For the victim
Abuse of isolated people is less likely to be detected and stopped. Social isolation can intensify stress.
A chronic disorder, functional impairment, or both
The ability to escape, seek help, and defend self is reduced.
People with a chronic disorder or functional impairment may require more care, increasing stress for the caregiver.
Risk of financial abuse and neglect is particularly high.
People with dementia may be difficult to care for, frustrating caregivers, and may be aggressive and disruptive, precipitating abuse by overwhelmed caregivers.
For the perpetrator
Alcohol or drug abuse, intoxication, and substance withdrawal are the leading predictors of abusive behavior. Substance-dependent caregivers may attempt to use or sell drugs prescribed to the older person, depriving the person of treatment.
Psychiatric disorders (eg, schizophrenia, post-traumatic stress disorder) and affective disorders (eg, major depressive disorder) increase the risk of abusive behavior.
Adult children discharged from an inpatient psychiatric institution may return to their elderly parents’ home for care. These patients, even if not violent in the institution, may become abusive at home.
History of violence
A history of violence in a relationship (particularly between spouses) and outside the family may predict elder abuse. One theory is that violence is a learned response to difficult life experiences and a learned method of expressing anger and frustration. Because reliable information about past family violence is difficult to obtain, this theory is unsubstantiated.
Dependence of the perpetrator on the older person
Dependence on the older person for financial support, medical or functional assistance, housing, emotional support, and other needs can cause resentment, contributing to abuse. If the older person refuses to provide resources to a family member (especially an adult child), abuse is more likely.
Stressful life events (eg, chronic financial problems, death in the family) and the responsibilities of caregiving increase the likelihood of abuse. Difficulties managing stress or coping with caregiving burdens may contribute to abuse.
For both victim and perpetrator
Shared living arrangements
Older people living alone are much less likely to be abused. When living arrangements are shared, opportunities for the tension and conflict that usually precede abuse are greater.
Adapted from Lachs MS, Pillemer K: Current concepts: Abuse and neglect of elderly persons. New England Journal of Medicine332:437–443, 1995.