Understanding Help-Seeking Among Victims of Elder Abuse: A National Population-Based Study

Background and Purpose: Elder abuse is a pervasive issue affecting approximately one in ten community-dwelling older adults in the U.S. Victimization is associated with serious consequences such as pre-mature mortality, hospitalization, and poor physical/mental health. Despite the scope of this problem, the vast majority of elder abuse victims remain hidden from formal response systems, such as adult protective services, legal/justice, law enforcement, or other agencies responsible for addressing this issue in the community. Thus, most victims endure their mistreatment in isolation from support systems designed to help reduce the risk and magnitude of the problem. Understanding help-seeking among victims of elder abuse is a critical challenge. The purpose of this study was to examine factors that facilitate or impede formal help-seeking, through self-reporting to police or other authorities, among victims of elder emotional abuse, physical abuse, and sexual abuse. Guided by the Behavioral Model of Health Services Use (BMHSU), we hypothesized that cases characterized by greater predisposing socio-structural/status advantage, personal and social enabling resources, and need would predict higher victim helping-seeking.

Methods: Data came from The National Elder Mistreatment Study, a national, population-based elder mistreatment study in the U.S. with a representative sample (n=304) of past-year victims. In accordance with recognized procedures to measure interpersonal violence, elder abuse subtypes were assessed with contextually oriented, multiple, behaviorally defined items describing specific mistreatment events. Multivariate logistic regression was used to identify help-seeking facilitators/barriers across BMHSU predisposing, enabling, and need dimensions.

Results: Help-seeking occurred among only 15.4% of EA victims. Help-seeking was higher among victims of physical abuse, poly-victimization (multiple forms of mistreatment), or those with a perpetrator having prior police trouble. Help-seeking was lower among victims who were dependent upon their perpetrator for daily care needs and in cases where the perpetrator had a large friendship network.

Conclusions and Implications: With a strong minority of victims seeking help from formal support systems, this study highlights the hidden nature of elder abuse in the U.S. Findings support a need to develop strategies that promote help-seeking among elder abuse victims, which incorporate factors attached to the victim, perpetrator, and victim-perpetrator relationship. Victims experiencing one form of abuse, particularly emotional abuse, appear to be a reluctant sub-population of victims requiring help-seeking outreach. Formal support programs may need to integrate services that help victims manage their daily care needs. The current study represents the largest examination of elder abuse victim help-seeking in the U.S. to date.