Enhancing national policy and programs to address elder abuse.


THE US AGING POPULATION IS RAPIDLY INCREASING, many of whom are highly vulnerable, which increases their risk for elder abuse. The World Health Organization has declared that elder abuse is a violation of an older adult’s fundamental rights to be safe and free of violence. Although prior research suggests the prevalence of elder abuse varies between 5% and 30%, recent estimates suggest that 1 in 10 older adults experience physical, psychological, and sexual abuse, neglect, and financial exploitation. At the same time, only a small fraction of elder abuse is reported to the Adult Protective Services (APS). Elder abuse is associated with morbidity and mortality, especially among vulnerable populations. In this Commentary, we highlight the existing elder abuse programs through 2 federal legislations: the Older American Act and the Violence Against Women Act, focusing on 4 major gaps in the field of elder abuse—funding, policy, research, and education/ training. The Older American Act is responsible for funding the National Center on Elder Abuse to provide grants to states’ elder justice system and state agencies to develop and enhance programs to address elder abuse. The Older American Act establishes long-term care ombudsman programs to identify, investigate, and resolve complaints related to these institutions; state-based services designed to provide legal assistance and other counseling services; and programs to support locally relevant projects, supportive services, and outreach and advocacy programs. The Older American Act designates state agencies and area plans and develops objectives, priorities, policy, and long-term plans for elder abuse prevention and services. The Violence Against Women Act authorizes the attorney general to formulate grants to enhance training and services to end violence against and abuse of older women. This program is intended to assist law enforcement, prosecutors, and local courts on the issues of elder abuse. In addition, the Violence Against Women Act authorizes the attorney general to create grants that provide or enhance services for persons experiencing elder abuse, conduct crosstraining for services organizations serving persons experiencing elder abuse, and create or support multidisciplinary collaborative community responses to persons experiencing elder abuse. Based on a recent Government Accountability Office report of the Department of Health and Human Services data, elder abuse–related spending in 2009 included $1.1 million by National Institutes of Health, $50 000 by the Centers for Disease Control and Prevention, $5.9 million by the Administration on Aging, $0.75 million by the Department of Justice Civic Division, and $1.2 million by the National Institute of Justice. The Office of Victims of Crimes and the Office on Violence Against Women spent $520 000 and $4.9 million, respectively. In 2009, these federal agencies spent $11.9 million for all activities related to elder abuse. This contrasts with the annual funding for violence against women programs ($649 million). Despite the wellintentioned services by these 7 federal agencies, the most basic needs are not met to protect older adults from abuse, neglect, and exploitation. The Elder Justice Act (EJA) is a part of the Affordable Care Act and, for the first time, the EJA authorizes federal response to the issues of elder abuse through training, services, and demonstration programs. The Administration on Aging is responsible for the implementation of the EJA as well as formation of the Elder Justice Coordinating Council and the National Advisory Board. More specifically, the Elder Justice Coordinating Council will be required to issue reports to describe the activities, accomplishments, and challenges faced as well as to provide legislative recommendations to congressional committees. The Administration on Aging has already solicited nomination for the National Advisory Board, which will be required to submit reports and recommendations regarding elder justice activities. The EJA will also be responsible for issuing human subjects protections guidelines to assist researchers and establishing elder abuse forensic centers. The EJA will provide grants and incentives for long-term care staffing and electronic medical records technology grants programs and will collect and disseminate annual data related to elder abuse from adult protective services. The EJA will also be respon-

DOI: 10.1001/jama.2011.835
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@article{Dong2011EnhancingNP, title={Enhancing national policy and programs to address elder abuse.}, author={Xinqi Dong and Melissa Andrea Simon}, journal={JAMA}, year={2011}, volume={305 23}, pages={2460-1} }