National Center on Elder Abuse
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National Center on Elder Abuse
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Risk Factors & Protective Factors
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Risk Factors and Protective Factors of Mistreatment
Risk Factors
Recognizing the factors associated with the increased risk of elder mistreatment is critical to help us understand the sources and causes of abuse, neglect, and exploitation. It is important to note at the outset that elder abuse is a complicated phenomenon, often rooted in the qualities of the elder and the perpetrator within the context of their interconnected relationship.74 Each situation is unique and the particular risk factors may vary.
Research studies have discerned both victim and perpetrator characteristics that offer insight as to why certain older people may be
susceptible to and targeted for mistreatment, and the reasons offenders may be more likely to commit acts of mistreatment. One study reported that offender traits may be a stronger predictor of abuse than victim features.75 Knowledge of the discrete and interrelated factors may inform efforts to mitigate the risk of elder abuse, manage environmental threats, and prevent recurrent abuse.76
Risk factors can be characterized as “static” or “dynamic.” Static variables are those elements in an individual’s world that are fixed and unlikely to change, such as historical violence or criminality. Dynamic variables, on the other hand, are those factors which may be modified
through risk management strategies and tailored interventions.77 This could include perpetrator substance abuse which may be controlled through treatment, medication, and/or court ordered protections.
Below are examples of risk factors commonly observed with victims and perpetrators. Because of the significance and interrelationship of abuse within the larger societal framework, the impact of socio-cultural risk factors will be addressed below as well.78
Victim Risk Factors
- Chronic medical conditions and poor physical health
- Functional disability and dependence
- Mental health problems
- Cognitive deficits
- Financial dependence
- Lower socioeconomic status
- Substance misuse
- High levels of stress and poor coping mechanisms
- Prior exposure to trauma
- Limited social support
- Poor relationship between the victim and the perpetrator 79 80
Other victim-centric variables that have been correlated with a potential increased risk of abuse include the following:
- Gender (women)
- Race (one study cited support for the proposition that, compared with Caucasians, older African Americans may be at increased risk of financial abuse and psychological abuse)81
- Younger older age
- Health care insecurity82 83
Perpetrator Risk Factors
- Chronic medical conditions and poor physical health
- Mental health problems
- Cognitive deficits
- Financial dependence
- Substance misuse
- High levels of stress and poor coping mechanisms
- Negative attitudes towards the older adult
- Early childhood abuse84
Risk of Revictimization
Causal factors that forecast the initial onset of abuse are relevant to revictimization. Additional considerations have been identified that create or contribute to an increased risk of recurrence. These perpetuating factors include an older adult’s perception of the mistreatment, the degree to which they protect or defend the offender, the receptiveness to help, barriers to accessing supportive services, and the extent of influence imposed by the perpetrator to quash an older adult’s help-seeking behavior.85
Potential Community and Socio-cultural Risk Factors
Community contexts and societal perceptions have been cited as possible predictors of elder abuse. Some studies have reported that living in urban centers may increase the likelihood of mistreatment. Others have noted that age bias and stereotypes about older people contribute to elder mistreatment. As public discourse and depictions portray elders as inept, fragile, or burdensome, audiences may begin to accept ageist misconceptions as fact and tolerate, even perpetuate, the adverse treatment of older adults.86 87
Protective Factors
There is scant evidentiary support for protective factors which may safeguard older adults from mistreatment. 88 Two factors, however, have been cited as effective means to shield elders from harm. High levels of social support and embedded community networks have been found to offer protection to ward off abuse. The other suggested supportive measure relates to the elder’s living environment. Empirical studies have found that shared living situations may accelerate the risk of abuse. Separation from conflict may serve to mitigate environmental stress which can foster mistreatment.89 90 For additional information on interventions, please see the section on Interventions, below.
