Journal of Elder Abuse & Neglect, 23:17–42, 2011

Copyright © Taylor & Francis Group, LLC

ISSN: 0894-6566 print/1540-4129 online
DOI: 10.1080/08946566.2011.534705

Elder Abuse and Oppression: Voices of

Marginalized Elders

CHRISTINE A. WALSH, PhD, RSW

Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada

JENNIFER L. OLSON, BSW

Social Work, Dalhousie University, Fort Simpson, Northern Territories, Canada

JENNY PLOEG, RN, PhD

School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton,
Ontario, Canada

LYNNE LOHFELD, PhD

Program for Educational Research and Development, Faculty of Health Sciences,
McMaster University, Hamilton, Ontario, Canada

HARRIET L. MACMILLAN, PhD

Department of Psychiatry and Behavioral Neuroscience and Pediatrics,
McMaster University, Hamilton, Ontario, Canada

The voices of elderly people from marginalized groups are rarely

solicited, and the relationship between elder maltreatment and
belonging to an oppressed group has not been adequately inves-
tigated. This article reviews the literature on oppression and elder
abuse and describes findings from the secondary analysis of data
from focus group discussions on elder abuse held with marginal-
ized older adults and (quasi)professionals caring for them in
two Canadian cities. Participants identified that increased vul-
nerability to elder abuse was related to oppression experienced

We wish to thank members of the focus groups for their honesty and willingness to share
their opinions with us. We wish to express our gratitude to Dr. Christopher Patterson, the
principal investigator of the Elder Abuse Study. This research was supported by the Canadian
Institutes of Health Research Institutes of Gender and Health; Aging; Human Development,
Child, and Youth Health; Neurosciences, Mental Health, and Addiction; and Population and
Public Health.
Address correspondence to Christine A. Walsh, PhD, RSW, Faculty of Social Work,
University of Calgary, 2500 University Drive NW, Calgary, Alberta, Canada T2N 1N4. E-mail:
cwalsh@ucalgary.ca

17
18 C. A. Walsh et al.

as a consequence of ageism, sexism, ableism/ disability, racism,

heterosexism/homophobia, classism, and various intersecting types
of oppression.

KEYWORDS elder abuse, oppression, ageism, sexism, disability,

racism, heterosexism, classism

Elder abuse research has been criticized for the lack of consideration of
diverse samples, excessive focus on quantitative methodologies, preoccupa-
tion with definitions of elder abuse, and inattention to the lived realities of
older adults (Erlingsson, 2007). The voices of elderly people from marginal-
ized groups are rarely solicited. Furthermore, the relationship between elder
maltreatment and belonging to an oppressed group has not been investi-
gated (Penhale, 2003; Schaffer, 1999). This article presents a review of the
literature on oppression and elder abuse among older adults and findings
from the secondary analysis of data from focus group discussions on elder
abuse held with marginalized older adults and (quasi)professionals caring
for them in two Canadian cities.
Oppression has been described as a system of dominance and subor-
dination where people are divided into categories, dehumanized, discrimi-
nated against, or made invisible simply by their membership (van Wormer,
2005). Analysis of oppression as a factor promoting elder abuse is limited
to either ageism (Harbison, 1999; Nahmiash, 2002; Ward, 2000), the gen-
dered nature of elder abuse (Hudson, 1997; Ramsey-Klawsnik, 2003; Weeks,
Richards, Nilsson, Kozma, & Bryanton, 2004), or the intersection between
sexism and ageism in the abuse of older women (Buchbinder & Winterstein,
2003; Crichton, Bond, Harvey, & Ristock, 1999; Griffen & Aitken, 1999;
Straka & Montminy, 2006; Vinton, 1999). The consideration of multiple forms
of oppression as “intersecting with each other at numerous points, creating
a total system of oppression” (Mullaly, 1997, p. 105) is absent in relation to
the maltreatment of older adults.
One way that oppression may promote abuse is that it creates power
imbalances that place the marginalized person at risk of abuse. It may be
that the experience of oppression increases an individual’s vulnerability to
elder abuse because they are perceived by society as weaker, dependent, or
different. Elder abuse research, however, has not fully incorporated analyses
of how power and control contribute to abuse of older adults.
Power is exerted in a second way for those involved in abusive relation-
ships. According to Spangler and Brandl (2007), elder abuse occurs within
“an ongoing relationship with an abuser who is using a pattern of coer-
cive tactics to gain and maintain power and control in the relationship or
financially exploit the elder” (p. 323). As will be discussed below, marginal-
ized elders and their caregivers in this study revealed oppression to be a
salient issue that often results in feelings of powerlessness, increases risk of
 Oppression and Elder Abuse 19

abuse, affects victims’ help-seeking behaviors, and influences actions taken

by professionals.
The purpose of this study is to explore the complex interrelationship
between oppression and elder abuse. Oppression is considered, in and of
itself, as abusive; it also may act to increase older adults’ vulnerability to
abuse and/or may exacerbate the experience of abuse among older adults.
In this article we will review relevant research on the role of oppression with
respect to elder abuse. Then we will present study findings generated from
the lived experiences of marginalized elders and care providers, focusing on
various aspects of oppression and abuse.

