U.S. Department of Justice

Office of Justice Programs

National Institute of Justice

R e s e a r c h i n B r i e f

National Institute of Justice

September 2001

continued...

A significant amount of research has

been conducted on ways to reduce abuse

against women and children, but very little research has been done on the domestic abuse of elderly persons. The lack of

a good understanding of elder abuse and

its consequences is worrisome. The U.S.

Bureau of the Census predicts that by

2030, the population over age 65 will

nearly triple to more than 70 million people and older people will make up more

than 20 percent of the population (up

from 12.3 percent in 1990).1

Estimates from the National Center on

Elder Abuse show an increase of 150

percent in reported cases of elder abuse

nationwide since 1986.2 Virtually all

State agencies charged with addressing

the problem of elder abuse reported

increases in their caseloads over the

past decade.3

Clinical accounts have documented

severe emotional distress and an increased mortality rate among mistreated elder persons.4 A small number

of empirical studies have shown that

abused elders often exhibit higher levels

of depression than nonabused elders.5

Elder abuse victims are in an especially

difficult situation because they often are

dependent on the abuser and have little

possibility of moving or otherwise ending

the abusive relationship.

Preventing repeat episodes of

elder abuse

Along with increased awareness of the

need to respond decisively to elder abuse

has come an increased appreciation that

elder abuse, like spousal violence and

other forms of family abuse, is a complex problem. Arrest, prosecution, abuser education, social services for victims,

and medical assistance each address

different parts of the problem, but none

alone provides an effective solution.

Therefore, coordination among agencies

has become more and more common.

Strategies for coordinated community

responses typically are planned by committees composed of staff from police,

prosecution, and probation agencies as

well as representatives from counseling

organizations, shelters, hospitals, substance abuse services, and the clergy.

It has become commonplace for victim

advocates to work with police officers,

following up on family violence calls 

Results from an Elder Abuse

Prevention Experiment in 

New York City

by Robert C. Davis and Juanjo Medina-Ariza

Issues and Findings

Discussed in this Brief: A field

experiment of an intervention to

reduce repeat incidents of elder

abuse. Randomly selected public

housing projects in New York City

received educational material

about elder abuse, while others

did not. Some households that

reported elder abuse to the police

were selected by lottery to receive

a followup home visit from a

police officer and a domestic violence counselor. Data on postreport abuse were collected at 6

and 12 months after the initial

report to the police.

Key issues: Experts increasingly

recognize that elder abuse, like

spousal violence and other forms

of family abuse, is a complex problem requiring multifaceted solutions. An evaluation of a domestic

violence intervention in the mid1980s found that victims were

more likely to call the police for

subsequent incidents if a police

officer–domestic violence counselor team intervened when police

were first called. Based on that

success, a field test was designed

to test the intervention with elder

abuse. The program consisted

either of public education about

elderly abuse, visits to families

where elder abuse occurred by a

police officer and domestic violence counselor, or both.

Key findings:

● The interventions were difficult

to implement. Only 50 percent of

targeted households received full

home visits, on average 56 days

Support for this research was provided through a transfer of funds to NIJ from 

the Office of Community Oriented Policing Services. COMMUNITY ORIENTED POLICING SERVICES

U.S. DEPARTMENT OF JUSTICE

Sarah V. Hart, Director
2

R e s e a r c h i n B r i e f 

Issues and Findings

...continued

and providing victims with crisis counseling, referrals, and court support.

New York City’s Domestic

Violence Prevention Project

One of the prototypes for today’s coordinated responses to family violence

is New York City’s Domestic Violence

Prevention Project (DVPP), which began

in 1983 as a joint project of the New

York Police Department and Victim

Services, Inc. (now called Safe Horizon).

DVPP pairs a police officer with a

domestic violence counselor to create a

team that visits homes several days after

an episode of family violence is reported

and police have made an initial patrol

response. The counselors speak to victims about the recurring nature of family

violence and the importance of reporting

incidents to the police. They develop

safety plans with victims and assess victims’ needs for counseling, shelter placement, financial assistance, employment

training, and other social services. The

police officer members of the team speak

to abusers, if present, and inform them

that the police will be monitoring the

household.

To evaluate DVPP, researchers designed

an experiment that randomly assigned

housing projects to receive education

about family violence through community

meetings and fliers.6 In addition, households reporting domestic incidents to the

police were randomly assigned either to

receive DVPP’s followup home visits or

to receive only the usual police patrol

response. Researchers successfully located and interviewed more than 7 in 10

eligible victims, an unusually high success rate for such a study.

