6-10 incidents of abuse 

4 More than 10 incidents of abuse 

8 Not applicable 

9 Unknown 

Data Standards or Guidelines 

None. 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS

 

 

Number of Perpetrators Involved in Most Recent Incident 

Description/Definition 

The number of perpetrators involved in the most recent incident. 

Uses/Data Element Type 

Allows examination of differences between incidents involving one perpetrator and incidents involving more than one 

perpetrator. 

Data element type: Core 

Discussion 

Incidents involving more than one perpetrator may differ in nature from those involving only one perpetrator. 

Data Type (and Field Length) 

Numeric (2). 

Allow for Multiple Responses 

No. 

Field Values/Coding Instructions 

Code Description 

Code actual number 

88 Not applicable 

99 Unknown 

Data Standards or Guidelines 

None. 

89 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS 90 

 

 

Abuse Reported 

Description/Definition 

Describes to whom the current incident of abuse was reported. 

Uses/Data Element Type 

Captures the agencies to which abuse was reported. 

Data element type: Core. 

Discussion 

Suspected Elder Abuse outcomes may vary based the agency/agencies to which the abuse was reported. This data element 

allows for analyses of outcomes based on the type of agency/agencies notified of the allegations. 

Data Type (and Field Length) 

Numeric (2). 

Allow for Multiple Responses 

Yes. 

Field Values/Coding Instructions 

Code Description 

01 Emergency department/hospital 

02 Physician or health care professional, including mental health, other than those in a hospital (use 01) or long-term 

care facility (use 08) 

03 Police/Sheriff/Law enforcement 

04 Prosecutor/District attorney/personal attorney 

05 Other court-related or criminal justice-related agency 

06 Adult Protective Services 

07 Area Agencies on Aging 

08 Assisted Living, Board and Care Facility, Nursing home, or other long term care facility staff 

09 Long-Term Care Ombudsman 

10 Agency that regulates long-term care facilities 

11 Landlord, security staff, or other staff related to rental housing (including independent living and retirement villages) 

12 Clergy 

13 Bank or other financial services official 

14 Shelter for abused elders 

15 Domestic violence program 

16 Rape crisis center 

17 Telephone hotline for victim services, other than those provided by a shelter or rape crisis center 

18 Victim-Witness Assistance program 

19 Other victim service agencies 

20 Other social service agencies, other than victim service agencies 

21 Other 

99 Unknown/not applicable 

Data Standards or Guidelines 

None. 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS

Abuse Substantiated 

Description/Definition 

Describes if the investigation finds that abuse actually exists (i.e., the investigation determined the abuse actually occurred or 

that the alleged perpetrator was shown to have committed the abuse). 

Uses/Data Element Type 

Captures whether this perpetrator was found by an investigating agency to have committed the alleged abuse. 

Data element type: Core. 

Discussion 

Abuse may be substantiated for one perpetrator but not substantiated for another in the same incident. Capturing the actual 

result of the case investigation separately by perpetrator can be useful in assessing risk for abuse and informing prevention 

efforts. 

Data Type (and Field Length) 

Numeric (1). 

Allow for Multiple Responses 

No. 

Field Values/Coding Instructions 

Code Description 

0 Unable to substantiate 

1 Substantiated 

8 Not applicable 

9 Unknown 

Data Standards or Guidelines 

None. 

91 
ELDER ABUSE SURVEILLANCE:

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ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS

Physical Abuse Data Elements
 
 


Data Elements 

Type of Injury from Physical Abuse............................................................................................................ 94



Weapon Type for Physical Abuse................................................................................................................. 95



Medical Care Required and Received as a Result of Physical Abuse..................................... 96



Physical Health Outcome for Elder after Physical Abuse.............................................................. 97



Psychosocial Outcome for Elder after Physical Abuse.................................................................... 98



93 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS 94 

 

Type of Injury from Physical Abuse 

Description/Definition 

Captures the type of injury the elder experienced as a result of the physical abuse. 