FORMS OF OPPRESSION INFLUENCING ELDER ABUSE

Age
Age places older adults at risk of abuse. A recent systematic review of stud-
ies measuring the prevalence of elder abuse or neglect, either reported by
older people themselves or family and professional caregivers, or investi-
gated using objective measures, concluded that one in four vulnerable elders
is at risk of abuse, only a small proportion of which is currently detected
(Cooper, Selwood, & Livingston, 2008). Many older victims of abuse do not
disclose mistreatment due to fear of abandonment, institutionalization, or
severe repercussions from the abuser (Cyphers, 1999).
At the very minimum, older people are stigmatized and socially
excluded on the basis of age (Calasanti, 2005; Nelson, 2005). Harbison (1999)
connects elder abuse to the veneration of youth and devaluation of older
adults. Nahmiash (2002) suggests elder maltreatment is related to disdain for
aging, societal rejection of the elderly, and an ingrained belief that older
adults are a burden. Crichton et al. (1999) note that ageism robs elders of
power and makes older adults vulnerable to abuse, and Podnieks (2006)
cites ageism as a factor in the underreporting of elder abuse.
Ageism is entrenched in our social institutions (Ward, 2000), which may
explain why the legal system in North America fails to protect elderly peo-
ple from consumer fraud (Cohen, 2006). Ageism also can be cited as the
reason why health services and social programs for older adults are lacking
resources in comparison to those provided to children and youth (Podneiks,
2006). This view also is reflected in the Missing Voices Report in which older
adults described themselves as vulnerable to elder abuse due to systemic
issues such as inadequate government income assistance for seniors, lack
of affordable and safe housing, inadequate health care, and poverty in the
family (WHO/INPEA, 2002). Because the needs of elderly people are not
a priority in many modern societies, the responsibility for providing care
largely falls to families (WHO/INPEA, 2002).
20 C. A. Walsh et al.

Gender
There is a lack of consensus about how gender-linked oppression is
associated with elder abuse. Although most published reports indicate
that victims of elder abuse are predominantly women (Anetzberger, 1997;
Crichton et al., 1999; Dunlop, Rothman, Condon, Hebert, & Martinez, 2000;
Hudson, 1997; National Center on Elder Abuse [NCEA], 2006; Penhale,
1999; Ramsey-Klawsnik, 2003; Weeks et al., 2004; Whittaker, 1995), Lachs,
Williams, O’Brien, Hurst, and Horwitz (1997) do not concur, and McCabe
and Gregory (1998) note that older men experience more abuse than women
but that women are subjected to more severe forms of abuse.
The elder abuse literature is also inconsistent regarding the gender of
the perpetrator. There is some support for the traditional view that women
are predominantly abused by men. In the study by Crichton et al. (1999),
comparison of elder abuse victims determined that 89% of incidents of elder
abuse involved male perpetrators. The majority of sexual abuse of elderly
people is directed to female victims by male perpetrators (Ramsey-Klawsnik,
2003; Teaster & Roberto, 2003).
However, other research differentiates among the types of abuse and
gender of perpetrator. Cyphers (1999) reports women as the majority of
perpetrators of neglect (52%), whereas men are primarily responsible for
physical abuse (62.6%), emotional abuse (60.1%), and financial abuse (59%).
Dunlop et al. (2000) and the NCEA (2006) document that women were the
perpetrators in over half of the cases of abuse or neglect, which contradicts
findings from a sample of older women using a shelter. In that study 37.6%
of the women had been abused by their husband or partner, 34.4% by a
male relative, 12.7% by a male friend or other male, and 12.2% by a female
relative (Lundy & Grossman, 2004).

Disability
According to Statistics Canada (2001) the rate of disability, defined as difficul-
ties with daily activities and the reduction in the amount or kind of activities
due to physical or mental conditions or health problems, among noninstitu-
tionalized persons is 40% for those aged 65 and 53% for persons aged 75.
Elderly people are particularly at risk of abuse stemming from oppression
related to physical and mental disabilities (Brozowski & Hall, 2004; Cyphers,
1999), as well as impaired ability to carry out activities of daily living (ADL)
(Fulmer et al., 2005; Lachs et al., 1997). Dementia has been reported as a risk
factor for elder abuse (Cooney & Howard, 1995; Dyer, Pavlik, Murphy, &
Hyman, 2000; Fulmer et al. 2005; Lachs et al., 1997), with risk increasing
with age. Depression also has been identified as a risk factor for elder abuse
(Fulmer, 2002; VandeWeerd & Paveza, 2005).
Elderly people with a mental or physical disability are identified as
being vulnerable to sexual abuse (Ramsey-Klawsnik, 2003). In a sample of
 Oppression and Elder Abuse 21

nursing home residents, Teaster and Roberto (2003) identify that mental and
physical impairments were present for the majority of older female victims
of sexual abuse. Older female victims of sexual assault also have higher rates
of mental illness and cognitive disabilities than younger women (Del Bove,
Stermac, & Bainbridge, 2005).
Older people with disabilities may be more susceptible to abuse because
they are less likely to report the abuse, fear they may not be believed, are unable
to physically resist violence (Ramsey-Klawsnik, 2003), may need the abuser to
provide care (Buchbinder & Winterstein, 2003; Ramsey-Klawsnik, 2003), or are
financially dependent on caregivers (Beaulaurier, Seff, Newman, & Dunlop,
2005). Alternatively, health care providers may minimize the abuse faced
by healthy elders, who are seen as being less at risk for maltreatment than
elders with a disability (Bergeron, 2001). In the case of older female victims
using domestic violence services, only a minority of women report having a
disability (Lundy & Grossman, 2004). In long-term abusive relationships where
the abuser has a disability, service providers may misinterpret the victim as
the perpetrator (Bergeron, 2001).