Perpetrator Identity
Perpetrators of elder mistreatment share some common characteristics but are largely heterogeneous with significant variability across types of abuse. Greater insight into these differences in typology may serve to inform appropriate interventions and remediation. Below are general offender patterns extrapolated from research. An Abuser Risk Measure has been developed to measure the risk of abuse by perpetrators.91
Offender Characteristics
- Age: The average age is 45.
- Gender: Much of the data indicates a lack of gender differences among offenders, but one study found that 62% of perpetrators were men.
- Race: 77% of perpetrators were found to be Caucasian.
- Education: 38% of perpetrators did not graduate from high school, although 44% received a high school diploma.
- Employment: Between one third and two thirds of offenders were unemployed at the time of the incident.
- Marital Status: 70% of elder abuse perpetrators were unmarried at the time of the offense.
- Health: Most perpetrators appeared to be relatively healthy.
- Family History: Almost half of the perpetrators reported a history of early childhood violence.
- Substance Abuse: 20% to 50% of perpetrators reported substance misuse.
- Mental Health: Approximately 25% to 35% of perpetrators reported having a serious mental illness.
- Criminal Record: Between 25% and 46% of perpetrators had a criminal record at the time of the offense.
- Relationship Problems: One study found that 68% of perpetrators experienced interpersonal relationship problems, while another reported only 21%.
- Living Arrangements: Between 53% and 64% of elder abuse victims and perpetrators cohabitated at the time of the offense.
- Financial Problems: 30% of financial exploitation perpetrators compared with less than 1% of interpersonal perpetrators had financial problems.
- Financial Dependence: Approximately one third of perpetrators were financially dependent upon the victim at the time of the offense.
- Social isolation: 35% of offenders reported lack of an individual they could contact to take them to the doctor or speak with if needed.92
Offender Identity by Type of Mistreatment
- Psychological Abuse: The most frequent offender is a partner/spouse.
- Physical: The most frequent offender is a partner/spouse.
- Neglect: Adult children are the most frequent perpetrators.
- Financial: Family members (54%) and care workers (31%), compared with partners (13%), were the more frequent perpetrators.
- Sexual abuse: There is little evidence to support a conclusion, but of the studies conducted it appears that sexual abuse was most often perpetrated by partner/spouses (40%) and acquaintances (40%).93
Offender Characteristics
One study differentiated perpetrators by personality and behavioral attributes. Four discrete profiles were identified: “Caregiver,” “Temperamental,” “Dependent Caregiver,” and “Dangerous.” Given the heterogeneity among offenders, researchers suggested that interventions be tailored by typology to effectively address the mistreatment and mitigate harm.94
Poly-victimization
Poly-victimization is the intersection of multiple co-occurring or sequential forms of abuse which result in cumulative and compounding harms for older adults. The concept of poly-victimization recognizes that past traumas over the life course can heighten the negative impact of mistreatment in older age. Early childhood adversity, both experiencing and witnessing mistreatment, can also exacerbate later life abuse.95 One study reported that approximately 1.7% of older people experienced prior year poly-victimization.96
74 Mosqueda, L., Burnight, K., Gironda, M. W., Moore, A. A., Robinson, J., & Olsen, B. (2016). The abuse intervention model: A pragmatic approach to intervention for elder mistreatment. Journal of the American Geriatrics Society, 64(9), 1879-1883.
75 DeLiema, M., Yonashiro-Cho, J., Gassoumis, Z. D., Yon, Y., & Conrad, K. J. (2018). Using latent class analysis to identify profiles of elder abuse perpetrators. The Journals of Gerontology: Series B, 73(5), e49-e58.
76 Storey, J. E. (2020). Risk factors for elder abuse and neglect: A review of the literature. Aggression and Violent Behavior, 50, 1
77 Storey, J. E. (2020). Risk factors for elder abuse and neglect: A review of the literature. Aggression and Violent Behavior, 50, 101339.
78 Storey, J. E. (2020). Risk factors for elder abuse and neglect: A review of the literature. Aggression and Violent Behavior, 50, 1
79 Storey, J. E. (2020). Risk factors for elder abuse and neglect: A review of the literature. Aggression and Violent Behavior, 50, 101339.