Uses/Data Element Type 

The type of injury can be utilized to evaluate the severity of the injury and estimate the costs of medical interventions. 

Data element type: Core. 

Discussion 

None. 

Data Type (and Field Length) 

Numeric (2). 

Allow for Multiple Responses 

Yes. 

Field Values/Coding Instructions 

Code Description 

01 Contusion (bruise, scrape) 

02 Laceration (cut, slice) 

03 Fracture 

04 Poisoning 

05 Penetrating wound (gunshot, stabbing) 

06 Burn 

07 Suffocation/strangulation 

08 Near drowning 

09 Crush injury 

10 Electric shock 

11 Other (specify) 

88 Not applicable 

99 Unknown/not applicable 

Data Standards or Guidelines 

National Violent Death Reporting System available at 

http://www.cdc.gov/ViolencePrevention/NVDRS/index.html. 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS

Weapon Type for Physical Abuse 

Description/Definition 

Describes the weapon used to inflict injury on the elder. 

Uses/Data Element Type 

These codes help describe the weapon used to inflict injury on the elder. An understanding of weapons used has implications 

for prevention in terms of access and lethality. 

Data element type: Core. 

Discussion 

None. 

Data Type (and Field Length) 

Numeric (2). 

Allow for Multiple Responses 

Yes. 

Field Values/Coding Instructions 

Code Description 

01 Firearm 

02 Sharp instrument 

03 Blunt instrument 

04 Poisoning 

05 Hanging, strangulation, suffocation 

06 Personal weapons (e.g., fists, feet) 

07 Fall 

08 Explosives 

09 Drowning 

10 Fire or burns 

11 Shaking 

12 Motor Vehicle (e.g., car, truck, bus, train, etc) 

13 Biological weapons 

14 Other 

88 Not applicable 

99 Unknown 

Data Standards or Guidelines 

National Violent Death Reporting System available at 

http://www.cdc.gov/ViolencePrevention/NVDRS/index.html. 

95 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS 96 

Medical Care Required and Received as a Result of Physical Abuse 

Description/Definition 

Describes the medical care the elder required and received for the most recent occurrence as a result of physical abuse. 

Uses/Data Element Type 

Allows for estimates of the monetary cost of Elder Abuse and the severity of physical injuries inflicted upon the victim. 

Data element type: Core. 

Discussion 

None. 

Data Type (and Field Length) 

Numeric (2). 

Allow for Multiple Responses 

Yes. 

Field Values/Coding Instructions 

Code Description 

00 No medical care received 

01 Medical care received at home (e.g., family, home health nurse, etc) 

02 Medical care received in the home of a neighbor or associate 

03 Medical care received in a shelter 

04 Primary care physician or nurse 

05 Specialist care physician 

06 Urgent care clinic 

07 Emergency department at a hospital 

08 Inpatient hospitalization 

09 Short term rehabilitation facility 

10 Nursing home 

11 Mental health professional or facility 

12 Other (specify) 

88 Not applicable 

99 Unknown 

Data Standards or Guidelines 

None. 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS

Physical Health Outcome for Elder after Physical Abuse 

Description/Definition 

Describes the health impact of the physical abuse on the elder. 

Uses/Data Element Type 

The health impact of physical abuse against an elder is significant. Data describing resulting injuries, disabilities, disfigurement 

and even death are important for understanding the costs of physical abuse to both victims and society. 

Data element type: Core. 

Discussion 

None. 

Data Type (and Field Length) 

Numeric (1). 

Allow for Multiple Responses 

Yes. 

Field Values/Coding Instructions 

Code Description 

1 Wounds / injuries 

2 Temporary disability 

3 Permanent disability 

4 Temporary disfigurement 

5 Permanent disfigurement 

6 Temporary disease/illness 

7 Permanent disease/illness 

8 Not applicable 

9 Unknown 

Data Standards or Guidelines 

None. 

97 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS 98 

Psychosocial Outcome for Elder after Physical Abuse 

Description/Definition 

Describes the psychosocial impact of the abuse on the elder. 

