Abuse of older people (or elder abuse) is an important public health problem in the United States. According to the Centers for Disease Control and Prevention (CDC), abuse of older people is an intentional act, or failure to act, that causes or creates a risk of harm to an older adult: defined as someone aged 60 years or older (Centers for Disease Control and Prevention, 2019). The five common types of abuse recognized globally include physical abuse (or physical violence), sexual abuse (or sexual violence), psychological aggression, neglect, and financial abuse. Abuse of older people can lead to suffering, financial loss, long-term psychological trauma, physical injuries, or even death (Carney, 2019; Lachs et al., 1998; World Health Organization, 2022). Published studies found that at least 1 in 10 U.S. non-institutionalized older adults experienced some form of abuse in the prior year (Acierno et al., 2010; Rosay & Mulford, 2017). With the U.S. population rapidly growing older (e.g., estimated 54.1 million adults aged 65 and older in 2019 [Administration for Community Living (ALC), 2021] compared to projected population of 88.5 million by 2050 [Vincent & Velkof, 2021]), the number of abuse cases among older adults is likely to increase significantly (Mohd Mydin et al., 2019).

A study of U.S. adults aged 60 years or older reported that the estimated non-fatal assault rate (per 100,000) increased 75.4% among men (from 77.7 per 100,000 population in 2002 to 136.3 in 2016) and increased 35.4% among women (from 43.8 per 100,000 population in 2007 to 59.3 in 2016) (Logan et al., 2019). Logan et al. (2019) also reported from 2010 to 2016 the homicide rate increased among all men aged 60 and older by 7.1% (from 2.95 to 3.16 per 100,000 population), and a 19.3% increase (from 3.31 to 3.95) was observed among men aged 60–69 years from 2013 to 2016. Logan and colleagues concluded that nearly half of homicides among older adults were perpetrated by a spouse/intimate partner, other relative or acquaintance; and growth in both the older adult U.S. population and rates of violence against this group, especially among men, suggest an important need for violence prevention strategies. In June 2022, the World Health Organization (WHO) published “Tackling abuse of older people: five priorities for the UN Decade of Healthy Aging 2021–2030.” The publication assessed the severity of abuse of older people globally and concluded with an investment case for addressing the issue, including generation of data on prevalence and risk and protective factors, and development of interventions to prevent abuse and neglect among older persons (World Health Organization, 2022).

There is a paucity of prevalence data available on abuse of older persons. In the U.S., population-based, cross-sectional studies and surveys of non-institutionalized older adults were conducted more than a decade ago; and prevalence estimates varied widely. Estimates of past-year psychological aggression or emotional abuse ranged from 4.6% to 12.1%; physical violence ranged from 0.2% to 1.7%, and sexual violence ranged from 0.6–0.9% (Acierno et al., 2010; Cannell et al., 2014; Laumann et al., 2008; Rosay & Mulford, 2017). Moreover, previous studies identified risk factors associated with abuse of older persons. For psychological aggression or emotional abuse, associated risk factors were being in a younger age cohort (e.g., 60–69 years), being employed, being married, having experienced a previous traumatic event, and having less social support (Acierno et al., 2010; Amstadter et al., 2011; Pathak et al., 2019; Policastro & Finn, 2017). Additional risk factors included being a woman, having a functional impairment (Laumann et al., 2008), and living in a household with income below $30,000 (Burnes et al., 2015). For physical violence, risk factors included being in a younger age cohort and having less social support (Acierno et al., 2010); having a functional impairment or living in a lower-income household (Burnes et al., 2015), and living alone (Pillemer & Finkelhor, 1988; Policastro & Finn, 2017). For sexual violence, risk factors included being a widow or living alone, having experienced previous traumatic event(s), having less social support, and having cognitive impairment (Acierno et al., 2010; Johannesen & LoGiudice, 2013; Shamaskin-Garroway et al., 2017). The limitation with these studies is that they did not use standard definitions and measurements of intimate partner violence and sexual violence, many of the studies occurred more than a decade ago and were limited to samples from specific geographical areas (Amstadter et al., 2011; Burnes et al., 2015; Pillemer & Finkelhor, 1988).

Obtaining accurate prevalence estimates of abuse of older adults in the U.S. is essential to informing the development and implementation of effective prevention strategies (Marshall et al., 2020). Such strategies need to take into account the magnitude of the problem, and key factors potentially placing older individuals at risk of abuse. The current study uses data from the 2016/2017 National Intimate Partner and Sexual Violence Survey (NISVS). NISVS provides past-year prevalence estimates for psychological aggression and physical violence victimization by intimate partners (IP) and sexual violence victimization by any perpetrator among the non-institutionalized U.S. population. Using these data, this study identifies risk factors as well as factors that might mitigate the risk of abuse. Findings from this study can be used to inform the development of prevention strategies for older adults aged 60 years and older.

