Crime and Abuse Against Seniors:
A Review of the Research Literature With Special Reference to the Canadian Situation

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EXECUTIVE SUMMARY

This report addressed the issue of elder abuse in Canada and internationally, including the prevalence of abuse, perpetrator and victim characteristics, crimes posing the greatest threat to seniors and gaps in research. The concluding section also comments on the extent to which the World Health Organization's definition of elder abuse adequately addresses the victimization of seniors.

CANADIAN RESEARCH

While much research remains to be done in Canada on the issue of the prevalence of crime and abuse against the elderly, the most authoritative (due to its rigour and size) national study, the General Social Survey on Victimization (2004), indicates that approximately 10% of seniors in Canada are victims of crime each year. As with other age groups, the majority of these crimes are property rather than violent crimes.

The body of Canadian research on crimes against the elderly is sparse. It is also difficult to arrive at generalizations at this time as studies vary as to the geographic area covered, the behaviour examined, the age range of the samples, and their time frames.

Findings drawn from the Canadian research literature include:

• Each year, about 10 percent of Canadian seniors are victims of crime. The vast majority of these are property crimes.
• Up to one percent of Canadian seniors experience violent crimes or physical abuse.
• About 4 5 percent of seniors report experiencing some form of abuse from the age of 65 on.
• Financial abuse/exploitation and emotional abuse appear to be the most prevalent forms of abuse.
• The overall prevalence of elder abuse in Canada is similar to the levels found in the United States, the United Kingdom and Australia.
• Seniors are less likely to report being victims of crime or spousal abuse than are non-seniors.
• Many crimes against seniors are not reported to police but are reported to health professionals, community groups, and financial institutions agencies.
• Senior victims of violence usually know their attackers, who are equally as likely to be family members as friends or acquaintances.
• Males report more incidents of violence than do females. While men report more violence at the hands of acquaintances and strangers, women report more family-related incidents.
• Seniors at more advanced ages report lower rates of violence than do younger seniors.
• Less than 10 percent of senior victims of violence suffer significant injuries.
• Physical force, rather than weapons, are most often used in violent attacks on seniors.
• The perpetrators of violent acts against seniors are usually males and tend, on average, to be older than those who commit these acts against younger people.
• Seniors were more likely than non-seniors to stay home due to the fear of crime, whereas non-seniors were more likely to alter their behaviour in some other way in order to protect themselves (e.g., to take self-defence courses).

AREAS OF GREATEST VULNERABILITY FOR SENIORS

The three principal areas of concern for seniors, identified in this review, are:

1. Financial crimes by strangers. A variety of fraudulent schemes fall in this category, including Ponzi schemes (investment), false promises of prizes, aggressive telemarketing, schemes involving health products, and fraudulent home repairs.
2. Crime and abuse by relatives and caregivers. This includes the full range of crime and abuse, including physical, emotional, and sexual abuse, as well as financial exploitation and neglect. There is also the undue exercise of control, such as isolating the senior from others or interfering with his or her participation in religious services. This report covered the signs of each type of abuse.
3. Crime and abuse in institutional settings. Here again, there is the full range of abuse and, in particular, physical, sexual, and emotional abuse, as well as systemic abuse.

Financial Crimes by Strangers

According to the United States Department of Justice, 20 to 40 percent of elder abuse cases involve financial exploitation. Factors increasing a senior's vulnerability to fraud committed by strangers include:

1. Home ownership;
2. A tendency to not solicit advice before making a purchase;
3. Financial risk-taking behaviour;
4. Lack of knowledge of consumer rights;
5. Lack of awareness of fraudulent schemes;
6. Openness to marketing appeals;
7. A reluctance to hang up the phone on telemarketers.

Perpetrators may use a variety of tactics to gain the compliance of the victim. They may try to isolate the victim, exert pressure to induce the victim to act quickly, use fear, and discourage them from seeking the counsel of others. Perpetrators of fraud against the elderly tend to be male, although they vary in age, race, social status, and in education. They are motivated both by profit and the sense of power achieved from defrauding a victim of means or one who is well-educated. They are not bound by conventional norms, often have some form of psychological dysfunction, and are able to rationalize their behaviour (Blum, 1972).

