National Center on Elder Abuse
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National Center on Elder Abuse
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HHS Administration for Community Living websites devoted to supporting Elder Justice
Interventions
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A number of strategies have been identified to aid the prevention and response to elder mistreatment. They range from interpersonal and community-based supports, to restorative and criminal justice remedies. Multidisciplinary teams represent another model of intervention developed to respond to the needs of older adults who have experienced abuse. Professional provider education and public awareness, as well, are established and growing efforts to bolster primary prevention. These models are addressed in greater detail below.
Studies have recommended implementation of harm reduction response interventions that align with the older adult’s preferred case resolution. Goal attainment scaling has been proposed as an approach tailored to meet the older adult’s individual needs. Using this model, each older person determines their own desired outcome or goal from a stated intervention.216 Another model suggests a severity framework to guide person-centered outcome measures.
This construct shifts the focus from binary remedies to nuanced interventions which consider the complexity, variability, and spectrum of mistreatment. This person-centric approach is tailored to the victim’s circumstances, needs, presenting harm, risk of recurrence, and contextual considerations.217
Other models have contemplated comprehensive approaches to intervention that go beyond victim-directed responses to holistically embrace the victim’s relationship with the offender, the context of abuse, and the home environment.218
Leading researchers in the field agree that high quality research is a requisite to evaluate and affirm best practice strategies to address elder mistreatment.219
Social Support
Low social support is one of the most common risk factors for abuse across types.220 Conversely, the presence of a social network may act as a protective influence to help prevent abuse. Available social resources may also mitigate adverse outcomes such as poor health and diminished mental health in the aftermath of mistreatment.221
The degree and tenor of social interactions have been found to impact an older adult’s perceived social support and susceptibility to abuse. Negative exchanges may lower the level of apparent support or contribute to an environment more conducive to perpetrator misconduct.222
Social reserves may be drawn from informal family, friend, and faith networks. Formal supports include institutional response systems such as law enforcement, Adult Protective Services, and the Long-term Care Ombudsman, addressed below. They also embrace formal health services such as homecare and community-based programs.223
Several community-based response models have been advanced to prevent and respond to elder mistreatment. Among them, Age-friendly Health Systems (AFHS) suggests a construct for screening older adults for abuse across health care settings. AFHS uses the 4M framework, namely, What Matters, Medication, Mentation, and Mobility in primary care, emergency departments, and long-term care facilities to detect and respond to suspected abuse.224
Adult Protective Services
Adult Protective Services (APS) is the most widely used intervention to address elder mistreatment and neglect. This social services agency is charged with investigating allegations of abuse and neglect and facilitating appropriate remedies. Interventions may embrace referrals to law enforcement and result in criminal prosecution. APS may make recommendations for protective elder abuse retraining orders or guardianships. Caseworkers may also suggest and help implement restorative resolutions.
APS arose out of Title XX of the Social Security Act of 1974, which provided federal funding to states to develop APS programs. In response, each state developed its own APS organization and infrastructure.225 Current APS systems are separately funded and administered by state and local governments. To date, no dedicated federal funds have been directly distributed to state APS agencies.226
Programs differ among states and between counties as to client eligibility and available resources. A California study evaluating APS investigations across county jurisdictions reported significant variability in findings.227 To better ensure consistent APS policies and practices nationwide, a working group of experts developed the Voluntary Consensus Guidelines for State APS Systems to provide a framework for state APS rules and laws. The guidelines address domains of program administration, response times, reports, investigations, interventions, training, and program evaluation. 228 229 The National Adult Maltreatment Reporting System (NAMRS) collects quantitative and qualitative data on APS
practices and policies and the outcomes of investigations, as reported to APS agencies.230 The results are contained in The Adult Maltreatment Data Report231
