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Elder Mistreatment in an Aging America:
An Urgent Need for Research

Statement of

Richard J. Bonnie

Chairman, Panel to Review Risk and Prevalence of
Elder Abuse and Neglect
National Research Council/National Academy of Science

and

Schools of Law and Medicine, University of Virginia

before the

Committee on Finance
United States Senate

June 18, 2002


Mr. Chairman and members of the Committee:

My name is Richard Bonnie. I am John S. Battle Professor of Law, Professor of Psychiatric Medicine, and Director of the Institute of Law, Psychiatry and Public Policy at the University of Virginia. I am a member of the Institute of Medicine of the National Academy of Sciences, and I am appearing before you today in my role as the chair of a study on elder abuse and neglect recently conducted by the National Research Council, the operating arm of the Academy. Our study committee was established in the spring of 2001, in response to a request by the National Institute on Aging, to assess the state of knowledge in this field, and to make recommendations for future research. Our report was released yesterday, and I am immensely pleased to have the opportunity to present our conclusions and recommendations to you and the American people today.

I have given the Committee's staff a pre-publication copy of the report, entitled Elder Mistreatment: Abuse, Neglect and Exploitation in an Aging America, and am appending to my written statement the Executive Summary of that report. In my testimony here today, I would like to make five points:

Very Little is Known

First, it is genuinely amazing how little we know about this important subject. A thorough search of the scientific literature turns up fewer than 50 peer-reviewed studies. No major foundation has identified elder mistreatment as one of its priorities, and federal investment has been modest at best. For example, fewer than 15 studies on this subject have been funded by the National Institute on Aging since 1990, and support from other agencies has been episodic. As a result, very little is known about the nature and magnitude of elder abuse and neglect, its causes and consequences, the effectiveness and cost of current interventions, or measures that could successfully be taken to prevent it or to ameliorate its effects. The best metaphor to describe current knowledge is a nearly blank slate, a tabula rasa. The gaps in our knowledge are enormous.

Prevalence Data are Urgently Needed

Second, there is an urgent need for studies on the prevalence of abuse, neglect and exploitation. I have participated in ten studies on behalf of the National Academy of Sciences. Reports in this genre typically begin by calling attention to the magnitude and social cost of the problem being explored, before going on to identify opportunities and priorities for research, programmatic action and policy initiatives. There is simply not enough information to describe the magnitude and social cost of elder mistreatment. That fact is a telling indication of the compelling need for the panel's report, as well as for an intensified program of research.

No survey of the U.S. population has ever been undertaken to provide a national estimate for the occurrence of any form of elder mistreatment. The magnitude of the problem--among community-dwelling elders, as well as those residing in long-term care facilities--is basically unknown. Most of the research thus far conducted in this field has relied on records of social service agencies. But valid prevalence data (rates of abuse, neglect and exploitation) can be developed only by studying populations (in communities or institutions, or wherever people are found). Studying reported cases is not sufficient. because only a very small proportion of cases reach agency attention -- and we have no idea what proportion it is. Only a handful of population-based studies have been conducted, and most of them have been fielded in other countries.

The panel's report offers a sequential strategy for prevalence research:

Though Unquantified, the Problem is Serious and Likely to Grow

Even in the absence of adequate prevalence data, available information from clinical and social service settings and agency records gives us a sound basis for believing that abuse, neglect and exploitation of elders are significant problems. In terms of magnitude, rough estimates, based on figures extrapolated from local studies, suggest that the national prevalence of elder mistreatment (including physical abuse, psychological abuse, and neglect) is likely to be between 2% and 4% of the older population, and perhaps twice that high if financial exploitation is included. At any point in time, between one and two million vulnerable elders may be experiencing (or are at high risk of experiencing) mistreatment.

It is likely that mistreatment is associated with substantial added morbidity and disability in an already vulnerable population (though, as I said, we have virtually no good data on the consequences of mistreatment). There is some evidence that mistreatment is associated with accelerated mortality.

Moreover, the occurrence and severity of elder mistreatment are likely to increase markedly over the coming decades, as the population ages, caregiving responsibilities and relationships change, and increasing numbers of older persons require long-term care.

Research is Needed to Respond Effectively to the Problem

Aside from prevalence research, here are some examples of what we need to know, and why it would help:

We Need to Build an Infrastructure for Research

In Understanding Child Abuse and Neglect (1993) and Violence in Families (1998), the National Research Council was able to map out a comprehensive blueprint for research in the adjacent domains of child mistreatment and intimate partner violence. However, so little is now known about elder mistreatment that it would be premature to draw up detailed research agenda. Instead, the panel's report is best seen as laying the foundation for a much-needed effort to "jumpstart" this nascent field of scientific investigation.

An important part of this effort is to establish an infrastructure for research, and to recruit researchers from the range of disciplines whose collaboration is needed. Here are a few ideas about how we might propel this field forward at a sensible and productive pace:

Concluding Comment

Although the magnitude of elder mistreatment is unknown, its social importance is self-evident. Abuse and neglect of older individuals breaches a widely embraced moral commitment to protect vulnerable people from harm and to ensure their well-being and security. To carry out this commitment, society cannot rely on good intentions alone. A substantial investment in scientific research along the lines outlined in the NRC panel's report is an essential component of a comprehensive and effective national response.

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