Uses/Data Element Type 

The psychosocial impacts of elder abuse may be significant. The experience may lead to changes in an elder’s living situation 

due to fear or elevated concerns regarding safety, decreased quality of life, as well as reduced confidence and self-efficacy. 

Data on such outcomes are essential to establishing the full scope of impacts accompanying elder abuse and may be useful 

for establishing the need for resources to support prevention and intervention. 

Data element type: Core. 

Discussion 

None. 

Data Type (and Field Length) 

Numeric (2). 

Allow for Multiple Responses 

Yes. 

Field Values/Coding Instructions 

Code Description 

01 Decline in ability to drive/transport oneself 

02 Decline in ability to prepare meals/feed oneself 

03 Decline in ability to manage finances/pay bills 

04 Decline in community interaction/social life 

05 Decline in ability to manage healthcare needs/medications 

06 Decline in ability to perform housekeeping and/or gardening tasks 

07 Decline in sexual activity or interest 

08 Increase in need for in home care/assistance (including additional assistance within a long-term care facility) 

09 Loss of home/moved to long-term care facility 

10 Emotional decline (e.g., depression, loss of confidence or trust, etc.) 

11 Other (specify) 

88 Not applicable 

99 Unknown 

Data Standards or Guidelines 

None. 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS

Sexual Abuse Data Elements
 
 


Data Elements 

Type of Injury from Sexual Abuse ..........................................................................................................100



Weapon Type for Sexual Abuse...............................................................................................................101



Activity at Time of Sexual Abuse.............................................................................................................102



Medical Care Required and Received after Sexual Abuse ......................................................103



Health Outcome for Elder after Sexual Abuse................................................................................103



Psychosocial Outcome for Elder after Sexual Abuse..................................................................103



99 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS 100 

Type of Injury from Sexual Abuse 

Description/Definition 

Captures the type of injury the elder experienced as a result of the sexual abuse. 

Uses/Data Element Type 

The type of injury can be utilized to evaluate the severity of the injury and estimate the costs of medical interventions. 

Data element type: Core. 

Discussion 

None. 

Data Type (and Field Length) 

Numeric (1). 

Allow for Multiple Responses 

Yes. 

Field Values/Coding Instructions 

Code Description 

1 Contusion (bruise, scrape, welt non-genital, oral, or anal) 

2 Laceration (cut, slice non-genital, oral, or anal) 

3 Dislocations/sprains 

4 Fracture 

5 Genital inflammation, abrasions, lacerations, tears, or scarring 

6 Oral inflammation, abrasions, lacerations, tears, or scarring 

7 Anal inflammation, abrasions, lacerations, tears, or scarring 

8 Other (specify) 

88 Not applicable 

99 Unknown 

Data Standards or Guidelines 

None. 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS

Weapon Type for Sexual Abuse 

Description/Definition 

Describes the weapon used to inflict sexual injury on the elder. 

Uses/Data Element Type 

These codes help describe the weapon used to inflict sexual injury on the elder. An understanding of weapons used has 

implications for prevention and provides insight on the types of weapons used during the perpetration of sexual abuse. 

Data element type: Core. 

Discussion 

None. 

Data Type (and Field Length) 

Numeric (1). 

Allow for Multiple Responses 

Yes. 

Field Values/Coding Instructions 

Code Description 

1 Penis 

2 Sharp instrument 

3 Blunt instrument (e.g., bottle, broom handle, etc.) 

4 Other personal weapons (e.g., fingers, fists, feet) 

5 Fire or hot object (e.g., cigarette, scalding liquid, etc.) 

6 Other 

8 Not applicable 

9 Unknown 

Data Standards or Guidelines 

None. 

101 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS 102 

Activity at Time of Sexual Abuse 

Description/Definition 

Describes the activity the elder was engaged in at the time of the abuse. 

Uses/Data Element Type 

These codes help describe the activity the elder was engaged in at the time the sexual abuse occurred. An understanding of 

activities as risk factors can inform prevention efforts, by allowing the context of the incident to be more thoroughly examined. 

