Grow old along with me!

The best is yet to be,

The last of life, for which the first was made.

Robert Browning[1]

I don’t think so!

G. Sallust[2]

This started as a blog on DARPA [The Defense Advanced Research Programs Agency][3], artificial intelligence and outer space. There’s always new stuff on technology that educates and alarms the innocents, such as ourselves, who don’t keep up with the news. And on the other hand, there’s a new Supreme Court ruling on when the police can up and shoot a law-breaker without themselves being prosecuted. Larry tells me it doesn’t blaze any new trails, but it does do a pretty good job of summarizing the current rules.[4] These are interesting subjects, well worth your time and mine, and no doubt we’ll do blogs on them; but I thought this time we ought to focus on something different, a subject that interests more and more of us each year; and that’s elder abuse.

This is Fred, by the way, and like you I’m growing older every day. That’s good, in a way, because the alternative is much less good. But really, it’s not a happy thing to age in the United States. As time goes by, the ageing lose control of their destinies; but not because they’re dumber than the people who try to defraud them, vandalize their property or invade their homes. Instead they simply don’t have the physical or financial resources to resist aggression. Threaten an old person, who’s never been sued, with a legal action of any kind, and watch him [or her] dissolve before your eyes.

Suppose you have a troublesome neighbor, who’s old, and you want to get rid of him [or her]. Suppose that person is unpopular. What can you do? Well, if the old person owns a house, try working through the Homeowner’s Association, if there is one. Dream up things for the owner to do, and send him [or her] threatening letters if they don’t. If the old person rents, complain to the landlord. File reports with the authorities, alleging real or imagined infractions of local rules. Spread lots of gossip, true or false; it doesn’t matter; an old person probably won’t have the money, energy etc. to sue a gossip for libel. Let it be known that you won’t object if individuals take informal, extra-judicial action against the offender, although you certainly aren’t sanctioning anything wrong or illegal.

You get the idea. Ramp up the dirty tricks, but don’t get caught. Anyway, what brought this to mind was an article from the Lancet that drifted into the Zoo inbox the other day.[5] The Lancet is a medical journal that’s been around since 1823. It publishes research, reviews, case reports, articles, news, correspondence and editorials and articles on medical subjects. The journal has editorial offices in London, New York, and Beijing.[6] We first stumbled on The Lancet a couple of years ago, when we were covering Ebola epidemic and its consequences. Nobody around here is a doctor, or familiar with medicine except as a patient. Nevertheless, we do try to recognize a good, honest publication when we see one, and The Lancet qualifies.

The article that caught my attention is Elder abuse prevalence in community settings: a systematic review and meta-analysis, not the catchiest title but certainly informative. The article defines elder abuse as one or more subtypes of abuse, any one or combination of which causes harm or distress to an older person. The subtypes include:

  • Physical abuse. Injuring an older person by hitting, kicking, pushing, slapping, burning, or other show of force.
  • Sexual abuse. Forcing an older person to take part in a sexual act when the elder does not or cannot consent.
  • Psychological or emotional abuse. Harming an older person’s self-worth or well-being. “Examples include name calling, scaring, embarrassing, destroying property, or not letting the elder see friends and family.”
  • Financial abuse. Illegally misusing an older person’s money, property, or assets.
  • Neglect. “Failure to meet an older person’s basic needs. These needs include food, housing, clothing, and medical care.”[7]

In this the article follows the definitions recommended by our own Centers for Disease Control.[8] That’s good because it means that, when scientists study elder abuse, use the dame definitions and compare notes, they’re will talk about the same things.[9] The CDC, I might add, has its own, specific page to deal with elder abuse.[10] It also has put out an elaborate manual to help standardize the way abuse data is reported.[11]

So what did the authors of The Lancet piece do? Well, they performed what is known as a meta-analysis of prior studies done around the world and through June 26, 2015. I don’t claim to understand how this works, but they say they searched 14 data bases and concentrated on studies that reported “estimates of past-year abuse prevalence in adults aged 60 years or older.” They used statistical techniques [subgroup analysis and meta-regression] to study “heterogeneity” and registered their study protocol with an outside source.[12] Of the 38 544 studies initially identified, ultimately 52 were found eligible for inclusion in the final report. The studies considered were geographically diverse (28 countries). [13]

And what did they discover?[14] Well, that elder abuse is a world-wide problem, affecting possibly 141 million people:

