Financial Exploitation of the Elderly - Methodology Paper
Darline Finzer

 
Introduction
 
            Financial or material exploitation of an elder is the illegal or improper use of an elder's property or financial resources without their consent or understanding (Wolf, 1996).  Financial abuse of the elderly tends to occur over time rather than a single overt act such as a robbery, purse snatching or car jacking (Wilbur and Reynolds, 1996).  A financial abuser does not need to be a stranger.  The financial abuser can be a family member, a caregiver or caretaker, a professional such as an accountant, lawyer, doctor or banker, or a boyfriend or girlfriend.  Regardless of who the individual is that is conducting the financial exploitation, three reasons for financial elder abuse have been identified by the Area Agency on Aging:
  1. Need or greed - people who take advantage of elders usually have financial problems or act out of greed.
  2. Opportunity - offenders often have opportunity to obtain an elders money or property by pressuring or otherwise influencing them or taking advantage of the trust, discretion or power that has been given to them.
  3. A sense of entitlement - offenders often believe that they deserve the money or because they believe that older people in general don't really need all their money.
Since financial abuse is the fourth most common type of elder abuse (Lewis, et al, 1999), understanding and identifying characteristics of elder abusers may assist with addressing the problem of elder abuse and mistreatment.  Ramsey-Klausnick (2000) proposed a typology of offenders as the following five types: 1) the overwhelmed, 2) the impaired, 3) the narcissistic, 4) the domineering and 5) the sadistic.  Anetzberger (2000) proposed an alternative explanation for elder abuse, the Explanatory Model for Elder Abuse, which theorizes that elder abuse is primarily a function of the perpetrator's characteristics and secondarily a function of the victim's characteristics.
            The prevalence of abuse, in general, among elderly is not entirely known (Macdonald, 1997).  However, elder abuse is estimated to affect 700,000 to 1.2 million older adults annually in the United States.  Only ten percent of the cases of elder abuse are estimated to be reported (Fulmer, et. al., 1984).  This in part is due to the lack of interventions developed for the prevention of elder abuse.  Most interventions that have been reviewed or evaluated are reactive in nature (Wyandt, 2004).  Three-quarters of the reported, substantiated cases of financial abuse involve victims over the age of 75 (Lewis, et. al.).  In some cases, the elderly person is not aware of the financial abuse.  In other cases, the elderly person is aware of the exploitation but denies the abuse because of total dependence (at least perceived) on the perpetrator or because the elderly person feels guilty, responsible or ashamed of the inability to care for himself or herself and falling victim to the financial abuse. 
There are several factors that can contribute to an elder being financially exploited.  Because there are so many factors that can play a part in an elderly person being financially exploited, it is difficult to detect when the abuse will happen.  For example, an assessment could be conducted of an elder to determine that he or she contains all the necessary characteristics of someone who is susceptible to financial abuse.  But if that person is not subjected to someone who is or will financially exploit him or her, then he or she may never be a victim of financial abuse.  Therefore, we must look at the entire framework for identifying abuse that includes: 1) characteristics of the older person that suggests vulnerability to abuse, 2) the nature of the relationship between the suspected wrongdoer and the older person, 3) the outcomes and interests served by the relationship, and 4) the type of influence used by the suspected wrongdoer.
           
 
 
Research Questions
 
            In an effort to determine who might be at risk for financial abuse as an elder, the following items need to be defined:
  1. What characteristics of an older person suggest vulnerability to abuse?
  2. What interaction does the older person have with others?  How can wrongdoers be categorized?
  3. Would the suspected wrongdoer stand to gain from the elder?
  4. How does the elder feel about the suspected wrongdoer?  Does the suspected wrongdoer seem to have any influence over the elder?
 
 
 
Methodology
Sampling
            It is anticipated that the samples will be the individuals who are receiving Eldercare Services through a CPA (certified public accountant.)  Eldercare services encompass a wide range of services that practitioners can provide in relation to the care of an individual.  Eldercare services are defined in the accounting arena as a service designed to provide assurance that care goals are achieved for elderly no longer able to be totally independent.  In determining what eldercare services are needed by the individual, a cpa (with the assistance of a geriatric care manager) must assess the elder to determine what needs exist. The cpa, in providing these services, should also be able to locate the professionals available to provide the needed care for the elder. 
   
Operationalization
I would want to determine what characteristics suggest vulnerability to or evidence of abuse.  Some of the behaviors that I would expect from someone who is being financially abused are: being withdrawn, confused or extremely forgetful, depressed, helpless, angry, hesitant to talk freely, secretive, and frightened.  I understand that not everyone will exhibit the same behaviors and that some of the behaviors might be a result of another factor, therefore, I would incorporate this assessment with the results of the remainder of the study to arrive at an overall assessment.
There are some risk assessment instruments for elder abuse that have been developed and evaluated.  The Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST) is an assessment where the researchers pooled over 1000 items from existing elder abuse assessment protocols to develop a 15 item tool which measured three aspects of abuse: (1) violation of personal rights or direct abuse, (2) characteristics of vulnerability, and (3) potentially abusive situations. It was designed to be completed by older people themselves.  This measurement tool has been evaluated by the Australian Women's Health Survey (Schofield, 1999). Two additional items were added to the original 15 item screening tool.  Then the survey group examined the reliability and validity of the resultant instrument on a nationally representative community-based sample of older Australian women (n=12,340). Their exploratory analyses led to the deletion of five of the 15 items from the H-S/EAST. The remaining 12 factors were divided into four categories which they labeled: vulnerability, dependence, dejection, and coercion. Further investigation revealed that "dependence" had more to do with autonomy than abuse and "dejection," with depression and mental health issues. The authors suggest that responses to the six remaining items could provide a simple screening tool for elder abuse:
  1. Are you afraid of anyone in your family?
  2. Has anyone close to you tried to hurt or harm you recently?
  3. Has anyone close to you called you names or put you down or made you feel bad recently?
  4. Does someone in your family make you stay in bed or tell you you're sick when you know you aren't?
  5. Has anyone forced you to do things you didn't want to do?
  6. Has anyone taken things that belong to you without your OK?
 