Race and Culture

A relatively large proportion of seniors in Canada are immigrants. In 2001
approximately 28.6% of persons aged 65 to 84 were immigrants (Statistics
Canada, 2002), yet the relationship between oppression associated with
race or culture and elder abuse is poorly understood (Patterson & Malley-
Morrison, 2006). Although some studies find no difference in the rate of elder
victimization based on race (Rennison & Rand, 2003), others support the
argument that members of visible minority groups experience higher rates of
elder abuse (Lachs et al., 1997). Still other studies show that members of cer-
tain ethnic groups are at greater risk of experiencing certain types of abuse.
For instance, Otiniano, Lorimer and Teasdale (1998) identify that Hispanic
and African-American elders are overrepresented as victims of fraud, and
Mouton et al. (2003) find a greater proportion of Caucasian elderly women
reporting verbal abuse. Given that there is more violence among Aboriginal
than non-Aboriginal people in Canada, it is assumed that it is also higher
among Aboriginal seniors. However, accurate statistics on the incidence and
prevalence of elder abuse are unavailable (Dumont-Smith, 2002). A substan-
tial body of literature suggests that African-American elders experience a
greater severity and prevalence of abuse than other ethnic groups (Cyphers,
1999; Dunlop et al. 2000; Grossman & Lundy, 2003; Hudson et al., 1999;
McCabe & Gregory, 1998; Mouton et al., 2003), but study samples, partic-
ularly those composed of Adult Protective Services (APS) cases, could be
affected by racial or class bias.
Cultural differences in how people define abuse are important to con-
sider (Anetzberger, Korbin, & Tomita, 1996; Chang & Moon, 1997; Hudson,
22 C. A. Walsh et al.

Armachain, Beasley, & Carlson, 1998; Kosberg, Lowenstein, Garcia, & Biggs,
2003; Tauriac, 2006) because they influence the frequency of reporting abuse
or help-seeking behavior (Beaulaurier et al., 2005; Chang & Moon, 1997;
Patterson & Malley-Morrison, 2006; Moon, 2000; Moon, Tomita, & Jung-
Kamei, 2001; Moon & Williams, 1993; Mouton et al, 2005; Sanchez, 1996).
Further complicating the issue is the fact that within ethnic groups, per-
ceptions of elder abuse are known to be affected by religion and levels of
acculturation, income, and education (Hudson, 1997; Hudson et al., 1999;
Kosberg et al., 2003; Moon & Williams, 1993; Tauriac, 2006).
In some situations, culture may be a protective factor against elder
abuse (Carson, 1995). However, it is also true that people from cultures
that emphasize the importance of kinship and familial ties are less likely
to disclose elder abuse than others (Beaulaurier et al., 2005). In particu-
lar, there are opposing forces to the cultural sanctions against elder abuse
among Aboriginal people. Although traditional Aboriginal cultures revere
elders, other factors—colonization, residential schools, poverty, inadequate
housing, and alcohol use—tend to increase the risk of abuse to Aboriginal
seniors (Buchwald et al., 2000; Dumont-Smith, 2002; Maxwell & Maxwell,
1992; National Indian Council on Aging, 2004).
Barriers to help-seeking for older women from ethnic minorities who
experience intimate partner violence (IPV) include culturally derived norms
and beliefs about violence, isolation from the dominant culture, and some-
times an inability to communicate in the dominant language (Hightower,
Smith, & Hightower, 2006; Schaffer, 1999). For instance, research has shown
that immigrant women perceived that they were not eligible for services to
ameliorate the abuse (Beaulaurier et al., 2005) and encountered economic
obstacles, which increased their dependency on abusive adult children after
immigrating to Canada (Hightower et al., 2006).

Sexual Orientation
There is a paucity of research on the links between elder abuse and
experiences of oppression within the gay, lesbian, bisexual and transgen-
dered (GLBT) population. Kosberg (1998) asserts that gay men are invisible
within elder abuse literature. Simpson (2005) advocates for more research
exploring elder abuse within the GLBT community. Fear of aging (Schope,
2005), discrimination, and experiences of homophobia and heterosexism in
nursing homes and other health care settings are significant concerns for
GLBT elders (Brotman, Ryan, & Cormier, 2003). Research exploring same-
sex battering indicates a high prevalence in the GLBT community (Burke
& Follingstad, 1999; McLaughlin & Rozee, 2001; Merrill & Wolfe, 2000);
however, previous research has not focused specifically on older same-
sex partners, so much is still not known about abuse that occurs in such
relationships.
 Oppression and Elder Abuse 23

The GLBT population has been historically and socially regarded as

deviant by many sectors of society, including the health care system (Brotman,
Ryan, & Cormier, 2003). Anetzberger, Ishler, Mostade and Blair (2004) describe
elderly gay and lesbian individuals as “the most invisible of all Americans”
(p. 24), in part because of institutional oppression within government programs
that exclude same-sex partners from the benefits provided to heterosexual
couples such as pensions, medical benefits, and alimony (Cook-Daniels, 1997).
In Canada, cohabiting same-sex couples have enjoyed legal rights since 1999,
but same-sex marriages became legalized only in 2005. To date, there has been
no research done to discover how these changes in laws affect the degree of
social inclusion of GLBT elderly. Homophobia among staff at senior centers
and nursing homes increases fear of disclosure of homosexuality to service
providers and can prevent GLBT elderly people from seeking medical, social,
or legal services (Cook-Daniels, 1997).

