Elder Abuse and Neglect: Considerations for Mental Health Practitioners.

Elder abuse and neglect are prevalent throughout the U.S. and are often unrecognized and untreated. It is projected that by the year 2030, the number of older adults (age 60 and older) will double, thereby increasing the likelihood that mental health practitioners will encounter instances of elder abuse and neglect. The authors address the symptoms, risk factors, consequences, current laws, interventions, and relevant prevention strategies related to these issues. ********** Elder abuse is, unfortunately, a devastating and largely unrecognized problem in the United States. According to the National Center on Elder Abuse (NCEA; 1998), more than 550,000 persons, older than 60 years of age, experience abuse and neglect in domestic settings. Moreover, approximately 84% of incidences go unreported (Levine, 2003). Many older victims of abuse decide not to disclose mistreatment because they fear abandonment, institutionalization, and severe repercussions from the abuser (Cyphers, 1999). A significant number of older adults are also unaware of available services, and in some communities, services are virtually nonexistent (Welfel, Danzinger, & Santoro, 2000). It is reasonable to surmise that mental health practitioners will encounter elder abuse and neglect because the population of older persons is steadily growing and people are living longer. Nevertheless, practitioners are rarely trained to recognize the signs of abuse and neglect, and many practitioners lack current knowledge on the appropriate response, treatment, and/or prevention of elder abuse (Schwiebert, Myers, & Dice, 2000; Welfel et al., 2000). Consequently, the purpose of this article is to alert mental health practitioners to the scope of the problem, potential causes, symptoms, risk factors, and consequences of elder abuse and neglect. Current laws, interventions, and preventions regarding elder abuse are addressed. DESCRIPTION OF THE PROBLEM Operational Definitions There are currently numerous conflicting definitions of elder abuse, but the general consensus in the literature is that elder abuse is "any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult" (NCEA, n.d., Frequently Asked Questions section). Although this narrowly defined definition seems fairly clear-cut, it is often challenged and sometimes refuted. A significant cadre of researchers (Cyphers, 1999; Dyer, Pavlik, Murphy, & Hyman, 2000; Levine, 2003; Nerenberg, 2000) have contended that it is not necessary for a perpetrator to be involved, arguing that self-neglect is a form of elder abuse. There also exists a reasoned school of research (Kosberg & Garcia, 1995; Quinn & Tomita, 1997; Reay & Browne, 2002; Wolf, 1998) that maintains any definition of abuse should be limited to intentional acts. Still others argue that using the term abuse deters individuals from seeking help because of the stigma attached to the word (Nerenberg, 2000). This lack of consensus and consistency inhibits researchers, service developers, policy makers, and program planners in identifying, developing, and studying effective services (Cyphers, 1999; Nerenberg, 2000). Therefore, a major task of the National Elder Abuse Incidence Study (NEAIS; NCEA, 1998) was to develop a standardized definition of elder abuse. The NEAIS (NCEA, 1998) and the NCEA (n.d., The Basics section) identified and defined seven subcategories of abuse: physical abuse, sexual abuse, emotional or psychological abuse, financial exploitation, abandonment, neglect, and self-neglect. Physical abuse is defined as the use of physical force that may result in bodily injury and includes "acts of violence such as hitting, striking, kicking, beating, pushing, shoving, shaking, pinching, burning, the inappropriate use of drugs and physical restraints, force-feeding, and physical punishment of any kind" (NCEA, n. …