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Elder maltreatment (EM) has been understood as a worldwide major public health threat for decades, yet it remains a form of victimization receiving limited attention, resources, and research. EM, which includes caregiver neglect and self-neglect, has far-reaching and long-lasting impacts on older adults, their families, and communities. Rigorous prevention and intervention research has significantly lagged in proportion to the magnitude of this problem. With rapidly growing population aging, the coming decade will be transformative: by 2030, one in six people worldwide will be aged 60 or older, and approximately 16% will experience at least one form of maltreatment (World Health Organization, 2021). The goal of this paper is to raise awareness of the context and complexities of EM, provide an overview of current intervention strategies based on a scoping review, and discuss opportunities for further prevention research, practice, and policy within an ecological model applicable to EM., (© 2023. Society for Prevention Research.)

This article provides a summary of salient trauma findings and conveys the dearth of research pertaining specifically to the trauma of elder abuse. This material, in conjunction with information contained in other articles composing this special issue, lays the foundation for advancing a trauma-informed approach to assisting older adults who have experienced polyvictimization. Informed by the findings presented and their extensive clinical experience with victims of violence, the authors suggest steps for providing a trauma-informed and victim-centered response to older adults who have suffered polyvictimization. These steps are then illustrated with an in-depth late-life polyvictimization case analysis.

In contrast to work within the child-abuse field, polyvictimization of older adults did not become a focus of professional attention until this decade. Despite this lack of formal identification, a search of the research and practice literature revealed that prior research investigating single forms of or other elder abuse issues contained evidence of what was variously termed "multiple," "multi-faceted," "co-occurring," or "hybrid" elder abuse. A wide range of victims (1.4%-89.7%) identified in existing elder abuse studies was found to have experienced what constitutes "polyvictimization." This late-life polyvictimization evidence, the contexts in which victims are harmed, and information regarding the impact of multifaceted elder abuse are all presented and discussed in this article. Selected published cases illustrate the clinical dynamics operating in late-life polyvictimization situations.

This study examined 64 cases of sexual victimization of women ages 65+ (mean = 81) living in facilities that were investigated by APS and regulatory agencies in five states over a six-month period. Typically, abuse involved molestation (53%) and unwelcome sexual interest in the body (20%). Abilities and needs of women in substantiated and unsubstantiated cases were comparable. Resident perpetrators were more likely to be substantiated than staff or any other perpetrator (p = 0.008). Our results underscore the need to evaluate differences associated with gender, age, and residence, and to train on reporting and intervention by disciplines serving victims.

The mission of Adult Protective Services (APS) is to protect older and vulnerable adults from abuse, neglect, and exploitation. The complexity of APS cases and the potential for life-changing interventions point to the need for research that examines and evaluates APS practices. A literature review identified 50 studies published during a 16-year period that used APS agencies, clients, data, or resources to test hypotheses regarding elder abuse. The analysis revealed promising efforts toward knowledge development about elder mistreatment and self-neglect. This article provides an overview of salient findings, notes the scarcity of studies that analyze the effectiveness of APS, and highlights the need for additional research. Lessons learned are described, and APS practitioners and researchers are urged to work collaboratively to develop key practice-related questions about APS processes and outcomes that can be tested with appropriate research methodologies.

An exploratory study of 284 cases of alleged elder sexual abuse revealed fairly equal numbers of reports to the criminal justice system (CJS) and to Adult Protective Services (APS). Comparison of these two routes of reporting indicated the following: Suspected victims reported to APS were more likely to reside in their own homes, not receive rape exams, and have cognitive disabilities. Their alleged offenders were typically spouse/partners or family members age 40 or older. Victims reported to CJS were more frequently abused in institutions, received rape exams, and were victimized by offenders under age 40 who also committed nonsexual crimes. In cases reported to the CJS, alleged offenders were less likely than those in the APS cases to be identified, but once identified, were more likely to be arrested, referred for prosecution, and convicted, or to plea bargain their case.

This article reports research findings concerning 119 alleged sexual perpetrators who were reported to state authorities for abusing elderly individuals residing in care facilities. The largest group of accused was employees of the facilities, followed by facility residents. Family members of the alleged victims and visitors to the facilities also were among those reported as sexually abusive. Investigation of the allegations by Adult Protective Services and regulatory staff resulted in 32 of these individuals being confirmed as sexual perpetrators against vulnerable elders. Male and female alleged and confirmed sexual perpetrators were identified as well as both male and female elderly sexual abuse victims. Perpetrator characteristics, victim vulnerabilities, abuse acts, locations of assaults, and available case outcomes are presented. Implications of the findings are discussed.