Poverty
There is mixed evidence regarding the relationship between socioeconomic
status (SES), as measured by income or education levels, and risk of elder
abuse. One recent study found SES was not a predictor of emotional abuse
of Canadian elders (Brozowski & Hall, 2004); however, other evidence
supports the relationship between elder abuse and class-based oppression
(Beaulaurier et al., 2005; Buchbinder & Winterstein, 2003; Buchwald et al.,
2000; Dimah & Dimah, 2002; Fulmer et al., 2005; Lachs et al., 1997; Mouton
et al., 2003). Podnieks (2006) includes poverty as a source of social exclu-
sion that increases elders’ vulnerability to abuse, Lachs et al. (1997) report
high levels of poverty among abused elders, and Whittaker (1995) identifies
the feminization of poverty as a contributor to the abuse of older women.
A large cohort study of postmenopausal women includes poverty and low
education levels as risk factors for abuse (Mouton et al., 2003). Other work
reveals that women remain in abusive relationships if they are unable to
survive financially on their own (Beaulaurier et al., 2005; Buchbinder &
Winterstein, 2003; Schaffer, 1999). Hightower et al. (2006) noted that for
elderly abused women, leaving an abusive partner involves more financial
risks and increased difficulty in obtaining safe and accessible housing. The
result is that many older women who are in abusive relationships often
must choose between living with an abusive partner or living in poverty
(Buchbinder & Winterstein, 2003).
In summary, although there is considerable literature describing the dis-
tinct forms of oppression that have been linked to elder abuse, this literature
does not provide a clear understanding of how oppression shapes the expe-
rience of abuse among marginalized older adults or their lives, nor does it
demonstrate that forms of oppression are interconnected. Secondary analy-
sis of focus group data from marginalized older adults and their caregivers
24 C. A. Walsh et al.

was conducted to explore in greater depth how oppression related to age,

gender, disability, race or culture, sexual orientation, and poverty influence
experiences of abuse from the perspectives of marginalized elders and care
providers.

METHODS

The present study is a secondary analysis of the Elder Abuse Study con-
ducted by our research team. The objective of the Elder Abuse Study was to
explore the perceptions of elder abuse held by groups of older adults and
caregivers who traditionally have not been widely consulted when defin-
ing or discussing elder abuse. Quasiprofessional and lay caregivers have
a depth of knowledge on the conceptualization on elder abuse, yet their
views are underrepresented in the literature, which is dominated by the per-
ceptions of professional health care providers—predominantly nurses and
physicians (e.g., Stones, 1995). The study design was a descriptive qualita-
tive investigation, because there is little published information about elder
abuse from the perspective of elders who belong to nondominant social
groups and care providers other than health care professionals (Erlingsson,
2007; Walsh et al, 2007). Data were collected in focus groups in order to
gain an in-depth understanding of the experience of elder abuse from the
perspectives of people residing in Canada who are rarely consulted on
this topic—older adults and (quasi)professional caregivers (Brown, 1999;
Drabenstott, 1992). The study received approval from the research ethics
boards of McMaster University (Hamilton, Ontario) and the University of
Calgary (Calgary, Alberta). All participants provided informed written con-
sent prior to joining a focus group. Purposive sampling was used to recruit
participants belonging to marginalized elder groups and their care providers.
Fifteen focus groups and one individual interview were completed in Alberta
and Ontario, Canada.
A detailed description of the methods used in the Elder Abuse Study
is provided elsewhere (Walsh et al., 2007). Briefly, semistructured group
interviews were conducted by trained facilitators. Participants were mem-
bers of preexisting groups, either care providers or members of stigmatized/
oppressed groups (women, immigrants, Aboriginals, lesbians, people diag-
nosed with mood disorders, or survivors of abuse) who were able to give
informed consent. In addition, one self-identified survivor of elder abuse,
identified by a case manager providing services to seniors was interviewed
privately at her request. Interview topics included the definition, scope, risk
factors, and effects of elder abuse, and interventions for abused older adults.
Audiotapes from each focus group were transcribed verbatim by a pro-
fessional typist, who removed all identifying information. To ensure cultural
relevance and accuracy of the data, certified translation was provided for the
 Oppression and Elder Abuse 25

immigrant focus groups by staff members of agencies that serve immigrant

populations. For transcripts of English-language interviews, one of the two
group facilitators compared the audiotaped and written versions of the
interview, making corrections as needed. A specialized software program
(NVivo) was used for data management and to help organize the coded data
into retrievable segments. A minimum of two researchers independently
read each transcript, developed codes to correspond with themes and sub-
themes related to the conceptualization of elder abuse found in the data,
and discussed their codes until consensus was achieved (Denzin & Lincoln,
2000; Guba, 1981; Patton, 1990). Composite versions of the codes were then
entered into the software program.
For the purposes of this secondary data analysis, data from care
providers, older adults, and victims of elder abuse were combined. The
transcripts were examined for indicators of oppression within any of the
following themes: ageism, sexism, ableism/disability, racism, heterosexism/
homophobia, and classism and intersecting types of oppression. The con-
ceptualization of oppression was derived both from drawing on the literature
and from the direct analysis made by study participants. Within these initial
themes, subthemes of resiliency and power/control emerged. Transcripts
were coded for these themes and subthemes before generating a list of codes
to identify relationships among themes. The findings are organized accord-
ing to each of the major themes of oppression with subheadings drawn from
participant’s statements. Relevant subthemes are embedded within each sec-
tion followed by the findings on intersecting forms of oppression, and
illustrative quotes identified by focus group number are presented in this
article to support study findings.

