Does reaching age of 60 or 65 years change a person's status with regard to possible incidents of EA/MOA?:

Within a legal system penalizing EA/MOA, a minimum age may be set, thus making EA/MOA a status offence with the status tied to chronological age. When Hollis and McDougal (Reference Hollis and McDougal2003) published their work, only a minority of 14 US states defined the protected older population as having a minimum age, generally 60 or 65 years. In these cases, similar to laws directed at children and minors, law defines a change of status with age. However, Hollis and McDougal also found that 19 states based the definition of the population protected by EA/MOA laws upon the (adult) victim having a diminished physical or mental capacity; this clearly illustrates that chronological age is not a gold standard in EA/MOA.

Except for such legal standards, it is hard to see how victimization and their consequences should change categorically by reaching a certain minimum age. If “age 60” or “age 65” is used because it may mark the entry into the retirement status passage, questions arise with regard to the connection between that transition and the possibility (or non-possibility) of EA/MOA. Legal and actual retirement ages vary largely between individuals and societies, and so does the meaning of retirement in the life course (depending mainly upon a person's pre-retirement social and vocational status). Retirement is becoming more and more an “uncertain and unscripted status transition” (Moen et al., Reference Moen, Flood and Louis2009, p. 4). This immediately leads on to the next question.

What does increasing developmental diversity in later life mean for using chronological age as a defining criterion?:

The increase in diversity in later life (as compared with earlier stages of the life course) has been emphasized by gerontological researchers for decades (see Gerstorf et al., Reference Gerstorf, Smith and Baltes2006; Smith and Gerstorf, Reference Smith, Gerstorf, Daatland and Biggs2006). In recent years, this finding has been linked to concepts of cumulative advantage/disadvantage (Dannefer, Reference Dannefer2003) and cumulative inequality (Ferraro and Shippee, Reference Ferraro and Shippee2009), both referring to the relevance of early and accumulated inequalities in life course trajectories.

If diversity is even more pronounced at higher ages than at earlier stages of life, this can be considered as a caveat against using a fixed minimum age as a sufficient criterion for being a potential victim of EA/MOA. Applying a uniform criterion to a heterogeneous group of participants raises questions as to the significance of that criterion. The special status ascribed to children and adolescents is a common feature of nearly every legal system, whereas the situation in the United States shows the difference of approaches taken to define persons protected by EA/MOA legislation.

Can a phenomenon like “intimate partner violence” be considered to transform into “elder abuse” at the victim's 60th or 65th birthday?:

People at every stage of the life course can be affected by interpersonal violence, starting with infanticide and child abuse and reaching into very old age. Some of these phenomena, such as intimate partner violence, may appear at different stages of the life course and extend over long periods of time.

A commonly cited definition of intimate partner violence (IPV) is the one used in the WHO's World report on violence and health (Heise and Garcia-Moreno, Reference Heise, Garcia-Moreno, Krug, Dahlberg, Mercy, Zwi and Lozano2002, p. 89). It describes IPV as behavior within an ongoing or former intimate relationship that causes physical, sexual, or psychological harm, and includes acts of physical aggression, sexual coercion, psychological abuse, and controlling behaviors. Except for locating violence in the context of an intimate relationship, these behaviors would fit most definitions of EA/MOA.

A growing body of research shows that IPV may continue into late adulthood (cf. Naegele et al., Reference Naegele, Boehm, Goergen, Kotlenga and Petermann2011) or appear in later life (Gravel et al., Reference Gravel, Lithwick and Beaulieu1997). While there is evidence that needs of victims gradually alter with age (cf. Wilke and Vinton, Reference Wilke and Vinton2005; Straka and Montminy, Reference Straka and Montminy2006), neither the phenomenon itself nor the dynamics underlying acts of IPV suddenly change at any given point in the adult life course. It would create some need for explanation to call an incident “IPV” if it happens when the age of victim is 59 years (or 64 years), and classify the same incident as EA/MOA if it happens when the victim is 60 years (or 65 years) old.

Looking again at definitions of IPV, it is remarkable that any idea of “neglect” is missing from the concept of IPV, although it goes far beyond physical violence (as the “prototype” of violent behavior). The reasons are obvious: While “emotional neglect” may be an unpleasant experience at any stage of adult life, the concept of “neglect” as it is used in EA/MOA discourses takes its significance from the idea of a victim with limited capacity to care for him- or herself. This will take us on to our next point: The possible status of vulnerability as a prerequisite for certain types of EA/MOA. Further, IPV definitions speak of “violence” and usually avoid the term “abuse.” If compared with “violence,” the term “abuse” suggests that the perpetrator makes “bad use” of something – power, responsibility, authority – that is given or ascribed to him.

