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America’s Growing Elderly Population

America's Growing Elderly Population

In the United States, the 2010 Census recorded the greatest number and proportion of people age 65 and older in all of decennial census history: 40.3 million, or 13% of the total population. This “Boomer Generation” effect will continue for decades.1

By 2050, people age 65 and older are expected to comprise 20% of the total U.S. population. The fastest growing segment of American’s population consists of those 85 and up.2 In 2010, there were 5.8 million people aged 85 or older. By 2050, it is projected that there will be 19 million people aged 85 or older.3

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Elder Abuse: The Size of the Problem

Elder mistreatment (i.e. abuse and neglect) is defined as intentional actions that cause harm or create a serious risk of harm (whether or not harm is intended) to a vulnerable elder by a caregiver or other person who stands in a trust relationship to the elder. This includes failure by a caregiver to satisfy the elder’s basic needs or to protect the elder from harm.4

Unfortunately, we simply do not know for certain how many people are suffering from elder abuse and neglect. It appears that female elders are abused at a higher rate than males and that the older one is, the more likely one is to be abused.5

Signs of elder abuse may be missed by professionals working with older Americans because of lack of training on detecting abuse. The elderly may be reluctant to report abuse themselves because of fear of retaliation, lack of physical and/or cognitive ability to report, or because they don’t want to get the abuser (90% of whom are family members) in trouble.

Below is a sampling of findings that show what is known about the incidence and prevalence of elder abuse and neglect:

  • The most recent major studies on incidence reported that 7.6%–10% of study participants experienced abuse in the prior year.6,7 The study that found an incidence of 1 in 10 adults experiencing abuse did not include financial abuse.8
  • Available data from state Adult Protective Services (APS) agencies show an increasing trend in the reporting of elder abuse.
  • Despite the accessibility of APS in all 50 states (whose programs are quite different), as well as mandatory reporting laws for elder abuse in most states, an overwhelming number of cases of abuse, neglect, and exploitation go undetected and untreated each year.
  • One study estimated that only 1 in 14 cases of elder abuse ever comes to the attention of authorities.9 The New York State Elder Abuse Prevalence Study found that for every case known to programs and agencies, 24 were unknown.10
  • Major financial exploitation was self-reported at a rate of 41 per 1,000 surveyed, which was higher than self-reported rates of emotional, physical, and sexual abuse or neglect.10

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Who are the Perpetrators of Elder Abuse?

  • Perpetrators are most likely to be adult children or spouses, more likely to be male, to have history of past or current substance abuse, to have mental or physical health problems, to have history of trouble with the police, to be socially isolated, to be unemployed or have financial problems, and to be experiencing major stress.11
  • In a study of 4,156 older adults, family members were the most common perpetrators of financial exploitation of older adults (57.9%), followed by friends and neighbors (16.9%), followed by home care aides (14.9%).12
  • In a sample of 5,777 older adults 60 or above, when comparing across types of mistreatment, a higher proportion of perpetrators of physical mistreatment (compared to emotional and sexual mistreatment) had problems with police, received psychological treatment, were using substances at the time of the incident, lived with the victim, and were related to the victim.13
  • A study on elder financial abuse found that instances of fraud perpetrated by strangers comprised 51% of articles related to elder financial abuse, followed by family, friends, and neighbors (34%), the business sector (12%), and Medicare and Medicaid fraud (4%). Nearly 60% of perpetrators were men, mostly between the ages of 30 and 59.14

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Abuse of Those with Disabilities

Approximately 14 million U.S. adults aged 65 and over and 19 million U.S adults aged 18 to 64 have a disability.15 Unfortunately, some of these vulnerable adults are abused by family members, service providers, care assistants and others. This abuse places the victim’s health, safety, emotional wellbeing, and ability to engage in daily life activities at risk.