RESULTS
Study Participants
The majority of older adult and care provider participants was female
(77% and 89%, respectively) and had English as their first language (51%
and 83%, respectively). More older adults and caregivers were married (41%
and 66%, respectively) and English-Canadian (37% and 71%, respectively)
compared to other categories. The mean age category of the older adults
was 60–69; the highest endorsed category was less than a high school edu-
cation (41%) and almost half reported their annual income between $10,000
and $29,999 CAD (49%). Caregivers were younger, with 26% within the
mean age range of 40–49; had university or college certificates (67%); and
reported annual incomes of $30,000 to $49,999 CAD (34.6%). A description
of the sample by focus group is found in Table 1.
Discussion of elder abuse in focus group interviews also generated
talk about oppression in its various separate and intersecting forms. Study
 TABLE 1 Description of Focus Groups by Participants Type and Group Size (n = 15)1

Participants

Focus Percentage/
group number Type (count)∗ Description

1 Aboriginal Elders 15% (11) Older Aboriginal adults who meet regularly for social support
2 Elders with Mood Disorders 11% (8) A hospital-based group of older adults with mood disorder who meet
regularly for social support
3 Latvian Immigrants 11% (8) Older adults who meet regularly at their church for social support
4 Farsi-Speaking Immigrants 13% (10) Farsi-speaking immigrant women identified by a resettlement agency
5 Punjabi-Speaking Immigrants 11% (8) Punjabi-speaking immigrant men identified by a resettlement agency
6 Chinese Immigrants 12% (9) Chinese-speaking immigrant women identified by a resettlement
agency
7 Older Wiser Lesbians (OWLS) 8% (6) Older adult lesbians who meet regularly for social support

26
8 Seniors Helping Advance 9% (7) Older adults who provide advice on gerontological research
Research Excellence (SHARE)
9 Survivors of Elder Abuse 12% (9) Survivors of elder abuse who meet regularly for formal support
Total Older Adults 100% (76)
10 Family Caregivers 21% (9) Family caregivers for older people with dementia
11 Personal Support Workers 14% (6) Personal support workers employed by a nursing agency
12 Elder Peer Support Group 21% (9) Older agency-based volunteers who provide support for other seniors
13 Aboriginal Case Managers 23% (10) Aboriginal case managers from First Nations reservations
14 Case Managers 9% (4) Health care professionals providing services for seniors
15 Case Managers 11% (5) Case managers that provide support for seniors
Total Caregivers 100% (43)
1
Table 1 is reprinted from Walsh, C. A., Ploeg, J., Lohfeld, L., Horne, J., MacMillan, H. & Lai, D. (2007). Violence across the lifespan: Interconnections among
forms of abuse as described by marginalized Canadian elders and their caregivers. British Journal of Social Work Special Issue − Caring for People: Social Work
with Adults in Next Decade and Beyond, 37(3), 491–514.
 Oppression and Elder Abuse 27

participants noted that belonging to a marginalized group resulted in power

imbalances as well as increased isolation and loneliness, all of which
increased older adults’ vulnerability to abuse. Powerlessness was a central
theme in all group interviews. Vulnerable groups such as women, older
adults, and people with disabilities were identified as being particularly at
risk for abuse because they are “weaker” (FG1, FG2, FG8, FG9, FG11, FG12),
“dependent” (FG8), and “can’t fight back” (FG1, II1).

Ageism: “Less than Human”

Overwhelmingly, participants identified the existence of ageism on the
micro, meso and macro levels. At the micro (individual) level, elders
described being treated “like a child” (FG3), as “incompetent” (FG2), a
“throwaway” (FG9), “less than human” (II1), and “an easy target” (FG3).
Older adults also indicated that being stereotyped and judged in these ways
had become internalized and negatively affected their sense of self. One
elder stated, “[people treat] seniors [like they] are a drag on society. You
actually feel like one” (FG2). A victim of elder abuse emphasized that elders
“feel useless” (FG9). According to a caregiver, some elders believe “I can’t
clean the house, I can’t look after the kids, I can’t be productive in [my]
family’s life, and I understand why they get angry at me or maybe whack
me, or whatever, you know” (FG11). Another participant summarized the
effects of ageism this way: “The bottom line to ageism is that it allows peo-
ple to be depersonalized and once you’re depersonalized . . . then you are
all vulnerable to abuse” (FG15).
On the meso, or service-delivery level, ageism was apparent in the
lack of services for the elderly and in the poor treatment of older adults
by service providers. Examples of the lack of services included support for
abused older adults, as one participant stated, “there isn’t anywhere a senior
can go if they’re abused” (FG2). An Aboriginal participant concurred, noting
that disclosure of abuse is futile: “The bottom line is, where do you go?
[Nowhere]. So, what’s the sense of asking?” (FG1). Despite an increased need
for medical support, older adults often felt belittled or ignored by medical
staff. One participant shared the story that her doctor told her “every time
you come in here, you complain” (FG2). Another participant described how
institutions maintained abusive situations rather than finding solutions:

Hospitals insist people come home . . . [but] home may not be the right
place . . . I had an 80 year-old couple and he’d been the abuser all his
life . . . she was exhausted. . . . She had to be coached to leave her home
because the hospital would not listen to her message that she could not
be a caregiver any longer. (FG15)

Ageism was also evident on the macro (societal) level. One partici-
pant shared the belief that “our society fears age . . . I believe, like from
28 C. A. Walsh et al.

my experience working here [in an agency providing help for seniors] and
looking at my own elder relatives . . . every senior’s abused at some level in
society, if it’s not domestic it’s this government policy that’s there” (FG15).
One victim emphasized, “there are no laws that protect the elderly” (FG9).
Study participants emphasized the lack of political will to provide ade-
quate pensions, qualified medical staff, nursing home beds, and shelters for
older adults. One participant noted ageism in government funding resulted
in “a lot of money [goes] toward youth programs in our community . . . but
there is nothing for the seniors” (FG13). An Aboriginal participant noted
that “the government itself is abusing us elders because we’re not getting
enough money to keep going” (FG1), and one victim of abuse noted, “I am
on [a] disability pension, and it’s very low; that gives me so much stress,
[and] depression” (FG9).

