Authors View Transitions over 20 Years

Article excerpt

Recently, elder abuse and neglect have made the front pages of newspapers around the United States. In California, the recent release of an $8 million request for proposals by the Archstone Foundation has prompted a flurry of activity, with organizations new to the field joining established ones in proposing new and ingenious programs. For those who have worked in the field for many years, it is gratifying to see the inroads that have been made in raising awareness, generating public debate and mobilizing communities. It is an exciting time and climate in which to begin the third edition of Elder Abuse and Neglect: Causes, Diagnosis, and Intervention Strategies, first released by the Springer Publishing Company in 1986, when little was known about elder abuse and neglect, and revised in 1997. Present developments also provide an opportunity to reflect on the influences and approaches that have shaped the field.

In the first edition, we drew from the literature on domestic violence and child abuse and neglect in proposing a framework for understanding elder abuse and neglect. It was the child mistreatment model that first gained prominence nationally. States overwhelmingly enacted laws affecting elders that were patterned after the reporting laws intended to protect children. Response systems were designed accordingly. The limitations of this approach soon became obvious. Unlike our colleagues in child protection, who could legally and dramatically intervene to ensure children's safety, protective services for elders were voluntary by law, and professionals needed to gain clients' compliance. Many didn't want help, and dealing with client resistance became a necessary part of how professionals practiced. The child abuse and neglect approach also sparked accusations of ageism and paternalism, which required protective service providers to continually reevaluate and reaffirm their commitment to elders' autonomy and the concept of the least restrictive alternative.

UNDERSTANDING MISTREATMENT

Initial speculation that caregiver stress caused elder abuse or neglect led early researchers to explore the caregiver literature, which suggested that the more care elders required, the greater the burden on their caregivers, resulting in greater caregiver stress. Researchers of elder abuse and neglect also explored the link between disability and abuse and neglect. Researchers in both fields eventually recognized that the extent of disability was perhaps less important than the quality of long-term relationships between caregivers and care receivers in predicting both stress and mistreatment. More work is needed to understand the impact of past conflict, including domestic violence and child abuse, and elder mistreatment in the caregiving context.

The Vulnerable Elder Rights Protection Program, created by Congress in the 1992 Amendments to the Older Americans Act, recast elder abuse and neglect as matters of rights and civil liberties, suggesting that abuse constituted a denial of elders' basic rights. The program called for advocacy on behalf of those unable to advocate for themselves owing to physical or mental disabilities, social isolation, or limited education or resources. The same year, interest in the domestic-violence model as it relates to elder abuse and neglect resurfaced with the groundbreaking 1992 AARP forum titled "Abused Elders or Older Battered Women?" That event assembled researchers and practitioners from the fields of elder abuse and domestic violence to explore the links between them.

In addition, the infusion of domesticviolence theory and practice into elder abuse further counterbalanced the emphasis on protection and disability. That's because domestic-violence theory and practice focuses on empowering abuse victims by applying such methods as consciousness-raising and advocating and planning for one's own safety. This perspective also shed light on the complex dynamics between abusers and victims and on the help-seeking process. …