Activity related information could help ascertain whether aspects such as a lack of sufficient or appropriate monitoring, 

supervision, or guardianship over a vulnerable or available elder or unique trust relationships providing higher levels of 

intimate access may have created conditions conducive to the perpetration of sexual abuse, in the presence of potential 

offenders (i.e., those able, willing, or seeking to perpetrate sexual abuse). Knowing the activities that were occurring at the 

time of sexual abuse may assist with the creation of strategies to prevent sexual abuse through the reduction of perpetration 

opportunities and the enhancement of protective relationships, arrangements, and policy structures. 

Data element type: Core. 

Discussion 

None 

Data Type (and Field Length) 

Numeric (2). 

Allow for Multiple Responses 

Yes. 

Field Values/Coding Instructions 

Code Description 

01 Bathing/using the bathroom 

02 Resting/sleeping 

03 Grooming/dressing 

04 Eating/preparing food 

05 Being transported in vehicle 

06 Socializing with family 

07 Socializing with friends 

08 Watching television 

09 Talking on the telephone 

10 Using a computer/other technology for communication 

11 Working around their home 

12 Working with finances 

13 Physician/medical visits 

14 Shopping 

15 Attending a public event (e.g., play, concert, sporting event) 

16 Other (specify) 

88 Not applicable 

99 Unknown 

Data Standards or Guidelines 

None. 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS

Medical Care Required and Received after Sexual Abuse 

See “Medical Care Received” data element under “Physical Abuse” 

Physical Health Outcome for Elder after Sexual Abuse 

See “Health Outcome for Elder” data element under “Physical Abuse” 

Psychosocial Outcome for Elder after Sexual Abuse 

See “Social Outcome for Elder” data element under “Physical Abuse” 

103 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS 104 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS

Psychological/Emotional Abuse 
 
 

Data Elements
 
 


Data Elements 

Activity at Time of Psychological/Emotional Abuse .......................................................................................................106



Medical Care Required and Received As a Result of Psychological/Emotional Abuse.............................107



Health Outcome for Elder after Psychological/Emotional Abuse..........................................................................108



Psychosocial Outcome for Elder after Psychological/Emotional Abuse ............................................................109



105 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS 106 

Activity at Time of Psychological/Emotional Abuse 

Description/Definition 

Describes the activity the elder was engaged in at the time of the abuse. 

Uses/Data Element Type 

These codes help describe the activity the elder was engaged in at the time the psychological/emotional abuse occurred. 

An understanding of activities as risk factors can inform prevention efforts, by allowing the context of the incident to be 

more thoroughly examined. Activity related information could help ascertain whether challenging aspects of activities being 

undertaken may have created conditions conducive to the perpetration of sexual abuse and the specific venues where 

psychological abuse was more or less likely to occur. Abuse that occurs in public versus private contexts or in isolation versus 

in the presence of others may require different strategies for prevention or intervention. 

Data element type: Core. 

Discussion 

None. 

Data Type (and Field Length) 

Numeric (2). 

Allow for Multiple Responses 

Yes. 

Field Values/Coding Instructions 

Code Description 

01 Bathing/using the bathroom 

02 Resting/sleeping 

03 Grooming/dressing 

04 Eating/preparing food 

05 Being transported in vehicle 

06 Socializing with family 

07 Socializing with friends 

08 Watching television 

09 Talking on the telephone 

10 Using a computer/other technology for communication 

11 Working around their home 

12 Working with finances 

13 Physician/medical visits 

14 Shopping 

15 Attending a public event (e.g., play, concert, sporting event) 

16 Other (specify) 

99 Unknown/not applicable 

Data Standards or Guidelines 

None. 
ELDER ABUSE SURVEILLANCE:

UNIFORM DEFINITIONS AND RECOMMENDED CORE DATA ELEMENTS

Medical Care Required and Received As a Result of Psychological/Emotional Abuse 

Description/Definition 

Describes the medical care the elder received for the most recent occurrence. 