Below is a sampling of research findings relating to abuse of adults with disabilities:

  • Institutionalized adult women with disabilities reported a 33% prevalence of having ever experienced interpersonal violence (IPV) versus 21% for institutionalized adult women without disabilities.16
  • When considering lifetime abuse by any perpetrator, a sample of 200 adult women with disabilities indicated that 67% had experienced physical abuse and 53% had experienced sexual abuse.17
  • In a study of 342 adult men, 55% of men experienced physical abuse by any person after becoming disabled. Nearly 12% of these men stated they experienced physical abuse by a personal assistance service provider over their lifetime.18
  • In a comprehensive review of literature published from 2000–2010, lifetime prevalence of any type of IPV against adult women with disabilities was found to be 26–90%. Lifetime prevalence of IPV against adult men with disabilities was found to be 28.7–86.7%. It was concluded that, over the course of their lives, IPV occurs at disproportionate and elevated rates among men and women with disabilities.19

Find a research-based fact sheet on abuse of adults with a disability.

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Dementia and Elder Abuse

Research indicates that people with dementia are at greater risk of elder abuse than those without.20,21 Approximately 5.1 million American elders over 65 have some kind of dementia. Close to half of all people over 85, the fastest growing segment of our population, have Alzheimer’s disease or another kind of dementia. By 2025, most states are expected to see an increase in Alzheimer prevalence.22 One 2009 study revealed that close to 50% of people with dementia experience some kind of abuse.23 A 2010 study found that 47% of participants with dementia had been mistreated by their caregivers.24

Find a research-based fact sheet on abuse of those with dementia.

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Abuse in Nursing Homes and other Long Term Care Facilities

Elder abuse occurs in community settings, such as private homes, as well as institutional settings like nursing homes and other types of long term care facilities. 3.2 million Americans resided in nursing homes during 2008.25,26

Below is a sampling of research findings relating to abuse in long term care facilities:

  • 7% of all complaints regarding institutional facilities reported to long term care Ombudsmen were complaints of abuse, neglect, or exploitation.27
  • In 2000, one study interviewing 2,000 nursing home residents reported that 44% said they had been abused and 95% said they had been neglected or seen another resident neglected.28
  • A May, 2008 study conducted by the U.S. General Accountability Office revealed that state surveys understate problems in licensed facilities: 70% of state surveys miss at least one deficiency and 15% of surveys miss actual harm and immediate jeopardy of a nursing home resident.29

Find a research based fact sheet on abuse of residents of long term care facilities

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Impact of Elder Abuse

Elders who experienced abuse, even modest abuse, had a 300% higher risk of death when compared to those who had not been abused.30 Research has also shown that victims of elder abuse have had significantly higher levels of psychological distress and lower perceived self-efficacy than older adults who have not been victimized.31 In addition, older adults who are victims of violence have additional health care problems than other older adults, including increased bone or joint problems, digestive problems, depression or anxiety, chronic pain, high blood pressure, and heart problems.32

The impact of abuse, neglect, and exploitation also has a profound fiscal cost. The direct medical costs associated with violent injuries to older adults are estimated to add over $5.3 billion to the nation’s annual health expenditures33, and the annual financial loss by victims of elder financial exploitation were estimated to be $2.9 billion in 2009, a 12% increase from 2008.34

Find a research based fact sheet on abuse of residents of long term care facilities.

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1U.S. Dept. of Commerce, U.S. Census Bureau. (2011) The older population: 2010 (Publication C2010BR-09). Washington, D.C.: Author.

2U.S. Dept. of Commerce, U.S. Census Bureau. (2008) Population projections, 2008. Washington, D.C: Author.

3U.S. Dept. of Commerce, U.S. Census Bureau. (2010) The next four decades: The older population in the united states: 2010 to 2050 (Publication P25-1138). Washington, D.C.: Author.

4Bonnie, R, & Wallace, R (Eds.). (2003). Elder mistreatment: Abuse, neglect and exploitation in an aging America. Washington, DC: National Academies Press.

