Defining and Studying Elder Abuse Polyvictimization

SPEAKER 1: Welcome to Justice Today, the official podcast of the Department of Justice's Office of Justice Programs, where we shine a light on cutting-edge research and practices and offer an in-depth look at what we're doing to meet the biggest public safety challenges of our time. Join us as we explore how funded science and technology help us achieve strong communities.

STACY LEE: Hello. My name is Stacy Lee Reynolds, a Communication Assistant supporting the National Institute of Justice, or NIJ. I'm your host for this episode of Justice Today. My guest is Yunsoo Park, a Social Science Analyst with NIJ's Office of Research, Evaluation, and Technology. At NIJ, Yunsoo currently works on topics related to services and programs for victims of crime, gender-based violence, including campus sexual assault, and elder abuse. She is also a licensed clinical psychologist with a Ph.D. in Clinical Psychology from Emory University. Welcome, Yunsoo.

YUNSOO PARK: Thanks, Stacy. Great to be here.

STACY LEE: Elder abuse is widespread in the United States, with as much as 11% of community-residing older adults aged 60 years or older experiencing some form of abuse or mistreatment in the past year, with some global estimates being as high as one in six in community settings. First, let's start with a definition of elder abuse. What kind of behaviors are considered elder abuse?

YUNSOO PARK: So elder abuse is an intentional act, or a failure to act appropriately, that involves harm or distrust, failure to provide an essential service, or a deprivation of basic needs to an older adult, usually around ages 60 to 65 and up. Elder abuse primarily includes five categories: physical abuse, emotional or a psychological abuse, sexual abuse, financial exploitation, and neglect. The abuse occurs within a relationship of trust, which means the abuse is committed by someone where there's an expectation of trust and/or the abuse can also occur when the older person is targeted based on their age or disability. An existing research shows us that older adults are at risk for polyvictimization or experiencing a range of different types of abuse and mistreatment.

STACY LEE: Can you go into more detail about how polyvictimization is defined?

YUNSOO PARK: Yes. So, polyvictimization is the co-occurrence of multiple or different forms of abuse and victimization. It may include one or more perpetrators of abuse, and generally these are people with whom the elder adults has a personal or professional relationship that is characterized by a societal expectation of trust. And polyvictimization can occur in a lot of different ways. So, multiple co-occurring types of abuse, single type of abuse by multiple people, multiple types of abuse committed by a single person, and some other potential combinations. And there really is no single definition of polyvictimization in the elder abuse field. 

And a recent NIJ-funded study suggested that a broad and inclusive definition of polyvictimization is most relevant, since multiple types of polyvictimization are related to poor outcomes. And it wasn't until recently that the polyvictimization framework was used to study elder abuse, even though previous work has shown frequent instances of co-occurring elder abuse. And there's evidence that many elder abuse victims experience polyvictimization, with some recent research from a few years ago showing that about two percent of older adults experience past year polyvictimization in a nationally representative sample of community-residing older adults in the United States. So this translates to about 970,000 older adults in the U.S. But these rates vary by region and social-cultural factors and may even be higher in some instances. 

STACY LEE: Can you discuss some of the difficulties that arise when trying to define and study elder abuse polyvictimization?

YUNSOO PARK: It can get really complicated to study how different types of abuse or maltreatment intersect. There's likely a range of different dynamics and risk factors that are involved, depending on the elder abuse type, but studying each abuse type separately provides a fairly limited view. We know that in most cases, abusive behaviors are not isolated events, meaning that different types of abusive behaviors co-occur and are related, and this makes it hard to understand and pinpoint specific impacts and--to identify the most appropriate intervention response.

STACY LEE: Yeah, absolutely. That sounds really complicated.

YUNSOO PARK: Yeah. And there is also no standardized method to define and assess elder abuse, meaning that people use different strategies to define elder abuse categories and to determine elder abuse rates, and there's no appropriate or comprehensive so-called gold standard measure of elder victimization that takes this polyvictimization framework into account. And since there is no such standardized method, you get different rates and different estimates across studies, which makes it hard to understand the full picture. Most definitions of polyvictimization include the co-occurrence of multiple types of abuse, as I spoke to earlier, but some definitions also consider experiencing a single type of abuse repeatedly to also be polyvictimization. And there's also research that suggests that elder polyvictimization should include the range of victimization experiences across the lifespan and not just those that happen in older ages, which then brings many complex experiences, and relationships, and risk factors into play. And, also, if you have more than one perpetrator involved, it also raises some similar challenges.

