Table of Contents

About This Course

1. Introduction to Elder Abuse
2. The Basics of Elder Abuse
3. Substance Use and Other Risk Factors
4. Screening and Assessment
5. Intervention and Treatment
6. Preventing Elder Abuse

Supplements
Case Studies
References
Resources

Out of the Shadows
Uncovering Substance Use and Elder Abuse

Theories of Elder Abuse

Practitioners have noted that the complex nature of elder abuse -- encompassing many forms and across various domains -- makes it difficult to construct one theory to conclusively explain the causes of elder abuse.

Furthermore, the number of constituencies -- including the medical community, judicial systems, and social service agencies -- bring widely varying perspectives regarding interventions for the victim and the perpetrator. Although expanding the group of stakeholders can only help address the problem, finding a common theoretical framework for discussion becomes more difficult.

The lack of clarity reflects an overarching uncertainty about how elder abuse fits within other theoretical frameworks related to violence. Parallels have been drawn between elder abuse and child abuse and between elder abuse and domestic violence (see Module 5). Many elder abuse cases fit the paradigm of family violence -- that is, acts of abuse or misuse of power that may result in harm to a family member. ref However, not all cases involve spouses or family members. Practitioners stress the need to understand the entire range of elder abuse and the underlying causes -- including self-neglect, abuse and neglect within the family, and abuse that occurs in institutional settings.

Theories about elder abuse have described many different kinds of contributing factors. These include factors in the individual, factors involving individuals in an abusive relationship, and factors in the environment and society. Some theories have withstood scrutiny better than others. Some have not been supported by current research. For example, early theories focusing on caregiver stress erroneously assumed that all victims of elder abuse were older and frail. This model has tended to overlook older victims of domestic violence who are in good physical and mental health. ref Rosalie S. Wolf, a pioneer in the field of elder abuse and former President of the National Committee for the Prevention of Elder Abuse, documented the following theories relating to elder abuse that have been proposed over the years: ref

• Psychological Model
  
  Researchers have looked at psychological factors to explain a correlation with elder abuse, such as the relationship of violent behavior and aggressive personality traits, and the proportion of abusers with mental illness and/or substance abuse problems.
• Social Learning Theory
  
  This theory states an individual adult's behavior relates to the social environment of childhood and views violence as a learned behavior. For example, a child observing an adult using violence to cope with conflict may revert to the same pattern as an adult.
• Situational Theory
  
  This early theory of elder abuse focused on the role of stress and the burden of care giving in leading to elder mistreatment and neglect. According to this theory, reducing the level of caregiving stress is one way to reduce the likelihood of elder abuse. However, experts note that the theory fails to consider key aspects of the interpersonal relationship at play.
• Symbolic Interactionism
  
  This theory notes the importance of an individual's expectation of his or her role when interacting with an older person. The level of stress related to dependency tasks, therefore, is subjective. According to this theory, behaviors in an older person consistent with individual expectations and roles result in less conflict than in situations in which a discrepancy exists in expectations.
• Social Exchange Theory
  
  This theory is based on the premise of reciprocity: when individuals contribute equally, a fair exchange results. If one person becomes disabled, it upsets this balance. Power is an important aspect of this theory, suggesting abuse can occur as a response to perceived powerlessness.
• Feminist Theory
  
  This theory is based on domestic violence models and highlights the role of violence among men as a way to demonstrate power.
• Ecological Model
  
  This theory looks at individual characteristics of abusers and their victims as well as behavior in the social context (family, work, school, and peer relationships).
• Political Economy Model
  
  This model refers to society's marginalization of older people as a cause of elder abuse.

Elder abuse theory still is evolving. Current theory focuses on the dynamics of the relationship between the perpetrator and the older adult victim and the behaviors of the perpetrator (including substance abuse) as well as risk factors affecting the victim. "There seems to be no scarcity of theories" relating to elder abuse, Dr. Wolf noted. "The critical issue with regard to elder mistreatment is the lack of rigorous scientific studies to test the theories." ref