Uses/Data Element Type 

Allows for estimates of the monetary cost of Elder Abuse and the severity of psychological/emotional injuries inflicted upon 

the victim. 

Data element type: Core. 

Discussion 

None. 

Data Type (and Field Length) 

Numeric (2). 

Allow for Multiple Responses 

Yes. 

Field Values/Coding Instructions 

Code Description 

00 No medical care received 

01 Medical care received at home (e.g., family, home health nurse, etc.) 

02 Primary care physician or nurse 

03 Specialist care physician 

04 Urgent care clinic 

05 Emergency department at a hospital 

06 Inpatient hospitalization 

07 Short term rehabilitation facility 

08 Nursing home 

09 Mental health professional or facility 

10 Other (specify) 

88 Not applicable 

99 Unknown 

Data Standards or Guidelines 

None. 

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Health Outcome for Elder after Psychological/Emotional Abuse 

Description/Definition 

Describes the health impact of the psychological/emotional abuse on the elder. 

Uses/Data Element Type 

The health impact of psychological/emotional abuse against and elder is significant. Data describing resulting injuries and 

disabilities are important for understanding the costs of psychological/emotional abuse to both victim’s and society. 

Data element type: Core. 

Discussion 

None. 

Data Type (and Field Length) 

Numeric (2). 

Allow for Multiple Responses 

Yes. 

Field Values/Coding Instructions 

Code Description 

01 Depression 

02 Anxiety 

03 Ulcers 

04 Other digestive problems (e.g., irritable bowel, heartburn) 

05 Chronic pain (e.g., migraines) 

06 Hypertension/High blood pressure 

07 Heart problems 

08 Fatigue/tiredness 

09 Sleep disorder 

10 Substance abuse problem 

11 Other (specify) 

88 Not applicable 

99 Unknown 

Data Standards or Guidelines 

None. 
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Psychosocial Outcome for Elder after Psychological/Emotional Abuse 

See “Psychosocial Outcome for Elder” data element under “Physical Abuse” 

109 
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Health Outcome for Elder after Neglect 

See “Health Outcome for Elder” data element under “Physical Abuse” 
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Neglect Data Elements
 
 


Data Elements 

Medical Care Received................................................................................................................................112



Health Outcome for Elder after Neglect ..........................................................................................113



Psychosocial Outcome for Elder after Neglect ............................................................................114



111 
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Medical Care Received 

See “Medical Care Received” data element under “Physical Abuse” 
ELDER ABUSE SURVEILLANCE:

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See “Health Outcome for Elder” data element under “Physical Abuse” 

See “Psychosocial Outcome for Elder” data element under “Physical Abuse” 

113 
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Psychosocial Outcome for Elder after Neglect 

See “Psychosocial Outcome for Elder” data element under “Physical Abuse” 
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Financial Abuse Data Elements
 
 


Data Elements 

Value of Assets Lost.......................................................................................................................................116



Other Outcome to Elder ............................................................................................................................117



115 
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Value of Assets Lost 

Description/Definition 

Describes the value of assets that were taken from the elder when the incident occurred. 

Uses/Data Element Type 

The value of assets an elder lost can significantly limit their ability to live independently and provide for their own needs. 

Data element type: Core. 

Discussion 

None. 

Data Type (and Field Length) 

Numeric (2). 

Allow for Multiple Responses 

No. 

Field Values/Coding Instructions 

Code Description 

01 Less than $10,000 

02 $10,000 - $24,999 

03 $25,000 - $49,999 

04 $50,000 - $74,999 

05 $75,000 - $99,999 

06 $100,000 - $124,999 

07 $125,000 - $149,999 

08 $150,000 - $174,999 

09 $175,000 - $199,999 

10 $200,000 - $249,999 

11 $250,000 or more 

88 Not applicable 

99 Unknown 

Data Standards or Guidelines 

None. 
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Other Outcome to Elder 

Description/Definition 

Describes how the elder was impacted as a result of the loss of assets. 

