Elder maltreatment is a significant and altogether too frequently experienced public health and human rights problem. The most recent data available on the prevalence of elder maltreatment suggests that at least 10% of older Americans—approximately 5 million persons—experienced emotional, physical, or sexual abuse, financial exploitation and neglect each year, and many of them experienced it in multiple forms.[i]
In addition, data from state Adult Protective Services (APS) agencies show an increasing trend in reports of elder maltreatment.[ii] These increases are concerning, particularly because other research estimates that as few as 1 in 23 cases of elder abuse,[iii] and 1 in 44 cases of financial exploitation,[iv] ever come to the attention of authorities, suggesting an even higher level of incidence than the data reflect.
Significant and serious health consequences ensue from the experience of elder maltreatment. Older adults who experience even modest forms have dramatically higher (300%) morbidity and mortality rates than those who have not experienced maltreatment.[v] Victims are four times more likely to be admitted to a nursing home[vi] and three times more likely to be admitted to a hospital.[vii] Older adults who are victims of violence have more 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.[viii],[ix],[x],[xi],[xii],[xiii] Those experiencing maltreatment have significantly higher levels of psychological distress and lower perceived self-efficacy than older adults who have not been victimized.[xiv] For older survivors of sexual violence, the negative health impacts of abuse are even more pronounced.[xv]
Elder maltreatment takes a sizeable toll on the health and well-being of our nation’s economy. It is estimated that older Americans lose a minimum of $2.6 billion annually due to elder financial abuse and exploitation.[xvi] There is a personal cost as well, and that must not be forgotten. Elder maltreatment threatens a person’s independence, undermines one’s dignity, and imperils physical and financial safety. Considering these factors together—the threat to human dignity and safety, higher rates of chronic conditions for victims of abuse, and higher costs of trauma associated with elder maltreatment—we are faced with a human rights, public health, and economic imperative to prevent and intervene to reduce incidence and redress the harm caused to those who are subjected to maltreatment.
The federal interest to address the problem of elder abuse, neglect, and exploitation began in 1962, when Congress authorized payments to states to establish protective services for adults through the Public Welfare Amendments to the Social Security Act. Most recently in 2010, Congress passed the Elder Justice Act, the first piece of comprehensive legislative authority designed to address and combat elder abuse, neglect, and exploitation. As of 2015, 49 states had a designated agency to address elder abuse under the auspices of Adult Protective Services.
As the effective and visible federal advocate for older Americans, the Administration for Community Living (ACL) has been committed to protecting seniors from maltreatment for many years. Since 1972, agencies under ACL have administered a number of programs promoting elder justice and elder rights, including the Older Americans Act programs for the Long-Term Care Ombudsman Program, the OAA Title VII Elder Abuse, Neglect, and Exploitation Program, and the National Center on Elder Abuse (NCEA).
The first iteration of the NCEA was created in 1988 as an information clearinghouse demonstration project on abuse, neglect, and exploitation, with the goals of identifying promising practices in prevention and treatment, serving as a repository of research, and conducting demonstration projects to promote effective and coordinated responses to elder abuse, neglect, and exploitation. Along with the establishment of the OAA Title VII Elder Abuse, Neglect, and Exploitation Program in 1992, amendments were also made to Title II of the OAA to permanently establish and maintain the NCEA.
Since 1992, when the NCEA was permanently established pursuant to Section 202(d) of the OAA, the NCEA has served as a national resource center dedicated to addressing elder maltreatment. The NCEA is operated as a grant program and provides relevant information and materials, and supports efforts to enhance state and local efforts to prevent and address elder maltreatment. NCEA disseminates information to professionals and the public, and it provides technical assistance to states and to community-based organizations. The NCEA makes available resources; provides consultation, education, and training; identifies and provides information about promising practices and interventions; answers inquiries and requests for information; and operates a listserv forum for professionals.
