Abstract Elder abuse is a complex and multifaceted problem. Although the majority of elder abuse still does take place in the domestic setting, increasing numbers of cases are occurring within the healthcare or nursing home setting. Measuring elder abuse is difficult due to inconsistent reporting, and the fact that most cases of elder abuse remain unreported. Responding to elder abuse requires cooperation between multiple agencies and organizations within criminal justice, the legal system, public health, and healthcare services. The impact of the criminal justice system has been to prevent and respond to elder abuse.

Introduction and Background

Criminalizing elder abuse is a relatively new phenomenon. Prior to 2000, elder abuse was construed as a private, family concern (Heisler, 2012). Just as attitudes toward child abuse and domestic violence changed during the 20th century, public attitudes and responses to elder abuse are finally shifting in the 21st century. As the senior population of the United States grows by the minute, elder abuse becomes an increasingly important issue from the perspective of healthcare and criminal justice systems.

However, it is not a simple matter to start transferring responsibility suddenly to the criminal justice system. Criminal justice system responses to elder abuse depend on having clear public policies in place. Furthermore, local, state, and federal laws need to provide a framework for responding effectively to elder abuse within the criminal justice system. Elder abuse is a multifaceted, complex problem that needs to be addressed in a multidisciplinary fashion, involving scholars, legislators, policy analysts, healthcare workers, attorneys, judges, and law enforcement agencies. Responses to elder abuse also require public attention and awareness, and knowledge of the special needs of diverse elder populations and their communities.

Elder abuse is highly prevalent, but notoriously difficult to measure due to a number of intervening variables. The first impediment to successful measuring of elder abuse prevalence is defining elder abuse. Some cases of elder abuse are relatively straightforward to define, but other cases, such as those involving financial abuse, also need to be taken into consideration when measuring prevalence. With so many different variables and different techniques used to measure elder abuse, it has been difficult to develop cohesive policy interventions.

Second, most elder abuse cases are not reported (Blowers, 2005). Some reports indicate as few as one in 27 cases are reported (Blowers, 2005, p. 1). However they are counted, numbers of cases are staggering, with over 500,000 non-institutionalized individuals 60 or older estimated to be the victims of abuse and/or neglect, and 1-2 million cases of abuse, exploitation, or neglect every year in total in the United States alone (Blowers, 2005, p. 1).

Defining Elder Abuse

Definitions of elder abuse are changing, to include a broader range of abusive and exploitative activities ranging from neglect to financial manipulation. The broadest definition of elder abuse is “any action or inaction by any person that causes harm or risk of harm to an older person,” (British Columbia Ministry of Public Safety and Solicitor General, n.d., p. 2). Evidence from geriatric and cognitive science is crucial to defining elder abuse more broadly and reliably. For example, financial abuse is more commonly being considered as a criminal form of elder abuse. As Wood, Rakela, Liu, et al (2014) point out, research on “specific cognitive domains linked to financial capacity including memory, calculation, and executive functioning” is necessary for defining elder financial abuse (p. 414). Some of the most obvious types of elder abuse include “intimidation, humiliation, physical assault, sexual assault, overmedication, withholding needed medication, censoring mail, invasion or denial of privacy or denial of access to visitors, neglect and self neglect,” (British Columbia Ministry of Public Safety and Solicitor General, n.d., p. 2). Which types of elder abuse can or should be criminalized is at the heart of the debate over the role of the criminal justice system in elder abuse cases. Severity and duration of the abuse might also factor into definitions of elder abuse. It may also be important to consider each case separately, rather than presuming that all cases fit under the same rubric.

Contexts of Elder Abuse

Elder abuse occurs in a number of different contexts, the main ones being at home and in nursing homes or healthcare facilities. The vast majority of cases occur domestically, though. As Blowers (2015) points out, “ an overwhelmingly large proportion of elder abuse, neglect, and mistreatment cases occur when the victim is living at home and most often the perpetrator is a family member or caretaker,” (Blowers, 2015, p. 1). However, it is important not to generalize about the contextual...