In that study, after 6 months, researchers

found that households that received only

the home visits or home visits plus public

education were significantly more likely

to call the police about future incidents

than those who did not receive any special intervention. Yet the researchers

found no difference between groups in

terms of the violence victims reported to

the research interviewers. The evaluation

findings indicated that calls for police

services increased as a result of the intervention, but violence apparently did not.

The researchers interpreted those 

findings to mean that the intervention

increased victims’ confidence in the

police and made them more willing to

report violence. They further reasoned

that if the intervention had, indeed,

increased victims’ willingness to report

abuse to the police, violence should

eventually decrease. The 6-month followup interval, however, may have been

too short to adequately test for reduced

violence. Thus, they decided to replicate

the study using a 1-year followup interval and to study elder abuse rather than

family violence.

The elder abuse prevention

experiment

While elder abuse cases were not precluded from the DVPP evaluation, the

sample consisted primarily of spousal

abuse cases. Elder abuse represented

an especially interesting test of the program model for several reasons. Elders

may be even more dependent on their

abuser than victims of spousal violence.

For example, they may be physically

unable to live independent of the abuser.

They may find it too difficult to sever ties

to their own children or grandchildren.

The model for the elder abuse field test

was adapted from the DVPP model for

family violence. As in the domestic violence prevention experiment, researchers

chose as their target population persons

who reported elder abuse incidents to the

after the initial call to police.

Only 6 percent of elderly residents at targeted housing

projects attended educational

presentations. The interventions showed no measurable

effects on victims’ knowledge

of elder abuse issues or of

social services.

● Nonetheless, households

that received home visits and

were in housing projects that

received public education

called the police significantly

more often, and also reported

significantly higher levels of

physical abuse to research

interviewers than control

households.

● Households that received

home visits only (but were not

in projects receiving public

education) also called the

police significantly more often

than control households, but

they did not report more

abuse to interviewers. These

increased calls to police were

found 6 months after the trigger incident but disappeared

by 12 months.

Several explanations are possible for these unexpected findings. The most plausible may

be that the combined interventions incited abusers rather

than deterring them. (The

study did not provide direct

evidence on this point, however, because abusers were

not interviewed.)

The researchers speculate that

elder abuse victims are often

dependent on their abusers in

multiple ways and, compared

with domestic violence victims,

may have even less hope of

gaining independence from

their abusers.

Target audience: Policymakers, police, and victim

services personnel.
3

R e s e a r c h i n B r i e f 

police in selected public housing units

of New York City.

Thirty of 60 public housing projects

were randomly assigned to receive

public education. Posters were placed

in public areas, leaflets were distributed to all elderly residents, and

project staff made presentations that

discussed definitions of abuse, the

legal rights of victims, and assistance

available from the police and social

service agencies. In addition, in

all 60 housing projects, half of the

households reporting elder abuse to

the police were randomly assigned

to receive home visits by a team of

a police officer and a domestic violence counselor. The team discussed

legal options and police procedures

and attempted to link the households

to social services. Victims were also

encouraged to call the police if repeat

violence occurred. In the few cases 

in which the abusers were present,

the police officer made it clear to

them that police would monitor the

household.

To determine whether abuse continued

to occur, police records were checked

and victims were interviewed 6 and

12 months after the trigger incident.

(See “Research Methodology” for

details of the methods used in this

study and “A Snapshot of Elder

Abuse Cases” for characteristics

of the sample.)

A surprising finding

According to both interview results

and official measures, new incidents

of abuse were more frequent among

households that both received home

visits and were in housing projects that

received public education. As in the

domestic violence prevention experiment, households that received home

visits called the police significantly

more often than controls, both in the

housing projects that received public

education and in those that did not.

Unlike the domestic violence experiment, however, these increased calls

to police were somewhat paralleled by

increased reports of abuse to research

interviewers. That is, when households

both received home visits and were

in housing projects that received public education, victims of elder abuse

reported significantly higher levels of

physical abuse to research interviewers (compared with households that

received neither intervention or only

one of them). This contrasts with the

earlier domestic violence experiment,

in which increased calls to police concerning abuse were not paralleled by

increased reports of abuse to research

interviewers.

The new elder abuse findings about

the effects of public education and

home visitation are all the more surprising in light of the difficulties in

implementing these interventions

(see “Research Methodology”).

Exhibit 1 compares the different

groups using survey and official report

measures of abuse during the first 6

months following the trigger incident.

Exhibit 2 (on page 6) compares the different experimental treatments from 6

to 12 months after the trigger incident.