To sum up, the use of a minimum chronological age as a sufficient criterion for being a potential victim of EA/MOA (in definitions as well as in research designs and sampling procedures) raises important questions referring to developmental diversity in later life (both between individuals and countries with dramatically different life expectancies) and the lack of connection between chronological age and the nature of offenses or victimization experiences. While chronological age facilitates comparison of data emerging from different studies, strong arguments plead against a rigid approach. Conversely, it would be a mistake not to consider age at all in EA/MOA, as Biggs and Haapala (Reference Biggs and Haapala2010, p. 1790) states the following:

This opens the doors to the necessity of analyzing EA/MOA by type instead of as a whole.

Vulnerability and EA/MOA:

The term “vulnerability” has its origin in the Latin word vulnus for wound. In a very broad sense, vulnerability can be understood as the capacity to be hurt or damaged, or as a person's risk of encountering a bad outcome (cf. Spiers, Reference Spiers2000; Aday, Reference Aday2001). Resilience, defined by Roisman (Reference Roisman2005, p. 64) as “a family of processes that scaffold successful adaptation in the context of adversity,” may be regarded as a complementary term to vulnerability.

Vulnerability needs to be understood as a “probabilistic concept,” capturing “the relationship or proximity of a subject to harm” (Schroeder-Butterfill and Marianti, Reference Schroeder-Butterfill and Marianti2006, p. 11), and as multi-dimensional. A model presented by Turner et al. (Reference Turner2003) differentiates between a system's exposure to hazards or risks, its sensitivity, and its resilience, hinging upon its capacities to adjust and cope. Schroeder-Butterfill and Marianti (Reference Schroeder-Butterfill and Marianti2006) describe threats, exposure, coping capacities, and outcomes as “domains that shape vulnerability in old age” (p. 14).

With regard to EA/MOA, vulnerability may refer to an older person's exposure to situations and conditions where abuse and mistreatment can occur, that person's capacity (or diminished capacity) to defend against abusive (or neglectful) acts (or omissions), his or her risk of suffering severe and long-lasting harm from abuse (or neglect), and the older person's health status or capacity (or lack of capacity) to cope with the abusive act (or the omission entailing neglect) and its consequences. While risk is strongly associated with extrinsic factors (such as characteristics of the abuser or the abusing environment), the concept of vulnerability focusses upon intrinsic characteristics of the victim (Fulmer et al., Reference Fulmer2005). In order to avoid bias and fully understand the phenomena of EA/MOA, research always needs to take into account both characteristics of the older adult and external risk factors (Reis, Reference Reis2000).

Vulnerability trends in the “fourth age”:

Taking account of ever increasing life expectancy in economically developed countries, gerontologists have suggested differentiations between stages of later life. Following the distinction between the third and fourth age (Baltes and Smith, Reference Baltes, Smith, Bengtson and Schaie1999; Reference Baltes and Smith2003), the former can be characterized as the post-employment years when the most older people are in relatively good health and show a high level of adaptive flexibility. In contrast, the fourth age is mainly a period of decline with regard to health and functional capacities. If the concept of vulnerability is applied to the fourth age, the following trends appear to be connected to changes associated with very old age:

1. 1. Compared with younger adults, people in their fourth age generally have a reduced exposure to risks of becoming a victim of violent acts in public spaces and by strangers: Internationally, police crime statistics as well as victim self-reports show a decline of victimization rates starting in early adulthood and continuing into older age (Truman, Reference Truman2011). This mirrors the well-known victim–offender overlap, i.e. the demographic similarities between victim and offender populations (mostly young, male, low socioeconomic status (SES), living in urban areas) and sometimes interchangeable roles of victims and perpetrators (Jennings et al., Reference Jennings, Piquero and Reingle2012). It also mirrors age-related changes in lifestyle, interpersonal contacts, mobility outside the home, and spatial environments often insufficiently adapted to older persons’ needs. Such changes may, for instance, be seen in research by Wilkie et al. (Reference Wilkie, Thomas, Mottram, Peat and Croft2008) showing that the prevalence of reported participation restriction in a general population sample of adults aged 50 years and over is as high as 50% and onset and persistence of participation restrictions become more common with increasing age. A recent study by Asher et al. (Reference Asher, Aresu, Falaschetti and Mindell2012) found that the majority of the older population in the United Kingdom is not able to keep up with the speed required to utilize pedestrian crossings, thus limiting independence and reducing opportunities for physical activity and social interaction. While reduced mobility outside the home and concomitant reduced contact with persons outside a close network can be regarded as having negative impact on the quality of life, they may at the same time be protective with regard to many types of ordinary crime and violence.

