What Is Elder Abuse? An Interview with Marti Riporetti-Brown

Marti Riparetti-Brown is a second year doctoral student at USC’s Davis School of Gerontology. She focuses on, among other things, the prevalence and risk factors of elder abuse and neglect in American caregiving. We spoke to Marti about the dangers of elder abuse and how we might protect our older adults from situations of neglect, scamming, and general loss of quality of life.

Liz: To start off, you are working towards your doctorate in gerontology, is that correct?

Marti: Yes. That’s defined as the study of human aging. Lots of people think it’s like geriatrics, which is the medical side of human aging, but I’m studying the social policy side of it.

Liz: How did you get into this field?

Marti: I had a job at UCLA where I basically studied intervention for caregiver depression; we did kundalini yoga and tai chi with elders and their caregivers. It was for the benefit of the caregivers, but we worked with both groups. That was the experience that I had working with older adults. From there I decided they were an interesting part of the population to study, especially as our population is aging in the U.S. and Europe.

Liz: And what specifically are you working on for your doctorate?

Marti: I think my dissertation topic is going to be on scams against older adults. Usually, it’s financial scams; some are organized by crime networks, others are identity fraud. Someone will say, “You just won a million dollars, but you have to give us your social security number and bank account number.” And as soon as they do that, the older adult has potentially given their identity to a criminal. Sometimes they’re international scams, perpetrated by people all the way in Nigeria and Jamaica; sometimes they’re domestic scams, done through the telephone, the internet, mail, or even personal contact.

I might want to look at risk factors and vulnerability: who are these older adults? What makes them vulnerable? Some research shows executive functioning impairments: that the part of the brain that deals with planning and decision-making can become impaired with age. That could increase the susceptibility for falling for these types of scams.

However, they also think there’s a level of addiction in it. Some of our social workers have been in the homes of these people when their telephones are ringing 100 times within two hours. And no matter how many times the social worker says, “Don’t answer the phone, it’s a scam,” the older adult will still run toward the phone and answer half of the time, even though they know for a fact that it’s fake and these people are using them. So there’s a strange addictive behavior involved that interests me.

Liz: And this type of financial scam, would you consider this a form of elder abuse?

Marti: I would. It’s a new form of abuse, falling under the category of “financial abuse.”

Liz: What other types of abuse are there?

Marti: There are five major types: neglect of older adults; emotional or psychological abuse; sexual abuse; physical abuse; and the last one, financial abuse. There’s also another one that’s sometimes defined as a form of elder abuse and typically considered a geriatric syndrome: self-neglect. This includes behaviors like letting your home decay, hoarding, not bathing, not showering. But it’s hard, because there’s no distinct perpetrator. In this case the older adult is both the victim and the offender.

Liz: What are the most common types of abuse? And how big of an issue is elder abuse in the U.S.?

Marti: We’re seeing more and more financial abuse of older adults. Psychological and emotional abuse is definitely the most prevalent overall, though it’s also the least prosecuted and the least defined. It includes things like, “If you don’t do this, I’m gonna send you to a nursing home,” or “I’m not going to talk to you.” Or “I’m gonna hurt your pet if you don’t clean up after yourself.” It’s really kind of insidious. But it’s hard to prosecute someone for saying those things. It’s kind of related to caregiver stress and depression—it can be overwhelming to care for someone with dementia, and the caregiver can lash out.

Liz: What measures can be taken to fight elder abuse, either individually or institutionally?

Marti: We’re still in the early stages. So far there’s been no intervention for elder abuse that has proven to be effective. We have a pretty good idea of what elder abuse is, but we don’t really know the best way to solve it.

There’s also this kind of dichotomy between elder autonomy versus protection and safety. So if you’re an older adult, and your son or daughter lives with you, and they yell at you occasionally—but at the same time, they make it so that you can stay at home rather than go to a nursing home—you might be willing to protect them or allow the abuse to happen, in exchange for this acknowledged living situation.

So it’s hard to say who’s right. If the interventionalist or social worker or doctor says the caregiver needs to be taken out of the picture, and this older adult needs to be taken to a managed care setting because they’re being abused—are they correct? Or if the older adult is saying, I know I’m being abused but I would rather have this life—are they correct? We don’t really know what the best outcome is.

In order to have a good death, it definitely requires having a care team available to you and having the socioemotional structure that surrounds people when they’re going through end-of-life issues. And I think when people are being abused, that’s taken away from them.

At the Forensic Center in Los Angeles, we basically have a bunch of professors who come together to talk about the most complicated cases of elder abuse. Usually, cases are presented by a social worker with Adult Protective Services—the service agencies in California who are the first responders to elder abuse, like Child Protective Services for adults. They usually come to the Forensic Center with a case, and it can be any form of the elder abuse I mentioned to you. And then a doctor, a forensic nurse, a psychologist, a district attorney, law enforcement, an ombudsman, and the public guardian that does conservatorships with older adults all sit at the table and help the social worker resolve the case, taking on different aspects.

So if the case is neglect, the doctor will go to the home, interview the older adult, and determine their need and level of functioning. Forensic psych will do an evaluation of the cognitive performance, and based on her findings, she’s often called upon to testify in court to say, “This caregiver is not doing their job,” “This older adult lacks the capacity to make their own decision and needs to be conserved by the state.” Conservators can take control over the adult and find a way to protect them.

So it’s a huge process just to take one person. The Forensic Center is one way: all the big players learning from each other’s disciplines. It’s an interesting model for solving elder abuse. So far, it’s been the only model that’s been proven to increase criminal prosecution of offenders—the people who do really horrible things that lead to death or severe injury or loss of income and homes. The Forensic Center’s cases are much more likely to be prosecuted than cases outside, normally handled by APS in isolation. Bringing everyone together is really helpful in increasing protection and justice.

But like I said, protection can be a conservatorship, justice can be a prosecution; but is that necessarily the best thing for the elder adults? Society would probably say yes, though the adults themselves might say no, I’d rather have this abusive relationship than a different living situation. It’s a complicated issue. I think it’s similar to death and dying—the whole idea of autonomy versus state protection and health, which are at odds sometimes.

Liz: Do you work with elders on end-of-life issues as well?

Marti: Not really, not in my own particular lab. Our goal is to protect life in cases where we’re seeing people with totally preventable illness, who have no reason to be in the physical state they are in, with no quality of life. In order to have a good death, it definitely requires having a care team available to you and having the socioemotional structure that surrounds people when they’re going through end-of-life issues. And I think when people are being abused, that’s taken away from them. They have no ability to have a good death; their assets are taken away from them, they’re put in a bedroom and neglected, they end up with horrible Stage 4 ulcers. We want them to have a peaceful transition. I can’t imagine a worse way to go than being abused. So I think everything works hand-in-hand.

Liz: Can you leave us with any advice for families and loved ones of seniors, who might want to ensure a safe, peaceful transition for them?

Marti: My recommendation is to talk about financial planning early. When a person has the capacity to make good decisions for themselves, that’s when they need to start having these conversations about who’s going to make these decisions, who’s going to be the Power of Attorney for finances and for health care. Those are the types of questions that are really going to make a big difference when we’re talking about how a person will be able to age more gracefully. Make sure they have their family and all their assets in line and in order.

If you do suspect elder abuse for someone you know or a neighbor, contact Adult Protective Services in your area.

Liz: Thanks so much for this enlightening interview, Marti!