During this period, the differences

in calls to the police disappeared,

but households that received both

0

2

1

4

3

5

6

7

8

Physical abuse Psychological abuse Calls to police

No intervention Public

education only

Home 

visit only

Public education and

home visit

Number of incidents

Exhibit 1. New incidents of abuse: 6 months1

1As displayed, results show all households assigned to receive home visits, whether or not those 

visits were successfully completed. These results also hold if households with unsuccessful home 

visits are excluded.
4

R e s e a r c h i n B r i e f 

public education and home visits

continued to report significantly

more incidents of physical abuse

to research interviewers.

Why the unexpected results?

Program planners hypothesized that

the major effect of the public education and home visit interventions

would be increased confidence in the

police. In the short run, this effect

would manifest itself through a greater

propensity to call the police in response to abuse. In the long run, victims would report fewer incidents of

physical and psychological abuse.

As expected, the researchers found

that among people who received home

visits only or who received both home

● Receiving both interventions

caused more abuse to occur.

The first two explanations are appealing because they are more benign

than the third. Yet if the sensitization

hypothesis were true, psychological

abuse should have increased more

than physical abuse because psychological abuse is more ambiguous and

subtle. Increased sensitivity ought to

have been observed primarily in the

measure of psychological abuse rather

than in the measure of physical abuse.

The opposite, however, is what was

observed.

The second explanation—that persons

who received both interventions were

more willing to report abuse both to

police and to research interviewers—

visits and public education, calls to

the police occurred sooner and more

frequently than among other victims

in the sample. Contrary to expectation,

however, victims who received both

interventions were more likely to

report more physical abuse as well.

What sense can be made of these

findings? Three possible explanations

come to mind:

● Persons who received both interventions did not suffer more abuse

but had become more sensitized

to abuse.

● Persons who received both interventions were more willing to report

abuse both to police and to research

interviewers.

ublic education. The study randomly assigned public housing projects

to receive public education and randomly

assigned households to receive home visits in a nested experimental design.

Sixty public housing projects from three

police service areas in Manhattan were

sorted into pairs matched on income,

race, and family composition. One member of each pair was randomly assigned

to receive public education and the other

was assigned to the control group.

The public education was made possible

through the cooperation of the New

York City Housing Authority (NYCHA).

It consisted of hanging posters, distributing brochures, and making community

presentations. Brochures and posters

describing elder abuse and giving phone

numbers for assistance were distributed

to building managers. The managers

placed the posters in lobbies, laundry

rooms, mail areas, rental offices, and

other common areas. Brochures were

also delivered to the apartments of 

elderly residents.

Community presentations at targeted

housing projects generally took place in

the NYCHA senior center adjacent to the

housing project or at a local senior center during a tenant association meeting.

After introducing an example of elder

abuse from their caseload, presenters

proceeded to define elder abuse as a

crime and describe the different perpetrators, such as caregivers, family members living at home, spouses, and adult

children. Emotional, physical, sexual, and

financial abuse were defined as forms of

elder abuse, and a video was presented

to illustrate these concepts.

Presenters also explained the role of the

police and Victim Services senior specialists. Finally, presenters explained the

difference between family court and

criminal court and strategies for gaining

an order of protection.

Home visits. After the public education

was completed, researchers gathered

data in the 60 housing projects from the

403 residents who reported elder abuse

to the police during the next 10 months.

Residents were assigned by lottery either

to a home visit by a team consisting of

a police officer and domestic violence

counselor or to normal police followup

(an initial police patrol response and a

generic letter that offered assistance but

did not contain specific information on

elder abuse).

During home visits, the counselor informed victims of their legal options

in criminal and civil court, police procedures, and services available to assist

them (for example, relocation assistance,

emergency financial assistance, and

counseling). They were encouraged to

call the police if repeat violence occurred.

Research Methodology P
abusers in the sample were children

or grandchildren.) Thus, elder abuse

victims are, in some respects, more

“stuck” than victims of spousal abuse.

If abusers of elderly relatives become

angered by attempts to intervene, victims may have no options for escape.

Implications

If the combined intervention has the

potential to bring about more abuse,

how should such programs be conducted? One option would be to discontinue them entirely. But this is

an unsatisfying alternative because

society has a strong preference to

intervene on the behalf of victims.

