Growing Older, Growing Problems

It is hardly news that Americans are living longer. According to the National Center on Elder Abuse (NCEA), the number of people in the U.S. in 2010 who were 65 and older was 40.3 million, or 13% of the population. By 2050, that percentage will grow to 20%. What is more, by 2050, it is anticipated that 19 million people will be 85 and older.

The actual incidence of elder abuse is not known, although there are indications it is on the rise. A Honolulu prosecutor’s office recently reported that elder abuse cases have tripled in five years. While the extent to which elder abuse is occurring is unknown, it is believed that (i) women are abused at a higher rate than men and (ii) rates of abuse increase with age.

Perhaps not surprisingly, the collateral medical consequences of elder abuse are substantial. According to the NCEA, elders who are abused experience a 300% higher risk of death, significantly higher levels of psychological distress and lower perceived self-efficacy, and additional health care problems that include depression or anxiety, chronic pain, high blood pressure, and heart problems.

There is significant concern that, due to lack of proper training, elder abuse routinely goes undetected by professionals working with older Americans. The underreporting may be traceable to reluctance on the part of many elderly to report abuse. They may fear retaliation, or, given that an exceptionally high percentage of incidents involve a family member, getting someone close to them in trouble. They may also be physically or mentally incapable of reporting.

A May 2008 study by the Government Accountability Office reported significant understating of problems in licensed nursing home facilities. According to this study, 70% of state surveys missed at least one deficiency, and 15% missed actual harm and immediate jeopardy of a nursing home resident. At the time of the study, there were 3.2 million Americans living in nursing homes.

Established by the U.S. Administration on Aging in 1988, the NCEA defines elder mistreatment as intentional actions that cause harm or, regardless of intent, create a serious risk of harm to a vulnerable elder by a caregiver or other person who stands in a trust relationship to the elder.

Comment by Bennett Blum, M.D.

In our experience, many cases of elder abuse could have been avoided.  To prevent or investigate elder abuse, it is necessary to (1) evaluate the elder’s strengths and vulnerabilities and (2) evaluate the suspected perpetrator’s behaviors and tactics.  Each of these is multifaceted and requires specialized expertise.  Unfortunately, this expertise is not common.  Many of the cases that come to PD&A involve inadequate and error-filled reports from treating physicians.


  1. National Center on Elder Abuse, Administration on Aging. Web. Dec. 11, 2013.
  2. Kawano, Lynn, “Elder abuse squad getting slammed with cases.” Hawaii News Now, Nov. 8, 2013. Web Dec. 11, 2013.