Theory-based models enhancing the understanding of four types of elder maltreatment
| DOI | 10.1177/0269758016630887 |
| Date | 01 September 2016 |
| Published date | 01 September 2016 |
| Author | Thomas L Hafemeister,Shelly L Jackson |
| Subject Matter | Articles |
Article
Theory-based models enhancing
the understanding of four types
of elder maltreatment
Shelly L Jackson
Institute of Law, Psychiatry and Public Policy, University of Virginia, Charlottesville, VA, USA
Thomas L Hafemeister
Independent
Abstract
Notwithstanding that elder abuse has existed since antiquity, it was only during the 1990s that
society began to recognize that elder abuse is a pervasive and pernicious problem needing a
systematic response. Despite this emerging attention to elder abuse and society’s dedicated
efforts to address it, little attention has been given to articulating a theory-based foundation to
explain the occurrence of elder maltreatment, whichinturnmayexplainwhysociety’sefforts
have had limited success. Using the results of our research as the foundation, we present here
distinct models that encapsulate four types of elder maltreatment, including one model that
focuses on what transpires when two relatively distinct forms of abuse co-occur. We assert that
elder maltreatment should be divided into distinct subtypes reflecting their different etiologies,
risk factors, interpersonal dynamics, correlates, and consequences, and which in turn necessitate
distinct societal responses. Without recognizing that this abuse occurs in the context of a
relationship, understanding of elder abuse and the building of relevant models will be significantly
limited. Although the application of these models has not yet been empirically tested, their
articulation should enhance the understanding of elder maltreatment and promote new lines of
related research and societal responses.
Keywords
Elder abuse, theory, financial exploitation, physical abuse, caregiver neglect, hybrid financial
exploitation
Corresponding author:
Shelly L Jackson, Institute of Law, Psychiatry and Public Policy, PO Box 800660, University of Virginia, Charlottesville,
VA 22908, USA.
Email: slj4u@virginia.edu
International Review of Victimology
2016, Vol. 22(3) 289–320
ªThe Author(s) 2016
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DOI: 10.1177/0269758016630887
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Introduction
As of 2010, 13%of the United States population was aged 65 and older, with older adults expected
to comprise 19.3%of the population by 2030 (U.S. Census, 2011). It is estimated that over 10%of
this country’s older adults experience some form of elder maltreatment (i.e. neglect, abandonment,
physical abuse, financial exploitation, sexual abuse, or psychological abuse) in a given year
(Acierno et al., 2010; Lachs and Berman, 2011; Lauman n et al., 2008). As the vast majority
(96.9%) of older Americans reside in domestic settings (U.S. Census, 2011), it is perhaps unsur-
prising that most (89.3%) incidents of elder maltreatment reported to Adult Protective Services
(APS), the agency established in every state to detect and respond to these incidents, occur in this
setting (Teaster et al., 2006). Although the definition of elder maltreatment continues to evolve
(Goergen and Beaulieu, 2013; Mysyuk et al., 2013a), according to the World Health Organization
(2002, p. 126): ‘Elder abuse is a single or repeated act, or lack of appropriate action, occurring
within any relationship where there is an expectation of trust which causes harm or distress to an
older person.’ Although the construct of elder abuse was first articulated in 1975 with the publi-
cation of Baker’s (1975) seminal paper entitled ‘Granny Battering,’ it was not until 2010 that
Congress passed the Elder Justice Act (P.L. 111-148), the first federal legislation specifically
targeting elder maltreatment.
The consequences of elder abuse are many and can be devastating (Bonnie and Wallace,
2003). They include psychological problems such as depression (Dong et al., 2008; Garre-
Olmo et al., 2009), emotional problems (Cisler et al., 2012), disruptions in social and family
relationships (Button et al., 2014; Jackson and Hafemeister, 2010), compromised health (Gibbs,
2014), physical injury (Murphy et al., 2013), hospitalization (Dong and Simon, 2013a), and
mortality (Dong et al., 2009; Lachs et al., 1998; Schofield et al., 2013), restrictions on and
elimination of autonomy such as institutionalization (Dong and Simon, 2013b; Lachs et al.,
2002) or imposition of a guardian (Jackson and Hafemeister, 2013a; Quinn, 2005), changes in
living arrangements (Barker and Himchak, 2006; Clancy et al., 2011; Jackson and Hafemeister,
2013a), and loss of assets including one’s home (Button et al., 2014; Jackson and Hafemeister,
2012a), financial losses via medical bills and the need to purchase new assistive devices
(Payne, 2011), as well as financial loss resulting from financial victimization (Button et al.,
2014; Holtfreter et al., 2014; Langton and Planty, 2010). In some cases, there are secondary
victims as well, for example, family members or the state may become physically and/or
financially responsible for the older adult (Gunther, 2010) or those who stood to receive an
inheritance will not do so. The consequences of elder a buse routinely lead to a diminished
quality of life for abused older adults.