Moreover, although the data extend

over a 12-month period, they do not

speak to the ultimate resolutions of

researchers did not interview abusers,

but precedents exist for such an outcome. David Ford, for example, reports

that batterers who were prosecuted to

conviction were significantly angrier

than those whose cases were diverted

or dropped.7

Also, an increase in abuse after intervention seems plausible when one considers the nature of relationships in

elder abuse cases. In domestic violence cases that come to the attention

of authorities, many victims ultimately

leave the abuser. In elder abuse cases,

however, victims may be more dependent, both physically and financially, on

the abuser. In addition, ties to one’s

children and grandchildren may be

harder to sever entirely than ties to

one’s spouse. (Two-thirds of the

5

R e s e a r c h i n B r i e f 

is also unlikely. Researchers found

no indication that these victims had

greater confidence in the police than

victims who did not receive the interventions. Victims who received the

interventions were no more likely to

express to interviewers their willingness to report future incidents of

abuse to authorities or to express 

satisfaction with the police.

How plausible is the third explanation—that receiving both interventions increased actual abuse? The

researchers had expected the interventions to suppress abusive behavior

by making abusers more circumspect.

Is it possible instead that the combined interventions may have incited

abusers? The study does not provide

direct evidence on this point because

The counselor also linked victims and

abusers to social services, including abuser intervention (respite care, caregiver

support groups, and substance abuse

treatment), health care assistance, or antiharassment measures (changing locks or

phone numbers, direct deposit of Social

Security checks, and so forth). When

abusers were present (less than 5 percent

of visits), the police officer also made

clear to them that the police would be

monitoring the household.

The difficulty of implementing community interventions. Community

interventions are difficult to implement.

Despite the efforts of the project, community residents may fail to attend community presentations. In fact, only 6

percent of the elderly residents (684 of

11,385) at the targeted housing projects

attended the presentations. Residents

may also ignore posters and brochures.

In surveys conducted 6 and 12 months

after their initial police contact, victims

living in housing projects receiving public

education failed to demonstrate any

greater awareness of services or knowledge of elder abuse than victims in the

other housing projects.

Home visits are also difficult to implement because residents may be difficult

to reach. Residents targeted for home

visits first received letters and phone calls

about the upcoming home visit. Two

attempts were then made to visit each

household. Nonetheless, only 50 percent

of victims targeted for home visits actually

received the full intervention. In another

23 percent of cases, some contact was

made with the household, generally by

telephone. In the remainder, the home

visit team left a letter and brochure.

The difficulty in reaching residents also

delayed many home visits. Although the

home visit was designed to occur within

a few days of the initial police contact,

home visits actually took place 56 days

after the initial call to police, on average.

The duration of home visits varied, but

most lasted less than 20 minutes: 37 percent lasted 5 to 10 minutes, 31 percent

lasted 10 to 20 minutes, 25 percent lasted 20 to 30 minutes, and 7 percent lasted

more than 30 minutes.

Tracking new abuse. One year after the

trigger incident, the researchers collected

data from police records on any new complaints of elder abuse filed by victims

within the previous 12 months.

At 6-month and 12-month intervals following the trigger incident, victims were

interviewed about new incidents of physical and psychological abuse. Victims were

primarily interviewed by telephone. The

completion rate was 69 percent for the

first interview and 67 percent for the

second interview.

Research Methodology (continued)
6

R e s e a r c h i n B r i e f 

these abusive relationships. It is possible, for example, that home visits and

public education bring issues associated with abuse to a head and, ultimately, to a resolution, sooner because

they exacerbate problems that otherwise would have continued to fester.

This research has raised serious questions that deserve further investigation.

What was it about these interventions

that apparently resulted in increased

subsequent abuse? And why did the

same basic intervention apparently

affect victims of domestic violence

and elder abuse differently?

Perhaps the best way to try to understand these paradoxical results is to

interview both abusers and victims.

From victims, researchers need to

better understand the dynamics of the

relationship between victim and abuser and to develop better measures of

the victim’s potential to gain independence from the abuser, if that is

the victim’s wish. Perhaps a measure

of potential for independence could

then be used as a control variable to

determine whether the intervention

has harmful consequences for some

victims (those who cannot escape)

and beneficial effects for others.

From abusers, researchers might obtain

insights into how such interventions

affect the abusers—their attitudes

toward the victim, their emotional

state, and their motivation to commit

abuse. Such research would be difficult to do well for several reasons:

The abusers might be difficult to

locate, might be unwilling to be interviewed, and would have strong incentives not to give honest responses to

all questions. Yet it is important that

this research be conducted so that

victims of elder abuse may be provided with the most effective and responsible service possible.

1

2

3

4

5

6

Physical abuse Psychological abuse Calls to police

No intervention Public

education only

Home 

visit only

Public education and

home visit

Number of incidents

0

Exhibit 2. New incidents of abuse: 12 months

ictim characteristics. Victims

were overwhelmingly female and minority; 81 percent were women, 66 percent were black, and 30 percent were

Latino. The median age was 65 years.

