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February 23, 2007


The Source of Information and Assistance on Elder Abuse

Elder Abuse: International and Cultural Perspectives - An Update of the Literature

In 2002, the Clearinghouse on Abuse and Neglect of the Elderly (CANE) produced two bibliographies recognizing the phenomenon of elder mistreatment as a worldwide problem, impacted by cultural, ethnic and racial influences (See Elder Abuse: A Global Issue and Cultural Issues in Elder Abuse). June 15, 2006 has been designated World Elder Abuse Awareness Day, focusing attention on this global concern. In support of this initiative, CANE has compiled a list of annotated references intended to supplement the earlier bibliographies.

The following international studies addressing elder abuse, neglect, self-neglect and exploitation underscore the universal nature of this human rights issue. The entries illuminate cultural similarities and variations regarding the causes of elder mistreatment, the perceptions held as to what constitutes abuse and neglect, and barriers to research, identification and intervention.

In addition, we have included references from the U.S. that speak to cultural, ethnic and racial aspects of elder mistreatment and interventions. While most articles address the topic directly, several deal with related issues (for example, risk factors.)

Most of the reference materials can be obtained through local university and community libraries or interlibrary loan services. Some must be ordered directly through the publisher or production company. When available, contact and pricing information is included with the abstract. Increasingly, many resources are available online, and the web addresses are also included.* If you have difficulty obtaining any of these materials, please contact the CANE office for assistance by emailing [email protected] or telephoning (302) 831-3525.

Note: This is a selected annotated bibliography, which does not include all published references related to this topic. The included references have been selected to provide readers with a current and comprehensive collection of articles representing a variety of perspectives on the subject. For earlier references on these topics, please review the following CANE bibliographies:

Elder Abuse: A Global Issue (July 2002)

Cultural Issues in Elder Abuse (July 2002)

To search for additional references on this and other topics related to elder abuse, please visit the CANE Web site at: . To search the CANE Bibliography Series, go to .

(*Web addresses may change without notice. If an address provided is no longer accurate, we recommend using a generic search engine, such as Google, to find a current link. If you cannot locate the online publication, contact the CANE offices for assistance by e-mailing [email protected] or telephoning (302-831-3525).

The National Center on Elder Abuse (NCEA) serves as a national resource for elder rights advocates, law enforcement and legal professionals, public policy leaders, researchers, and citizens. It is the mission of NCEA to promote understanding, knowledge sharing, and action on elder abuse, neglect, and exploitation.

The NCEA is administered under the auspices of the National Association of State Units on Aging.

NCEA Partners
  • National Association of State Units on Aging (NASUA), Lead Partner
  • American Bar Association (ABA) Commission on Law and Aging
  • Clearinghouse on Abuse and Neglect of the Elderly (CANE) at the University of Delaware
  • National Adult Protective Services Association (NAPSA)
  • National Committee for the Prevention of Elder Abuse (NCPEA)

This publication was made possible through the support provided by the National Center on Elder Abuse. Major funding for the National Center on Elder Abuse comes from the U.S. Administration on Aging, Department of Health and Human Services.                    Grant No. 90-AM-2792.

Opinions or points of view expressed do not necessarily reflect the official position or policies of the U.S. Administration on Aging.


1. S6145-7
Hinrichsen, G.
Why Multicultural Issues Matter for Practitioners Working With Older Adults
Professional Psychology: Research and Practice; Vol. 37 (1), 29-35; 2006.
Journal article (scholarship)
This article describes the need for mental health practitioners to be sensitive to multicultural issues among older clients. It is noted that just as the percentage of elders in American society is increasing, the percentage of minorities among all elders is increasing. Minority elders are at risk for ageism as well as ethnic and racist stereotyping and they experience health and economic disparities when compared with non-minority elders. They also encounter many barriers when accessing health care services. In particular, they underuse mental health services. Using a number of authentic clinical experiences, the author explores a number of issues and dynamics against the backdrop of the American Psychological Association's "Guidelines on Multicultural Education, Training, Research, Practice and Organizational Change for Psychologists" (2003). Themes include minority clients working with non-minority clinicians, non-minority clients working with minority clinicians, overt expressions of racism on the part of the older client, and religious differences. (U.S.)

2. S6138-11
Malley-Morrison, K., Nolido, N. & Chawla, S.
International Perspectives on Elder Abuse: Five Cases Studies
Educational Gerontology; Vol. 32 (1), 1-11; 2006.
Journal article (scholarship)
This article serves as an introduction to an issue of Educational Gerontology dedicated to international and cultural perspectives related to elder abuse. The authors review the existing literature to highlight cultural differences in how elders and others throughout the U.S. perceive various forms of mistreatment, and provide a brief comment regarding the World Health Organization's Missing Voices research series which addressed elder mistreatment throughout eight countries (including five developing countries as well as western, industrialized nations). Researchers describe the cognitive-ecological approach that their international working group has adopted. The perspective focuses on "individual, neighborhood, and sociocultural contributors to abuse -- and conceptions of abuse." Universal themes of human rights and the impact of traditional roles within culturally specific settings are also examined. The "Cross-Cultural Definitions of Family Violence and Abuse Survey," is also described. The instrument was developed by the research group, translated into 20 languages, and posted online in order to generate cross-cultural data, which is the source of information for the studies included in this special issue. The themes of collectivism and individualism are among those highlighted by the articles selected for this issue. (International) (Note: The survey is accessible online at: .

The following articles are included in this issue:

3. S6180-11
Arai, M.
Elder Abuse in Japan
Educational Gerontology; Vol. 32 (1), 13-23; 2006.
Journal article (research)
In traditional Japanese culture, the Confucian principle of filial piety implies that care for elderly parents becomes the responsibility of the oldest son; however, in reality this responsibility falls upon his wife, who becomes the caretaker for not only her in-laws but her aging spouse as well. Conflicts arising from the clash of traditional and modern influences are believed to contribute to elder abuse and neglect. One hundred women and 46 men, aged 19 to 60, were asked to provide examples of elder abuse and neglect, and to rank them according to degree of severity. Among the findings, the type of abuse most commonly viewed as extreme in nature was physical abuse, followed by neglect, blame, and psychological abuse. Physical abuse also accounted for nearly 25 percent of the examples described as moderate in degree, followed closely by neglect (21 percent of examples given), economic abuse (15 percent), and emotional abuse (12 percent). Psychological neglect and psychological abuse were perceived as the most common forms of mild mistreatment, although examples of verbal, emotional, physical abuse and neglect were also provided. (Japan)

