Culture Diversity and Elder Abuse: Implications for Research, Education, and Policy

Article excerpt

Elder abuse is a pervasive public health issue-a challenge that cries out for culturally appropriate training and education to enable practice and policy changes that will best protect our increasingly diverse aging population.

Elder abuse is a substantial global public health issue. The World Health Organization has declared that elder abuse is a violation of one of a human being's most basic fundamental rights: the right to be safe and free of violence (World Health Organization, 2002). In the United States, an estimated 10 percent of elders experience abuse each year, and many of them experience it in multiple forms (Beach et al., 2010; Acierno et al., 2010). In addition, elder abuse is associated with increased risk of premature morbidity and mortality (Dong et al., 2009; Dong et al., 2011a; Dong, Simon, and Evans, 2011; Dong et al., 2011c). Despite the accessibility of Adult Protective Services (APS) and nursing home regulations in all fifty states, an overwhelming number of abused older adults pass through our healthcare system undetected and untreated.

A major complexity in advancing the field of elder abuse is exemplified by the issues of cultural diversity surrounding elder abuse. In 2003, the National Research Council put forth a strong recommendation to urge the field to explore cultural issues related to elder abuse. In 2010, the National Academy of Sciences and the National Institute on Aging organized a state-ofscience meeting on research issues in elder mistreatment and financial fraud, including discussion of cultural diversity (The National Academies Committee on National Statistics, 2010). Despite these reports and the continued effort of multiple disciplines across academic, community, state, and federal organizations, there remain vast gaps in our understanding of cultural issues in elder abuse.

In the United States, the aging population (ages 65 and older) represents approximately 40 million (12.9 percent) of the population; by 2030, there will be about 72.1 million older people, more than twice the number in 2000. In 2010, approximately 20 percent of people ages 65 and older were minorities; 8.4 percent were African American; 6.9 percent were of Hispanic origin; 3.5 percent were Asian or Pacific Islander; and 1 percent were American Indian or Native Alaskan (Administration on Aging, 2012).

Recent studies have expanded our knowledge about elder abuse in African American, Latino, Korean, Indian, Native American, and Chinese populations. However, we need more studies to fill in the large gaps in our knowledge. We need quantitative and qualitative studies to better define the concept and cultural variations in the construct, definition, and understanding of elder abuse; and we need cultural explorations to better study the barriers to reporting elder abuse and help-seeking behaviors with respect to the specific sociocultural contexts. Studies also are needed to understand the prevalence, incidence, risk/protective factors, and consequences associated with incident cases of elder abuse and its subtypes in diverse populations. And we must have research to explore the issues of cultural norms and cultural expectations in relation to the perception, determinants, and impact of elder abuse in different racial and ethnic communities.

A Call for Community-Based Participatory Research

Significant challenges exist in the preparation and conduct of aging research in minority communities, especially regarding culturally sensitive issues such as elder abuse. A communitybased participatory research (CBPR) approach could be a potential model for exploring the issues of elder abuse in minority communities.

CBPR necessitates equal partnership between academic institutions with community organizations and key stakeholders to examine the relevant issues. This partnership requires reciprocal transfer of expertise and needs to build infrastructure toward sustainability. Recent elder abuse research in the Native American and Chinese communities has demonstrated success and has enhanced infrastructure and networks for community-engaged research and community-academic partnerships (Dong et al. …