The NCEA has become a valued resource to many professionals working with elders who have experienced maltreatment, including but not limited to Adult Protective Services (APS); national, state, and local aging networks; law enforcement; health care professionals; domestic violence networks; Working Interdisciplinary Networks of Guardianship Stakeholders (WINGS) coalitions, community-based multi-disciplinary teams and others.
[i] Acierno R, Hernandez MA, Amstadter AB, et al. 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. 2010; 100:292-297.
[ii] Teaster PB, Dugar T, Mendiondo M, Abner EL, Cecil KA, Otto JM. The 2004 Survey of Adult Protective Services: Abuse of Vulnerable Adults 18 Years Of Age And Older. National Center on Elder Abuse: Washington, DC. Retrieved May 8, 2015 from:
[iii] Multiple studies to measure the incidence and prevalence of elder maltreatment have been undertaken in recent years. Including:
National Research Council. (2003) Elder Mistreatment: Abuse, Neglect and Exploitation in an Aging America. Washington, D.C.: The National Academies Press;
Lachs, Mark, et al. (2011); Under the Radar: New York State Elder Abuse Prevalence Study Final Report. Lifespan of Greater Rochester, Inc.: Weill Cornell Medical Center of Cornell University and New York City Department for the Aging.
Acierno, R, Hernandez, M, 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. Am J Public Health; 100(2): 292–297.
[iv] Lachs, Mark, et al. (2011) Under the Radar: New York State Elder Abuse Prevalence Study Final Report. Lifespan of Greater Rochester, Inc.: Weill Cornell Medical Center of Cornell University and New York City Department for the Aging.
[v] Lachs MS, Williams CS, O'Brien S, Pillemer KA, Charlson, ME. The Mortality of Elder Mistreatment. Journal of the American Medical Association 1998; 280:428-432.
[vi] Lachs, M., Williams, C.S., O’Brien, S., & Pillemer, K. (2002). Adult Protective Service use and nursing home placement. The Gerontologist, 42(6), 734-739.
[vii] Dong, X.Q., & Simon, M.A. (2013). Elder abuse as a risk factor for hospitalization in older persons. JAMA Internal Medicine, 173(10), 911-917.
[viii] Bitondo Dyer C, Pavlik VN, Murphy KP, Hyman DJ. The high prevalence of depression and dementia in elder abuse or neglect. Journal of the American Geriatrics Society. 2000; 48:205-208.
[ix] Burt M, Katz B. Rape, robbery, and burglary: responses to actual and feared criminal victimization, with special focus on women and the elderly. Victimology: An International Journal. 1985; 10:325-358.
[x] Mouton CP, Espino DV. Problem-orientated diagnosis: health screening in older women. American Family Physician. 1999; 59:18-35.
[xi] Fisher BS, Regan SL. The extent and frequency of abuse in the lives of older women and their relationship with health outcomes. The Gerontologist, 2006; 46:200-209.
[xii] Coker A, Davis K, Arias I, et al. Physical and mental health effects of intimate partner violence for men and women. American Journal of Preventive Medicine. 2002; 23:260-268.
[xiii] Stein M, Barrett-Connor E. Sexual assault and physical health: findings from a population-based study of older adults. Psychosomatic Medicine. 2000; 62:838-843.
[xiv] Comijs HC, Penninx BWJH, Knipscheer KPM, and van Tilburg W. Psychological distress in victims of elder mistreatment: the effects of social support and coping. Journal of Gerontology, 1999; 54B:240-245.
[xv] Stein M, Barrett-Connor E. Sexual assault and physical health: findings from a population-based study of older adults. Psychosomatic Medicine. 2000; 62:838-843.
[xvi] Metlife Mature Market Institute (MMI). (2011). The MetLife Study of Elder Financial Abuse: Crimes of Occasion, Desperation, and Predation Against America's Elders. Report prepared for the MetLife Mature Market Institute by the National Committee for the Prevention of Elder Abuse and the Center for Gerontology at Virginia Polytechnic Institute and State University. Retrieved November 26, 2013 from: https://www.metlife.com/mmi/research/elder-financial-abuse.html