All states, except New York, require statutorily specified professionals to report incidents of suspected elder abuse to reporting agencies, including APS. Mandatory reporters may include healthcare professionals, social service providers, caregivers, clergy, financial institutions, among others. The list of mandated reporters as defined by state statute can be accessed here. Generally, individuals who have experienced abuse must consent to APS services and interventions. Older people with decisional capacity may decline APS assistance. Under certain circumstances, APS may render involuntary protective assistance to individuals who lack capacity or when the exigencies of the situation require intervention. A screening tool has been developed to assess the decisional capacity of abused and neglected older adults.232
Studies have been conducted to evaluate older adults’ utilization of APS services,233 examine barriers to victim self-reports,234 and measure older adults’ satisfaction with APS services and investigations.235 Researchers have explored the effectiveness of APS outcomes236 237 and means to measure person-centered case resolutions.238 239
Long-term Care Ombudsman
Like APS efforts in the community, long-term care ombudsmen investigate allegations of abuse in facilities. Ombudsmen serve as advocates who act at the behest of residents to help resolve complaints, protect their rights, and improve systemic problems in long-term care. 240
The Long-term Care Ombudsman Program was authorized in 1978 under the Older Americans Act to establish a consumer advocacy program intended to maintain or improve the quality of life for long-term care residents. Administered at the state level, programs employ both paid and volunteer ombudsmen to investigate complaints.241
Data regarding program activities, including facility visits, complaints, information and assistance provided, and community education are reported in the National Ombudsman Reporting System (NORS), which is housed on the Administration for Community Living’s website. Additional data is available through the AGing, Independence, and Disability (AGID) Program Data Portal. Both NORS and AGID Reports are publicly accessible.242
Forensic Centers and Multidisciplinary Teams
Cases of elder abuse are often complex and multifactorial, invoking several different and disparate domains of practice. A single case may intersect social service, health care, law enforcement, and civil legal disciplines. Multidisciplinary teams (MDT) provide regular, coordinated elder mistreatment case review across practice areas. Integrated case review is associated with greater interagency collaboration, intended to enhance the efficient delivery of remedial assistance to older victims of abuse.243
Team characteristics, program structures, resources, constituent members, and processes differ by team.244 MDT’s typically have a geriatric health, social service, mental health, law enforcement, victim advocate, and prosecutorial presence. 245 More recently, some MDTs have added forensic accountants to their teams.246 One type of MDT, the elder abuse forensic center (FC), applies forensic science to address complicated cases of abuse.247 248 FC’s often support the efforts of frontline workers and include conducting home visits to assess older adult’s medical and mental health capacities. 249
MDTs continue to replicate across urban and rural areas across the country.250 As a response to elder mistreatment, MDTs have demonstrated promise as an effective intervention.251 As teams grow, researchers have suggested that the field develop a coordinated, uniform data collection strategy to advance best practices.252
Awareness, Education, and Training
Community awareness campaigns continue to be an important approach to enhance understanding of aging and elder abuse. World Elder Abuse Awareness Day (WEEAD), celebrated across the United States and internationally since 2006, continues to be an annual platform for global awareness, recognition, and engagement.253 By increasing recognition of the issues, awareness and educational platforms may help recast public perceptions of older people and shift behaviors of aging.254
The Reframing Aging and Reframing Elder Abuse initiatives have developed evidence-based communication strategies to increase public awareness and promulgate systemic solutions to prevent and address elder abuse.255 In collaboration with the Frameworks Institute, the NCEA created a public communications strategy recontextualizing elder abuse as a social justice imperative. Access this link for more information about reframing elder abuse.
Educational programs have also been identified as an intervention. Older people can receive instruction in understanding the risks factors associated with mistreatment and the availability of helping agencies and resources.256
For example, the Keep Control campaign in Dublin, Ireland is a strengths-based intervention which empowers older adults to protect themselves from financial abuse.257
Middle school students to undergraduates have been found to benefit from classroom education on aging and ageism.258 259Intergenerational programs have also been identified to increase awareness and reduce age bias and discrimination.260 Studies have reported on the efficacy of intergenerational service learning,261 pen pal projects,262 and art activities.263
Professional provider instruction and training in the signs and symptoms of elder mistreatment is an essential intervention. Healthcare providers are often best positioned to detect mistreatment, report abuse, and identify helping resources. In addition to medical and mental health clinicians, educating other mandatory reporters, as designated by state statute, is a key component to prevention and early identification of abuse. For additional information, see Interdisciplinary Professions and Elder Abuse above.