5National Center on Elder Abuse, Westat, Inc. (1998). The national elder abuse incidence study: Final report. Washington D.C.: Authors

6Lifespan of Greater Rochester, Inc., Weill Cornell Medical Center of Cornell University. & New York City Department for the Aging. (2011) Under the Radar: New York State Elder Abuse Prevalence Study. New York: Author.

7Acierno R, Hernandez MA, Amstadter AB, Resnick HS, Steve K, Muzzy W, et al. (2010). Prevalence and correlates of emotional, physical, sexual, and financial abuse and potential neglect in the United States: The national elder mistreatment study. American Journal of Public, 100(2), 292-297.

8Teaster PB, Dugar T, Mendiondo M, Abner EL, Cecil KA, & Otto JM. (2004). The 2004 survey of adult protective services: Abuse of adults 60 years of age and older. Washington DC: National Center on Elder Abuse.

9National Research Council. (2003) Elder mistreatment: Abuse, neglect and exploitation in an aging America. Washington, D.C.: The National Academies Press.

10Lifespan of Greater Rochester, Inc., Weill Cornell Medical Center of Cornell University. & New York City Department for the Aging. (2011) Under the Radar: New York State Elder Abuse Prevalence Study. New York: Author.

11Lachs, M., and Pillemer, K. (2015). Elder Abuse. New England Journal of Medicine, 373: 1947-56. DOI: 10.1056/NEJMra1404688.

12Peterson, J., Burnes, D., Caccamise, P., Mason, A., Henderson, C., Wells, M., Lachs, M. (2014). Financial Exploitation of Older Adults: A Population-Based Prevalence Study. Journal of General Internal Medicine, 29(12), 1615-23. doi: 10.1007/s11606-014-2946-2.

13Amstadter, A., Cisler, J., McCauley, J., Hernandez, M., Muzzy, W., and Acierno, R. (2011). Do Incident and Perpetrator characteristics of Elder Mistreatment Differ by Gender of the Victim? Results from the National Elder Mistreatment Study. Journal of Elder Abuse & Neglect, 23: 43-57. doi: 10.1080/08946566.2011.534707

14National Committee for the Prevention of Elder Abuse, Virginia Tech, Metlife Mature Market Institute (2011). The MetLife Study of Elder Financial Abuse: Crimes of Occasion, Desperation, and Predation Against America’s Elders (PDF). New York, NY.

15U.S Census Bureau (2010). Census 2010, American Fact Finder. Washington, D.C: Author

16Barrett, K. A., O’Day, B., Roche, A., & Carlson, B. L.(2009). Intimate partner violence, health status, and health care access among women with disabilities. Women’s Health Issues, 19(2), 94-100.

17Powers, L., Curry, M., Oschwald, M., Maley, S., Saxton, M. & Eckels, K. (2002). Barriers and strategies in addressing abuse: A survey of disabled women’s experiences. Journal of Rehabilitation, 68(1), 4-13.

18Powers, L, Saxton, M., Curry, M. Powers, J., Mc-Neff, E. & Oschwald, M. (2008). End the silence: A survey of abuse against men with disabilities. Journal of Rehabilitation, 74(4), 41-53.

19Hughes, R., Lund, E., Gabrielli, J., Powers, L, & Curry, M. (2011). Prevalence of interpersonal violence against community-living adults with disabilities: A literature review. Rehabilitation Psychology, 56(4), 302-319.

20Cooney C, Howard R, Lawlor B. (2006) Abuse of vulnerable people with dementia by their carers: Can we identify those most at risk? International Journal of Geriatric Psychiatry, 21(6), 564-571.

21Vande Weerd C, Paveza G. (2006) Verbal mistreatment in older adults: A look at persons with Alzheimer's disease and their caregivers in the state of Florida. Journal of Elder Abuse & Neglect, 17(4), 11-30.