Warning signs of possible consumer fraud include: Large volumes of unsolicited mail congratulating the recipient on winning a prize; numerous unsolicited phone calls offering prizes and investment opportunities; financial difficulties in covering basic expenses when the senior's income should be sufficient; and a stranger accompanying an elderly person to the bank and encouraging him or her to make a major withdrawal.

Abuse by Relatives and Caregivers

The vast majority of elder abuse incidents occur in the community and not in nursing homes or other residential settings. Elder abuse tends to occur in the home and the usual perpetrators are family members or professional caregivers. Sometimes the abuse is part of a longstanding pattern of physical and emotional abuse in the family. Often, it is related to changes in the physical and cognitive condition of seniors and their growing dependency on family members for care.

Offenders are usually considerably younger than the elderly victim. About 40 percent are under 40 years of age and another 40 percent are between the ages of 41 and 59. The majority are males and about 60 percent are relatives of the victim. There are three general categories of offenders:

1. Adult children, grandchildren, and other relatives;
2. Professional caregivers; and
3. Close friends or others in a position of trust.

The majority of offenders fall in the first category.

Family situations and stresses faced by caregivers may contribute to elder abuse. Conflicts in the family may be created by the senior's presence. The lifestyle adjustments and financial stresses can be enormous. In some cases, elder abuse is simply a continuation of abuse (e.g., spousal abuse) of a pattern of violence that has been occurring in the family over many years. Spouses and offspring of perpetrators may turn the tables and vent their rage or withhold nourishment from their historic abusers.

Social isolation can increase the likelihood of abuse. While it can be a deliberate strategy for keeping abuse secret, it may also be an accidental result of the stresses of caring for a dependent older family member, leaving little time for the caregiver to socialize. Isolation cuts off family members from the support they need to cope with the stresses of caregiving. It also prevents outsiders from intervening and protecting an elderly person in an abusive situation and from offering help to both the victim and abuser.

While there is some debate about this matter, the risk of elder abuse may become magnified when the caregiver is responsible for an older person who is ill or impaired. Caregivers often feel trapped in such situations and may resort to force or verbal abuse to manage difficult situations. When the caregiver is dependent financially on an impaired older person, there may be financial exploitation or abuse. Psychological problems of caregivers can put them at risk for abusing an older person in their care. A caregiver who is addicted to drugs or alcohol, or has a personality disorder is more likely to become abusive when confronted with the frustrations of caring for an elderly person, rather than reaching out for help (American Psychological Association, 2009; Kurrle et al., 1997).

Societal attitudes and cultural factors may play a role in elder abuse that occurs within the family. Very often, abuse within the family is regarded as a private matter. Different cultural groups have varying ideas as to what abuse is and there are differences in terms of the tolerance of abuse against women in general. Finally, social attitudes that devalue the elderly and view them as dispensable also facilitate disrespect and abuse toward seniors.

Abuse in Institutional Settings

Close to ten percent of Canadian women and five percent of Canadian men, 65 years of age and over, live in long term care facilities, including personal care homes, nursing homes, and complex care facilities.

The forms of institutional abuse include physical abuse and neglect, emotional/verbal abuse and neglect, financial abuse, and sexual abuse. Those in institutional care may also experience systemic abuse, which refers to system-wide practices that produce neglect, sub-standard care, overcrowding, and the violation of dignity.

One Ontario study surveyed over 1,600 nurses and nursing assistants and found that close to a third had witnessed each of the following:

• The rough handling of patients in nursing homes;
• Staff verbally abusing patients by yelling or swearing at them;
• Embarrassing comments being made to patients.

In addition, 10 percent witnessed staff members hitting or shoving patients.

The segment of the population at greatest risk of institutional abuse comprises women 85 years of age and over. In Canada, over a third of these women live in an institutional setting, as women tend to outlive their husbands and may not have the health or support required to live in the community. Thus, a high proportion of residents in institutional facilities are women over 85 and they are at greatest risk due to their numbers in these facilities. There is disagreement as to whether impairment is a factor. While physically and cognitively impaired individuals would appear to be more vulnerable to abuse, more active seniors may be less compliant with institutional rules, thereby creating the potential for conflict with institutional staff.

Those living in institutional settings may be vulnerable to abuse due to isolation from the community and the handling of incidents internally within the facility. Incidents may therefore remain hidden from scrutiny. As the number of physically and cognitively impaired individuals grows in society with increasing life expectancy, the challenges are greater for staff. The potential for abuse increases as the mismatch grows between the needs of residents and the skills of staff.