STACY LEE: I see there are a lot of things to consider when discussing elder abuse polyvictimization. Now how often does elder abuse in general go unreported?

YUNSOO PARK: So, the current prevalence rates are likely underestimates because of underreporting. There are reports estimating that for every one reported case of elder abuse or neglect, there are about five cases that are unreported. So this means that the true prevalence rates are probably about five times higher.

STACY LEE: Now how hard is it to study elder abuse polyvictimization if researchers don't have a full picture of the extent of the problem?

YUNSOO PARK: So there's evidence that many elder abuse victims experience polyvictimization and that looking at just one type of victimization really limits our understanding of the complex and diverse issues that are involved. There may be a wide range of different and complex factors, different contexts, and different behaviors that are important to recognize, and failing to understand this can lead to inappropriate and incorrect assumptions and it can also hinder effective intervention or prevention strategies. And examining just one type of victimization alone may not capture the range of victimization experiences for many older adults, and practitioners may attribute some negative outcomes to just one single type of victimization when, actually, the negative outcomes are due to the cumulative burden of experiencing multiple forms of victimization across the lifespan and in different settings and contexts. 

So, we also need to better understand the associations between early life victimization and stressors and late life abuse, and the cumulative impact of these experiences. And this type of polyvictimization framework in some other fields, like, you know, in fields such as child abuse and youth violence, this--this has shown that the effect of different types of victimization is a better predictor of different mental and physical health outcomes than any one single type of victimization. And incorporating this perspective to study elder abuse can also help us to understand this comprehensive lifespan burden of victimization for elders, but we currently don't know what those patterns of polyvictimization look like in elder adults.

STACY LEE: Is that because of the lack of standard method to measure polyvictimization?

YUNSOO PARK: Yes. As I mentioned, there's no standard way to define and measure elder abuse polyvictimization that has been used consistently in the field. So, you know, on the part of the practitioner, this also raises some complex challenges. Since a lot of elder abuse victims do experience polyvictimization, we know that they probably need more extensive assistance and a range of services to address all of their concerns and needs, but it's difficult to know how to best address these range of issues since we don't yet have a comprehensive understanding of the problem and many of the complicated factors and pathways and the impacts across the lifespan.

STACY LEE: What are some of the risk factors for elder abuse polyvictimization?

YUNSOO PARK: So, of course, there are general risk factors for elder abuse like poor health, poverty, low educational achievement, chronic medical conditions, et cetera. Also, we know that one of the biggest risk factors for being subjected to violence is prior victimization. Recent research has shown that, compared to elder non-victims and elders who experienced just a single form of victimization, that elder abuse polyvictims have more problems accomplishing various daily activities, things like grocery shopping, paying bills, getting dressed. And polyvictims are more likely to need assistance. They're also more likely to have limited social support, so not having that connection to others. And, also, they're more likely to report past experience of traumatic events, so things like a major accident or a natural disaster. There's also some evidence suggesting that family members are more likely to engage in multiple forms of elder abuse compared to perpetrators who are not related to the older adult.

STACY LEE: What are some of the implications elder abuse polyvictimization has for physical and mental health outcomes?

YUNSOO PARK: There's research showing that experiencing any form of elder abuse is associated with a range of serious physical and mental health problems like depression and anxiety, malnutrition, severe bodily injuries, and also premature death. There's also some recent research specifically on elder polyvictimization which shows that polyvictims experience lower cognitive functions, so problems of memory and processing speed. They also experience lack of self-esteem, feelings of powerlessness, and different types of mental health issues like post-traumatic stress disorder. 

