Clinical Geriatrics

Each year in the United States, 2.5-3 million senior citizens are victims of abuse.1 Mistreatment of seniors occurs in 3-10% of the older population.2,3 After reviewing information on the rising incidence of elder abuse, the Select Committee on Aging of the U.S. House of Representatives issued a report on “Elder Abuse: The Hidden Problem” in 1978. A full congressional report in 1981 encouraged all states to develop and implement laws to protect elderly persons from physical, emotional, and financial exploitation.4 Since that report, all 50 states have enacted elder abuse statutes, and several include financial exploitation as a specific part of their statutes dealing with the mistreatment of senior citizens.5,6 In spite of these laws, many inconsistencies exist from state to state concerning the reporting of domestic and institutional elder abuse, neglect, and exploitation.5 The American Medical Association’s definition of elder abuse states, “Abuse shall mean an act or omission which results in harm or threatened harm to the health or welfare of an elderly person. Abuse includes intentional infliction of physical or mental injury, sexual abuse, or withholding of necessary food, clothing and medical care to treat the physical and mental health needs of an elderly person by one having the care, custody or responsibility of an elder person.” A section on financial abuse notes that “Exploitation is the misuse of a vulnerable adult’s income or other financial resources.”7

One dilemma faced in enforcing laws to protect the elderly from financial exploitation is our cherished view that seniors should maintain self-determination and autonomy. Many states take the position that seniors’ normal financial transactions, unless they are clearly impaired or coerced, are their responsibility, and that such financial decisions carry the full legal protections and responsibilities accorded to younger persons. The law assumes that the unimpaired elderly are fully capable of making decisions and are thus responsible for their financial acts. One must therefore determine whether a senior has been unduly influenced and, if so, how. In cases where contested financial decisions are brought before a jury, one must decide what standards should be used to show coercion or exploitation. The most commonly used standards involve reduced mental capacity, exploitation of increased need, or induction by fear to force older persons to inappropriately divest themselves of cash, property, or other valuable assets.
Wilber and Reynolds8 note that exploitation of the elderly is seen in several different frameworks, which are referred to under such terms as financial abuse, material abuse, fiduciary abuse, financial exploitation, financial mistreatment or maltreatment, and economic victimization. In each case, the perpetrator misappropriates the assets of an elder for his or her own benefit through coercion, misrepresentation, or theft.

Current Florida statutes note that:

“(1) ‘exploitation of an elderly person or disabled adult’ means: (a) knowingly, by deception or intimidation, obtaining or using, or endeavoring to obtain or use, an elderly person’s (or disabled adult’s) funds, assets, or property with the intent to temporarily or permanently deprive the elderly person or disabled adult of the use, benefit, or possession of the funds, assets, or property, or to benefit someone other than the elderly person or disabled adult, by a person who: 1. stands in a position of trust and confidence with the elderly person or disabled adult; or 2.