Elder mistreatment

Elder mistreatment (EM) is a serious and prevalent syndrome that is estimated to affect between 500,000 to 1.2 million older adults in the United States annually (Pillemer & Finkelhor, 1988). This chapter reviews both the state of the published science and limitations in the knowledge base on the topic. The literature for this review was obtained through computer-assisted searches of PubMed (878 citations), the Cumulative Index of Nursing Research (CINAHL) (593 citations) and Psych-Info databases (443 citations). The search terms used were elder mistreatment, elder neglect, elder abuse, or domestic abuse of the elderly. No limit was placed on the age of publications because of the relative scarcity of research on the subject. Nonnursing articles were included because there are so few nurse researchers addressing this topic. The age limit for subjects in these studies was 65 years and older. Studies were limited to those conducted in the United States, and descriptive studies were included as they form the majority of the research to date. Findings indicate that frail, very old (over 75 years), older adults who have a diagnosis of depression or dementia are more likely to be mistreated (Dyer, Pavlik, Murphy, & Hyman, 2000; Coyne, Reichman, & Berbig, 1993; Fulmer & Gurland, 1996; Lachs & Pillemer, 1995; Lachs et al., 1997; Lachs, Williams, O'Brien, Pillemer, & Charlson, 1998; Lachs & Fulmer, 1993; Lachs, Berkman, Fulmer, & Horwitz, 1994). Those older adults who required assistance with activities of daily living had poor social networks and were at higher risk for EM (Lachs & Pillemer, 1995; Lachs et al., 1997; Lachs et al., 1998; Lachs & Fulmer, 1993; Lachs et al., 1994). Neglect, as a subcategory of EM, accounts for the majority of cases (Fulmer, Paveza, Abraham, & Fairchild, 2000; Pavlik, Hyman, Festa, & Bitondo Dyer, 2001; Fulmer & Gurland, 1996). There is still debate regarding the role of minority status, abuse in childhood, and the persons most likely to mistreat older adults. There is a critical need for replication studies and new research on this important topic. Problems with measurement, funding challenges, and the paucity of investigators conducting research on EM have left the field with several unanswered questions and some conflicting findings. This chapter summarizes the interdisciplinary literature and makes recommendations for future nursing research programs.