2. 2. Due to an increasing prevalence of functional limitations and activities of daily living (ADL) restrictions, the population segment of the very old can generally be assumed to be characterized by increased sensitivity to risks and reduced adaptation skills: Compared with younger age groups, very old people have higher levels of disability and more restrictions in ADL and can therefore be assumed to be both more susceptible to attempts to abuse and victimize them and less able to cope with victimization attempts and completed acts, thus showing increased vulnerability and reduced resilience. While there is now considerable evidence of compression, implying that ageing processes are modifiable and people increasingly enjoy longer time without severe disability (e.g. Christensen et al., Reference Christensen, Doblhammer, Rau and Vaupel2009), numerous studies have demonstrated that prevalence of functional limitations increases with age (e.g. Berlau et al., Reference Berlau, Corrada and Kawas2009). This has even been demonstrated for middle adulthood (e.g. Murray et al., Reference Murray2011), but prevalence increases significantly in old age (see, for example, a study by Manini and Pahor (Reference Manini and Pahor2009) on mobility limitations; among community-dwelling persons in the United States, aged 70 to 79 years at baseline and showing no mobility limitations at that time, 34.3% of men and 47.4% of women had developed mobility limitations 4.5 years later). Such functional limitations can be regarded as critical in a double sense. On the one hand, they weaken a person's capacity to ward off attacks directed against him or her. This does not only refer to physical fitness but also includes cognitive functioning, e.g. being of importance for understanding attempts to deceive a person or reading signs of escalation in a conflict situation. In the special case of neglect, functional limitations, disability, and frailty are part of the conditions that create the very possibility of being neglected (Nerenberg, Reference Nerenberg2008). On the other hand, functional limitations are crucial for a person's capacity to cope with incidents of abuse that have occurred. Again, this refers to both physical and psychological functioning.

3. 3. While risks of becoming victimized in public spaces decrease with age, there is at the same time a heightened risk exposure in specific areas for very old people: While the risk of becoming a victim of acts that happen outside of one's place of residence (whether this is a private home or a residential institution) may decrease in later life due to reduced opportunities to commit such acts, this does not necessarily imply that the later stages of life can be regarded as safe. New and specific risks develop and create new vulnerabilities. This refers at least to the following two fields:

4. • Abuse and neglect in caregiving: With increasing functional limitations, dependency upon support and caregiving also increases (Wolff and Kasper, Reference Wolff and Kasper2006). Caregiving (both by professionals and laypersons) implies multiple stressors and potential for conflict (Roth et al., Reference Roth, Perkins, Wadley, Temple and Haley2009). Current criminological perspectives emphasize the importance of opportunity for the occurrence of crime and violence. The Routine Activity Theory, originally developed by Cohen and Felson (Reference Cohen and Felson1979), postulates the co-occurrence of a suitable target, a “motivated offender” or “likely offender,” and the absence of capable guardians as a necessary prerequisite of crime (cf. Felson and Boba, Reference Felson and Boba2010; see Goergen and Beaulieu, Reference Goergen and Beaulieu2010 for a discussion of the relevance of this approach for EA/MOA topics). From such a point of view, domestic caregiving contexts in particular can be considered as almost perfect fields of action for motivated offenders. Domestic caregiving virtually happens “behind closed doors” where the level of formal and informal social control is low. Potential victims are weak, and therefore vulnerable and with little capacity to defend themselves. Offenders can act from a position of trust, which makes EA/MOA and its concealment easy. Caregiving inevitably implies physical contact, thus creating opportunities for abuse. In many cases, symptoms and effects of abuse are difficult to distinguish from symptoms and effects of illnesses and disabilities. The probability that an abused care recipient will report the abuse to the police or to any other helping institution is low. Very old victims in abusive situations may experience limitations of acting as a witness (Jones and Elliott, Reference Jones and Elliott2005) in caregiving contexts against motivated offenders.