22Alzheimer’s Association. (2009). Alzheimer’s Disease Facts and Figure. Chicago, IL: Author

23Cooper, C, Selwood, A,, Blanchard, M., Walker, Z., Blizard, R., & Livingston, G. (2009) Abuse of people with dementia by family carers: Representative cross sectional survey. British Medical Journal, 338, b155

24Wiglesworth A, Mosqueda L, Mulnard R, Liao S, Gibbs L, & Fitzgerald W. (2010). Screening for abuse and neglect of people with dementia. .Journal of the American Geriatrics Society.58(3), 493-500.

25U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. (2009) Nursing Home Data Compendium. Washington, D.C.: Author.

26National Center for Assisted Living. (2009). Assisted Living Resident Profile. Washington DC: Author.

27U.S. Department of Health and Human Services, Administration on Aging. (2010). 2010 National ombudsman reporting system data tables. Washington, DC: Author.

28Broyles, K. (2000). The silenced voice speaks out: A study of abuse and neglect of nursing home residents. A report from the Atlanta Long Term Care Ombudsman Program and Atlanta Legal Aid Society to the National Citizens Coalition for Nursing Home Reform. Atlanta, Ga: Authors.

29U.S. Government Accounting Office (2008). Nursing Homes: Federal Monitoring Surveys Demonstrate Continued Understatement of Serious Care Problems and CMS Oversight Weaknesses (Publication GAO–08-517).

30Dong X, Simon M, Mendes de Leon C, Fulmer T, Beck T, Hebert L, et al. (2009) Elder self-neglect and abuse and mortality risk in a community-dwelling population. Journal of the American Medical Association, 302(5),517-526.
Dong X, Simon MA, Beck T, Farran, C., McCann, J., Mendes de Leon, C, et al. (2011). Elder abuse and mortality: The role of psychological and social wellbeing. Gerontology, 57(6), 549-558.
Lachs MS, Williams CS, O'Brien S, Pillemer KA, & Charlson ME. (1998). The mortality of elder mistreatment. Journal of the American Medical Association, 280(5),428-432.

31Comijs, H.C., Penninx, B.W.J.H., Knipscheer, K.P.M., & van Tilburg, W. (1999). Psychological distress in victims of elder mistreatment: The effects of social support and coping. Journal of Gerontology, 54B(4), 240-245.

32Bitondo Dyer C., Pavlik V. N., Murphy K. P., and Hyman D. J. (2000). The high prevalence of depression and dementia in elder abuse or neglect. Journal of the American Geriatrics Society. 48, 205-208.
Burt,M. and Katz, B. (1985). Rape, robbery, and burglary: Responses to actual and feared criminal victimization, with special focus on women and the elderly. Victimology: An International Journal, 10, 325-358.
Mouton C. P., Espino D. V. (1999). Problem-orientated diagnosis: Health screening in older women. American Family Physician, 59, 1835.
Fisher, B.S., and Regan, S.L. (2006). The extent and frequency of abuse in the lives of older women and their relationship with health outcomes. The Gerontologist, 46, 200-209.
Coker, A., Davis, K., Arias, I., Desai, S., Sanderson, M., Brandt, H., et al. (November 2002). Physical and mental health effects of intimate partner violence for men and women. American Journal of Preventive Medicine, 24(4), 260-268.
Stein, M. & Barrett-Connor, E. (2000). Sexual assault and physical health: Findings from a population-based study of older adults.” Psychosomatic Medicine, 62, 838-843.

33Mouton CP, Rodabough RJ, Rovi SL, Hunt JL, Talamantes MA, Brzyski RG et al. (2004) Prevalence and 3-year incidence of abuse among postmenopausal women. American Journal of Public Health, 94(4),605-612.

34National Committee for the Prevention of Elder Abuse, Virginia Tech, Metlife Mature Market Institute (2011). The metlife study of elder financial abuse: Crimes of occasion, desperation and predation against america's elders. Westport, CT: Authors

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