4. S6141-11
Konig, J. & Leembruggen-Kallberg, E.
Perspectives on Elder Abuse in Germany
Educational Gerontology; Vol. 32 (1), 25-35; 2006.
Journal article (research)
This article describes the responses of 74 German participants (57 women and 17 men, aged 15 through 62) who provided examples of what they perceived as extremely, moderately or mildly abusive behaviors of adult children towards elderly parents. The authors note the difficulty in finding a translation for the English word abuse; they used the term "missbrauch" which means "misuse" and can include "sexual abuse, substance abuse and taking unfair advantage of someone," and "misshandlung" which refers to physical violence. Among the findings, physical abuse was categorized most frequently as extremely abusive in nature, as were physical neglect and abandonment; psychological abuse was more often viewed as moderately abusive; economic abuse was viewed typically as moderate; and psychological neglect was viewed as primarily mild. A few gender and age differences were noted; for example, women offered more examples of psychological abuse as mild in degree, and men offered more examples of physical abuse as moderate in degree. (Germany)

5. S6179-14
Rabi, K.
Israeli Perspectives on Elder Abuse
Educational Gerontology; Vol. 32 (1), 49-62; 2006.
Journal article (research)
Observing that a significant number of Israeli elders live within the community, have limited economic resources, rely heavily on family members for assistance and therefore may be a greater risk for elder mistreatment, this article considers the perceptions of elder abuse and neglect among two ethnic groups, the Ashkenazi (n=42) and the Sephardic (n=27). Participants, aged 18 to 80, provided examples of various types of mistreatment, and categorized the examples according to severity. Examples of physical abuse and neglect/abandonment were most commonly identified by both ethnic groups as extreme in nature. However, Ashkenazi were more likely to view physical and economic abuse as moderate in nature, and abandonment/neglect as mild in nature. Gender differences were also analyzed, and the one significant difference noted was that women were more likely to view disrespect as moderate abuse while men were more likely to view it as mild. (Israel)

6. S6139-12
Tauriac, J. & Scruggs, N.
Elder Abuse Among African Americans
Educational Gerontology; Vol. 32 (1), 37-48; 2006.
Journal article (research)
In this article, the authors review sociohistorical and other culturally specific elements that influence the perceptions of elder abuse among African-Americans. Financial strain is considered, along with the traditional characteristic of extended family, which often provides support and stability, but may also render the system vulnerable to conflict. In this convenience sample study, 25 female and 10 male African-American participants, aged 16 to 63, were asked to provide examples of extreme, moderate and mild elder abuse. Extreme abuse was predominantly characterized by examples physical aggression; verbal abuse was least frequently categorized as extreme; neglect/abandonment was classified as extreme in half of the examples provided. Although research suggests that it is a more common form of elder abuse among African-Americans (Dimah & Dimah, 2002; Griffin, 1994, 1999), only three examples of financial abuse or exploitation were given. Gender and age differences among responses are also discussed, along with implications for prevention and intervention. (U.S.)


7. S6165-52
Age Concern New Zealand
Age Concern Elder Abuse and Neglect Prevention Services - An Analysis of Referrals for the Period: 1 July 2002 to 30 June 2004
Age Concern New Zealand, Inc.; Wellington, NZ; November 2005.
Agency report
This statement provides an analysis of over 1200 cases of elder abuse and neglect reported to Elder Abuse and Neglect Prevention services (EANP) from July 2002 through June 2004. Among the findings, the majority of abusers (70 percent) are family/whanau
members, typically sons or daughters, regardless of the client's living situation; older perpetrators (aged 65 and up) are more likely to be husbands; family violence occurs even when elders are living in residential care facilities, with two-thirds of all residential client abuse being attributed to family/whanau members; psychological abuse, including verbal intimidation and harassment, is the most frequently experienced type of abuse, followed by material or financial abuse. The researchers note that these statistics are based on reported cases only, and that international studies suggest that this only represents the "tip of the iceberg." (Note: This report is available online only at .) (New Zealand)

8. R6051-6
Boldy, D. et al.
Addressing Elder Abuse: Western Australian Case Study
Australasian Journal on Ageing; Vol. 24 (1), 3-8; March 2005.
Journal article (research)
A questionnaire regarding the prevalence and characteristics of elder abuse was mailed to over 1,000 organizations and 129 general practitioners (GPs) throughout Western Australia. Analysis of the 340 completed and returned surveys revealed that there were 182 substantiated and 253 suspected cases of abuse throughout the region, suggesting an estimated prevalence rate of 0.58 percent. Women and individuals over 75 were at increased risk of abuse, and financial abuse was identified as the most common form of mistreatment. Perpetrators were most commonly adult children and other relatives of the victims. Recommendations include the need for increased awareness and education among professionals dealing with elders, along with respite care, advocacy and counseling. (Australia)

9. R6036-5
Brownell, P. & Podnieks, E.
Long-Overdue Recognition for the Critical Issue of Elder Abuse and Neglect: A Global Policy and Practice Perspective
Brief Treatment and Crisis Intervention; Vol. 5 (2), 187-191; 2005.
Journal article (scholarship)
This article presents an overview of global initiatives involving the International Network for the Prevention of Elder Abuse (INPEA) to promote awareness of elder mistreatment. The recommendations generated by the Second World Assembly on Ageing (Madrid, Spain, 2002) and "Missing Voices: Views of Older Persons on Elder Abuse" (World Health Organization/WHO and INPEA, 2002) are summarized. Pending initiatives include World Elder Abuse Awareness Day, to be held on June 15, 2006, and the ongoing "A World View on Elder Abuse" project. (International)

10. R6054-5
Butler, T.
Learning from Rowan Ward - Developing an Audit Tool to Improve the Systems and Processes for Quality of Care and Safety of Service Users
Journal of Adult Protection; Vol. 6 (4), 22-26; December 2005.
The report by the Commission for Health Improvement (CHI, 2003), identified nine characteristics that were underlying the poor care and mistreatment of patients in Rowan ward, a geropsychiatric mental health ward in Manchester, England. This article profiles the development of an audit tool, based upon input from the report, for use in self-evaluation of programs serving vulnerable populations. The tool allows for the evaluation of seven areas of governance: assessment and planning, the role of service users in planning, consent to treatment, complaints policy, arrangements for service users' views, arrangements for care providers' views, and arrangements for relatives' views. The tool has been posted on the National Institute for Mental Health in England (NIMHE) Web site and is being pilot tested by a number of services. (U.K.)

