Abuse and Victimization

Experiences of abuse and victimization beyond age 60 in Germany

Thus, we ended up with a broad range of data sources:

• German Police Crime Statistics 1994-2006
• Police files on frauds / scams against people 60+ (n=303)
• A nationwide survey among persons aged 40-85 years (n=3.030)
• A survey among home care nurses (n= 503)
• A survey among family caregivers of care recipients 60+ (n=254)
• Qualitative interviews with care recipients, family caregivers and nurses (178 interviews and 4 group discussions; interviews referring to 90 family care arrangements)

I briefly summarize some results from our study and start with findings on criminal victimization and domestic violence after age 60.

• German Police Crime Statistics show that adults beyond age 60 have a far lower risk of becoming a victim of violent offences than adults aged 21-59 years. This holds true especially for men. In recent years, the annual risk of a man ages 21-59 of becoming a victim of a police-recorded completed violent offence has been in the range of 800 per 100.000 persons; for men beyond age 60, the ratio was about 50:100.000 per year.
• The nationwide representative survey conducted in 2005 shows a similar tendency of declining risk in older age. Whereas in the age range 50-54 years, about 30% of men and women reported having been a victim of at least one violent, sexual or property offence during the last five years, this proportion fell below 15% after age 70. About one in four subjects aged 60+ reported experiences of verbal aggression by family and household members within a 12 month period, whereas only 1.3% of older men and 1.6% of women beyond age 60 reported physical violence. Prevalence of both physical and psychological victimization by family and household members was about twice as high among middle-aged adults (ages 40-59) than among those beyond age 60.

So, at first sight the emerging picture appeared fairly clear: German adults aged beyond age 60 are victimized less often than younger adults. This applies to police recorded as well as to unrecorded (self-reported) experiences of crime and to stranger-perpetrated offences as well as to domestic violence. However, self-report data on experiences of victimization are available only up to age 85 and are – of course - limited to older people capable of standing a lengthy standardized survey. Up to now, German Police Crime Statistics report victim data only for violent offences (including robbery) but not for property offences.

There are multiple victimologically relevant effects of being very old, frail and dependent upon care. These characteristics diminish a person’s capacity to defend against attempts to victimize her or him. They reduce that person's capacity to report an offence to the police and in many cases her or his willingness to do so. If a person is dependent upon someone else's help, if he/she fears retaliation in case he/she reports, he/she will think it over twice before contacting the police - provided he/she has the capacity to do so at all. Being frail also affects a person's capacity to complete a victimization survey. Putting these pieces together, the picture that emerges is one of heightened vulnerability on the one hand and of probable underrepresentation in official and survey data on the other. Care recipients can and must be considered "potentially invisible victims" – for law enforcement, for health, nursing, and social professions, and for research. This status of "potentially invisible victim" does not necessarily imply that prevalence and / or incidence of victimization are higher than in other social groups. It rather marks possible underestimation in different data sources which thus cannot be used to cross-validate findings. A low level of police-recorded crime against care recipients can hardly be used to validate findings from population-based victimization surveys if both share the same blind spots – not seeing those who are severely ill, unable to speak, cognitively impaired.

A closer look at some of the findings (and at the difficulties of collecting data on victimization in very old age and among care recipients) shows that – while the majority of older people in Germany live safely most of the time – there are areas of heightened danger. I will turn to two of them.

(a) Property offences / financial exploitation targeted at the very old: There is a considerable number of types of frauds and scams (like the infamous "it's me scam" where a perpetrator pretends being a family member via the telephone and then asks for money), and cases of deception burglary and larceny-by-trick that are specifically targeted at very old persons, and predominantly at those living alone. Perpetrators select victims because of characteristics they associate with very old age (being weak, being slow, being easy to deceive, living alone). In many cases, they pretend trust relationships by posing as relatives (via telephone), craftsmen etc. Figure 1 shows the age and gender distribution of police-recorded victims of deception burglary and larceny-by-trick per 1.000 inhabitants of the respective group per year in the German federal state of Bremen. Contrary to the general distribution of police-recorded crime risks, very old females – many of whom live alone – bear the highest risk.