     The Indicators of Abuse Screen (Reis & Nahmiash, 1998) is a tool that is very different from the one just described because it is completed by trained professionals, usually after a 2-3 hour comprehensive assessment (filling out the form itself takes about 20 minutes). The study isolated 29 abuse indicators from a preliminary checklist of 48 problems and 12 background/demographic items that related both to the caregiver and care recipient, scored on a 5-point rating scale. The 29 items could be organized into three categories:
  1. Caregiver intrapersonal problems/ issues (e.g. mental health, behavioral, and alcohol or other substance abuse difficulties);
  2. Caregiver interpersonal problems (e.g. marital and family conflict and poor relationships generally with the care receiver, etc.); and
  3. Care receiver social support shortages and past abuse.

The strengths of the tool include its demonstrated reliability and validity and successful identification of 78-84% of senior abuse cases.

 
In determining what the needs are of the elder, the cpa conducts an assessment of the individual, including an eldercare recipient information questionnaire.  This questionnaire contains some basic census data requests, but it also contains questions relating to the financial aspect of the individual.  Analyzing the financial data of the individual would also be an indicator of potential wrongdoing.  Also, both of the above measures would be useful in conducting this study.  The Australian Women's Health Study questions could be included on the eldercare recipient information questionnaire used by the cpa in the assessment.  The Indicators of Abuse Screen could be used by the geriatric care manager who will be assisting the cpa in conducting the assessment of needs of the elderly person.

Statistical Analysis  
            I believe the analysis that would be used would be multiple regression analysis because this analysis would allow us to depict model relationships in graph form and allow us to view the influence of the independent variables (characteristics, susceptibility to a wrongdoer, etc.) on the elderly person.
 
References
 
Anetzberger, G.J., Summer 2000.  Caregiving: Primary Cause of Elder Abuse. Generations, 46-51.
 
Anetzberger, G.J., Palmisano, B.R., Sanders, M., Bass, D., Dayton, C., Eckert, S., Schimer, M.R.  2005. A Model Intervention for Elder Abuse and Dementia.  The Gerontologist, 40, 492-497.
 
Fulmer, T., Cahill, V.M.  1984.  Assessing Elder Abuse: A Study.  Journal of Gerontological Nursing, 10(12), 16-20.
 
Fulmer, T., Street, S. Carr, K. (1984).  Abuse of the Elderly: Screening and Detection.  Journal of Emergency Nursing, 10(3), 131-140.
 
Hwalek, M.A., Sengstock, M.C. 1986. Assessing the Probability of Abuse in the Elderly: Toward Development of a Clinical Screening Instrument.  Journal of Applied Gerontology, 5(2), 153-173.


Lewis, G. A., Cohen, S.B., Cohen, S.F., Thompson, C., Ecklund, K.J., Popovitch, R.L., Blanco-Best, M., Roeder, C.A., Lovelace, T.W., Hart, P.I.  1999.  Guide to Providing Eldercare Services.  Fort Worth, Texas: Practitioners Publishing Company.
 
Macdonald, A.J.D.  1997.  ABC of Mental Health: Mental Health in Old Age.  BMJ, 315 (August 16), 413-417.
 
Neale, A.V., Hwalek, M.A., Scott, R.O., Sengstock, M.C., and Stahl, C. 1991. Validation of the Hwalek-Sengstock Elder Abuse Screening Test. Journal of Applied Gerontology, 10(4), 406-418.


Ramsey-Klausnik, H.  Summer, 2000.  Elder Abuse Offenders: A Typology.  Abuse and Neglect of Older People, 17-22.
 
Reis, M., Nahmiash, D. 1995a. Validation of the Caregiver Abuse Screen (CASE). Canadian Journal on Aging, 14(sup2), 45-60.

Reis, M., Nahmiash, D. 1995b. When Seniors are Abused: An intervention Model. The Gerontologist, 35, 666-671.


Reis, M., Nahmiash, D. 1998. Validation of the Indicators of Abuse (IOA) Screen. The Gerontologist, 38(4), 471-480.


Wilbur, K.H., Reynolds, S.L.  1996.  Introducing a Framework for Defining Financial Abuse of the Elderly.  Journal of Elder Abuse & Neglect, 8(2), 61-80.
 
Wolf, R., 2000.  National Center on Elder Abuse Newsletter.
 
Wolf, R.S.  1996.  Understanding Elder Abuse and Neglect.  Aging Magazine, 367, 5-9.
 
Wyandt, M.A.  2004.  A Review of Elder Abuse Literature: An Age Old Problem Brought to Light.  Californian Journal of Health Promotion, 2, 3, 40-52.