Although robust prevalence studies are sparse in low-income and middle-income countries, elder abuse seems to affect one in six older adults worldwide, which is roughly 141 million people. Nonetheless, elder abuse is a neglected global public health priority, especially compared with other types of violence.[15]

The overall rate of elder abuse, around 15.7%, is a composite of all of the subcategories identified earlier. It includes reports of elders who are psychologically abused (about 12%), taken advantage of financially (about 7%), abused through neglect (4%), physically abused (2.5 %) or sexually attacked (about 1%).[16] These are estimates only, based on the most reliable current data. Results may vary over time. But so far there doesn’t seem to be a significant difference between men and women in terms of whether they are abused.[17]

So what are we to make of all this? This is a survey and analysis of world literature about elder abuse. Are we to assume that the conclusions apply to the United States as well? Granted we’re part of the world, but we’re also a rich and powerful nation. A city on a hill, some people say. The Bible says that’s a good thing, but our forefathers warned about that. We’re not automatically special. All that means is that we are watched.[18] God and the people will notice if we do things like abandon the elderly.

For that reason, I’m grateful our own CDC is focusing on elder abuse. We need more data on how big the problem might be; on who’s doing it, inside or outside our various governments; and what needs to be done to frustrate the miscreants. It’s a medical and legal issue, and the folks at CDC are the right ones to take the lead, with the able assistance of law enforcement when it’s needed. Forget the lawyers; mostly they just prey on the weak.

Oh, and did I mention that I’m authentically old? Sometimes I forget.

 

 

 

 

[1] See Oxford Dictionary of Quotations (6th edition) (Oxford, 2004) at p. 161, Robert Browning, n.3. The quote is from Browning’s Rabbi Ben Ezra (1864). Hereafter, the Oxford Dictionary will be cited as ODQ at ___.

[2] G. Sallust is our disreputable founder.

[3] The main DARPA website is at http://www.darpa.mil/

[4] See White v. Pauly, 580 U.S. ___ (2017) (per curiam), a slip opinion currently available from the Court at https://www.supremecourt.gov/opinions/16pdf/16-67_2c8f.pdf

[5] See The Lancet, Yon, Mikton, Gassoumis & Wilber, Elder abuse prevalence in community settings: a systematic review and meta-analysis (Feb2017), available at http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30006-2/fulltext?elsca1=etoc Hereafter this will be cited as The Lancet, Elder Abuse at ___.

[6] Wikipedia has a nice introduction to The Lancet; it’s available at https://en.wikipedia.org/wiki/The_Lancet

[7] These bullet points are basically a paraphrase or direct quote from The Lancet. .

[8] See CDC, Elder Abuse: Definitions, at https://www.cdc.gov/violenceprevention/elderabuse/definitions.html .

[9] Id. “A consistent definition is needed to monitor the incidence of elder abuse and examine trends over time. Consistency helps to determine the magnitude of elder abuse and enables comparison of the problem across locations.”

[10] See CDC, Elder Abuse, at https://www.cdc.gov/violenceprevention/elderabuse/index.html

[11] See CDC, Hall, Karch & Crosby (compilers), Elder Abuse Surveillance: Uniform Definitions and Recommended Core Data Elements (2016), available from https://www.cdc.gov/violenceprevention/pdf/ea_book_revised_2016.pdf

[12] Id. at p. 147, Methods.  That’s with PROSPERO; some of you statisticians might know that. The registration number is CRD42015029197

[13] Id. at p. 147, Findings.

[14] See The Lancet, Elder Abuse at p. 147, Methods.

[15] See The Lancet, Elder Abuse at p. 147, Interpretation.

[16] See The Lancet, Elder Abuse at p. 147, Findings.

[17] See The Lancet, Elder Abuse at p. 153, Discussion. “Despite several additional analyses, our research found no significant difference in prevalence between older women and older men. Few studies have examined gender differences in elder abuse; those that did found mixed results, with some identifying disparate rates across genders. Yet in studies of intimate partner violence, gender symmetry is reported, supported by both systematic review and meta-analysis. Although much research on abuse has used gender roles and masculinity as a predictor for violent behaviour [“behavior” in the U.S.], emerging evidence has shown a weak association between gender roles and abuse.”

[18] See ODQ at p. 841, John Winthrop: “We must consider that we shall be a city upon a hill, the eyes of all people are on us; so that if we shall deal falsely with our God in this work we have undertaken, and so cause him to withdraw His present help from us, we shall be made a story and a byword through the world.” John Winthrop was an early American settler; he lived from 1588 – 1649.

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