Elder maltreatment theory
Scholars (Anetzberger, 2012; Bonnie and Wallace, 2003; Jackson and Hafemeister, 2013b;
Lowenstein, 2009; NIJ, 2014) have admonished the field for failing to articulate and develop
a theory-based foundation to enhance our understanding of the occurrence of elder maltreat-
ment. Recent research has found that interventions currently being employedtoprotectand
assist the victims of this maltreatment are relatively ineffective, and sometimes even counter-
productive (Daly, 2011; Ploeg et al., 2009). Given that theory should drive and direct inter-
vention (e.g., Jackson and Hafemeister, 2013b; Mysyuk et al., 2013b), one possible explanation
for this failure may be that these interventions have an insufficient or flawed theory-based
290 International Review of Victimology 22(3)
foundation. For example, one criticism of the current, widely employed societal response to
elder mistreatment is its tendency to treat all forms of this maltreatment as a monolithic
phenomenon to which a single, one-size-fits-all approach is deemed the best response (Jackson
and Hafemeister, 2013b). Furthermore, adult protective services’ (APS) practice has tended
to focus exclusively on the victim (Quinn and Zielke, 2005), without regard to the a busive
individual (Jackson, 2014), a practice that if relied upon could misguide the development
of theory.
Our research has found significant and meaningful differences across four predominant types of
elder maltreatment with regard to their respective risk factors (Jackson and Hafemeister, 2011). In
addition, a qualitative analysis of the interpersonal dynamics involved in these cases further
confirms the importance of differentiating among the various types of elder maltreatment (Hafe-
meister and Jackson, n.d.).
1
This provides the foundation for our assertion that in formulating
theory-based explanations pertaining to elder maltreatment, distinctions should be made among the
different types of abuse.
A search for existing theory-based explanations for this behavior in general tends to be
unrewarding. Although psychological (Biggs and Haapala, 2010; McGuire, 2004; Pillemer,
2005), phenomenological (Band-Winterstein and Eisikovits, 2010), gerontological (Bengtson
et al., 2009, 2002; Hooyman and Kiyak, 2011), criminological (Anderson and Dyson, 2002;
Payne, 2011; Setterlund et al., 2007), sociological (Ansello, 1996; Wilber and McNeilly, 2001;
Wolf, 1997), feminist (Penhale, 2003), and ecological (Schiamberg and Gans, 2000) models
exist, none of them adequately explain our—and other researchers’—findings. (See Jackson and
Hafemeister, 2010, for a review and critique of some of these theory-based explanations.) As
indicated, these shortcomings are in part due to the tendency of these models to treat elder
maltreatment as a monolithic phenomenon (Gordon and Brill, 2001; Penhale, 2003, p. 171), as
well as their propensity to draw their postulates from a narrow domain or discipline (Payne,
2002), and their failure to encompass the respective roles and perceptions of both the victim and
the abusive individual (Jackson and Hafemeister, 2011). In addition to establishing the impor-
tance of distinguishing among the different types of elder maltreatment, we have also previ-
ously reported that the characteristics and motivations of both the older victim and the abusive
individual, as well as the nature of their interactions, are important factors that should be taken
into account when attempting to explain the occurrence of elder maltreatment (Jackson and
Hafemeister, 2011).
Thus, there is a need for an enhanced theory-based foundation pertaining to elder maltreat-
ment. This paper proposes four distinct theory-based models to explain, respectively, four of
the predominant types of elder maltreatment, namely, pure financial exploitation (PFE) (i.e.
financial exploitation that does not co-occur with another type of elder abuse), caregiver
neglect, physical abuse, and hybrid financial exploitation (HFE) (i.e. financial exploitation
that co-occurs with physical abuse and/or caregiver neglect). As part of this analysis, an effor t
is made to (1) articulate a model for each type of elder maltreatment, and (2) have each model
encompass the behavior and motivations of both the older adult and the abusive in dividual, as
well as the nature of their interactions. For each type of abuse, the key distinguishing victim
and abusive individual variables associated with that type of maltreatment are initially pre-
sented, followed by a theory-based model that explains and predicts its occurrence based on
these variables. These models have not yet been empirically tested, but their articulation is
intended to further our understanding of this behavior, to generate testable hypotheses, and to
suggest new lines of research.
Jackson and Hafemeister 291
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