11. P5842-7
Community and District Nursing Association (CDNA)
CDNA Elder Abuse Survey - draft report (U.K.)
Agency report
This report presents the results of the Community and District Nursing Association (CDNA) Elder Abuse Survey. Three-thousand nine-hundred and twenty-two surveys were mailed to members of the CDNA. Two-hundred seventy-six responses were received, representing a seven percent return rate. Of the respondents, 40 percent had witnessed or were aware of elder abuse occurring during 2004. A major finding was that nearly half of the respondents knew more than one patient who had been abused. Verbal abuse was most commonly observed, followed by emotional abuse and physical abuse. Eighty-two percent of the incidents were known to have occurred in the patients' homes. While 77 percent of the abusive incidents were perpetrated by family members, half of the respondents indicated that they were aware of abuse perpetrated by professional caregivers. Nearly two-thirds of the incidents were reported to social services, and approximately half were reported to general practitioners. Eighty-eight percent of the respondents indicated that they were in need of more training regarding elder abuse. (U.K.) (Note: The results of this survey are posted online at: .)

12. R6048-15
Erlingsson, C., Saveman, B., & Berg, A.
Perceptions of Elder Abuse in Sweden: Voices of Older Persons
Brief Treatment and Crisis Intervention; Vol. 5 (2), 213-227; 2005.
Journal article (research)
This article reports the findings of a focus group study conducted in Sweden as part of a global initiative to address elder abuse from the perspectives of older individuals. Six focus groups (comprised of 37 participants) were conducted throughout the southern regions of Sweden. Qualitative content analysis of the group interviews revealed the themes of causes, conceptions, consequences and coping strategies related to elder abuse and neglect. In addition to changes in societal and family structures, individual factors, such as substance abuse on the part of the perpetrator, were identified as causes of mistreatment. While a number of types of abuse were identified, elders most commonly identified physical assault as a result of robbery, and fear was the most common consequence. Coping strategies were individualized and included taking responsibility to report abuse and to obtain medical care. Societal interventions were also recommended, and included enhanced education to improve intergenerational relationships, and the provision of support and advocacy. Ageism and gender issues were also considered. (Sweden)

13. R6044-4
Etkin, M.
The 'Hidden Crime' of Elder Abuse
Canadian Nursing Home; Vol. 16 (1), 23-26; March/April 2005.
Journal article (scholarship)
Recent Canadian statistics indicate that 24 percent of elder mistreatment is being perpetrated by unrelated caregivers, suggesting that abuse is a concern in nursing homes, assisted living facilities and among long-term care patients in the community. This article examines factors that place residents with dementia at risk for elder abuse and neglect. Inappropriate use (or over use) of medication and toxic work atmospheres (including facilities that are understaffed, inadequately supervised, have frequent staff turnover, or are inappropriately managed, or that employ staff who are ageist or inadequately trained) are among the risk factors identified. Care staff are instructed to ask to see the facility's policy regarding abuse and neglect, and are reminded that having a cognitive impairment does not mean that a resident is not credible or capable of disclosing mistreatment. (Canada)

14. S6178-12
Iecovich, E.
Elder Abuse and Neglect in Israel: A Comparison Between the General Elderly Population and Elderly New Immigrants
Family Relations; Vol. 54 (3), 436-447; July 2005.
Journal article (research)
This study, based upon data gathered on the occurrence of elder abuse occurring in Beer Sheva, a city in the southern region of Israel, focuses on the differences of the types and frequency of elder mistreatment experienced by individuals from the general elderly population and new elderly immigrants. Researchers hypothesized that immigrants would be at greater risk for all types of mistreatment, and that predictors for mistreatment would differ among these two cultural groups. The first phase of the research involved health and social care professionals and paraprofessionals completing a brief questionnaire on clients that they suspected were being victimized. The referrals were evaluated by trained social workers who followed-up on cases with strong indicators of elder mistreatment. Among the findings, 120 new cases of elder abuse and neglect were identified in this city during a one-year period, including 48 cases involving new immigrants from former Soviet Union countries. The overall incidence rate of new cases was 0.5 percent, only slightly higher among new immigrants compared to the general population. Although new immigrants were at lower risk for physical abuse, they were at significantly higher risk for neglect. The article also discusses specific sociodemographic characteristics that appear related to various types of elder mistreatment. Limited information is also provided regarding perpetrator characteristics. (Israel) (Note: For additional information on the incidence study, see the following entry: CANE file number R6027-19 "Elder Abuse and Neglect - A Pilot Incidence Study in Israel", item # 28 of this bibliography.)

15. R6031-9
Shibusawa, T., Kodaka, M., Iwano, S. & Kaizu, K.
Interventions for Elder Abuse and Neglect with Frail Elders in Japan
Brief Treatment and Crisis Intervention; Vol. 5 (2), 203-211; 2005.
With the increase in formal home health care services, Japanese health and social services
professionals are becoming more aware of elder mistreatment. Currently, there is no formal notification system for reporting elder abuse and neglect, and there are no investigatory agencies (such as Adult Protective Services) in Japan. This article describes the crisis intervention strategies implemented by social workers at Home Care Support Centers in response to cases of elder abuse and neglect encountered in family caregiving situations. A summary of Japanese research is provided, which has been based mainly on surveys of formal service providers, and suggests that most elder mistreatment occurs within a caregiving context, though not most commonly the result of caregiver burden or stress. Adult children providing care, including a high percentage of daughters-in-law, are the most common perpetrators. The three case illustrations presented demonstrate a spectrum of abuse, ranging from unintentional mistreatment to neglect and physical abuse, and also highlight cultural issues that must be considered when attempting to intervene. Interventions also vary according to the type of abuse and the family and client's willingness to accept services. Ongoing monitoring, the provision of support services (such as formal in-home health care) and the separation of victim and perpetrator through institutionalization are the interventions implemented in these case studies. (Japan)

16. R6056-10
Simpson, A.
Cultural Issues and Elder Mistreatment
Clinics in Geriatric Medicine; Vol. 21 (2), 355-364; 2005.
Journal article (scholarship)
In this overview, the author draws upon her own experiences as a physician, as well as her personal background as an African-American growing up in a rural community, to illustrate how cultural influences impact elder abuse and neglect. Not only do different cultural groups define abuse differently, cultural norms may influence whether or not mistreatment is reported, or if help from "outsiders," such as protective services professionals, is acceptable. Community and family expectations, limited social supports and inadequate financial resources may contribute to risk of abuse, neglect and exploitation. The author also emphasizes that there is a tendency to take a generalized approach to understanding ethnic backgrounds that may hinder service delivery. For example, it is overly simplistic to assume that all Native Americans share the same cultural background, when in reality there are hundreds of tribal communities. The importance of addressing macro levels of mistreatment among populations such as the gay/lesbian/transgendered and the hearing impaired is also discussed. (U.S.)