Sexism: “The Weaker Sex”

The participants in this study attributed experiences of gender related
oppression to micro level factors; participants’ comments did not reveal
an understanding of the impact of meso or macro level variables on this
relationship.
Participants perceived women as being at higher risk of elder abuse
than men because they are “the weaker sex” (FG1). According to case man-
agers, the majority of elder abuse victims are “definitely mostly women,
obviously more than men. We see some men, too, but the majority are
female” (FG14). An Aboriginal participant noted, “I think a woman gets
abused more than a man . . . [because] men are physically able to protect
themselves better than women” (FG1).
Participants noted that elder abuse often involved severe forms of IPV.
Injuries sustained by older women were “just as horrific as anything in
younger women—black eyes, broken bones, burns, scalds, sexual assaults,
sexual assaults with . . . objects” (FG15). One case manager described a sit-
uation in which the “husband abuses her sexually . . . She won’t leave. He
threatens her life, and she’s afraid to leave everything she has. . . . He goes
into her room when she’s asleep and he gets into bed and forces himself
on her” (FG12). One participant described the barriers faced by an older
woman who left an abusive partner:

For two years she didn’t have access to her share of the money, which
was half of the house, half of the assets and everything, because the court
case was just dragging out . . . She lived in such poverty [due to being in
a sponsorship agreement]. . . . So you are penalizing the person who is
separating and trying to make a life on their own, and this is usually for
women because they don’t have the extra pension; they never worked
outside of the home or whatever. . . . [She] is so threatened and so fearful
 Oppression and Elder Abuse 29

that she sleeps in her street clothes every night because she never knows
when she has to run, and just jump and run from the house in the middle
of the night. (FG14)

Participants described that abuse of older adults is “common, but

women keep it to themselves. They don’t tell anyone [because of] shame
[and loss of] dignity” (FG2). One immigrant woman described how cultural
gender roles not only put them at risk for sexual abuse but make it difficult to
disclose the abuse: “I couldn’t tell anyone anything because they—the men
are so strong and they don’t think that we should say ‘No’ because they
believe that . . . they are the owner of the woman” (FG4). Another immi-
grant woman sponsored by her adult son described spending one month in
a shelter to escape his abuse: “I care about my child. I don’t want to put
him in a bad situation because of breaking the agreement—[the] sponsor-
ship agreement. I have to just adapt to this abuse and that life” (FG4). An
Aboriginal case manager emphasized also that “they [older women] do not
want to admit that their family member is doing this to them . . . these are
their children. . . . We can’t tell them that their adult child is doing this. They
just deny it” (FG13). A Chinese woman also described this experience when
she explained:
There is a saying in Chinese community that says if bad things happen
in [the] family you don’t go outside and spread it to other people . . . .
Anything that is unpleasant you shouldn’t tell people about it. So the
only thing she [an abused older woman] can do is try to be patient and
try to forgive, and hopefully that will reduce the tensions between the
family members. (FG6)

Disability: “A Whole Person with Less Able Parts”

Study participants also believed that older adults with cognitive or physical
disabilities are at risk for elder abuse because they are powerless to defend
themselves because of micro level factors. For example, stories were shared
about elders with disabilities and mental illnesses who were neglected and
abused financially, psychologically, and emotionally. Financial abuse was
commonly cited for “very elderly people who have some cognitive impair-
ment . . . They are so targeted, it’s unbelievable” (FG14). As one woman
stated:

I became disabled. I couldn’t drive us anymore, and I was on

medication—morphine, you name it, . . . and [my daughter] took over
as a parent, and I became a child . . . Not only was she stealing money
out of my account, she was stealing all of my credit cards . . . [and] she
stole my car. She stole my truck, did forty-five hundred dollars worth of
damage to my truck . . . and eighteen hundred worth of damage to my
car. (FG9)
30 C. A. Walsh et al.

Meso level factors were highlighted for elders with cognitive impair-
ments. Inadequacies in care provision not only increased the vulnerability to
abuse and revictimization, they impacted on the seniors’ ability to disclose.
For example, one participant described the greater vulnerability of abuse
that faces adults with dementia: “if a person has a confusional state . . . they
are much more vulnerable because . . . things can be done and they may not
remember” (FG13). One elder noted hearing stories of long-term care facil-
ity staff “playing sexually with the older ones who can’t fight back” (FG2).
When older adults with dementia did disclose abuses against them, often
their complaints were ignored and attributed to their dementia or being
“confused” (FG8). It was not surprising, therefore, to hear a disabled senior
who had been abused describe elder abuse as “a hidden thing—it’s hidden
under layers of cover up” (II1).
On the societal level for elders with disabilities, ageism and (dis)ableism
combine to further disempower and dehumanize older adults:

Who do we see when we look at this grey-haired person who is incon-

tinent, who is dribbling? Do we see a responsible person, or do we just
see the old grey-haired dribbly person? They are a whole person with a
few . . . less able parts. (FG11)

Perpetrators of abuse were identified as having power over elders with

disabilities. One immigrant woman described witnessing verbal abuse of her
disabled husband by nursing home staff: “I couldn’t say anything because I
thought that I cannot make them mad because of what they can do to my
husband” (FG3). Another participant shared, “We had a caregiver, not in our
agency, but she’s a social worker and we had to get [a blind man] on with a
trustee because she bilked him out of a good ten thousand dollars” (FG11).

