Dr. Tony Rosen has seen his share of cuts, bruises and broken bones. In his job as an emergency room physician at New York-Presbyterian Hospital, he witnesses the painful end result of accidents and attacks involving aging adults.
“I see lots and lots of older adults who either report that they fell or the caregiver or whoever’s standing next to them says, ‘They fell,’” Rosen said in a recent interview. “And we assume that some of those falls are, in fact, not falls but physical abuse.”
As of yet, there aren’t good ways to distinguish one from the other. But after working with professionals in other areas, including law enforcement, a prosecutor’s office and social workers, Rosen was able to figure out what happens before the violence descends.
In a recent research study with Karl Pillemer, Mark Lachs and others, Rosen qualitatively analyzed the criminal files from 87 cases of physical elder abuse in Kings County (Brooklyn, N.Y.) from 2003 to 2014. In all of the cases, the perpetrator either pleaded guilty or was convicted at trial.
The case files included the criminal complaints, or charging documents, that the district attorney filed. Those include some initial evidence the prosecution puts forward for the case. The researchers also looked at police reports and victim statements, when available.
The abuser in the greatest proportion of cases (41 percent) was the victim’s son.
“What we found when we looked at these legal records was, wow, there was a lot of information,” Rosen said. “Looking at the qualitative stories, understanding the narrative of what happened,” and seeing the case from multiple perspectives, even, at times, the abuser’s — all was helpful.
As part of the findings of what Rosen called their “preliminary research,” the group assembled a list of what they termed acute triggers of physical elder abuse, he said during a presentation on the study at the annual Gerontological Society of America (GSA) meeting in Orlando, Fla., last month. (I attended the conference as a GSA Journalism Fellow this year.)
Triggers of Abuse
The 10 categories of acute precipitants were these, the study found:
- Victim attempting to prevent the perpetrator from entering or demanding that he/she leave
- Victim threatening or attempting to leave/escape
- Threat or concern that the victim would involve the authorities
- Conflict about romantic relationship
- Presence during/intervention in ongoing family violence
- Issues with multi-generational child-rearing
- Conflict about the perpetrator’s substance abuse
- Confrontation about financial exploitation/demanding money
- Dispute over theft/destruction of property
- Disputes over minor household issues
The abuser in the greatest proportion of cases (41 percent) was the victim’s son. The second largest group were spouses (18 percent). The median age of the mostly female (72 percent) victims was 68, and 18 percent of abusers were “acutely intoxicated with alcohol or illicit substances” when the abuse occurred, Rosen said.
Resemblance to Domestic Abuse
Advocates for domestic abuse victims may be thinking the list sounds familiar, since some of the triggers — such as attempting to leave a relationship — have been identified as particularly dangerous for intimate partner victims.
Rosen said that he had, in fact, studied domestic violence and acknowledged the similarities in the abuse triggers. Some types of abuse no doubt fall into both categories, such as when a spouse is involved.
He said the study did not look at whether the perpetrator provided some care for the victim, and if so, how much care. He hoped to be able to explore that more in future research, he said.
Dr. Laura Mosqueda, associate dean of primary care at Keck School of Medicine at the University of Southern California and director of the National Center on Elder Abuse and one of Next Avenue’s 2015 Influencers in Aging, praised Rosen’s research.
“It’s great because it’s rigorous,” she said. One particular element Mosqueda found notable: the high percentage of abusers who were under the influence of alcohol or drugs. “Is alcohol abuse a risk factor for violence behavior? It certainly seems like it is,” she said.
Mosqueda offered a caveat to the research, however: it was looking at a specific population — that is, cases in which the police got involved and there were a charge and conviction on elder abuse. The results may or may not apply to cases that never saw the light of day.
The Real Triggers?
In addition, Mosqueda questioned whether the “triggers” could really reflect the larger context of what was going on. For instance, in one case, a 62-year-old woman was arguing with her 29-year-old son because “the abuser believed his soap was missing.” He then picked up his mother’s wooden cane and repeatedly struck her with it.
In many of these situations, Mosqueda said, “It’s hard to know what the actual trigger is.”
Rosen said he and his team have submitted the study for possible publication in the Journal of Interpersonal Violence. He said he hoped it would make a difference.
“Research into acute precipitants will help us to know when older adults who are at high risk for elder abuse are most vulnerable and what we can do to protect them and help them protect themselves,” he noted.