Addressing Elder Mistreatment

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Improving Responses to Elder Abuse

Some jurisdictions have developed innovative approaches to improve their response to elder mistreatment, such as instituting special elder abuse prosecution units, forming elder fatality review teams, and expanding and improving statutes that mandate abuse reporting for vulnerable adults. Although these approaches show promise, they are in the nascent stages of development and have not been rigorously evaluated. Similarly, Adult Protective Services (APS) vary widely across the country, and research related to screening, risk assessment and interventions used by APS is limited.

Computerized Decision Support System for Elder Abuse

NIJ funded a team of researchers to develop a computerized decision support system for elder abuse.[1] The Elder Abuse Decision Support System (EADSS) contains assessments for physical, sexual, and psychological abuse; neglect; and financial exploitation. In Phase 1, the team assessed infrastructure requirements and "end-user criteria" through an environmental and infrastructure scan. They held meetings with key informants from the Illinois Department on Aging, teleconferences with national experts, and focus groups and interviews with practitioners and local experts. In Phase 2, the researchers developed the prototype using computerized adaptive testing methods and other appropriate measurement formats. In Phase 3, they demonstrated the prototype and held a second round of focus groups and interviews with local and national experts to elicit feedback regarding its usefulness, quality and affordability. NIJ is funding a follow-up study to pilot test the EADSS in six Illinois APS agencies.

Constructing and Validating an Elder Abuse Risk Assessment Tool

In another NIJ-funded study, investigators worked with APS in New Hampshire to construct and validate a risk assessment tool.[2] The goal of the study was to determine which APS clients were at high risk for future abuse or neglect so that resources could be targeted efficiently to those clients. In the initial stage of the study, New Hampshire’s Bureau of Elderly and Adult Services collected data on theoretical and empirical factors related to risk of future abuse or neglect. Among the sample of 763 clients for whom data was collected in Phase 1, the risk classification significantly corresponded to the outcomes the clients experienced. For example, in the six-month follow-up period, 23.9 percent of clients classified as high risk had a subsequent APS investigation, compared with 9.4 percent of clients classified as moderate risk and 5.2 percent of clients classified as low risk. Proportions for founded allegations of abuse were 14.7 percent for high-risk, 4.7 percent for moderate-risk and 2.0 percent for low-risk clients.

The final phase of the study was a validation of the risk assessment tool, using a new set of 1,064 clients who were followed for one year. Unfortunately, the risk assessment did not perform as well in the validation sample as it did in the construction sample. In the validation sample, 22.0 percent of high-risk, 29.0 percent of moderate-risk and 13.1 percent of low-risk clients had subsequent APS investigations. The proportions for founded allegations of abuse were 13.6 percent for high-risk, 10.5 percent for moderate-risk and 7.7 percent for low-risk clients. Although the risk assessment tool statistically corresponded to APS outcomes, investigators must further improve the classification abilities of actuarial tools to make them useful in APS practice. 

Evaluating the Elder Abuse Forensic Center Model

NIJ funded an evaluation of the effectiveness of a multidisciplinary team intervention in addressing elder abuse. The researchers evaluated the Los Angeles County Elder Abuse Forensic Center's effectiveness in prosecuting elder abuse cases, protecting vulnerable older adults, and reducing or preventing recurring cases of abuse.

The researchers used a quasi-experimental design that focused on elder abuse cases involving victims 65 or older. They compared outcomes of two groups: those who received the usual APS care plus assistance from the Center and those who received only the usual APS care. They found that:

  • Significantly more cases reviewed by the Center were submitted to the District Attorney's Office (22.0 percent) compared with APS-only cases (3.0 percent).
  • Significantly more cases reviewed by the Center were referred to the Office of the Public Guardian (30.6 percent) compared with APS-only cases (5.9 percent).
  • Cases reviewed by the Center were more likely to have experienced prior recurrence within APS (42.7 percent) than APS-only cases (16.7 percent).
  • From baseline, recurrence was significantly reduced in the Center cases (from 42.7 percent to 24.6 percent), whereas APS-only cases saw a small increase (from 16.7 percent to 20.3 percent).

Overall, the study indicated that the Center's model improved prosecution and guardianship outcomes for victims of elder abuse.[3]

Manual to Help Elder Abuse Fatality Teams

The Office for Victims of Crime teamed with the American Bar Association (ABA) to produce a replication manual to help elder abuse fatality teams review the causes of elder deaths and enhance community agencies' response to elder victims of abuse. NIJ also funded the ABA to assess five court-based initiatives across the United States.[4] Investigators conducted site visits, interviewed key stakeholders and analyzed court records to explore initiatives in Alameda County, Calif., Hillsborough County, Fla., Palm Beach County, Fla., Jefferson County, Ky., and Kings County, N.Y. The findings suggest that the court-sponsored initiatives improve the handling of elder abuse cases, but more empirical evidence is needed.

Learn more from the Office for Victims of Crime about elder abuse programs and publications.

Prosecution Challenges

Prosecutors face a number of challenges in handling elder abuse cases. Of particular concern is the lack of research on the forensic aspects of elder mistreatment. At present, the medical community cannot easily distinguish between the types of injuries that indicate abuse or neglect and those that are the natural effects of illness or aging.

Learn about research on identifying elder abuse.

There are a number of other challenges:

  • Few experts are available to testify in court.
  • Limited data exist to bolster cases brought into the system.
  • Elder abuse victims are frequently reliant on the perpetrators of abuse. In many cases, successful prosecution means that the victim would need to be placed in a nursing home, which many victims wish to avoid.
  • Determining successful victim-centered outcomes for elder abuse cases is more complicated than doing so for most other types of crime.
  • Prosecuting elder abuse cases requires patience and resources that many district attorney offices do not have.

See the Department of Justice Elder Justice website for resources for prosecutors.


[1] Conrad, Kendon J., Madelyn Iris, Barth B. Riley, Edward Mensah, and Jessica Mazza, Developing End-User Criteria and a Prototype for an Elder Abuse Assessment System, Final report to the National Institute of Justice, grant number 2009-IJ-CX-0202, February 2013, NCJ 241390.

[2] Johnson, Kristen, Kathy Park, Andrea Bogie, Shannon Flasch, and Jennifer Cotter, Developing an Actuarial Risk Assessment to Inform Decisions Made by Adult Protective Services Workers, Final report to the National Institute of Justice, grant number 2008-IJ-CX-0025, December 2012, NCJ 240410.

[3] Wilber, Kathleen H., Adria E. Navarro and Zachary D. Gassoumis, “Evaluating the Elder Abuse Forensic Center Model,” Final report to the National Institute of Justice, grant number 2009-IJ-CX-0017, April 2014, NCJ 246428.

[4] Stiegel, Lori A., and Pamela B. Teaster, A Multi-Site Assessment of Five Court-Focused Elder Abuse Initiatives, Final report to the National Institute of Justice, grant number 2007-IJ-CX-0107, June 2011, NCJ 238287.

Date Modified: May 12, 2015