17. R6102-16
Twomey, M., of the San Francisco Consortium for Elder Abuse Prevention for the National Center on Elder Abuse (NCEA)
Teleconference Summary: "Working with the Faith Community on Elder Abuse Prevention"
National Center on Elder Abuse (NCEA); Washington, D.C.; 2005.
Recognizing that more people turn to clergy than other professional helping groups, the National Center on Elder Abuse hosted two nationwide teleconferences in the spring of 2004 to discuss the role that faith based communities can play in addressing elder abuse. This publication summarizes the content of these teleconferences. Elizabeth Podnieks reported findings from exploratory research conducted in Ontario, Canada, and Lisa Curtis reported on Denver's Clergy Against Senior Exploitation (CASE) project. Recommendations were made to enhance outreach to faith communities, for educating clergy, and for recognizing the special needs of elders. (Canada and U.S.) (Note: This publication is available on the NCEA Web site at: .)


18. R6050-2
Anme, T.
A Study of Elder Abuse and Risk Factors in Japanese Families: Focused on the Social Affiliation Model
Geriatrics and Gerontology International; Vol. 4 (S1), S262-S263; 2004.
Journal article (research)
This two-part study was designed to assess risk factors for elder abuse in Japanese families. The first phase of research was a mailed survey to 3,600 residents of an agricultural village to identify perceptions regarding elder caregiving (response rate not given). Responses suggested that people who thought that family should take on caregiving responsibilities also believed that elders should "obey the family's opinions" without expressing their own. They also felt that there was great stigma attached to not caring for elders, and that caregiving was an extreme burden. In the second phase of the study, a home visit survey of all community-dwelling frail elders (n=78) identified a total of 14 victimized elders, representing a prevalence rate of 17.9 percent. Half were victims of emotional abuse, six were neglected, and three were physically abused. Those who were senile, incontinent, who wandered, who overate, and who had lost their social roles were more likely to be abused. Logistical analysis revealed that wandering due to senility, caregiver's health problems, and caregiver's misunderstanding of the elder's condition were significant predictors of abuse. (Japan) (Note: To view a power point presentation which highlights the findings of this study, in comparison to previously conducted Japanese research, visit: .)

19. P5914-17
Brozowski, K. & Hall, D.
Growing Old in a Risk Society
Journal of Elder Abuse & Neglect; Vol. 16 (3), 65-81; 2004.
This paper examines the interpersonal risk factors for emotional elder abuse among Canadians. Weighted data from 2,366 responses of elder participants of the 1999 Canadian General Social Survey on Criminal Victimization was analyzed. The survey operationalized emotional elder abuse as attempts to limit the elder's contact with family and/or friends, efforts to damage or destroy the elder's property or possessions, efforts to harm or threaten to harm someone the elder is close to, or insults towards the elder. Among the findings, elders who were isolated from external supports and elders who had a change in marital status were more likely to experience emotional elder abuse. Differences between those seniors who were abused by their children and those abused by others are also considered. (Canada)

20. R6076-11
Cambridge, P. & Parkes, T.
The Case for Case Management in Adult Protection
Journal of Adult Protection; Vol. 6 (2), 4-14; September 2004.
In this article, authors propose a return to a model of adult protective case management for all cases involving adult protection throughout the U.K.'s social services and health care systems. This approach has been transformed due to interagency collaborations and specialized client groups, such as mental health patients and adults with learning disabilities. As a result, standards for case responsibilities vary widely not only across agencies, but within agencies as well. The role of the specialist adult protection coordinator (APC), which exists in some social service districts, is highlighted. (U.K.)

21. S6120-20
Doron, I., Alon, S. & Offir, N.
Time for Policy: Legislative Response to Elder Abuse and Neglect in Israel
Journal of Elder Abuse & Neglect; Vol. 16 (4), 63-82; 2004.
Journal article (scholarship)
This article provides an overview of the history of the policy response to elder abuse and neglect in Israel. The initial legislative response is characterized by the authors as paternalistic, followed by a punitive response, which required mandatory reporting. The third phase emphasized protection and intervention. It appears that the current phase is evolving to emphasize education and empowerment. The authors advocate for a policy response that is multidisciplinary, involves the "unheard voice" of the older population, and provides for the allocation of resources necessary to develop and implement training and education initiatives. (Israel)

22. R6074-6
Fear, T. et al.
Home or Hell: Older Tenants' Experiences in the Private Rented Sector
Journal of Adult Protection; Vol. 6 (2), 15-20; September 2004.
Journal article (research)
This article reports upon the findings of a research project, supported by Help the Aged, designed to identify the main forms of abuse and harassment experienced by older tenants in private rented sectors throughout different areas in England. In addition, the study examined the extent of landlord harassment, abuse and exploitation, and sought to identify unscrupulous practices in order to develop effective prevention strategies. Among the types of harassment identified were irregularities in rent collection (including additional fees for rent collection, changes in fee payment processes, erratically scheduled collections), untimely or inadequate responses to repair requests (or no effort to make repairs), repairs followed by exorbitant rent increases, and disputes over privacy. Renters also encountered problems with other tenants who were involved in prostitution and illegal drug use. Recommendations include the need for collaboration among health and social services (including public health agencies) and housing agencies. (U.K.)

