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The full extent of elder abuse is uncertain. There are few reliable national measures of elder abuse. This is partially because there is no uniform reporting system for elder abuse in the U.S. Additionally, the available national incidence and prevalence data from administrative records are unreliable because states have different definitions of elder and different reporting mechanisms.
An NIJ-funded, nationally representative study of more than 7,000 community-residing elders found that approximately one in 10 elders reported experiencing at least one form of elder mistreatment in the past year. See Extent of Elder Abuse Among Community-Residing Elders for more from this study.
Other large-scale studies of elder abuse have been undertaken, but the data used in many of those studies make it difficult to confidently draw conclusions about the national picture of elder abuse.
The Extent of Elder Abuse Among Community-Residing Elders
The NIJ-funded National Elder Mistreatment Study examined the prevalence of elder mistreatment and victimization among 7,000 elders living in the community:
- Eleven percent of elders reported experiencing at least one form of mistreatment — emotional, physical, sexual or potential neglect — in the past year.
- Financial exploitation by a family member in the past year was reported by 5.2 percent of elders.
- Past-year prevalence was 5.1 percent for emotional mistreatment, 1.6 percent for physical mistreatment, 0.6 percent for sexual mistreatment and 5.1 percent for potential neglect. Risk factors for elder mistreatment include:
- Low household income
- Unemployment or retirement
- Poor health
- Experiencing a prior traumatic event
- Low levels of reported social support
The Extent of Elder Abuse in Residential Care Facilities
Reports of Abuse in Assisted Living Facilities
In an NIJ-funded study of reports of abuse in assisted living facilities, verbal and psychological abuse were the most common forms of abuse reported by direct care workers. Overall, resident abuse by staff was relatively uncommon, but the study’s findings indicate that there is room for improvement, especially for verbal and psychological abuse.
- Prevalence rates. Researchers calculated one-year prevalence rates for resident abuse indicators. The highest rates were for items in the verbal (e.g., humiliating remarks, 203 per 1,000 residents) and psychological abuse (e.g., critical remarks, 163 per 1,000) categories. Generally, physical abuse, material exploitation and medication abuse items were less common. Sexual abuse items were the least common.
- Factors associated with abuse. Some facility- and individual-level factors associated with abuse were low staffing levels, residents with dementia or physical limitations, and having an administrator with a shorter tenure and lower education level.
Researchers sent questionnaires to administrators and direct care workers at a random sample of 1,500 assisted living facilities across the U.S. The questionnaires asked workers about observations and reports of abuse and exploitation of residents in seven categories: verbal, physical, psychological, caregiving, medication, material and sexual. The researchers received 1,376 questionnaires back from administrators (a response rate of 84 percent) and 12,555 questionnaires back from direct care workers (81 percent).
Resident-to-Resident Abuse in Nursing Homes
Researchers and caregivers are increasingly recognizing resident-to-resident elder mistreatment as a source of abuse in residential care facilities. In an NIJ-funded study, researchers found that staff reported higher rates of resident-on-resident abuse than was documented in reports and charts., 
The study sought to:
- Enhance institutional recognition of resident-to-resident abuse.
- Identify the most accurate method of reporting and detecting resident-to-resident mistreatment.
- Develop institutional guidelines for reporting resident-to-resident mistreatment in residential facilities.
- Prevalence. The average number of incidents reported across the nursing homes ranged from 0 to 4.3, depending on the reporting mechanism — the direct service staff reported 4.3 incidents, but no incidents were documented in accident/incident reports.
- Reporting accuracy. The direct service staff were the most accurate mechanism for reporting or detecting resident-to-resident elder mistreatment. The residents themselves were the second most accurate mechanism. The facilities’ accident/incident reports provided the smallest number of resident-to-resident mistreatment incidents.
Environmental factors. Environmental factors (i.e., loud noise or congestion in public spaces due to equipment, such as walkers) may contribute to resident-on-resident mistreatment.
Researchers concluded that the discrepancy between staff-reported rates of resident-to-resident mistreatment and rates recorded in reports and charts illustrated the need for better documentation practices. To improve reporting, documentation and management, the researchers suggest institutional support in the form of staff training and institutional guidelines setting out standard practices for how to address resident-to-resident mistreatment.
The study was carried out in 10 nursing homes with 1,846 residents. The researchers gathered information about resident-to-resident abuse from residents and staff, observation by researchers, incident and accident reports, and chart reviews within a two-week period.
About This Article
The research described in this article was funded by NIJ awards 2009-IJ-CX-0001 and 2010-IJ-CX-0023, awarded to Joan & Sanford I Weill Medical College of Cornell University and the University of Pittsburgh.
This article is based on the grantee reports Documentation of Resident to Resident Elder Mistreatment in Residential Care Facilities and Examination of Resident Abuse in Assisted Living Facilities.
[note 1] Acierno, Ron, Melba Hernandez-Tejada, Wendy Muzzy and Kenneth Steve, “National Elder Mistreatment Study,” Final report to the National Institute of Justice, grant number 2007-WG-BX-0009, March 2008, NCJ 226456.
[note 2] Castle, Nicholas, “Examination of Resident Abuse in Assisted Living Facilities,” Final report to the National Institute of Justice, grant number 2010-IJ-CX-0023, March 2013, NCJ 241611.
[note 3] The NIJ-funded study was a companion award to a National Institute on Aging award. The findings presented here are attributed to the efforts of both awards.
[note 4] Lachs, Mark, Jeanne A. Teresi and Mildred Ramirez. “Documentation of Resident to Resident Elder Mistreatment in Residential Care Facilities,” Final report to the National Institute of Justice, grant number 2009-IJ-CX-0001, March 2014, NCJ 246429.