Definitions for abuse are not standardized in the legislation, nor is there complete agreement about what types of abuse exist (Pillemer and Finkelhor, 1988). The five types of abuse most consistently mentioned in some form are physical abuse, emotional abuse, material (or financial) abuse, active neglect, and passive neglect. Godkin, Wolf, and Pillemer provide fairly standard definitions of each (1

Most sources concur that the psychological status of the abuser has considerable influence. Myers and Shelton (1987, 212) report that “a significantly higher percentage of caregivers in abuse/neglect cases has a history of mental or emotional illness” when compared to caregivers in a non-abuse sample (40.7% compared to 5.3%). Additionally, many more of the abusive caregivers had experienced a recent decline in mental health (45.8% as opposed to 5.0%). Unfortunately, “psychological status” is an umbrella, which shelters almost any psychosocial disorders, and therefore imparts no specific information about the abusive relationship. Another popular explanation is the “cycle of violence” theory, which contends that those who abuse elders were abused by those elders as children. Myers and Shelton (1987, 377) report that “1 in 400 children who are reared nonviolently attack their parents later in life, compared to 1 in 2 children who are abused by their parents,” a statistic found by Steinmetz in 1978. Godkin, et al. states that “there is no evidence to support this premise”(1989). Pillemer and Finkelor directly challenged this “generational inversion” theory with their finding that 58% of abusers are spouses, as compared to 24% who are children (1988, p. 55). Another common theory is that physical, mental, and/or emotional impairments of the elder leave him or her dependent upon the caregiver and vulnerable to abuse. Godkin, et al. found that elders who were abused had “significantly worse” cognitive functioning and emotional and mental health than a comparison group of non-abused elders (1898, 212). Interestingly, they found no difference between the two groups in the number of physical impairments requiring attention, though significantly more of the abused elders had “experienced a recent decline in physical health” (1989, 213).

Powell and Berg found that victims of elder abuse were very reluctant to initiate legal action against their abuser, “generally because of fear of retaliation or a need to protect the abuser” (1987, 78). Interventions such as visitations by the caseworker and/or enlisting the aid of friends or relative were generally positively received. It is important to remember that an elder is an adult, and such is entitled to make autonomous decisions unless he or she truly lacks the capacity to do so.

Myers and Shelton cite studies which assert that “the public at large is unaware of and unconcerned about abuse of older persons” (1987, 379). As members of a health care profession, we have an obligation to be informed about the risk of abuse faced by their elderly patients, to help their patients understand this risk, and provide preventative education.

Mandatory reporting laws regarding elder abuse vary from state to state. In Washington, state laws RCW 74.34 and RCW 26.44 require health care professionals and residential care facility personnel, among others, to report suspected abuse to law enforcement or to Adult Protective Services at the Department of Social and Health Services (“Adult Protective Services Reporting Guide,” 1992). If an individual in good faith makes a report or gives testimony regarding elder abuse, he or she is immune from both civil and criminal liability (“Adult Protective Services Reporting Guide,” 1992).

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