Financial Management
Diminished financial management abilities and reduced cognitive function have been identified among the risk factors that predispose older adults to financial exploitation. Evidence-based approaches such as the Success After Financial Exploitation (SAFE) program, developed by the Lifespan Fraud and Scams Prevention program in Rochester, New York, educate and coach older adults on finances and money management. They also provide information on fraud and scams to professionals who work with older people.264 In addition to providing education, elder financial programs may help older adults respond to consequential financial hardships in the wake of exploitation.
Restorative Justice
As noted above, cases of elder abuse are often complex and multilayered. Traditional interventions, such as criminal justice and social service remedies, may not be the preferred resolution for older adults at the center of conflict. More recently, as person-centered outcomes have risen to the fore, restorative justice approaches have gained increased currency.
Researchers have found that restorative processes have the potential to prevent social isolation, a predictor of abuse, and serve as an alternative remedy for abuse.265 Specifically, researchers have drawn attention to restorative processes to educate offenders on harmful behaviors, mitigate social isolation, heal relationship rifts, and support overwhelmed caregivers.266
Trauma-informed Response
Recent articles have addressed the application of trauma-informed care principles to older people who have experienced abuse in later life and compounding harms across the lifespan. This holistic, conceptual framework recognizes the collective neurological, biological, psychological, and socio-cultural impacts of trauma and the weight that burden places on individuals, families, and communities. A trauma-informed approach incorporates the six principles of safety, trust, peer support and self-help, collaboration, empowerment, voice, and choice. With these principles in mind, trauma-informed services integrate person-centered care and tailored services to empower elders, improve the community response, and reduce the risk of revictimization.267
Service Advocate
Another client-centered, restorative practice that has emerged is the Service Advocate Model. This approach developed as an extension of forensic center services. Working within the forensic center, the Service Advocate provides case management, crisis intervention, and supportive services to forensic center clients. The Advocate promotes client wellbeing and self-efficacy, while balancing their preferences and protective interests. The Service Advocate may also offer resources and services to the offender to promote safety and wellbeing within the caregiver/client dyad.268
Elder Mediation
Elder mediation is a community-based, voluntary intervention that has been utilized to help older adults and their family members resolve conflict.269 It is a specialized form of dispute resolution that addresses conflicts arising within the context of aging and elder issues. Typically, a neutral, impartial mediator assists parties to collaboratively arrive at mutual agreement using an interests-based, solutions-oriented approach. The focus is generally client-centered, with an emphasis on preserving elder rights, preferences, and needs. Education, care planning, and resource dissemination may be part of the recommended resolution. Studies have found that mediation may be an effective strategy to prevent or end financial abuse.270
Elder Shelters
Elder shelters, such as the prototype Weinberg Center for Elder Justice in New York, provide a safe haven and resources to older adults who have been abused. Beyond providing a home, medical care, and provisions, shelters can be a hub for a coordinated, interdisciplinary community response to abuse.271 Advocates help residents access their legal rights and available remedies in the aftermath of trauma.
A report from The Weinberg Center for Elder Justice, Need, Access, Impact and Opportunities: Findings from a Multi-Site Evaluation of Elder Justice Shelters in the U.S., reveals that elder shelters contribute to greater long-term stability and well-being among Adult Protective Services clients and underscores the crucial need for more elder shelters nationwide.
Research and Policy
Since the passage of the Elder Justice Act in 2010, the elder justice movement has gained traction, but federal recognition and funding have only begun to address the prevailing and mounting need to prevent elder mistreatment and address consequential harms. Several recent articles discuss the present and future of elder justice.272 273 274 275
216 Lachs, M., Mosqueda, L., Rosen, T., & Pillemer, K. (2021). Bringing Advances in Elder Abuse Research Methodology and Theory to Evaluation of Interventions. Journal of Applied Gerontology, 0733464821992182.
217 Burnes, D., Lachs, M. S., & Pillemer, K. (2018). Addressing the measurement challenge in elder abuse interventions: need for a severity framework. Journal of Elder Abuse & Neglect, 30(5), 402-407.
218 Burnes, D., MacNeil, A., Nowaczynski, A., Sheppard, C., Trevors, L., Lenton, E., ... & Pillemer, K. (2020). A scoping review of outcomes in elder abuse intervention research: The current landscape and where to go next. Aggression and Violent Behavior, 101476.