A total of 10,171 respondents, representing an estimated 67 million total U.S. population aged 60 years or older were included in the analysis. Table 1 presents characteristics of the total study sample including unweighted counts and weighted percentages with 95% CIs. Among individuals aged 60 years or older, 60.6% were in the 60–69 age group, 54.3% were female, 78.4% were non-Hispanic White, 64.3% reported an education level beyond high school, and 50.9% lived in a household with a total annual income greater than or equal to $35,000. More than half (58.6%) of respondents were married or living with a partner. The majority (80.8%) lived in an urban area, and more than a third (37.5%) resided in the South. The percentage of older adults having severe hearing or vision impairment was 22.4%; having activity of daily living impairment was 30.4%; and having cognitive impairment was 11.7%.

Findings from this nationally representative study suggest an estimated 1.4 million (2.1%) adults in the U.S. aged 60 years or older are victims of at least one incident of psychological aggression by an IP in the past 12 months. Over half a million (0.8%) are victims of past-year IP physical violence. Further, an estimated 1.1 million older adults are victims of past-year sexual violence by any perpetrator. Compared to previously published U.S. prevalence estimates, this study reported a lower prevalence of IP psychological aggression (2.1% compared to 4.6%–12.1% reported previously), a comparable prevalence of IP physical violence (0.8% compared to 0.2%–1.7% reported previously), and a higher prevalence of sexual violence (1.7% compared to 0.6%-0.9%) (Acierno et al., 2010; Cannell et al., 2014; Laumann et al., 2008; Rosay & Mulford, 2017). Differences in estimates between this and other studies could be at least partially due to the lack of standard definitions and measurements, as well as the difference in the age ranges of studied population. For example, in two other studies the older population had the same age range as this study which was 60+ years. However, in one study the population was defined as 57–85 years old, while another was 70 + .The difference could also be partially a function of our assessment of psychological aggression and physical violence perpetrators, which only included intimate partners.

The identification of demographic characteristics and health conditions associated with IP psychological and IP physical violence and sexual violence by all perpetrators during the past 12 months reported in this study contributes to an understanding of the context in which these forms of violence occur among older adults. Consistent with previously published studies (Acierno et al., 2010; Laumann et al., 2008), the present study found that adults aged 70 years and older had lower odds of IP psychological aggression and sexual violence than adults aged 60–69. Lachs et al. (2015) suggested that the “young-old” (i.e., ages 60–69 in this study) may live with a spouse or adult children who are considered likely abusers potentially associated with their shared living environment. In the present study, older adults who were unmarried or not in a relationship (e.g., divorced, separated, widowed, or never married) had 2.5 times the odds of experiencing sexual violence than those who were married or living with a partner. This finding is consistent with prior studies suggesting marriages or partnerships lasting into late adulthood may be considered a protective factor of abuse, while being divorced or separated may be associated with unstable, conflictive familial relationships posing greater risk of abuse (Burnes et al., 2015). Several studies suggest indicators of social isolation, including being widowed, divorced, or separated, living alone, and having limited formal or informal contacts, were associated with all forms of abuse, including sexual violence, among older adults (Brozowski & Hall, 2004; Chokkanathan, 2018; De Donder et al., 2016; Dong & Simon, 2013).

The present study also found that males had significantly greater odds of experiencing IP physical violence than females. There were no significant sex differences for IP psychological aggression and sexual violence. Our results are consistent with previous studies (Logan et al., 2019; Melchiorre et al., 2016; Pillemer & Finkelhor, 1988). Those studies suggest that older men may experience higher rates of physical abuse, including physical abuse perpetrated by an intimate partner, because they are more likely to be living with someone else. In addition, Melchiorre et al. (2016) suggested that abuse among older males is under-recognized, under-detected and under-reported. This is largely due to social/cultural norms supporting traditional male characteristics of fortitude, strength and therefore may tend to overlook the vulnerability of older men.

Older adults in this study with severe hearing or vision impairment had significantly greater odds of reporting IP psychological aggression and IP physical violence, but not sexual violence. According to a literature review, physical disability, including hearing and vision impairments, is one of the strongest predictors of abuse among older adults (Pillemer et al., 2016). Several studies found that older adults with physical vulnerability had greater odds of being victimized through psychological aggression (Anme et al., 2005; Laumann et al., 2008) as well as being victims of physical violence (Burnes et al., 2015). Roberto (2016) reasoned that the association of abuse of older adults and physical impairment could be related to isolation, which can decrease the likelihood that abuse will be detected (Roberto, 2016). Physical limitations may also be associated with reduced victim self-esteem and increased dependency on others for assistance, which are both associated with increased risk of being abused (Kong & Jeon, 2018).