Apart from insufficient staffing and inadequate staff training, there may be a number of systemic and other factors contributing to abuse:

• Management that fails to cultivate respectful relationships between staff and residents;
• Varying definitions among staff as to what constitutes abuse;
• Work-related stress and staff burnout;
• Staff retaliation following aggression displayed by a resident;
• Societal factors that cultivate a view of the elderly as unimportant members of society;
• Poor enforcement of standards for residential care facilities.

Behavioural or environmental indicators of abuse in institutions may include such things as mail censorship, lack of privacy, and the sudden deterioration in the physical or mental health of a resident.

The perpetrators of institutional abuse are more likely to be young staff members. Male staff are more often abusive than are females. Abusers have been observed to be aggressive, dominant, less caring, and less tolerant to aggression on the part of residents.

Gaps in Research

Gaps in research identified in this report include some of the following themes:

The Prevalence of Victimization

Much remains to be learned about the prevalence of crimes against Canadian seniors. There has been just one national survey dedicated to the study of this issue and it is nearly 20 years old (Podnieks et al., 1990). More studies are needed to learn about the prevalence of criminal victimization and different forms of abuse over the previous 12 months, as well as over the senior years. Furthermore, while some studies provide an overall figure for the prevalence of all forms of victimization, other studies provide a figure for each form of abuse.

Institutional Abuse

There is an enormous void in our understanding of the extent, patterns, and types of abuse, as well as risk factors in Canadian institutions.

Definitional and Methodological Issues

Studies vary in terms of their focus (crime versus elder abuse), the types of abuse (physical, sexual, emotional, or financial), their geographic scope (national or provincial), the settings (institutional versus those residing in private homes), and in their time frames (abuse over the past year or lifetime as senior). There are also differences in terms of how senior is defined (over 55 or over 65 years of age). Sampling biases are also a concern in many studies as seniors who participate in surveys and focus groups may disproportionately be community leaders, independent, and in good health. Protocols for conducting national studies need to be developed to ensure rigour and comparability across studies.

Perpetrators of Crime/Abuse Against Seniors

Apart from a lack of sufficient research on the perpetrators of abuse, there is a wall of silence as many forms of maltreatment are not reported to officials or even in surveys. As a result, perpetrators usually avoid detection and consequences.

Those Who Avoid Abuse and Exploitation

Aside from further research on victim characteristics, more can be learned about seniors who manage to avoid financial and other forms of abuse (Johnson, 2002). Such research can provide valuable guidance with regard to actions to be taken by, and on behalf of, seniors in general in order to increase their resistance to abuse.

Domestic Crimes/Abuse

The wall of silence surrounding cases of abuse is especially hard to penetrate in the case of domestic incidents. The underreporting of maltreatment of elderly people at the hands of family members is especially significant. Little is known about the true extent of maltreatment, the most prevalent forms, the triggers, risk factors, distinguishing characteristics of perpetrators, and all the consequences for the elderly victims.

Markers of Abuse

Caregivers, agencies providing protection for seniors, medical personnel, and law enforcement officers often lack the tools to distinguish between injuries resulting from maltreatment and those due to illness, accidents, or aging. There is no single test for abuse or neglect. Research needs to identify the forensic markers of abuse both in institutional and other settings.

Consequences of Abuse

There is some evidence that the consequences of crime and abuse are far more profound for seniors. Preliminary evidence indicates that seniors who have been assaulted are more likely to die and to experience serious injuries than are more youthful victims. They may also lose independence, resulting in some form of institutional placement following a criminal attack. More qualitative research is needed to understand these consequences of crime in order to identify appropriate interventions.

Fear of Crime

While much has been written about seniors' "exaggerated" level of fear, a better understanding is required as to why the elderly tend to be more fearful than other age groups. Is this higher fear level due to feelings of physical vulnerability or social isolation? Understanding the sources of this fear can contribute to the development of appropriate interventions as fear itself can isolate seniors, produce mental health issues, and make seniors more vulnerable to financial exploitation.

Prevention Strategies: What Works?

Research needs to catalog interventions around the globe that are currently in place to prevent elder abuse. Rigorous evaluations of policies and programs need to be conducted and best practices identified. Such evaluations need to take into account the financial costs of different measures, as well as consequences for seniors in terms of their independence and personal security.

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