219 Lachs, M., Mosqueda, L., Rosen, T., & Pillemer, K. (2021). Bringing Advances in Elder Abuse Research Methodology and Theory to Evaluation of Interventions. Journal of Applied Gerontology, 0733464821992182.
220 Acierno, R., Hernandez, M. A., Amstadter, A. B., Resnick, H. S., Steve, K., Muzzy, W., & Kilpatrick, D. G. (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 health, 100(2), 292-297.
221 Acierno, R., Hernandez-Tejada, M. A., Anetzberger, G. J., Loew, D., & Muzzy, W. (2017). The National Elder Mistreatment Study: an 8-year longitudinal study of outcomes. Journal of elder abuse & neglect, 29(4), 254-269.
222 Liu, P. J., Wood, S., Xi, P., Berger, D. E., & Wilber, K. (2017). The role of social support in elder financial exploitation using a community sample. Innovation in aging, 1(1).
223 Burnes, D., Acierno, R., & Hernandez-Tejada, M. (2019). Help-seeking among victims of elder abuse: Findings from the National Elder Mistreatment Study. The Journals of Gerontology: Series B, 74(5), 891-896.
224 Alshabasy, S., Lesiak, B., Berman, A., & Fulmer, T. (2020). Connecting Models of Care to Address Elder Mistreatment. Generations, 44(1), 26-32.
225 Jackson, S. L. (2017). Adult protective services and victim services: A review of the literature to increase understanding between these two fields. Aggression and violent behavior, 34, 214-227.
226 Jackson, S. L. (2017). Adult protective services and victim services: A review of the literature to increase understanding between these two fields. Aggression and violent behavior, 34, 214-227.
227 Mosqueda, L., Wiglesworth, A., Moore, A. A., Nguyen, A., Gironda, M., & Gibbs, L. (2016). Variability in Findings From Adult Protective Services Investigations of Elder Abuse in California. Journal of evidence-informed social work, 13(1), 34–44. https://doi.org/10.1080/15433714.2014.939383
228 Bobitt, J., Kuhne, J., Carter, J., Whittier Eliason, S., & Twomey, M. (2017). Building the adult protective services system of tomorrow: The role of the APS national voluntary consensus guidelines. Journal of Elder Abuse & Neglect, 30(1), 93–101.
229 Bobitt, J., Carter, J., & Kuhne, J. (2020). Using diffusion of innovations framework to examine the dissemination and implementation of the adult protective services national voluntary consensus guidelines. Journal of Elder Abuse & Neglect, 1-16.
230 Administration for Community Living. (2020). National Adult Maltreatment Reporting System (NAMRS). Retrieved from
https://acl.gov/programs/elder-justice/national-adult-maltreatment-reporting-system-namrs
231 Aurelien, G., Beatrice, M., Cannizzo, J., Capehart, A., Gassoumis, Z., & Urban, K. (2019). Adult Maltreatment Data Report 2018.
232 Abrams, R. C., Ansell, P., Breckman, R., Karlawish, J., Lachs, M., Holt-Knight, D., ... & LoFaso, V. (2019). The Interview for Decisional Abilities (IDA): a tool to assess the decisional capacity of abused and neglected older adults. Journal of elder abuse & neglect, 31(3), 244-254.
233 Jackson, S. L., & Hafemeister, T. L. (2018). Detecting and Reporting Four Types of Elder Abuse: How Official Adult Protective Services Reports Obscure Older Adults’ Self-Efficacy. J Aging Gerontology Res, 1(1), 101.
234 Pickering, Carolyn E. Ziminski, and Veronica F. Rempusheski. "Examining barriers to self-reporting of elder physical abuse in community-dwelling older adults." Geriatric Nursing 35.2 (2014): 120-125.
235 Booker, J. G., Breaux, M., Abada, S., Xia, R., & Burnett, J. (2018). Assessment of older adults’ satisfaction with adult protective services investigation and assistance. Journal of Elder Abuse & Neglect, 30(1), 64-74.
236 Liu, P., Conrad, K., Conrad, K., & Iris, M. (2018). SELF-NEGLECT OLDER ADULTS’OUTCOMES AFTER ADULT PROTECTIVE SERVICES INTERVENTIONS. Innovation in Aging, 2(Suppl 1), 876.