23. R6026-16
Ferreira, M.
Elder Abuse in Africa: What Policy and Legal Provisions are There to Address the Violence?
Journal of Elder Abuse & Neglect; Vol. 16 (2), 17-32; 2004.
Journal article (scholarship)
This overview of the phenomenon of elder abuse and neglect in Africa describes the types of mistreatment identified and theoretical explanations for the abuse, and reviews policies and legislation addressing the problem. Elders are among the poorest residents and most have no income security. Political and economic instability, natural calamities and disasters, diseases and epidemics, intergenerational burdens and gender inequities exacerbate the vulnerability of elders. Older women appear to be twice as vulnerable as their male counterparts. Violence towards elders are classified as economic (aimed at gaining assets), social, community, political and witchcraft-related. (Violence related to witchcraft occurs when a frail older women with particular physical traits is scapegoated as the cause of misfortunes that befall a community; as a result, the woman may be ostracized or banished, lynched, tortured, injured or murdered.) While the constitutions of a number of African countries ensure protections of the rights of all citizens, none specifically address the rights of elders. Recommendations are detailed and include the need for international and nongovernmental organizations (NGOs) to promote human rights for elders, and to utilize media and other mechanisms for advocacy and increased public awareness. (Africa)

24. R6072-11
Goergen, T.
A Multi-Method Study on Elder Abuse and Neglect in Nursing Homes
Journal of Adult Protection; Vol. 6 (3), 15-25; November 2004.
Journal article (research)
In this multimodal study, data was gathered on abuse and neglect among nursing home residents in the region of Hesse, Germany. In-depth interviews were conducted with 251 individuals (residents, staff members, and others) from eight nursing homes in the area; 361 professional caregivers from 27 nursing homes were surveyed; data was analyzed from 188 nursing home control agency site visits; and 35 prosecutor's case reports were examined. Although respondents' summary judgments indicated the experience of care was positive overall, interviews with staff revealed the following: 70 percent themselves had acted abusively or neglectfully on at least one occasion; more than half had witnessed psychological abuse and/or verbal aggression; 47 percent witnessed paternalism or infantilization; 39 percent had witnessed neglect; 35 percent had witnessed psychosocial neglect, 21 percent had observed physical abuse; and 20 had observed inappropriate use of chemical restraints. Survey results indicated 71 percent of the participants reported at least one act of abuse or neglect during the previous year, and more than half had observed neglect and nonphysical abuse. In addition, staff estimated that only one in three severe acts of physical abuse were reported to management, and that most cases of inappropriate use of restraints were unnoticed. Substance abuse on the part of staff, physically aggressive behavior by residents, caregiver burnout, and the ratio of residents to registered nurses were among the greatest predictors of abuse and neglect. Evidence of elder abuse and neglect was identified in over one-third of the site inspections conducted. Analysis of court cases revealed barriers to police investigations and prosecutions of institutional elder mistreatment, including impairment (or even death) of witnesses and victims, poor documentation, and insufficient evidence. The article concludes with a summary of the strengths and weaknesses of each of these methodological approaches within this research context. (Germany)

25. P5996-11
Harbison, J., Coughlan, S., Karabanow, J. & VanderPlaat, M.
Offering the Help That's Needed: Responses to the Mistreatment and Neglect of Older People in a Rural Canadian Context
Rural Social Work; Vol. 9, 147-157; December 2004.
In this grounded theory analysis, researchers explore the efforts to address elder abuse, neglect and self-neglect occurring in rural Eastern Canadian communities. Interviews were conducted with 55 key informants from a variety of health and social service agencies, and focus groups were convened among participants involved directly with clients. Participants identified a number of limitations to providing assistance, including the restrictions of the Adult Protection Act which requires "just cause" and collateral investigation before an alleged victim can be approached; the ethical and practical issues surrounding competency; balancing autonomy with the client's best interest; and bureaucratic restrictions. Creativity and multidisciplinary collaboration were the most beneficial resources identified among outreach and intervention strategies. (Canada)

26. P6005-20
Holkup, P. et al.
Community-Based Participatory Research: An Approach to Intervention Research with a Native American Community
Advances in Nursing Science; Vol. 27 (3), 162-156; July-Sept 2004.
Community-based participatory research (CBPR), a form of action research which emphasizes the involvement of members of the study population, is a promising approach for reaching vulnerable populations. The model incorporates local knowledge and perceptions while fostering creativity in utilizing existing resources. This article describes the framework of CBPR and details how the approach was recently applied in the Caring for Native American Elders study. In this application, a Native American social worker, experienced in family conferencing in child protective services cases, teamed with researchers to adapt the intervention for use in elder abuse cases. Flexibility, self-awareness, collaboration, ethical sensitivity, cultural sensitivity, time constraints and project sustainability are among the concepts considered. The process of establishing evaluation criteria for the project is also discussed. (U.S.)

27. R6027-19
Iecovich, E., Lankri, M. & Drori, D.
Elder Abuse and Neglect - A Pilot Incidence Study in Israel
Journal of Elder Abuse & Neglect; Vol. 16 (3), 45-63; 2004.
Journal article (research)
This pilot study was intended to measure the scope of elder mistreatment in Beer Sheva, a southern Israeli city. It was also designed to identify characteristics of both victims and perpetrators, and to identify family pathology that contributed to risk of mistreatment. Prior to the study, only a handful of abuse cases among the city's 24,200 elders had been reported to health and social services professionals. In the initial phase of the research, a series of multidisciplinary meetings were convened to gather input, raise awareness, and develop a systematic referral process to the local Social Service Center for Elderly Persons. All professionals and paraprofessionals working with elders were asked to complete a formal referral to social services if elder abuse was suspected. In cases where there was a strong suspicion of mistreatment, a specially trained social worker conducted an in-home assessment. If mistreatment was substantiated, an intervention plan was implemented. One-hundred and twenty new cases were identified throughout the area from December 2001 through December 2002, suggesting a citywide incidence rate of 0.5 percent. Unmarried women, who were frail and disabled, living with others, were at greatest risk for all types of abuse and neglect. Mental abuse (including verbal abuse and threats) was most commonly reported (65.8 percent) followed by physical abuse (59.3 percent). Forty percent reported financial exploitation and neglect was substantiated in nearly one-fourth of all cases. Two cases of sexual abuse (rape by adult sons) were also reported. Family conflicts were the most commonly reported risk factors for elder abuse, while caregiving for dependent elders appeared to be the least commonly reported. (Israel)

