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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America
a result of what had happened earlier with family violence. I think that as focus has been brought on the perpetrator, prosecution is now an intervention, where it never was before. In the social service field, they felt that prosecution was not anything that should be done, partly because older people don’t want to prosecute, they don’t want to bring charges against their children or their grandchildren. So it was more in keeping with the wishes of the victim, and prosecution was not a possibility. Then there were difficulties with perpetrators; it is hard to find them sometimes.
Constantine Lyketsos: Given that the dementia problem increases with age, if you look at reports of sentinel events or reports of events in much higher age groups in which dementia is more prevalent, do you see an increase of reports of abuse from communities as people get much older? Do you have any data on that?
Wolf: There are data in terms of reporting through adult protective services, which show that the highest number of reports of abuse within the age categories is among the 85 and over category. However, the prevalence study showed no difference in age. Since the author of that study is here, later on he can explain more about that.
Karl Pillemer: I think one of the reasons for some of the confusion is that there are two strands or traditions of research that have been used. One is the Murray Strauss school of family violence research, which is equally applicable to child abuse or wife abuse when you take a survey approach. The other has come out of the gerontological family caregiving tradition, which has looked at caregivers as samples—and hasn’t used the general population. That typically doesn’t include elderly spouse abuse, for example, which might occur among healthy elders.
That is where these lines become a lot less clear. So I think that is one reason for some of the confusion.
Wolf: I won’t try to answer the first part, because it raises the whole issue of why do we segregate a whole service system, how do we approach the needs of elders. It is a separate service system. Why do we have the Administration on Aging, for instance?
Most states use the criterion of people age 18 and over who are vulnerable. So the vulnerability risk factor shows up very strongly in adult protective services. Some of the states don’t use that criterion and instead serve all adults who are 60 or over; in those states, one doesn’t see such a strong showing of vulnerability as a risk factor.
For instance, I think the statistics show that in states in which adult protective services serve younger and older persons with disabilities, about 40 percent of the reports that come in for people age 18 and over are collected from caregivers. In contrast, the state that I come from, Massachusetts, doesn’t include vulnerability as a criterion. It has physical abuse and neglect without any necessary indicators. Illinois, which doesn’t have