Improving the Identification of and Responses to Victims of Elder Mistreatment

Elder mistreatment—which refers to physical, psychological, and sexual abuse; fraud and financial exploitation; and neglect—is a serious public health issue and growing area of concern as the percentage of the U.S. population age 60 and older continues to rise. Older adults are more likely to have vulnerabilities that put them at heightened risk for victimization, such as limited mobility, cognitive impairment, social isolation, and other morbidities and dependencies. These vulnerabilities also make it more difficult to detect when someone is experiencing elder mistreatment and thus to intervene to prevent escalation. Additionally, older victims who experience mental, physical, sexual, or financial abuse might have different needs in the aftermath of the crime than younger victims. The same factors related to increased risk of victimization—declining health and cognitive conditions, social isolation, challenges to living independently or managing finances—could make intervention and the prevention of revictimization more difficult. These challenges are compounded by the fact that most victims of elder mistreatment have ongoing relationships with the perpetrators and often rely on these individuals for various forms of care.

Medical, financial, legal, and social service providers who encounter older adults can be well positioned to identify persons at risk of or experiencing elder mistreatment and connect them with other service providers to address their needs. However, more information is needed about (1) the tools and training that improve identification and (2) the best way to intervene or respond when a victim has been identified, particularly given that older victims' service needs might differ from those of younger victims and might be culturally specific.

To explore these challenges and potential solutions, RAND and RTI International convened an expert panel in 2023 to explore best practices and tools that can be used by first responders and service providers to better identify elder mistreatment and those at risk of it and provide appropriate support and services. The workshop was one in a series conducted through the Priority Criminal Justice Needs Initiative, which informs the science and technology innovation agenda of the National Institute of Justice. These workshops regularly obtain direct feedback from practitioners, researchers, and policymakers to recommend priorities for research and innovation to meet the most-pressing needs of the field.

This workshop, titled Identifying and Responding to Elder Mistreatment, identified high-priority needs related to the identification of and responses to elder mistreatment. A need represents the combination of a challenge related to effectively identifying and/or responding to elder mistreatment and a potential solution to address that challenge. The needs prioritized through the workshop relate to

1. research and evaluation to ensure that interventions to address elder mistreatment are evidence-based
2. holistic support to those experiencing elder mistreatment
3. a deeper understanding of the impacts and outcomes of systems- and community-based responses to elder mistreatment
4. culturally appropriate responses to elder mistreatment
5. widespread adoption of successful practices for identifying and responding to elder mistreatment.

What We Found

Workshop participants identified and prioritized 48 needs using a modified Delphi approach for ranking. Twelve of these needs were ranked as the highest priorities. In order of how they were ranked, the highest priority needs for effective identification of and responses to elder mistreatment addressed limitations or challenges related to the availability of evidence-based interventions, strategies to provide holistic support to individuals who are at risk for or who have experienced mistreatment, evidence about the full variety of programs available to identify and respond to elder mistreatment, culturally appropriate response strategies, and approaches to support adoption of evidence-based strategies. Each of these challenges or opportunities were associated with multiple potential solutions to address the issue.

Selected Priority Needs

Results

Lack of evidence-based interventions

• Start the development of evidence-based interventions with rigorous testing of those programs for which there is reasonable case study evidence that they reduce harm.
• Incorporate research and evaluation into the development of new intervention programs to build an evidence base.
• Develop a strong conceptual framework, building on work done around other types of violence, to inform the development of interventions.
• Conduct a systematic review of case study evidence, demonstration studies, randomized controlled trials, multi-site evaluations, and replication with different populations and geographic areas.

Lack of holistic support

• Consider approaches that build relationships with victims and offer victim-centered care.
• Conduct rigorous research to identify the full scope of elder mistreatment victim needs.

Adoption and implementation challenges for prevention, detection, and intervention strategies

• Incorporate principles of implementation science within any intervention research to better understand how to apply those interventions to different contexts and subpopulations.