Elder Abuse: Risk and Protective Factors

Risk Factors

A combination of individual, relational, community, and societal factors contribute to the risk of becoming a perpetrator of elder abuse. They are contributing factors and may or may not be direct causes.

Understanding these factors can help identify various opportunities for prevention.

Risk Factors for Perpetration

Individual Level

• Current diagnosis of mental illness
• Current abuse of alcohol
• High levels of hostility
• Poor or inadequate preparation or training for care giving responsibilities
• Assumption of caregiving responsibilities at an early age
• Inadequate coping skills
• Exposure to abuse as a child

Relationship Level

• High financial and emotional dependence upon a vulnerable elder
• Past experience of disruptive behavior
• Lack of social support
• Lack of formal support

Community Level

• Formal services, such as respite care for those providing care to elders, are limited, inaccessible, or unavailable

Societal Level
A culture where ―

• There is high tolerance and acceptance of aggressive behavior
• Health care personnel, guardians, and other agents are given greater freedom in routine care provision and decision making
• Family members are expected to care for elders without seeking help from others
• Persons are encouraged to endure suffering or remain silent regarding their pains
• There are negative beliefs about aging and elders

In addition to the above factors, there are also specific characteristics of institutional settings that can increase the risk for perpetration of vulnerable elders, including the following:

• Unsympathetic or negative attitudes toward residents
• Chronic staffing problems
• Lack of administrative oversight, staff burnout, and stressful working conditions

Protective Factors for Elder Abuse

Protective factors reduce risk for perpetrating abuse and neglect. Protective factors have not been studied as extensively or rigorously as risk factors. However, identifying and understanding protective factors are equally as important as researching risk factors.

Several potential protective factors are identified below. Research is needed to determine whether these factors do indeed buffer elders from abuse.

Protective Factors for Perpetration

Relationship Level

• Having numerous, strong relationships with people of varying social status

Community Level

• Coordination of resources and services among community agencies and organizations that serve the elderly population and their caregivers.
• Higher levels of community cohesion and a strong sense of community or community identity
• Higher levels of community functionality and greater collective efficacy

Protective factors within institutional settings can include the following:

• Effective monitoring systems
• Solid institutional policies and procedures regarding patient care
• Regular training on elder abuse and neglect for employees
• Education and clear guidance on durable power of attorney and how it is to be used
• Regular visits by family members, volunteers, and social workers

Additional References

Connecting the Dots [PDF 2.51MB]
Lists specific risk and protective factors for elder maltreatment: Wilkins, N., Tsao, B., Hertz, M., Davis, R., Klevens, J. (2014). Connecting the Dots: An Overview of the Links Among Multiple Forms of Violence. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention Oakland, CA: Prevention Institute.

Surveillance [PDF 4.00MB]
Longstanding divergences in the definitions and data elements used to collect information on Elder Abuse (EA) make it difficult to measure EA nationally, compare the problem across states, counties, and cities, and establish trends and patterns in the occurrence and experience of EA.

Also identified in the literature: Johannesen M1, LoGiudice D. Elder abuse: a systematic review of risk factors in community-dwelling elders. Age Ageing. 2013 May;42(3):292-8. doi: 10.1093/ageing/afs195.

National Research Council (US) Panel to Review Risk and Prevalence of Elder Abuse and Neglect; Bonnie RJ, Wallace RB, editors. Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Washington (DC): National Academies Press (US); 2003. 5, Risk Factors for Elder Mistreatment. Available from: https://www.ncbi.nlm.nih.gov/books/NBK98788/