237 Liu, P. J., Hass, Z., Conrad, K., Conrad, K., Yeh, J. C., Iris, M., ... & Butler, A. (2019). TELLING THE STORY OF ADULT PROTECTIVE SERVICES: CALIFORNIA’S IDENTIFICATION, SERVICES, AND OUTCOMES MATRIX. Innovation in Aging, 3(Supplement_1), S843-S844.
238 Burnes, D., Connolly, M. T., Hamilton, R., & Lachs, M. S. (2018). The feasibility of goal attainment scaling to measure case resolution in elder abuse and neglect adult protective services intervention. Journal of elder abuse & neglect, 30(3), 209-222.
240 Snyder J., Benson W.F. (2017) Adult Protective Services and the Long-Term Care Ombudsman Program. In: Dong X. (eds) Elder Abuse. Springer, Cham. https://doi.org/10.1007/978-3-319-47504-2_15
241 Daly, J. M. (2017). Elder abuse in long term care and assisted living settings. In Elder Abuse (pp. 67-91). Springer, Cham.
242 National Long-Term Care Ombudsman Resource Center. (2020). LTC Ombudsman Program Data. Retrieved from https://ltcombudsman.org/omb_support/nors/nors-data
243 Burnes, D., Kirchin, D., Elman, A., Breckman, R., Lachs, M. S., & Rosen, T. (2020). Developing standard data for elder abuse multidisciplinary teams: Acritical objective. Journal of elder abuse & neglect, 1-8.
244 Yonashiro-Cho, J., Rowan, J. M., Gassoumis, Z. D., Gironda, M. W., & Wilber, K. H. (2019). Toward a better understanding of the elder abuse forensic center model: comparing and contrasting four programs in California. Journal of elder abuse & neglect, 31(4-5), 402-423.
245 Burnes, D., Kirchin, D., Elman, A., Breckman, R., Lachs, M. S., & Rosen, T. (2020). Developing standard data for elder abuse multidisciplinary teams: Acritical objective. Journal of elder abuse & neglect, 1-8.
246 Dauenhauer, J., Heffernan, K., Webber, K., Smoker, K., Caccamise, P., & Granata, A. (2020). Utilization of a forensic accountant to investigate financial exploitation of older adults. The Journal of Adult Protection.
247 Yonashiro-Cho, J., Rowan, J. M., Gassoumis, Z. D., Gironda, M. W., & Wilber, K. H. (2019). Toward a better understanding of the elder abuse forensic center model: comparing and contrasting four programs in California. Journal of elder abuse & neglect, 31(4-5), 402-423.
248 A. Navarro, J. Wysong, M. DeLiema, E. Schwartz, M. Nichol, K. Wilber Inside the black box: The case review process of an elder abuse forensic center The Gerontologist, 56 (4) (2016), pp. 772-781.
249 Yonashiro-Cho, J., Rowan, J. M., Gassoumis, Z. D., Gironda, M. W., & Wilber, K. H. (2019). Toward a better understanding of the elder abuse forensic center model: comparing and contrasting four programs in California. Journal of elder abuse & neglect, 31(4-5), 402-423.
250 Burnes, D., Kirchin, D., Elman, A., Breckman, R., Lachs, M. S., & Rosen, T. (2020). Developing standard data for elder abuse multidisciplinary teams: Acritical objective. Journal of elder abuse & neglect, 1-8.
251 Burnes, D., Kirchin, D., Elman, A., Breckman, R., Lachs, M. S., & Rosen, T. (2020). Developing standard data for elder abuse multidisciplinary teams: Acritical objective. Journal of elder abuse & neglect, 1-8.
252 Burnes, D., Kirchin, D., Elman, A., Breckman, R., Lachs, M. S., & Rosen, T. (2020). Developing standard data for elder abuse multidisciplinary teams: Acritical objective. Journal of elder abuse & neglect, 1-8.
253 Podnieks, E. (2020). The Power of Elder Abuse Networks in Canada: A Model for Social Change. In International Handbook of Elder Abuse and Mistreatment (pp. 111-136). Springer, Singapore.