Perpetrators are diverse, as are the situations that surround elder abuse. Perpetrators are “heterogeneous with important differences across types of abuse,” (Jackson, 2014, p. 265).
Financial exploitation is a common context of elder abuse. According to the NCPEA (2008), perpetrators of financial abuse of elders include caregivers, unscrupulous businesspersons, or persons with malicious intent. Caregivers and loved ones may perpetrate elder abuse by misappropriating funds, forging signatures, diverting inheritance funds, and disenfranchising the elder and/or siblings from financial entitlements (NCPEA, 2008).

Unscrupulous business practitioners can be health service providers or senior living facilities overcharging for services, or billing for unused services. While these types of behaviors fall more into the category of general fraud, they can be conceptualized as elder abuse given the unique circumstances of elder cognition and behavior (Wood, Rakela, Liu, et al, 2014). Similarly, malicious or predatory individuals might seek out elders as victims of business scams due to the vulnerability of this population. Elders with memory or cognitive impairments are at an especially high risk for financial abuse. Types of financial abuse range from pledges of romantic or companionship interests, promises to provide services like housekeeping, or email and other online scams (NCPEA, 2008). Conceptualizing financial abuse of elders as a criminal justice concern helps to raise awareness of the prevalence of the problem and free up resources to prosecute offenders. The criminal justice system can thereby help prevent instances of elder abuse by creating and enforcing the legal framework for responding to elder abuse of all types.

Perceptions of Elder Abuse

It is important to change public perceptions of elder abuse, in order to view it as a criminal justice issue. Perceptions of elder abuse determine how people recognize warning signs, what behaviors are classified as elder abuse, and how people respond to elder abuse. Responding to elder abuse can take different forms, including the use of the criminal justice system. Moreover, different perceptions of elder abuse also impact a person’s sense of agency and also their beliefs about community resources available to elders or their family members (Roberto, Teaster, McPherson, et al, 2015).

Because the majority of cases occur within the home with a family member or primary caretaker as the perpetrator, elder abuse has until recently, and often still is, construed as a “family issue” and not a criminal justice one (Blowers, 2015, p. 1). Framing elder abuse as a family issue is problematic because it reduces the chance for elders to have a sense of agency. The elder or victim might have negative perceptions of the criminal justice system, too, not believing that the criminal justice system will help or worrying that the criminal justice system might put their caregiver or loved one in jail. “Perceptions of elder abuse are shaped by experiential, cultural, contextual, and generational variables that influence both individuals' abilities to recognize elder abuse and their likelihood to report concerns to authorities,” (Roberto, Teaster, McPherson, et al, 2015, p. 9).

Types of Interventions Available

The two most important types of interventions for elder abuse include the criminal justice system and the healthcare system. Ideally, the criminal justice system and the healthcare system work in tandem to improve awareness, access, and response efficacy. It is important to develop a multifaceted approach to conceptualizing and responding to elder abuse, because it is a complex and heterogeneous issue. “Multiple conceptualizations can and must co-exist, a framework which is consistent with the multidisciplinary team approach becoming prevalent in the field,” (Jackson, 2016, p. 1). Currently, interventions that use the criminal justice system involve law enforcement and legal counsel.

Role of law enforcement in cases of elder abuse includes ensuring the victim is safe by enforcing restraining orders and performing checks on the person’s wellbeing (NCPEA, 2008). Law enforcement should also provide “leverage and assistance to other professionals in fulfilling their mandates to investigate and intervene,” (NCPEA, 2008). Arrests can be made when necessary, and alternative sanctions such as access to psychological counseling or victim encounters can also be provided by law enforcement. Law enforcement can also intervene by ensuring that the perpetrator, such as a caregiver, is behaving in accordance with the law by regularly visiting the domicile (NCPEA, 2008).

Legal counsel plays a major role when responding to elder abuse in a criminal justice context. The role of legal counsel is to offer information related to how to seek protective services in the case of physical abuse,…