Moving the Field Forward: Elucidating the Nexus Between Elder Abuse and Trauma.

At least 10% of older adults (age 60 and older) experience some form of elder abuse in a given year, with an additional 5% experiencing some form of financial fraud. However, conceptualizations of traumatic stress remain less well developed for elder abuse relative to other forms of trauma, such as child maltreatment and intimate partner violence. Incorporating a trauma framework into elder abuse research promises to deepen and expand our understanding of elder abuse, with the goal of preventing abuse and improving responses to older victims. This special section seeks to spur further research on the nexus between trauma and elder abuse. To frame the special section, this introduction describes current scholarship on this topic and multiple ways to enhance understanding of the nexus between elder abuse and traumatic stress in order to advance research, theory, and practice. The introduction offers an overview of three papers that apply trauma conceptualizations and related theories to distinct areas of inquiry: financial exploitation, criminology's General Strain Theory, and historical trauma experienced by American Indian and Alaska Native populations.

A Systematic Review of Financial Exploitation Measures in Prevalence Studies.

The financial exploitation of older adults has garnered the attention of society as well as state and federal governments in a way that elder abuse has never been able to achieve. It is frequently asserted that financial exploitation deserves this attention in part because it is the most prevalent form of elder abuse. This article systematically reviews the measurement of financial exploitation in comparison with other forms of elder abuse and concludes that its measurement is considerably more variable than other forms of abuse. Consequently, improvements in the measurement of financial exploitation are warranted.

Five-year all-cause mortality rates across five categories of substantiated elder abuse occurring in the community.

Elder abuse increases the likelihood of early mortality, but little is known regarding which types of abuse may be resulting in the greatest mortality risk. This study included N = 1,670 cases of substantiated elder abuse and estimated the 5-year all-cause mortality for five types of elder abuse (caregiver neglect, physical abuse, emotional abuse, financial exploitation, and polyvictimization). Statistically significant differences in 5-year mortality risks were found between abuse types and across gender. Caregiver neglect and financial exploitation had the lowest survival rates, underscoring the value of considering the long-term consequences associated with different forms of abuse. Likewise, mortality differences between genders and abuse types indicate the need to consider this interaction in elder abuse case investigations and responses. Further mortality studies are needed in this population to better understand these patterns and implications for public health and clinical management of community-dwelling elder abuse victims.

All Elder Abuse Perpetrators Are Not Alike: The Heterogeneity of Elder Abuse Perpetrators and Implications for Intervention.

The tendency to label all elder abuse perpetrators as the "bad guys" has diminished our ability to respond effectively. A review of the literature demonstrates that elder abuse perpetrators are in fact heterogeneous with important differences across types of abuse. A reformulation of perpetrator interventions away from a singular emphasis on prosecution to meaningful alternatives that utilize criminal justice and/or therapeutic approaches tailored to the needs of the case is needed. These interventions must incorporate the needs of both victims and perpetrators, take into consideration the type of abuse involved, acknowledge the variations in perpetrator culpability, and recognize the continuum of complexity among these cases. Without addressing these nuances, intervention and prevention efforts will be futile if not harmful.

Second-Generation Prisoners and the Transmission of Domestic Violence.

Adult inmates who experienced the incarceration of a parent, known as "second-generation prisoners," experience unique challenges and are at heightened risk for experiencing other adversities throughout the life span. Our study investigated one specific, and previously unexplored, type of adversity--domestic violence--within a sample of 293 incarcerated adults. We examined the relation between generation status (first- or second-generation prisoners), childhood exposure to domestic violence, and participation in adult relationship violence prior to incarceration. Results indicate that prisoners who had been exposed to domestic violence in childhood were more likely to engage in intimate partner violence resulting in inflicted and received injury. Relative to first-generation prisoners, second-generation prisoners reported more childhood domestic violence exposure and were more likely to have been injured by a relationship partner. However, this relation between second-generation status and injury victimization was mediated by domestic violence exposure. These results support an intergenerational pattern of domestic violence and suggest that second-generation prisoners are a unique population worthy of future investigation and mental health intervention.

The impact of relationship dynamics on the detection and reporting of elder abuse occurring in domestic settings.

There is a keen desire to increase the detection and reporting of elder abuse. The purpose of this study was to describe the circumstances under which abuse is detected and reported and to identify the relationship dynamics that might be impacting detection and reporting decisions. Interviews were conducted with 71 Adult Protective Services (APS) caseworkers, 55 of their elderly clients, and 32 third-party adults. Detection and reporting are distinct but related acts. The temporal relationship between detection and reporting generally differed depending on the nature and quality of the relationship between (a) the victim and offender and (b) the victim and reporter. Efforts to increase reporting may benefit from taking into consideration these relationship dynamics. A range of individuals detected and reported elder abuse, including victims, under a range of circumstances, reinforcing the value of public efforts to increase awareness of elder abuse.

How case characteristics differ across four types of elder maltreatment: implications for tailoring interventions to increase victim safety.

PURPOSE: The purpose of this study was to determine whether case characteristics are differentially associated with four forms of elder maltreatment. METHOD: Triangulated interviews were conducted with 71 APS caseworkers, 55 victims of substantiated abuse whose cases they managed, and 35 third party persons. RESULTS: Pure financial exploitation (PFE) was characterized by victim unawareness of financial exploitation and living alone. Physical abuse (PA) was characterized by victim's desire to protect the abusive individual. Neglect was characterized by isolation and victim's residing with the abusive individual. Hybrid financial exploitation (HFE) was characterized by mutual dependency. IMPLICATIONS: These differences indicate the need for tailoring interventions to increase victim safety. PFE requires victims to maintain financial security and independence. PA requires services to meet the needs of abusive individuals. Neglect requires greater monitoring when elderly persons reside with another person. HFE requires the provision of services to both members of the dyad.