Although income level varied, 39 percent reported incomes between $5,001

and $9,999 and 17 percent reported

incomes of less than $5,000. Eightyfour percent of the sample reported

having a high school education or less.

Twenty-eight percent were on disability.

Almost half (45 percent) lived with their

abuser, but it is not known whether the

home belonged to the victim or the

abuser or who was paying the majority

of the rent.

Abuser characteristics. Perpetrators

were largely male (66 percent). Their

median age was 36 years; 25 percent

were younger than age 25. The race

of the perpetrators reflected that of the

victims: 65 percent were black and 30

percent were Latino. Four-fifths of the

perpetrators were related to the victim:

53 percent were children, 19 percent

were grandchildren, 16 percent were

romantic intimates (either spouses or

boyfriends/girlfriends), and 12 percent

were other relatives.

Episode characteristics. Forty-nine

percent of the trigger incidents involved

only verbal arguments. Most others

were classified by the police as family

disputes (15 percent) and misdemeanor

offenses (9 percent). Physical injuries

were reported by the police in 4 percent of incidents and hospitalization

of the victim occurred following in

3 percent of incidents.

V A Snapshot of Elder Abuse Cases
7

R e s e a r c h i n B r i e f 

Notes

1. U.S. Bureau of the Census, Statistical

Abstracts of the United States (11th ed.).

Washington, D.C.: U.S. Department of

Commerce, Bureau of the Census, 1991.

2. National Center on Elder Abuse, “Elder

Abuse Information Series, No. 2.” Available

online at http://www.elderabusecenter.org/

basic/fact2.pdf.

3. Tatara, T., “Understanding the Scope and

Nature of Domestic Elder Abuse with the Use

of State Aggregate Data: Summaries of Key

Findings of a National Survey of State APS and

Aging Agencies,” Journal of Elder Abuse and

Neglect 5(1993): 35–57.

4. Wolf, R.S., “Elder Abuse and Neglect: An

Update,” Reviews in Clinical Gerontology

7(2)(1977): 177–182.

5. Philips, L., “Abuse and Neglect of the 

Frail Elderly at Home: An Exploration of

Theoretical Relationships,” Journal of

Advanced Nursing 8(5)(1983): 379–392;

Pillemer, K.A., and D. Prescott, “Psychological

Effects of Elder Abuse,” Journal of Elder

Abuse and Neglect 1(1989): 65–73; Wolf, R.S.,

and K.A. Pillemer, Helping Elderly Victims:

The Reality of Elder Abuse. New York:

Columbia University Press, 1989; Harris, S.,

“For Better or for Worse: Spouse Abuse Grown

Old,” Journal of Elder Abuse and Neglect

8(1996): 365–380.

6. Davis, R.C., and B. Taylor, “A Proactive

Response to Family Violence: The Results of

a Randomized Experiment,” Criminology

35(2)(1997): 307–333.

7. Ford, D.A., “Preventing and Provoking

Wife Battery Through Criminal Sanctioning: A

Look at the Risks.” In Abused and Battered:

Social and Legal Responses to Family

Violence, ed. D.D. Knudsen and J.L. Miller,

New York: Aldine de Gruyter, 1991: 191–209.

Robert C. Davis is senior research

associate at the Vera Institute of

Justice in New York City.

Juanjo Medina-Ariza is a lecturer in

criminology and social policy in the

Department of Applied Social Science

at the University of Manchester in

England.

The study reported here was supported

by grant number 95–IJ–CX–0061 to

Victim Services, Inc., of New York by

the National Institute of Justice and

the Office of Community Oriented

Policing Services.

Copies of the full report, “Reducing

Repeat Incidents of Elder Abuse:

Results of a Randomized Experiment”

(NCJ 189086), are available for a fee

from the National Criminal Justice

Reference Service by calling

800–851–3420. Documents under

25 pages are $10.00 each; documents

25 pages and over are $15.00 each.

The dataset for this report (ICPSR

#3130), “Effectiveness of a Joint

Police and Social Services Response to

Elder Abuse in Manhattan [New York

City], New York, 1996–1997,” is

available online through the National

Archive of Criminal Justice Data

at the University of Michigan at

http://www.icpsr.umich.edu/NACJD/

Findings and conclusions of the research

reported here are those of the author and do

not necessarily reflect the official position or

policies of the U.S. Department of Justice. 

The National Institute of Justice is a 

component of the Office of Justice 

Programs, which also includes the Bureau

of Justice Assistance, the Bureau of Justice

Statistics, the Office of Juvenile Justice and

Delinquency Prevention, and the Office for

Victims of Crime.

NCJ 188675

This and other NIJ publications can be

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