254 McGuire, S. L. (2017). Aging education: A worldwide imperative. Creative Education.
255 Mosqueda, L., Neumann, A., & Ruiz-Lopez, E. (2020). Reframing Elder Abuse. Generations, 44(1), 17-19.
256 Burnes, D., Acierno, R., & Hernandez-Tejada, M. (2019). Help-seeking among victims of elder abuse: Findings from the National Elder Mistreatment Study. The Journals of Gerontology: Series B, 74(5), 891-896.
257 O’Donnell, D. (2020). Keep Control: A Co-designed Educational and Information Campaign Supporting Older People to Be Empowered against Financial Abuse. In Advances in Elder Abuse Research, 121-135.
258 Ginschel, F., & Schlüter, K. (2020). Education on Old Age and Ageing in School: An Analysis of Students’ Conceptions of Old Age and Ageing and Implications for Teaching. Education Sciences, 10(11), 307.
259 Lytle, A., Nowacek, N., & Levy, S. R. (2020). Instapals: Reducing ageism by facilitating intergenerational contact and providing aging education. Gerontology & Geriatrics Education, 1-12.
260 Aguilera-Hermida, A. P. (2020). Fighting Ageism through Intergenerational Activities, a Transformative Experience. Journal of Transformative Learning, 7(2), 6-18.
261 Sugar, J. A., Haslem, H., Skaar, T., Brancamp, T., & Harris, S. G. (2017). REDUCING AGEISM THROUGH INTERGENERATIONAL SERVICE LEARNING. Innovation in Aging, 826-826.
262 Martin, D. (2019). Reflections from the Field: Reduce Age Stereotyping through Experiential Learning: An Intergenerational Pen Pal Project. Journal of Intergenerational Relationships, 17(2), 250-254.
263 Robson, C., Gutman, G., Marchbank, J., & Blair, K. (2018). Raising awareness and addressing elder abuse in the LGBT community: An intergenerational arts project. Language and Literacy, 20(3), 46-66.
264 Lichtenberg, P. A., Hall, L., Gross, E., & Campbell, R. (2019). Providing assistance for older adult financial exploitation victims: Implications for clinical gerontologists. Clinical gerontologist, 42(4), 435-443.
265 Brown, M. T., & McNeal, M. H. (2020). Addressing elder abuse: service provider perspectives on the potential of restorative processes. Journal of Elder Abuse & Neglect, 32(4), 357-376.
266 Brown, M. T., & McNeal, M. H. (2020). Addressing elder abuse: service provider perspectives on the potential of restorative processes. Journal of Elder Abuse & Neglect, 32(4), 357-376.
267 Ernst, J. S., & Maschi, T. (2018). Trauma-informed care and elder abuse: A synergistic alliance. Journal of elder abuse & neglect, 30(5), 354-367.
268 Rowan, J., Gassoumis, Z., Homeier, D., Rath, L., & Wilber, K. (2018). PERSON-CENTRIC CARE OF ELDER MISTREATMENT: LESSONS LEARNED FROM A SERVICE ADVOCATE. Innovation in Aging, 2(suppl_1), 526-527.
269 Wood, E. (2016). Recharging adult guardianship reform: six current paths forward. Journal of Aging, Longevity, Law, and Policy, 1(1), 5.
270 Bagshaw, D., Adams, V., Zannettino, L., & Wendt, S. (2015). Elder mediation and the financial abuse of older people by a family member. Conflict Resolution Quarterly, 32(4), 443–480.
271Levin, M. K., Reingold, D., & Solomon, J. (2020). Elder Abuse Shelter Programs: From Model to Movement. Generations, 44(1), 74-80.
272 Petruy, E., & Dalin, H. (2020). The Future of Elder Justice: A Perspective from the Administration for Community Living. Generations, 44(1), 98-100.
273 Blancato, R. B., & Whitmire, M. (2020). Elder Justice Policy: Where We Are Now and Where Do We Go Next?. Generations, 44(1), 106-110.
274 Bobitt, J., Carter, J., & Kuhne, J. (2018). Advancing national policy on elder abuse. Public Policy & Aging Report.
275 Anetzberger, G. J., Breckman, R., Caccamise, P. L., Freeman, I. C., & Nerenberg, L. (2020). Building a National Elder Justice Movement, State by State. Generations, 44(1), 111-116.
Last Modified: 05/13/2024