(b) Abuse and neglect of older care recipients: Since this topic is hardly accessible via standardized victim self-reports, alternative and additional approaches have to be considered, like surveying possible perpetrators and witnesses, including qualitative approaches, and integrating multiple perspectives upon a specific family care arrangement (care recipient; family caregiver; nurse). In our research, we tried to combine different methodological approaches:

• A survey amongst home-care nurses in the German city of Hanover found that 39.7% reported having abused or neglected at least one patient within the last 12 months. Psychological abuse/verbal aggression (21.4% of all respondents) and neglect (18.8%) were the most common forms. Figure 2 displays some results. Serious problem behaviour could be predicted by patients’ aggressive behaviour, the number of clients suffering from dementia, subjects’ use of alcohol as a means of alleviating work-related stress, and nurses’ general judgments of quality of care delivered by the respective home-care service.

• In a survey of 254 family caregivers, 53.2% reported one or more incidents of problem behaviour towards care dependent elderly during the last 12 months. Again, psychological abuse/verbal aggression was most common (47.6% of all respondents), followed by physical abuse (19.4%). There was a higher risk for significant problem behaviour towards care recipients in the last 12 months if the caregiver judged the development of his or her relationship to the care recipient as negative, if he or she used reported using alcohol to combat care-related stress, if he or she reported frequent assaults by the care recipient, and if the care recipient was severely limited in his functional capacities and highly dependent upon care.
• In our qualitative interview study in 90 family care arrangements we conducted interviews with care recipients, family caregivers and nurses in three German regions in 2005/2006. We identified several factors linked to abuse by family caregivers: a low quality of the pre-caregiving relationship; a motivation to care which is mainly financially based; the constellation of a stressed caregiver attributing the care recipient‘s challenging behaviour to „bad intentions“ (and not to his or her illness); a caregiver‘s bad physical and mental health status; substance abuse by the family caregiver; a caregiver‘s missing knowledge about illnesses; poverty and lack of financial resources, and the care recipient‘s challenging behaviour.

In conclusion, it can be said that for most older people in Germany, 3rd age (or “early old age”) is a stage of life rather untroubled by experiences of violence and crime – especially if compared to other stages of adulthood. However, large-scale victimization surveys and police crime statistics as our main data sources run the risk of selectively ignoring the very old and the care dependent. These latter groups face specific risks regarding property offences targeted at "suitable old victims" and abuse and neglect by family and professional caregivers. In general, becoming old does not expose people to a heightened risk of crime – but being very old bears specific risks and some groups of offenders are ruthless enough to search for the most vulnerable victims. For future research, this implies that studies on elder abuse must go beyond victim self-reports in order not to collect data on abuse and neglect mainly from 3rd agers who are hardly at any risk of these offences. With regard to prevention of victimization in old age it means that measures should focus upon identified specific danger zones. Beside the two mentioned above, this includes the problem of non-detection of non-natural deaths (including homicides) among the very old. We see special need for action also in the lack of infrastructure for older (female) victims of intimate partner violence. While helping institutions for IPV victims have grown and developed a lot over the last two or three decades, specific help for older victims is largely missing.

German government is taking measures to tackle these specific security problems in old age. Together with our colleagues from Zoom - Society for Prospective Developments, Göttingen, Germany, my department at German Police University (Muenster) is coordinating a 3-year programme “Secure life in old age” (November 2008- to October 2011), focussing upon specific problem areas where preventive action is deemed necessary:

• Abuse and neglect of older care recipients in family settings (strengthening the preventive potential of in-home nursing services)
• Intimate partner violence in old age (making domestic violence services and other relevant institutions elder-ready)
• Property offences specifically targeted at old people (providing information on frauds, scams, financial exploitation of seniors; training bank employees to better detect and handle cases of financial abuse)
• Homicide in old age (sensitizing physicians regarding risk of non-detection of non-naturals deaths among very old care dependent people)

The programme is being funded by the German Federal Ministry for Family, Seniors, Women, and Youth (BMFSFJ). It runs under the acronym SiliA (“Sicher leben im Alter”).

references

• Bundesministerium für Familie, Senioren, Frauen und Jugend (Ed.) (2009). "Sicherer Hafen" Oder "gefahrvolle Zone"? Kriminalitäts- und Gewalterfahrungen im Leben alter Menschen: Ergebnisse einer multimethodalen Studie zu Gefährdungen älterer und pflegebedürftiger Menschen. Berlin: Bundesministerium für Familie, Senioren, Frauen und Jugend
  
• Görgen, T., Herbst, S., Kotlenga, S., Nägele, B. & Rabold, S. (2009).  Kriminalitäts- und Gewaltgefährdungen im Leben älterer Menschen - Zusammenfassung wesentlicher Ergebnisse einer Studie zu Gefährdungen älterer und pflegebedürftiger Menschen. Berlin: Bundesministerium für Familie, Senioren, Frauen und Jugend