And there's also evidence that elder adults who experience polyvictimization experience worse outcomes compared to those who experience primarily a single type of victimization. So, for example, elder adults who experience both financial exploitation and physical abuse and/or neglect, they're more likely to be in poor health when compared to elder adults who experience financial exploitation in isolation. And these polyvictims were also more likely to experience potentially stressful life changes. So, for example, to be appointed a guardian, which consists of a significant loss of freedom and is often dreaded by the elder adult. They're also more likely to experience a change in living arrangements, which can also be very stressful and traumatic for elder adults. And polyvictims are also more likely to have a subsequent adult protective services report filed regarding possible maltreatment, which suggests that these elder adults are at continued risk for abuse. 

Based on research on youth and non-elderly adults, we know that the total number of types of victimization is a better predictor of mental and physical health status compared to any one single type of victimization. So, taking this polyvictimization perspective can really help us to more comprehensively understand risk and protective factors and outcomes.

STACY LEE: Can you talk about some recent studies that NIJ has funded on the topic of elder abuse polyvictimization?

YUNSOO PARK: Yeah. So, one recent study by researchers at the University of Texas Health Science Center used a large, multi-year, statewide adult protective services dataset to study individual-level, perpetrator-level, and community-level risk factors for elder abuse. And the researchers found that there are different factors involved and different forms of abuse, specifically looking at pure financial exploitation versus polyvictimization. So what they called hybrid FE, and this is hybrid financial exploitation with other forms of abuse. And, importantly, the research showed that the presence of an apparent injury had the greatest importance in predicting polyvictimization, or hybrid financial exploitation, versus pure financial exploitation. And that hybrid financial exploitation was associated with a range of negative quality of life issues. So things like lack of appropriate medical supervision and inadequate food supplies. The study also found that alcohol and drug use by others in the home was more predictive of hybrid financial exploitation or polyvictimization.

And another recent NIJ study by researchers at the--at the University of Texas Health Science Center used the same dataset to operationalize elder abuse polyvictimization and to look at associations with mental and physical health, mortality, and prior exposure to violence. And this study suggested that a broad and inclusive definition of polyvictimization is the most relevant, since multiple types of polyvictimization are related to poor health, poor mental health, and mortality. And the study also found that multiple types of co-occurring abuse, regardless of the number of perpetrators, is associated with increased odds of death, also dementia and depression. And the study found that when older victims present with poorly explained injuries, when they present with limited social networks, hazardous living conditions, and a history of violence, so either intimate partner violence or domestic violence, that they are more likely to be experiencing multiple types of abuse by a single perpetrator.

STACY LEE: Now, can you discuss some strategies for intervention and prevention?

YUNSOO PARK: There likely is no blanket intervention and prevention for elder abuse, especially in the context of polyvictimization. With that said, we should consider family- and community-based strategies that consider factors beyond just focusing on the individual elder adult. We know that polyvictims are more likely to have limited social support. So, encouraging and supporting these social connections is really important. Also, educating elder adults about how to maintain their independence and safety promotes their wellbeing. And one way to do this is with formalized programs. 

One recently closed NIJ-funded study by researchers at the University of Southern California found that a program that's designed to educate, support, and link caregiving dyads with services and supports, that this program was associated with lower levels of elder mistreatment and higher social quality of life after three months. And another recently closed NIJ-funded study by researchers at the Urban Institute found that a program that focuses on resiliency and also provides resources, that this program was associated with a range of positive outcomes related to safety and wellbeing. 

And, in addition to focusing on the victims, we also need to think about addressing risks and needs of the people who commit the acts of abuse. For example, people who perpetrate financial exploitation and other forms of abuse may frequently experience some significant life stressors or have other risk factors like unemployment, substance abuse, and criminal history. So, by providing help and assistance and meeting their needs, for example, through mental health supports and treatment, this may reduce certain instances of elder abuse. Also given that a close family member or a relative may be the ones who are committing the acts of abuse, we also need to think about how to support and promote healthy and supportive family dynamics and relationships across the lifespan.

STACY LEE: Wow. That’s great work, and really encouraging to hear that NIJ is funding those projects. Thank you for sharing that, and thank you so much for joining us today, Yunsoo. It's been a very interesting conversation.

YUNSOO PARK: Thank you, Stacy. It's been my pleasure.

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