80 Pillemer, K., Burnes, D., Riffin, C., & Lachs, M. S. (2016). Elder abuse: global situation, risk factors, and prevention strategies. The Gerontologist, 56(Suppl_2), S194-S205.
81 Pillemer, K., Burnes, D., Riffin, C., & Lachs, M. S. (2016). Elder abuse: global situation, risk factors, and prevention strategies. The Gerontologist, 56(Suppl_2), S194-S205.
82 Rosay, A. B., & Mulford, C. F. (2017). Prevalence estimates and correlates of elder abuse in the United States: The national intimate partner and sexual violence survey. Journal of elder abuse & neglect, 29(1), 1-14.
83 Hamby, S., Smith, A., Mitchell, K., & Turner, H. (2016). Poly-victimization and resilience portfolios: Trends in violence research that can enhance the understanding and prevention of elder abuse. Journal of Elder Abuse & Neglect, 28(4-5), 217-234.
84 Storey, J. E. (2020). Risk factors for elder abuse and neglect: A review of the literature. Aggression and Violent Behavior, 50, 101339.
85 Burnes, D., Elman, A., Feir, B. M., Rizzo, V., Chalfy, A., Courtney, E., ... & Rosen, T. (2020). Exploring risk of elder abuse revictimization: Development of a model to inform community response interventions. Journal of applied gerontology, 0733464820933432.
86 Pillemer, K., Burnes, D., Riffin, C., & Lachs, M. S. (2016). Elder abuse: global situation, risk factors, and prevention strategies. The Gerontologist, 56(Suppl_2), S194-S205.
87 Storey, J. E. (2020). Risk factors for elder abuse and neglect: A review of the literature. Aggression and violent behavior, 50, 101339.
88 Pillemer, K., Burnes, D., Riffin, C., & Lachs, M. S. (2016). Elder abuse: global situation, risk factors, and prevention strategies. The Gerontologist, 56(Suppl_2), S194-S205.
89 Heisler, C. J. (2017). Moving forward: Recommendations for advancing late-life polyvictimization practice, policy, and research. Journal of elder abuse & neglect, 29(5), 351-363.
90 Pillemer, K., Burnes, D., Riffin, C., & Lachs, M. S. (2016). Elder abuse: global situation, risk factors, and prevention strategies. The Gerontologist, 56(Suppl_2), S194
91 Conrad, K. J., & Conrad, K. M. (2019). Abuser risk measure: Reports by alleged victims to adult protective services. The Gerontologist, 59(5), e403-e414.
92 Jackson, S. L. (2016). All elder abuse perpetrators are not alike: The heterogeneity of elder abuse perpetrators and implications for intervention. International journal of offender therapy and comparative criminology, 60(3), 265-285.
93 Jackson, S. L. (2016). All elder abuse perpetrators are not alike: The heterogeneity of elder abuse perpetrators and implications for intervention. International journal of offender therapy and comparative criminology, 60(3), 265-285.
94 DeLiema, M., Yonashiro-Cho, J., Gassoumis, Z. D., Yon, Y., & Conrad, K. J. (2018). Using latent class analysis to identify profiles of elder abuse perpetrators. The Journals of Gerontology: Series B, 73(5), e49-e58.
95 Hamby, S., Smith, A., Mitchell, K., & Turner, H. (2016). Poly-victimization and resilience portfolios: Trends in violence research that can enhance the understanding and prevention of elder abuse. Journal of Elder Abuse & Neglect, 28(4-5), 217-234.
96 Williams, J. L., Racette, E. H., Hernandez-Tejada, M. A., & Acierno, R. (2020). Prevalence of elder polyvictimization in the United States: data from the national elder mistreatment study. Journal of interpersonal violence, 35(21-22), 4517-4532.
Last Modified: 02/28/2024