Uses/Data Element Type 

Changes in lifestyle and security of the elder can result in vulnerability for other types of Elder Abuse. 

Data element type: Core. 

Discussion 

None. 

Data Type (and Field Length) 

Numeric (2). 

Allow for Multiple Responses 

Yes. 

Field Values/Coding Instructions 

Code Description 

01 Inability to drive/transport oneself 

02 Inability to provide for basic needs (e.g., food, clothing, etc.) 

03 Inability to pay bills (e.g., utilities, telephone, etc.) 

04 Inability to participate in community interactions 

05 Inability to afford healthcare/medications 

06 Inability to afford home repairs and meet basic shelter needs 

07 Inability to pay for in home care/assistance 

08 Inability to pay for stay in long-term care facility 

09 Loss of home 

10 Loss of emotional security (e.g., fear of the future, loss of stability, etc.) 

11 Negative impact on credit rating 

12 Resulted in foreclosure of residential mortgage 

13 Resulted in loss of lease of residential rental property 

14 Resulted in bankruptcy filing 

15 Assignment of a public guardian 

16 Other (specify) 

88 Not applicable 

99 Unknown 

Data Standards or Guidelines 

None. 

117 
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END NOTES
 
 


i The term public health surveillance refers to: the ongoing and systematic collection, analysis, and interpretation of 

health-related data for use in setting priorities and making other decisions regarding prevention efforts. 

ii Several global terms are used by others to label the behaviors and phenomena described in this document. Some 

examples of other terms include elder abuse, elder neglect, elder mistreatment, elder maltreatment, senior abuse, 

abuse in later life, abuse of older adults, and inadequate care of the elderly. Early CDC work utilized the term “elder 

maltreatment.” Although “elder maltreatment” is occasionally used in the field, it is used much less than terms such 

as “elder abuse” or “elder mistreatment.”The term elder maltreatment also lacks widespread use or recognition by 

lay audiences and often requires further clarification to facilitate comprehension. Lastly, the term maltreatment is 

not embraced by many experts, front line professionals or older survivors because it is perceived as a softer term 

which minimizes or does not adequately communicate the traumatic events and devastation experienced by 

many older victims. Accepted alternatives to the term “elder maltreatment” are “elder mistreatment,”“elder abuse, 

neglect, and exploitation,” and “elder abuse.”While the term “elder mistreatment” is more widely accepted, its use, 

unfortunately, presents the same problems as the use of the term elder maltreatment. The term “elder abuse, neglect, 

and exploitation” is closer to the language used by most stakeholders. However, Galbraith (1989) argued that treating 

neglect, and by extension exploitation, as wholly separate and distinct constructs reinforces the tendency to focus 

in isolated ways on either a perpetrator’s action or inaction. He believed the true concern should be the end results 

of these behaviors which may be similar or not easily distinguishable in some cases. Moreover, physical abuse, 

neglect, and exploitation may co-occur or have underlying behavioral or situational drivers that may overlap greatly. 

Therefore, CDC, in consultation with members of the expert panel, decided to use the term “elder abuse.”The term 

has the broadest public and professional recognition, has the capacity to accommodate the broadest variety of 

conceptually relevant behavioral categories, and can be appropriately used as an omnibus label for various situations 

where older adults or elders have been harmed as a result of being handled, treated, or used wrongly or improperly 

by caregivers or other persons in relationships where there is an expectation of trust. 

iii Elder Abuse, as specified in the "Uniform Definitions" and used throughout the "Recommended Core Data Elements," 

refers to intentional acts or failures to act by a caregiver or another person in a relationship involving an expectation 

of trust, that causes or creates a serious risk of harm to an older adult. 

iv Refers to the act of mapping, matching, or translating definitions or data elements in one data source to definitions or 

data elements in another data source. 
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Centers for Disease Control and Prevention | National Center for Injury Prevention and Control | www.cdc.gov/violenceprevention