America’s burgeoning elder population has affected every segment of the social, political, and economic landscape. Public debate of the issues surrounding the special needs of the approximately 44 million persons in this country age 60 years and over has heightened national awareness and concern. As a result, public policies relating to issues such as retirement security, affordable long-term care, and quality of life are changing to meet the unique needs of the aging population.
Yet, as the public looks toward improving the lives of the elderly, abuse and neglect of elders living in their own homes have gone largely unidentified and unnoticed. The National Elder Abuse Incidence Study has shed new light on this significant problem with the finding that approximately 450,000 elderly persons in domestic settings were abused and/or neglected during 1996. When elderly persons who experienced self-neglect are added, the number increases to approximately 551,000 in 1996. Additionally, through this study we have learned that:
Female elders are abused at a higher rate than males, after accounting for their larger proportion in the aging population. Our oldest elders (80 years and over) are abused and neglected at two to three times their proportion of the elderly population. In almost 90 percent of the elder abuse and neglect incidents with a known perpetrator, the perpetrator is a family member, and two-thirds of the perpetrators are adult children or spouses. Victims of self-neglect are usually depressed, confused, or extremely frail.
The National Elder Abuse Incidence Study (NEAIS) was conducted by the National Center on Elder Abuse at the American Public Human Services Association (formally known as the American Public Welfare Association) and the Maryland-based social science and survey research firm, Westat. The Administration for Children and Families (ACF) and the Administration on Aging (AoA) in the U. S. Department of Health and Human Services jointly funded this research. The study asked the fundamental question: What is the incidence of domestic elder abuse and neglect in the United States today?
In public health and social research, the term “incidence” means the number of new cases occurring over a specific time period. The NEAIS used a rigorous methodology to collect national incidence data on what has been a largely undocumented phenomenon, and it provides the basis to estimate the incidence of domestic elder abuse and neglect among those aged 60 and above in 1996.
The NEAIS originated in 1992 when Congress, through the Family Violence Prevention and Services Act of 1992 (P. L. 2-295), directed that a study of the national incidence of abuse, neglect, and exploitation of elderly persons be conducted under the auspices of the Administration for Children and Families. ACF consulted with the federal Administration on Aging, resulting in the two agencies combining resources and expertise to support the national study. Because the legislative mandate primarily was concerned with the prevention of violence in domestic settings, the study focused only on the maltreatment of non-institutionalized elderly.
Elders living in hospitals, nursing homes, assisted-living facilities, or other institutional or group facilities were not included in the study. In order to maximize the utility of the research, the study also collected and analyzed data about elder self-neglect in domestic settings, and these findings are reported separately from the findings for abuse and neglect. In the NEAIS, the phrase “elder maltreatment” generally refers to the seven types of abuse and neglect that are measured in the study-physical abuse, sexual abuse, emotional or psychological abuse, financial or material exploitation, abandonment, neglect, and self-neglect.
An early task of the NEAIS was to develop standardized definitions for each specific type of abuse and neglect, which are provided later in this executive summary. Prior attempts to generate national data on domestic elder abuse in the United States relied on state-compiled statistics of suspected abuse, with considerable variations in definitions and comprehensiveness of reporting systems.
These earlier studies, frequently designed to estimate the prevalence (i. e. the total number of cases at a designated time period) of elder abuse rather than the incidence (i. . , the new cases occurring over a specific period of time), varied considerably in their research questions, methodology, sources of data, analysis, and findings. Accordingly, comparisons of earlier research with the NEAIS findings should be done cautiously. The NEAIS gathered data on domestic elder abuse, neglect, and self-neglect through a nationally representative sample of 20 counties in 15 states.
For each county sampled, the study collected data from two sources: (1) reports from the local Adult Protective Services (APS) agency responsible for eceiving and investigating reports in each county: and (2) reports from “sentinels”-specially trained individuals in a variety of community agencies having frequent contact with the elderly. The NEAIS study design and methods are described more fully later in this Executive Summary.
The NEAIS research is groundbreaking because it provides, for the first time, national incidence estimates of elder abuse, which can serve as a baseline for future research and service interventions in this critical problem. Its findings confirm some commonly held theories about elder abuse and neglect, notably that officially reported cases of abuse are only the “tip of the iceberg,” or a partial measure of a much larger, unidentified problem. The NEAIS final report offers insight into critical questions, including: who are the victims of elder abuse and neglect, and who are the perpetrators?
Who are the reporters of abuse and neglect? What are the characteristics of self-neglecting elders? What is the extent of the problem of abuse, neglect, and self-neglect in our communities and what forms do they take? National Elder Abuse Incidence Estimates To arrive at the most accurate estimate of the national incidence of elder abuse and neglect in 1996, researchers added two numbers: (1) reports submitted to APS agencies and substantiated (i. e. , determined to have occurred or be occurring) by those agencies, and (2) reports made by sentinels and presumed to be substantiated.
Consistent with three national incidence studies on child abuse and neglect, this methodology assumes the sentinel reports represent substantiated reports. Because the incidence estimate is statistically derived from the nationally representative sample, researchers also calculated the standard error to establish the range of the incidence estimate within a 95 percent confidence interval. \l “P44_6926” Using the identical methodology, researchers also separately calculated the estimated national incidence of elder abuse, neglect, and/or self-neglect in 1996. Both incidence estimates are for unduplicated elderly persons.
In other words, individuals are counted only once, even if: (1) they were bused and neglected and/or self-neglecting, (2) more than one report were received about the same incident, or (3) different incidents were reported for the same elderly person during the study period. Estimated Incidence of Elder Abuse and/or Neglect in 1996 The best national estimate is that a total of 449,924 elderly persons, aged 60 and over, experienced abuse and/or neglect in domestic settings in 1996. Of this total, 70,942 (16 percent) were reported to and substantiated by APS agencies, but the remaining 378,982 (84 percent) were not reported to APS.
From these figures, one can conclude that over five times as many new incidents of abuse and neglect were unreported than those that were reported to and substantiated by APS agencies in 1996. The standard error suggests that nationwide as many as 688,948 elders or as few as 210,900 elders could have been victims of abuse and/or neglect in domestic settings in 1996. Estimated Incidence of Elder Abuse, Neglect, and/or Self-Neglect in 1996 The best national estimate is that a total of 551,011 elderly persons, aged 60 and over, experienced abuse, neglect, and/or self-neglect in domestic settings in 1996.
Of this total, 115,110 (21 percent) were reported to and substantiated by APS agencies, with the remaining 435,901 (79 percent) not being reported to APS agencies. One can conclude from these figures that almost four times as many new incidents of elder abuse, neglect, and/or self-neglect were unreported than those that were reported to and substantiated by APS agencies in 1996. The standard error suggests that nationwide as many as 787,027 elders or as few as 314,995 elders could have been abused, neglected, and/or self-neglecting in domestic settings in 1996.