How do abused elderly persons and their adult protective services caseworkers view law enforcement involvement and criminal prosecution, and what impact do these views have on case processing?

This study examined law enforcement and prosecution involvement in 71 cases of elder abuse where pure financial exploitation (PFE), physical abuse (PA), neglect (Neglect), or hybrid financial exploitation (HFE) (financial exploitation co-occurring with physical abuse and/or neglect) occurred in a domestic setting. Victims of elder abuse and assigned Adult Protective Services (APS) caseworkers were systematically interviewed. Law enforcement officials were involved in 54% of the cases, and 18% of the cases were prosecuted. PA was significantly more likely to trigger a law enforcement response and to be prosecuted than Neglect or PFE. HFE involved prosecution for assault rather than financial exploitation. Generally, the victims of elder abuse were not receptive to criminal justice involvement, which appears to have a significant impact upon the level of this involvement. The reasons for this reluctance are discussed, as well as the challenges and limitations of criminal justice system involvement and related implications for policy and practice.

Enhancing the safety of elderly victims after the close of an APS investigation.

PURPOSE: The purpose of this study was to test whether particular actions on the part of adult protective services (APS), the elderly victim, and/or society's response to abusive individuals, are associated with the continuation of abuse after the close of an APS investigation and thereby compromise victim safety. METHOD: Interviews were conducted with 71 APS caseworkers, 55 of the elderly victims of substantiated abuse, and 35 third-party persons. RESULTS: A small proportion of elderly victims continue to experience abuse after the close of an APS investigation. Elderly victims were more likely to experience continued abuse when they chose to have ongoing contact with their abusers, vis-à-vis cohabitation or otherwise, and when their abusers experienced no consequences. Although continuation of abuse did not differ by the type of maltreatment involved, reasons for the cessation of abuse, and other safety indicators, did. IMPLICATIONS: To enhance victim safety, greater monitoring may be warranted in cases wherein elderly victims continue to have contact with their abuser and when abusive individuals experience no consequences. To further enhance victim safety, abusive individuals must be incorporated into an overall strategic response to elder abuse. A potential avenue for facilitating victim safety while maintaining victim autonomy is to understand their motivations for desiring continued contact with their abuser and developing interventions based upon such knowledge.

A systematic examination of smoke-free policies in multiunit dwellings in Virginia as reported by property managers: implications for prevention.

PURPOSE: In most states, smoking has been curtailed to some extent in public buildings, workplaces, and restaurants. The next frontier for smoke-free policies is the multiunit dwelling industry. However, the extent to which smoke-free housing currently is available is unknown. The purpose of this study was to measure the market for smoke-free housing in Virginia and to identify barriers to adopting smoke-free policies. DESIGN: Telephone interviews were conducted with property managers of rental apartments, townhouses, senior housing, and public housing in four Virginia cities. SETTING: Four cities in Virginia. SUBJECTS: Two hundred sixty-three property managers in four cities in Virginia (approximately 75 property managers per city). MEASURES: Property managers were administered a brief telephone survey. RESULTS: Only 33.8% of property managers reported some type of smoke-free policy, with only 15% of those policies prohibiting smoking in residential units. Most property managers without a smoke-free policy were not considering adopting such a policy for a variety of reasons. CONCLUSION: The availability of smoke-free multiunit dwellings is severely lacking. This study identified a number of science-based and legal misperceptions that may prevent the adoption of smoke-free policies. Correction of these misperceptions is warranted to increase the availability of smoke-free housing. Such policies will be useful in creating environments that support good health practices while simultaneously protecting tenants from exposure to secondhand smoke.

Risk factors associated with elder abuse: the importance of differentiating by type of elder maltreatment.

Elder abuse research rarely differentiates by the type of elder maltreatment involved when identifying risk factors. The purpose of this study was to compare risk factors across four predominant types of elder maltreatment (financial exploitation, physical abuse, neglect by others, and hybrid financial exploitation [HFE]). Data were collected from two sources: interviews with victims of substantiated elder abuse, responding adult protective services (APS) caseworkers (N = 71), and third-party informants; and a statewide database that contained all substantiated cases over a corresponding 2-year period (N = 2,142). Using chi-square (interview data) and logistic regressions (Adult Services/Adult Protective Services [ASAPS] data), significant differences across the four types of elder maltreatment were found. These two datasets provide converging evidence for the importance of differentiating by type of maltreatment when identifying risk factors for elder maltreatment and for the importance of considering both the elderly victim and the abusive individual when predicting type of elder maltreatment.

A USA national survey of program services provided by child advocacy centers.

OBJECTIVE: Child Advocacy Centers (CACs) are designed to improve the community collaborative response to child sexual abuse and the criminal justice processing of child sexual abuse cases. CACs, in existence for 16 years, now have standards for membership developed by the National Children's Alliance (NCA) that include nine core components. And yet no systematic examination of the CAC model exists. The purpose of this paper was to assess the variations within these core components as they exist in the field. METHOD: Using a stratified random sampling design, 117 CAC directors were interviewed using a semi-structured interview that was based on the NCA's standards for membership. The eight core components of the CAC model examined in this study include: a child-friendly facility, a multidisciplinary team, an investigative child interview, a medical examination of the child, provision of mental health services, victim advocacy, case review, and case tracking. RESULTS: Results reveal the CAC model has been widely adopted by both member and nonmember centers, although variations in implementation exist. CONCLUSIONS: Future developments in the CAC model must include evaluation of the model.