According to the Elder Maltreatment Alliance, an estimated three to five million older adults in America were victims of some form of abuse in 2011. One such case of elderly exploitation has been highlighted in The New York Times: For the last 20 years of her life, Huguette Clark, a copper heiress worth $300 million, lived in a New York City hospital room. Within months of her arrival, officials at Beth Israel Medical Center hounded her for donations. Officials visited her room often and plied her with gifts as a form of persuasion; court documents attest to the fact that the hospital's chief executive as well as his presumably more sympathetic mother became part of the targeted fund-raising campaign.

As Clark's relatives see it, a woman who did not need constant medical care was coerced into giving a nonprofit hospital a piece of her large fortune. "What this is about is not just a will contest, it's about the accountability of professionals," John Morken, the lawyer for the relatives, told The New York Times. By the time of her death two years ago at age 104, Clark had given the hospital at least $4 million in donations and a further $1 million bequest in her final, contested will.

Many people would count Clark among the lucky. After all, during her final years, she was attended to and treated kindly on a physical level.

The same cannot be said of the thousands of middle and lower class elders who are physically abused each year.

Physical Abuse in Nursing Homes

In a recent study undertaken at Michigan State University, researchers investigated the prevalence and risk factors of staff members becoming physical abusive with elderly individuals in nursing home care. A random sample of 452 adults with elderly relatives, older than 65 years and in nursing home care in Michigan, completed a telephone survey regarding elder abuse and neglect experienced by the elder family member in the care setting.

Shockingly, nearly one quarter of the respondents reported at least one incident of physical abuse by nursing home staff. Researchers then estimated the importance of various risk factors in nursing home abuse. Limitations in activities of daily living (ADLs), older adult behavioral difficulties, and previous victimization by non-staff perpetrators were linked to a greater chance of experiencing physical abuse.

"Interventions that address these risk factors may be effective in reducing older adult physical abuse in nursing homes," wrote lead-author of the study, Lawrence B. Schiamberg, a professor at Michigan State University, in an article published in Journal of Elder Abuse & Neglect last year.

In a separate large-scale, random sample survey published in The Gerontologist, researchers conducted interviews with 2,020 community-dwelling elderly persons in the Boston metropolitan area. Participants were questioned on their experience of physical violence, verbal aggression, and neglect. The prevalence rate of overall maltreatment was 32 elderly persons per 1000. Spouses were found to be the most likely abusers and roughly equal numbers of men and women were victims, although elderly women suffered more serious abuse.

If studies find that gender is not a predictor of abuse, then what characteristics are?

Dementia as a Predictor

In a study questioning whether Alzheimer's disease and other dementias may be associated with a greater risk for physical abuse, researchers from the University of Medicine & Dentistry of New Jersey examined a group of demented patients and their caregivers.

First, they distributed an anonymous questionnaire to 1,000 caregivers who called a telephone help line specializing in dementia. Demographic characteristics of patients and caregivers were assessed, the occurrence of abuse was examined, and then the caregivers completed further tests and interviews. In total, 342 caregivers completed questionnaires. A little more than half of the caregivers were adult children caring for parents, while 111 (or just over a third) cared for spouses, and 25 (8.4 percent) cared for other relatives.

Thirty three caregivers (11.9 percent) reported that they had performed physically abusive behavior (e.g., pinching, shoving, biting, kicking, striking) toward the dementia patient in their care. These caregivers had been providing care for more years, cared for patients functioning at a lower level, displayed higher burden scores, and showed higher depression scores than caregivers who reported no abuse.

What's more, 92 caregivers (one-third) reported that the patient directed abuse toward them during the course of providing care. Caregivers who had been abused by patients, in comparison to those who had not, were more likely to direct abusive behavior back toward the patient in their care.

"These results support the hypothesis that abuse involving cognitively impaired older adults and their caregivers may be associated with the relatively high psychological and physical demands placed on family members who care for relatives with dementia," wrote the authors in The American Journal of Psychiatry.

The mistreatment of nursing home residents by other residents must also be considered when examining elder abuse.

Resident-to-Resident

The Department of Health Policy & Management at the University of Pittsburgh provides students with advanced training in research design and methods appropriate for studying the health care system. Researchers there recently investigated the nature, scale, and scope of resident-to-resident abuse in nursing homes, including verbal, physical, material, psychological, and sexual abuse. A total of 249 nursing homes from 10 states were examined and a total of 4,451 nurse's aides participated by way of completing extensive questionnaires.

"Our findings clearly show that both the scale and scope of resident-to-resident abuse is high in nursing homes," wrote Nicholas Castle, Ph.D., a professor with the University of Pittsburgh, in an article appearing last year in Journal of Elder Abuse & Neglect.

Most nursing homes experienced verbal, physical, material, and psychological abuse. Sexual abuse was reported as less common. The authors believe resident-to-resident abuse is common enough to be considered an issue of concern impacting both the quality of life and safety of many residents.

In conclusion, victims of abuse include senior citizens who are both rich and poor, afflicted and able-bodied, living at home and in an institution. Although neglect remains the most common type of maltreatment, compassionate professionals and family members alike must remain aware of the potential threat of physical abuse. For information on reporting elder abuse, read this.

Sources: Schiamberg LB, Oehmke J, Zhang Z. Physical abuse of older adults in nursing homes: a random sample survey of adults with an elderly family member in a nursing home. Journal of Elder Abuse & Neglect. 2012.

Pillemer K, Finkelhor D. The Prevalence of Elder Abuse: A Random Sample Survey. The Gerontologist.1988.

Coyne AC, Reichman WE, Berbig LJ. The relationship between dementia and elder abuse. The American Journal of Psychiatry. 1993.

Castle NG. Resident-to-resident abuse in nursing homes as reported by nurse aides. Journal of Elder Abuse & Neglect. 2012.