5. • Specific property offences targeted at the very old, mostly involving deception, i.e. building trust and abusing it: Specific threats are posed to older persons by some types of property offences whose common characteristic is deception of the victim. These include deception burglary, larceny-by-trick, and different fraudulent offenses. Offenders select victims because of characteristics they associate with very old age – being weak, slow, easy to deceive, and living alone. Perpetrators pose as relatives (via telephone) or tradesman (at victims’ doorstep), or they appeal to victims’ readiness to help by pretending to be in a situation of distress. The general aim behind this is obtaining trust and support and gaining access to homes and valuables (e.g. Cohen, Reference Cohen2008; Mulroy and O'Neill, Reference Mulroy and O'Neill2011).

Challenges of measuring vulnerability:

Any proposal to include vulnerability as a variable in research on EA/MOA leads to challenges connected to measurement of vulnerability. These challenges must be considered substantial, given the complex nature of vulnerability, the specificity of risks/hazards to which a person can be considered to be vulnerable, and the need to take person and environment factors into consideration. Furthermore, vulnerability has to be considered as a continuous and not simply a dichotomous variable. However, despite these measurement challenges, vulnerability is becoming a legal issue in some jurisdictions. In March 2012, Canada amended the Criminal Code to render age-related abuse an aggravating factor in sentencing. To prove that a crime is age-related, there is an implication of vulnerability, meaning that this vulnerability will have to be demonstrated in court. Jurisprudence is awaited to analyze the content of this demonstration. In Québec, since 1976, the Article 48 of the Charter of Rights and Liberties looks at exploitation of the older adult and the person living with disabilities. To be prosecuted, there is a need to show that the person is vulnerable or dependent (Commission des droits de la personne et de la jeunesse, 2001). The application of this Article has been criticized because it implies that a non-vulnerable or a nondependent older adult cannot be abused. These legal dispositions seem to indicate that beside the scientific need to measure vulnerability there is a pragmatic way to assess it.

With regard to EA/MOA, especially for neglect, health status and limitations in performing ADL are considered key indicators of vulnerability (see Morrone et al., Reference Morrone, Scrivens, Smith and Balestra2011, on vulnerability indicators). Dependency upon support and care by others creates the possibility of being neglected. However, aspects of vulnerability may also include living conditions such as poverty or homelessness. Sets of indicators considered appropriate to measure vulnerability may differ between types of abuse (e.g. financial abuse on the one hand, physical or sexual abuse on the other).

To sum up, vulnerability may refer to exposure to situations and conditions where EA/MOA can occur, the capacity to defend against abusive acts, the risk of suffering substantial harm, and the capacity to cope with an abusive act and its consequences. Vulnerability is a prerequisite for any meaningful concept of neglect in later life. It is linked to ageing, especially to physical, cognitive, and functional limitations gaining more and more significance in the fourth age. With regard to very old age, different vulnerability trends can be assumed, including increase in disability and frailty, reduced exposure to risks in public spaces and by strangers, and increased exposure to specific risks in caregiving contexts and deceptive offences selectively targeted at the very old. In combination with a minimum chronological age, some defined type and intensity of vulnerability may come close to describing in a meaningful way a population that can be affected by EA/MOA. Such approaches require a refinement of concepts and measures of vulnerability.

Concept of interpersonal trust:

As stated previously, trust is a common concept in EA/MOA definitions. This section will briefly review concepts of interpersonal trust and discuss their possible significance for research on EA/MOA.

Kassebaum (Reference Kassebaum2004), Riegelsberger (Reference Riegelsberger2005), and others describe trust as a person's readiness or willingness to be vulnerable to the actions of a trusted person, this readiness being based upon positive expectations regarding the actions of the trustee. Trust implies the expectation and some degree of confidence that the other person will act as agreed upon, although he or she has the freedom to do otherwise since control is either not possible or not wanted (cf. Kassebaum, Reference Kassebaum2004, p. 21). Luhmann (Reference Luhmann and Gambetta1988) has stressed the importance of trust as a means of reducing social complexity and transforming objective uncertainty into subjective certainty. Accordingly, interpersonal trust implies a person's (trustee) willingness to be vulnerable to the actions of another (trusted) person, trustee's confidence that the trusted person will behave in a beneficial way, risk of harm if the trusted person does not behave accordingly, and the inability or limited ability of the trusting person to enforce a specific behavior by the trusted person. It is evident that trust is linked to risk, vulnerability, and also to differential power.