28. R6068-10
Jeary, K.
Sexual Abuse of Elderly People: Would We Rather Not Know the Details?
Journal of Adult Protection; Vol. 6 (2), 21-30; September 2004.
Journal article (research)
This exploratory study was designed to analyze sexual harassment, inappropriate touching and extreme sexual violence perpetrated against elders. Fifty-two case records of elder sexual abuse, randomly selected from predominantly criminal justice agencies, were examined in order to determine the range of sexually abusive behaviors and the context in which they occurred. In addition, semi-structured interviews were conducted with professionals working with sex offenders and involved in the development of treatment programs, and focus groups were conducted with professionals working with elders in residential and long-term care settings. One-third of the cases involved reported sexual abuse occurring in residential care settings. These victims were predominantly female, and abusers were fellow residents, staff members, or family members or other visitors. One case illuminated the complexity of addressing sexuality and the need for intimacy among elders with questionable decision-making capacity. The study also describes cases of elder sexual abuse occurring in the community. Rarely, the perpetrators were professional home care providers. Case examples depict sexual harassment towards patients, and also situations wherein caregivers were encouraged or drawn into abusive behavior patterns. Cases were also reported involving elders living independently in the community, without formal care. In many of these assaults, offenders admitted that it was not the vulnerable appearance of the elder, but of the home, that caused them to target the particular victim. Poor documentation in case records, an inability to substantiate allegations in some cases, and ageism were problems identified through the study. (U.K.)

29. R6022-17
Jonson, H. & Akerstrom, M.
Neglect of Elderly Women in Feminist Studies of Violence - A Case of Ageism?
Journal of Elder Abuse & Neglect; Vol. 16 (1), 47-63; 2004.
Journal article (literature review)
This article provides a discussion regarding the underreprestentation of older victims in the feminist analysis of violence against women, with an emphasis on the Scandinavian perspective. Scandinavian feminist research that addresses gender and violence rarely includes findings regarding older battered women, and bibliographies do not include a special category for elderly victims. The authors consider the possibility that feminism is a form of ageism that serves to further marginalize older women. A recent study in Sweden that addresses elder abuse of both men and women is highlighted. While the vulnerability of older women is the main result of the study, findings indicate that 16 percent of the older women who were surveyed were victimized and 13 percent of the older men were also victimized. The fact that there are male victims and female offenders threatens the feminist perspective that suggests that violence among elders can be attributed to the general dominance of men over women in society. (Sweden)

30. R6067-8
Juklestad, O.
Elderly People at Risk: A Norwegian Model for Community Education and Response
Journal of Adult Protection; Vol. 6 (3), 27-33; November 2004.
Journal article (scholarship)
While Norway has an effective social welfare system, particularly addressing the needs of children and battered women, elder abuse services are in need of development. This article reports on an initiative in Norway designed to promote public awareness of elder abuse and neglect and the development and implementation of appropriate interventions. After providing a brief history of the Norwegian response to the recognition of elder abuse as a societal problem, the author describes the Elder Protective Services project which is located in a Senior Citizen Centre in Oslo. A guiding principle of the program is that elder protection should be an integral part of routine health and social service care. The initial phase of the project involved the designation of a key worker, who served as a liaison with other health and welfare professionals, and the distribution of education materials to families as well as human service organizations, the media, law enforcement and seniors themselves through a variety of settings (senior centers, pensioners' clubs, church congregations, etc.). Through analysis of the cases identified as a result of the project, policy developers learned that many cases of elder abuse involved long-standing domestic violence, and other cases of marital conflict were exacerbated by late life transitions, such as retirement and illnesses. Adult children (particularly sons) with social or psychological problems were also identified as abusers. The project has been successfully replicated in the three other districts in Oslo. The article also describes the Norwegian Centre on Violence and Traumatic Stress. (Norway)

31. P6007-10
Litwin, H. & Zoabi, S.
A Multivariate Examination of Explanations for the Occurrence of Elder Abuse
Social Work Research; Vol. 28 (3), 133-142; September 2004.
Journal article (research)
In this matched case-control study, variables were analyzed to evaluate four explanations for the rise in elder abuse in a once traditional culture now in transition. Predictors related to sociodemographic status, dependency, modernization, and social integration were examined and compared among abused (n=120) and nonabused (n=120) Arab Israeli elders living in Northern Israel in 1998. Lower income, increased dependency, increased modernization, and poor social integration were positively associated with elder abuse. Findings suggest that there are multiple explanations for the increase in elder mistreatment. However, increased modernization, compounded by poor social integration, were most significantly associated with elder abuse and neglect; this suggests that these are the dominant factors contributing to this trend. (Israel)

32. P5906-8
Doctors, Elder Abuse, and Enduring Powers of Attorney
Matthews, F.
The New Zealand Medical Journal; Vol. 117 (1202); September 2004.
Journal article (scholarship)
Intended for physicians, this article presents a discussion of the shortcomings of New Zealand legislation regarding the means of protecting people with diminished decision making capacity. The Protection of Personal and Property Rights Act (PPPR Act, 1988), administered by the Family Court, allows for surrogate decision making by either a court appointed welfare guardian and/or property managers, or through an enduring power of attorney (EPA, which is comparable to a "durable power of attorney" in the U.S.) appointed by an individual (called a "donor" in New Zealand, known as a "grantor" in the U.S.) prior to incapacitation. Welfare guardians are instructed to consult with the person for whom they act and to encourage the incapacitated adult to make his or her decisions whenever possible. Attorneys named in the EPA are not specifically instructed to consult with the donor or promote his or her welfare. However, anyone suspecting mistreatment of the donor by the attorney can request a court review of the appointment. A recent study of elder abuse committed through misuse of the EPA identified two broad categories of mistreatment: financial impropriety and failure to provide appropriate care. Recommendations to enhance the protection of incapacitated elders include the need for monitoring of the mental status of the donor at the time of an appointment of an attorney, and the need for the donor to obtain legal advice upon the appointment of an attorney. (New Zealand) (Note: This article is available online at: .)

33. R6052-6
Minshull, P.
Avoiding Systemic Neglect and Abuse in Older People's Inpatient Mental Health Care Settings
Journal of Adult Protection; Vol. 6 (4), 27-32; December 2004.
Journal article (scholarship)
In this article, the author describes how the tendency to move away from patient centered care toward an overemphasis on the needs of the institution can create an environment for abuse and neglect of elderly mental health inpatients. The development of a forum to address inpatient mental health care for older individuals is outlined. The forum operates on three levels: locally, it involves working units within a hospital setting; a governance group is created from the local forums; and a regional forum is convened by the National Institute for Mental Health in England (NIMHE). The forum is empowered to implement national policy guidelines established for the care and treatment of older mental health patients. Configuration, membership, accountability and authority, procedures and collaboration are discussed as key elements of successful initiatives. (U.K.)