Previous research on the sexual abuse of older adults has revealed few cases of the sexual abuse of older men. The first national study of the sexual abuse of vulnerable adults in facilities, reported in this article, collected data on alleged, investigated, and substantiated cases of sexual abuse. This study revealed 26 cases reported and screened in for investigation concerning the alleged sexual abuse of older men (aged 50 and older) residing in nursing homes. Cases occurred in five states within a six month time period. Of these cases, six were confirmed upon investigation by Adult Protective Services or other regulatory agencies. Victims tended to be predominantly white males with cognitive and physical deficits that limited their ability for self care. The most typical sexual abuse alleged and substantiated was fondling. Residents were more often substantiated as the abuser than other perpetrators. Sexual abuse of older men in nursing homes crosses traditional gender, cultural, and role boundaries for both victims and perpetrators.

Addresses some of the perplexing issues involved in understanding and responding to elder-abuse offenders. Offers a typology of offenders to elucidate the dynamics when people mistreat the elderly. (Contains 13 references.) (Author)

The purpose of this study was to identify characteristics of investigations of sexual abuse concerning vulnerable adults residing in facility settings that were associated with case substantiation. Data on 410 reports of sexual abuse were collected prospectively from Adult Protective Services (APS) and state licensure agency staff in New Hampshire, Oregon, Tennessee, Texas, and Wisconsin over a six-month period. Specifically, we examined differences between reports that were substantiated and those that were not by comparing characteristics of alleged victims, alleged perpetrators, and aspects of investigation using logistic regression. We found that a relatively low proportion of cases (18%) were substantiated overall. Compared to cases that were not substantiated, cases that were substantiated were more likely to feature nursing home residents, older victims, female victims, and allegations of physical contact between the alleged perpetrator and victim. Despite the high proportion of alleged perpetrators who were facility staff (51%) compared to resident perpetrators (25%), cases with resident-to-resident allegations of abuse were much more likely to be substantiated, accounting for 63% of substantiated cases. In light of these findings, we believe it is important that investigators are trained to handle sexual abuse cases appropriately and that they are able to investigate the case thoroughly, promptly, and with as much information as possible. It is also critical that investigators make substantiation decisions using the appropriate standard for confirmation (e.g., preponderance of the evidence, beyond a reasonable doubt, clear and convincing evidence) as state law dictates. [ABSTRACT FROM AUTHOR]

This article explores the issue of sexual abuse of vulnerable younger and older adults living in long-term care facilities. Clinical findings regarding the sexual abuse of adults who are elderly or have disabilities are presented, and practice implications for psychiatric nurses are discussed. A review of relevant existing literature and previous research is provided. A research study presently under way is then described. This is the first national study of sexual abuse in long-term care. This study seeks to fill current knowledge gaps and inform the practice of nursing and other professionals who are responsible for the care of vulnerable adults. [ABSTRACT FROM PUBLISHER]

Suspected elder sexual abuse cases investigated by the Massachusetts Elder Protective Services Program between 1993 and 2002 were qualitatively analyzed using clinical consultation records. Cases that involved perpetrators who were family members of their victims inform this discussion of elder sexual abuse within the family. The cases fall into two groups: marital sexual abuse and incestuous abuse. Three patterns of marital cases were observed: (1) long-term domestic violence, (2) recent onset of sexual abuse within a long-term marriage, and (3) sexual victimization within a new marriage. Incestuous elder abuse involved cases perpetrated by adult children, other relatives, and quasi-relatives. Clinical dynamics observed in all types of cases are discussed. Selected cases illustrate abuse dynamics, problems confronting victims, and perpetrator characteristics. The range of abusive behaviors observed, etiological and contributing factors, and forensic markers of elder sexual abuse are discussed. [ABSTRACT FROM PUBLISHER]

Suspected elder sexual abuse cases investigated by the Massachusetts Elder Protective Services Program between 1993 and 2002 were qualitatively analyzed using clinical consultation records. Cases that involved perpetrators who were family members of their victims inform this discussion of elder sexual abuse within the family. The cases fall into two groups: marital sexual abuse and incestuous abuse. Three patterns of marital cases were observed: (1) long-term domestic violence, (2) recent onset of sexual abuse within a long-term marriage, and (3) sexual victimization within a new marriage. Incestuous elder abuse involved cases perpetrated by adult children, other relatives, and quasi-relatives. Clinical dynamics observed in all types of cases are discussed. Selected cases illustrate abuse dynamics, problems confronting victims, and perpetrator characteristics. The range of abusive behaviors observed, etiological and contributing factors, and forensic markers of elder sexual abuse are discussed. [ABSTRACT FROM AUTHOR]