In the UK prevalence study on EA/MOA (O'Keefe et al., Reference O'Keefe2007), relationships with an “expectation of trust” were understood as victims’ relationships to family members, close friends, and some professional or semi-professional roles (such as physicians, nurses, social workers, home helps/home-care staff, and voluntary sector care workers). Dixon et al. (Reference Dixon2010) point at the necessity to distinguish between trust in affective relationships on the one hand and functional positions of trust (as those taken by paid carers) on the other.

Trust in later life:

As with vulnerability, it is worth raising the question as to what might be the specifics of trust in later life. In long-standing relationships not characterized by conflict or violence, trust is usually seen as something “natural” that is shared by both persons in a relationship. However, with a concept of interpersonal trust in mind that includes a notion of being vulnerable to the actions of others, the following aspects can be highlighted:

• • Age-related functional limitations and restrictions in ADL functions can be expected to create an enhanced need for trust. If a person depends upon other persons in the sense that he or she does not have the choice of “doing it by himself/herself,” the need increases to be in a position to be able to be vulnerable to the actions of another person and to be free from fear at the same time.

• • The ability to trust is crucial for a person's quality of life if that person is vulnerable and dependent upon others. For those without substantial functional or cognitive limitations, trust may be a matter of choice – a choice that makes some things in life easier and reduces social complexity in Luhmann's (Reference Luhmann and Gambetta1988) sense. For those with considerable limitations and needing help and support to master the requirements of everyday life, trust may simply be a necessity. The term “ability to trust” is used in a double meaning – as a personal attribute (“being trustful”) on the one hand, and as an attribute of the conditions under which a person lives on the other (“being in a position to trust where trust is needed, without running too much risk”).

• • Trust always implies the possibility to abuse it; the implications of this possibility change with increasing vulnerability and dependency upon others. The possibility of abuse is an inherent characteristic of trust; trust is always based on judgments under uncertainty. However, the (anticipated and real) implications and consequences of a breach and misuse of trust may vary according to a person's dependency upon others and his or her options to choose between possible trustees. If dependency is high, if it refers to vital or crucial functions, if the trusting person has little or no choice as to where to allocate trust, the risks associated with the breaching of trust gain a special quality.

• • Trust can wilfully be built with the intention to abuse it; this happens in a broad range of scams and frauds directed at older persons. This aspect has already been discussed in the section on vulnerability. There are many offences where offenders do not brutally rob victims to gain possession of their property, but induce victims into handing over the desired goods to them or distract their attention by pretending to be tradesmen, police officers, or other trustworthy professionals, thus enabling accomplices to search the residence for valuables. Recent research (Asp et al., Reference Asp, Manzel, Koestner, Cole, Denburg and Tranel2012) suggests that “vulnerability to misleading information, outright deception, and fraud in older persons is the specific result of a deficit in the doubt process” (p. 9), which is mediated by the ventromedial prefrontal cortex.

• • Trust does not presuppose asymmetric relationships and unequal power distribution. But dependency enhances the importance of trust. Although the trustee always has some degree of power over the trusted person with regard to the outcome to which trust refers, it does not presuppose unequal distribution of power in a relationship in general. However, both the significance of risks taken by being trustful and the inevitability of trust increase with helplessness and powerlessness.

Trust is present in a majority of relationships that people do create over their lifespan. While a majority of longstanding relationships will remain safe throughout life, some relationships can degenerate at any age, but maybe even more when people are losing autonomy, therefore becoming vulnerable. Regarding EA/MOA, research has shown many gray areas where a trusted person on certain aspects can be non-trustful on others. An example might be the changing relationship between the alcoholic or drug addict adult child that lives with his ageing mother. While intoxicated, he can be harmful to her; he can even steal money from her to buy his drug or alcohol. On the other hand, when sober, he may take care of important duties in the home, becoming a much-appreciated caregiver. To some degree, the notion of trust may have been introduced in the EA/MOA literature more to exclude crimes against elderly adults performed by strangers (such as home invasion, bag-snatching on the street, etc.) than to describe a specific nature of a victim–abuser relationship.