34. P5637-52
Nerenberg, L. (primary author), for the National Indian Council on Aging (NICOA) and the National Center on Elder Abuse (NCEA)
Preventing and Responding to Abuse of Elders in Indian Country
NCEA; Washington, D.C.; June 2004.
Agency report
In 2002, the National Indian Council on Aging (NICOA) was retained by the NCEA to study the scope and nature of elder abuse in Indian Country, and to identify the unique needs of vulnerable and abused Indian elders. The study involved a literature review (see CANE file # P5638-29, below) along with a review of existing policies regarding elder abuse and neglect, an assessment of current projects and programs as well as recommendations from the "Healing Ourselves, Healing Our Spirits, Healing Our World" conference (2002), small group discussions, surveys of Tribal Title VI Coordinators, input from the Indian Health Services Combined Clinical Councils regarding promising practices, and comprehensive interviews with tribal representatives and other key informants. Title VI directors were asked which types of abuse had been most commonly reported. Among the findings, financial abuse was most commonly reported, with neglect and self-neglect also frequently reported. Physical and psychological abuse was also reported, while no respondents indicated that sexual abuse happened often. However, 46 percent of the directors indicated that sexual abuse was reported on occasion. Seven principles to guide policy development for prevention and intervention are identified, and emphasize the need for initiatives to be culturally compatible. The need for elder abuse initiatives to remain within the jurisdiction of the tribes as sovereign governments is also considered essential. Recommendations include the need for tribe-specific assessments and planning along with national research, including epidemiological studies. The publication also includes promising practices, resources, and contact information. (U.S.) (Note: This report is available online at: .

35. P5638-29
Nerenberg, L. (primary author), for the National Indian Council on Aging (NICOA) and the National Center on Elder Abuse (NCEA)
Review of the Literature: Elder Abuse in Indian Country - Research, Policy, and Practice
NCEA; Washington, D.C.; June 2004.
Literature review
This publication presents a summary of the literature review that was conducted as part of the National Indian Council on Aging's (NICOA) initiative (funded by the NCEA) to study the scope and nature of elder abuse in Indian Country, and to identify the unique needs of vulnerable and abused Indian elders. Studies by Brown, Maxwell and Maxwell, and Buchwald et al. are highlighted. Additional publications by the NCEA, Baldridge, Brown, Carson, Hand, Hudson & Carlson, and others are described. Cultural beliefs that may increase or reduce risk within this population are considered. Federal initiatives and tribal responses to elder abuse are highlighted (including tribal elder abuse codes, such as those developed by the Lakota Sioux and the Yakima Nation, and the Navajo's Dine Elder Protection Act) along with issues related to jurisdiction. The publication concludes with a needs assessment for further research, policy development and service delivery. (U.S.) (Note: This publication is available online at: .

36. R6030-17
Neikrug, S.
Creating an Intergenerational Learning Community for the Study of Elder Abuse
Journal of Elder Abuse & Neglect; Vol. 16 (2), 33-49; 2004.
Journal article (scholarship)
Observing the limitations of teaching about the topic of elder abuse through literature only, this article describes an educational experience for undergraduate social work students in Israel. The course structure was designed to reflect the principles of contemporary social work through the integration of practice-oriented instruction while providing direct contact with elders through intergenerational, team teaching. The instructional concept of andragogy (which incorporates the accumulated life experience and knowledge of both teacher and students into the learning process) is described as it is applied in this project. A summary of ideas developed by the student group as a result of this educational process is presented, and reflects an emphasis on prevention of abuse and exploitation through the empowerment of the aging individual, and the need to draw upon the expertise of elders in developing policy response to elder mistreatment. (Israel)

37. R6038-2
Sims, B.
How Protected are the Vulnerable?
Nursing & Residential Care; Vol. 6 (9), 418-419; September 2004.
Journal article (scholarship)
In this brief analysis, the author highlights some of the reasons that elder mistreatment has been difficult to address in the U.K., including the fact that abuse is wide ranging in nature, that most occurs in the victim's home, and that elder issues are perceived as a relatively low priority. A recent Health Select Committee report may bring about positive policy changes, in part because it has raised the visibility of the problem. Although the government's reaction to the recommendations has been disappointing thus far, new initiatives are being implemented, such as the Protection of Vulnerable Adults (POVA) scheme, which bans known abusers from working with vulnerable adults. (U.K.)

38. R6075-11
Touza, C., Segura, M. & Prado, C.
Initial Conclusions on the Design and Validation of the 'Inadequate Treatment Detection Scale' for Elders
Journal of Adult Protection; Vol. 6 (1), 4-14; November 2004.
Journal article (research)
This article reports the findings of the Ciudad Lineal District Elder Abuse Detection Project of Madrid, Spain, particularly focusing on the development and testing of the "Inadequate Treatment Detection Scale (SIT)". The tool was designed to assist health and social services professionals in determining whether further assessment of potential abuse, neglect or self-neglect is warranted. The SIT is a 76 item scale designed to be completed based upon the professional's perception of the elder's situation versus self-report by the elder. The instrument was pilot tested using information from 34 elder social service cases in order to evaluate the response format, content validity, consistency, sensitivity and ease of administration. Item-by-item analysis suggests that there are elements of the scale effective in differentiating cases in which inadequate treatment is suspected. Indicators of neglect, physical abuse, sexual abuse, and conflictive family environments were identified, along with perpetrator risk factors. Although the tool requires further testing and certain items are likely to be deleted, results suggest that this tool will also be useful in developing treatment interventions based upon the individual's needs and circumstances. (Spain)

39. P5752-70
Waters, H. et al., for the Department of Injuries and Violence Prevention, World Health Organization (WHO)
The Economic Dimensions of Interpersonal Violence
World Health Organization (WHO), Geneva, Switzerland; 2004.
Agency report
This study examines the costs associated with interpersonal violence, and the research that supports the cost effectiveness of preventive efforts. The study considers the individual, relationship, community and societal risk factors of interpersonal violence within an ecological framework. Existing research is presented describing the costs of child abuse and neglect, intimate partner violence, sexual violence, workplace violence, youth violence and other violent crimes (the costs of elder abuse are largely undocumented). Direct costs include such expenses as legal and medical services, policing, controlling and incarceration of perpetrators, security, foster care and economic benefits to perpetrators. Indirect costs include losses in earning, time and investment in human capital, indirect protection, insurance costs and psychological costs. (International) (Note: This report is accessible online at: .)