In our study, older adults with cognitive impairment, which included difficulty concentrating, remembering, or making a decision, were at significantly greater risk of sexual violence. This finding is consistent with other studies suggesting cognitive impairment and declining health may be associated with increased vulnerability to abuse (Biggs et al., 2009; Dong et al., 2014; Friedman et al., 2017; Johannesen & LoGiudice, 2013; Roberto, 2016). Cognitive impairment could also increase vulnerability to sexual violence through diminished capacity for sexual consent (White, 2010).

The findings of this study have implications for clinical and prevention practice. Regarding clinical practice, older adults, especially those with physical and mental disabilities, frequently interact with healthcare professionals and these professionals have a vital role in safeguarding older persons from abuse (Abrahams, 2021). Providers, especially nurses, geriatricians, and other medical providers, are among the first groups who come in contact with the older population and can identify and assess cases of abuse (Ranabhat et al., 2022; Shamaskin-Garroway et al., 2017; Yaffe et al., 2008). A systematic review of 14 research articles published between 2010 and 2021 revealed education and training for nurses to detect abuse of older adults can significantly enhance their knowledge and increase identification and reporting of abuse cases (Ranabhat et al., 2022). Older adults experiencing violence victimization use emergency departments and hospitals frequently (Rosen et al., 2023), and these healthcare sites could be an ideal venue for abuse screening, especially among older adults with physical and mental health disabilities identified as risk factors in this study (Abujarad et al., 2020; Choo et al., 2021; Yaffe et al., 2008). From a prevention practice perspective, there are no rigorously evaluated interventions to prevent the occurrence or recurrence of abuse against older adults, including intimate partner violence and sexual violence (Atkinson & Roberto, 2023; Baker et al., 2016; Marshall et al., 2020). The CDC has compiled the best available evidence, including strategies and approaches for preventing intimate partner violence (Niolon et al., 2017) and sexual violence (Basile et al., 2016). Prevention strategies that could be implemented or adapted to prevent these forms of violence among older adults include promoting social norms to protect against violence (e.g., bystander approaches), teaching safe and healthy relationship skills (e.g., healthy relationship programs for older adult couples), creating protective environments (e.g., modifying physical and social environments of neighborhoods and other place-based approaches to prevent violence within communities), strengthening economic supports for families (e.g., household financial security), and supporting victim and survivors to increase safety and lessen harms (e.g., victim-centered services). Although these strategies were not specifically developed and evaluated to address the prevention of abuse among older adults, it may be the case that these programs, policies, and practices could have preventive effects in reducing IP psychological aggression, IP physical violence, and sexual violence addressed in this study. There remains an urgent need for future research to develop and rigorously evaluate approaches or adapt existing interventions to prevent abuse specifically against older adults (Marshall et al., 2020; World Health Organization, 2022). Future research could be informed by the findings of this study.

This study is subject to several limitations. First, estimates generated from the 2016/2017 NISVS data should be considered underestimates of the true prevalence. Participants might not have felt comfortable disclosing their victimization to a live interviewer for several reasons including the sensitivity of intimate partner and sexual violence, stigma, self-blame, or having an abuser nearby when they completed the interview. Second, the findings cannot be generalized to institutionalized populations as the NISVS sample did not include persons living in a residential, nursing, or memory care facility. Third, NISVS data are cross-sectional, so the directionality of the victimization and health conditions cannot be determined. Further, although the NISVS survey content is comprehensive, it does not include other forms of abuse experienced by older persons including financial abuse, physical and psychological abuse by non-intimate partners, and neglect. Additionally, recall bias may have affected the accuracy of reporting past 12-month victimization, because some respondents may not recall the timing of their victimization. Relatedly, memory impairments might have prevented some participants from reporting their victimization (Dong et al., 2011).

The NISVS data included in this report did not allow for the examination of inequities in intimate partner and sexual violence by race and ethnicity due to small cell sizes among respondents in racial and ethnic minority groups. Although overall prevalence estimates of intimate and sexual violence are reported for men and women, statistical instability due to small cell sizes did not permit stratified estimates of contextual factors associated with these forms of violence by sex. Future surveillance efforts to oversample such groups could inform whether inequities in violence exist and among which populations to inform prevention efforts. Finally, common with recent random-digit-dial studies, the response rate was low (i.e., 7.8%). However, response rates are not necessarily an indication of low population representativeness. Efforts were made in the NISVS 2016/2017 survey to address the possibility of non-response and noncoverage bias (e.g., non-response follow-up phase), and comparisons to external benchmarks showed similar estimates (Kresnow et al., 2022).

Notwithstanding the specified limitations, this study reports prevalence estimates of past 12-month IP psychological aggression, IP physical violence, and sexual violence by any perpetrator of U.S. adults aged 60 years and older. This study identified demographic and other health-related factors that were associated with these forms of abuse. These results support the importance and urgency of developing and adapting violence prevention strategies for this growing population within the U.S.