40. P5934-15
Weeks, L. et al.
A Gendered Analysis of the Abuse of Older Adults: Evidence from Professionals
Journal of Elder Abuse & Neglect; Vol. 16 (2), 1-15; 2004.
Journal article (research)
Employing an ecological framework, researchers analyzed the gendered nature of elder abuse through the experiences of medical and non-medical professionals working with seniors. One-hundred and twenty-one professionals (representing a 46.9 percent response rate) throughout Prince Edward Island, Canada, were surveyed regarding their exposure to elder abuse cases. Of the 51,893 seniors that these respondents had collectively worked with, 260 had been identified as abused (0.5 percent), and 40 of the participants had encountered at least one case of elder abuse. Of the 75 abuse cases described, 50 victims were female, 17 were male, four were of unknown gender, and two cases involved couples. Dementia was identified among eleven percent of the victims; five cases involved other mental health problems; five cases involved alcohol abuse; and five cases involved women with other health conditions. In 40 percent of the cases, victims were abused by males; in 22 .4 percent there were multiple abusers; 14.9 percent of the perpetrators were female; 14.9 percent of the cases involved self-abuse. Power and control issues, prevalent in domestic violence, were identified in the twelve cases involving abusive husbands. Researchers suggest that the gender may also be a factor in the professional's likelihood of identifying elder abuse cases; female participants in this study were disproportionately more likely to identify abuse cases. (Canada)

41. P5769-9
Yan, E. & Tang, C.
Elder Abuse by Caregivers: A Study of Prevalence and Risk Factors in Hong Kong Chinese Families
Journal of Family Violence; Vol. 19 (5), 269-277; October 2004.
Journal article (research)
After providing a review of the international literature on prevalence and incidence studies of elder abuse, this article reports upon research designed to study prevalence rates and associated risk factors (age, gender, living arrangements, visual and memory abilities, chronic illness and dependence upon caregivers) of abuse among Hong Kong Chinese individuals aged 60 and over. Participants were referred from five community elder centers, with the final sample consisting of 90 males and 186 females, ranging in age from 60 to 91. Ninety-one percent of the participants were living with family members at the time of the study. Researchers administered oral questionnaires regarding their experiences of verbal and physical abuse and violation of personal rights occurring within the previous 12 months. Of the findings, 27.5 percent of the elders experienced some form of abuse. Verbal abuse was the most prevalent mistreatment experienced (by 26.8 percent of the participants); violation of personal rights was experienced by 5.1 percent; and physical abuse was experienced by 2.5 percent. Eighty-eight percent of the abusers were adult children. Over a quarter of the cases involved multiple abusers. Strongest predictors for all types of mistreatment were victim's poor visual ability, dependence on caregivers, and memory impairment, and caregivers' nondependence on victims. Physical abuse was also predicted by caregivers' nondependence on elders and elders' dependence on caregivers. Advanced age was the only significant predictor of violation of personal rights. (Hong Kong)


42. P5122-8
Akaza, K. et al.
Elder Abuse and Neglect: Social Problems Revealed from 15 Autopsy Cases
Legal Medicine; Vol. 5 (1), 7-14; 2003.
Journal article (research)
This retrospective study examined cases of individuals aged 65 and older who died and were autopsied from 1990 through 2000 in the Department of Legal Medicine at the Gifu University School of Medicine in Japan. The analysis revealed that in the sample of 125 cases, 15 deaths were attributed to elder abuse and neglect. Among the 13 domestic cases classified as abuse, the perpetrator was most often the victim's son. Eight of the perpetrators were unemployed, four had a history of mental illness, and two were alcoholics. Each case is briefly described. In seven cases, criminal investigations were initiated and three perpetrators were psychiatrically hospitalized. (Japan)

43. R6012-19
Erlingsson, C., Carlson, S., & Saveman, B.
Elder Abuse Risk Indicators and Screening Questions: Results from a Literature Search and a Panel of Experts from Developed and Developing Countries
Journal of Elder Abuse & Neglect; Vol. 15 (3), 185-203; 2003.
Journal article (research)
One of the major goals of the Global Response Against Elder Abuse (GREAT) is the development of a universal elder abuse detection instrument. This article describes the first steps of the initiative: a literature search and a modified Delphi process to identify consensuses and divergences among experts throughout the world on risk indicators. In all, 565 risk indicators, 17 instruments, and 67 screening questions were identified throughout the literature search. These items formed the basis for the Delphi panel questionnaires. Consensus existed for the following risk indicators: a history of violence or addiction; an isolated and physically impaired abused elder; a hostile abuser; and physical markers of abuse such as fractures, dehydration, burns, etc. The article details differences that existed among the results from the literature search and the Delphi process, as well as differences observed among experts depending upon the development status of their country. (International)

44. P5477-11
Grossman, S. & Lundy, M.
Use of Domestic Violence Services Across Race and Ethnicity by Women Aged 55 and Older
Violence Against Women; Vol. 9 (12), 1442-1452; 2003.

Journal article (research)
Observing that there is limited research on older minority victims of domestic violence (DV), this study examines race and ethnicity differences among a population of female DV service users aged 55 and over. Data collected by the Illinois Coalition Against Domestic Violence of clients who utilized services funded by the Coalition from July 1990 through June 1995 was analyzed. Of the 2,702 older women requesting assistance, nearly 77 percent were White, 17.5 percent were African American, 4.5 percent were Hispanic, 0.7 percent were Asian, 0.2 percent were American Indian, and 0.3 percent were biracial. The White, African-American and Hispanic groups were similar in that nearly all service users experienced emotional abuse, but a higher percentage of White and African-American women had special needs (9 and 8.5 percent, respectively) than Hispanic women (5.1). Hispanics were more likely to be married than members of the other racial groups, and had the highest rate of abusers identified as spouses or former spouses. Sixty-one percent of the White females reported abuse by husbands or former husbands, compared to 44.5 percent of the African-American victims. Hispanic women reported the highest rate of sexual abuse (17 percent), while White women reported an 11 percent rate and African-American women reported 4.4 percent rate. Hispanic women also reported the highest rate of physical abuse (77.1 percent), while African-American women reported a rate of 74 percent and White women reported a rate of 70.5. The article also provides an interesting contrast to research generated within the Adult Protective Services (APS) field and the implications of such variances. (U.S.)

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