Racism: “Because You’re a Different Colour”

Racism as an oppressive factor played a role in elder abuse on both micro
and macro levels. Individuals disclosed experiences of racism, prejudice,
and discrimination due to language barriers and “because you’re a different
colour” (FG1). One person described being financially abused due to hav-
ing First Nations status: “You go to the store and you buy something, and
they take more money than they should” (FG1). A Punjabi man witnessed
physical and emotional abuse of an older community member: “Once a few
girls . . . they took the turban of one older person, 70 years or older, and
started running with the turban. Two of us were there and we saved him.
They had a knife as well” (FG5).
Elder abuse appears to be related to cultural erosion that often occurs
in multigenerational immigrant families as they adjust to the life ways of
the host country. A Chinese interpreter translated for one senior who noted,
 Oppression and Elder Abuse 31

“there’s no respect so [elders] have lost that important role that they used
to have [in the Chinese culture]” (FG6). An Aboriginal case manager shared
the following observation: “I hear [about] different cases [of elder abuse] and
I’ve been witness to abuse in my own family. . . . It’s really disheartening
and sad to [see] what happened to all those [traditional] teachings . . . in the
Aboriginal culture” (FG13). Another person in the same focus group noted
that the Aboriginal culture was destroyed by residential school, and that
the resultant loss of culture manifests in violence and abuse within families.
Aboriginal people “learned not to show feelings or care because that was a
weak sign . . . They learned how not to feel for the next person who was
getting kind of beat [up] . . . It was a lot of nasty stuff” (FG13).
Immigration laws were commonly cited as a factor in maintaining abu-
sive situations. One Chinese woman who was sponsored by her adult son
living in Canada stated, “[sponsored elders] want to move out on their own
but financially it’s a problem because they are under their family’s spon-
sorship, and during that 10 years they are not eligible for any government
assistance . . . [so] they’ll have to endure the abuse, financially, emotionally”
(FG6).
Case managers also described situations of abused immigrants:

[We know of] people with no English . . . who have been . . . locked
up in basements . . . [without] adequate food [or]adequate medical atten-
tion . . . [A] 75-year-old woman [was] forced to work in a restaurant
from four in the morning until . . . four in the afternoon and then go
home and cook for her family and look after children . . . on a spon-
sorship . . . . [Older immigrants have been] threatened with deportation
[if they don’t cooperate with their abusers]. They’ve [been] threatened all
kinds of things. (FG15)

Culture also was implicated in help-seeking behaviors as a Farsi-

speaking woman articulates that in using a shelter for domestic violence
“she really had a bad time in the shelter because in her culture, to be in
shelter is not a good thing” (FG4). Barriers to help-seeking also were related
to limited English skills: “you have no place to go. She had limited English.
She didn’t know where to turn for help” (F11). The loss of English language
due to aging was identified as a risk in that an individual is “simply left
without ability to tell what is wrong” (FG3).

Heterosexism and Homophobia: “Back into the Closet”

Homophobia and heterosexism were linked to a sense of powerlessness
over loss of identity for lesbian participants as they age. These were
described on the societal level as a result of isolation and discrimination and
at the meso level in terms of inadequate care provision. Women identified
32 C. A. Walsh et al.

the fear of losing both their identity and community when moving into a
nursing home. One participant remarked, “What if [staff and residents] find
out [that I am a lesbian]? . . . you have to stop being the person that you
really are” (FG7). As she further explained, “if you move into a residence . . .
and you can’t be an ‘out’ lesbian, you become isolated. You’re not your-
self. You’re not with the people that you are accustomed to being with.”
The absence of older women within the lesbian community was identified,
and one participant postulated “they are going back into the closet” (FG7).
Another participant identified “extreme isolation” (FG15) as a factor in the
abuse of gay or transgendered men.
Participants expressed fear of discrimination in hospitals or nursing
homes based on age and identity: “If you’re . . . an old woman in an old
folk’s home, other old people will sit with you, but if you are a lesbian
woman . . . then you’d be sitting on your own” (FG7). One woman also
explained that homophobic family members can isolate older persons by
prohibiting visits by their lesbian partners:

There is no way that a heterosexual couples’ [family] could prevent the

husband from having contact with the wife. But if you are in a lesbian
partnership, it’s not considered legal and so the family does have the
right to say [the partner] can’t come here. (FG7)

Classism: “Poor and Abused”

Participants cited poverty as another factor associated with oppression that
increased one’s vulnerability to elder abuse at the micro, meso, and macro
levels. As one Aboriginal participant noted, “I think poor people are more
likely to be abused” (FG1). Another person stated, “if you don’t have over
$2,000 per month to pay [for private nursing homes], then the waiting list for
you to get in there is astronomically long” (FG10). For a lesbian participant,
poverty increases older women’s sense of isolation because they often must
move away from their supportive community: “Without money . . . you are
at the mercy of the system that does not provide enough beds” [implying that
people waiting for placement in a nursing home must agree to move into
the first long-term care facility with an opening, regardless of its location]
(FG7). Impoverished elders may lack awareness of services they are entitled
to: “Many people are living far below the poverty line . . . and are not getting
benefits or programs or services . . . because they don’t know about them”
(FG15).
Poverty or financial dependency also surfaced as a barrier for elders
to disclose abuse, leave an abusive situation, or be provided a safe envi-
ronment by their family. Despite experiencing abuse at her son’s home, an
Aboriginal victim was denied other available options by her family, who
brought her back to her perpetrator’s house when she was discharged from
 Oppression and Elder Abuse 33

the hospital “because it was costing them money” (FG13). In addition, as

participants explained, poverty exacerbates and compounds other forms of
oppression. A case manager illustrated the combined impact of poverty,
language barriers, immigrant status, sexism, and ageism on one immigrant
woman:

I had a case where an East European lady, she had been living in a
marriage for over 30 years with a husband who was an alcoholic and
a very aggressive guy. She was regularly subjected to beatings. There
was constant psychological abuse—putting her down [by saying], “You
are stupid. You are no good for anything.” He basically kept her as a
personal slave . . . She had absolutely no money, not even enough for
a stamp. . . . Several times she ended up in the hospital because of the
beatings. She is 82 years old now. . . . She had limited English. She didn’t
know where to turn for help. She believed that she would end up on
the street. (FG14)

Intersecting Forms of Oppression: Multibarriered People

Participants shared stories that demonstrate how different forms of oppres-
sion are often interwoven for marginalized elders. The literature on elder
abuse has identified older women as being at particular risk of elder abuse
due to the intersection of gender and age (Hightower et al., 2006; Penhale,
2003). However, participants from this study indicated that all forms of
oppression intersect in complex ways to increase older adults’ vulnerability
of victimization. According to one care provider,

[older adults have] ageism going against them, but they also have lan-
guage barriers. They have cultural issues that prevent them from feeling
secure, seeking police protection and seeking medical help—seeking
medical assistance for mental illness. And so the barriers—if you want to
talk about multibarriered people, anybody over the age of 65 from the
“get go” is multibarriered. (FG15)

Risk of elder abuse increased with the multiplicity of forms of oppression.

As one lesbian woman explained, “Not only do you have the same kind
of abuse that the elderly heterosexual women would have, you get some
added on as well” (FG7).

DISCUSSION

The voices of marginalized elders and care providers in this study con-
textualize our understanding of elder abuse. As in previous research, our
study participants clearly noted that older adults are particularly vulnerable
34 C. A. Walsh et al.

to abuse due to oppression related to age (Harbison, 1999; Ward, 2000),

gender (Fulmer, Guadagno, & Bolton, 2004; Weeks et al., 2004), disabil-
ity (Brozowski & Hall, 2004; Cyphers, 1999; Dimah & Dimah, 2001; Lachs
et al., 1997; Fulmer et al., 2005; Teaster & Roberto, 2003; Weeks et al., 2004),
race or ethnicity (Lachs et al., 1997; Otiniano et al., 1998), sexual orien-
tation (Cook-Daniels, 1997), and socio-economic status (Beaulaurier et al.,
2005; Buchbinder & Winterstein, 2003; Buchwald et al., 2000; Fulmer et al.,
2005; Lachs et al., 1997; Mouton et al., 2003). Similar to previous research
on family violence, elder abuse occurs at the micro, meso, and macro lev-
els (Nahmiash, 2002), with power and control filling a fundamental role
(Crichton et al., 1999; Lundy & Grossman, 2004; Montminy, 2005; Ramsey-
Klawsnik, 2003; Spangler & Brandl, 2007) in the link between oppression
and abuse at the level of group membership and related to powerlessness
and lack of control due to dependency.
This study builds upon previous research about the abuse of older
adults by identifying how intersecting forms of oppression exacerbate both
the risk of harm and the invisibility of marginalized elders, greatly reducing
the chance that their oppression and abuse are recognized and addressed.
Although some authors (Griffin & Aitken, 1999; Jönson & Åkerström, 2004)
attribute the obscurity and invisibility of elder abuse to the intersection of
sexism and ageism, current models of elder abuse that include these vari-
ables are still not sufficiently robust enough to account for the experiences
of older adults oppressed in multiple ways.
It is noteworthy that the issue of oppression was neither a focus nor
was it raised by the focus group facilitators in the original study. Rather,
this topic emerged from the dialogue of older adults and care providers
within the context of a general discussion about the conceptualization of
elder abuse. Participants readily identified the links among various forms
of oppression, and how the complexity and pervasiveness of oppression
contribute to both the existence elder abuse and its invisibility. This is an
important finding, which demands attention from clinicians and researchers
to further explore the relationship between oppression and victimization of
older persons.
The present study provides support for other investigators who note
that stereotypes about older adults often became internalized by the older
adults themselves. This helps explain why older adults are often minimized
or ignored by healthcare workers and law enforcement officials, resulting in
a lack of services and legislation specifically for older adults. According to
Mullaly (2002), “stereotypes help to reinforce the notion of the problematic
and the necessity of surveillance and control. Stereotypes also make preju-
dice, oppression, and even violence at the personal level more acceptable”
(p. 86).
Our study participants identified a number of stereotypes about aging,
all of which served to label and define older adults as the “other.” According
 Oppression and Elder Abuse 35

to Dominelli (2003), “othering” is how oppression differentiates between

those with power and those who are excluded from having power. Further,
by eroding older adults’ identity and sense of self, oppression creates a
vulnerability to abuse by members of socially more powerful groups. The
forces of oppression also contribute to the dramatic underreporting of elder
abuse, in part because there are not enough service providers to address the
needs of abused elders. In addition, lack of awareness, language barriers,
cultural factors, shame, family dynamics, and fear of further victimization
compound the issues for elders or their caregivers when disclosing abuse.
Focus group participants identified the lack of appropriate and sensi-
tive health and social services for elders. In examining the practice of social
services professionals with older adults, Kam (2002) notes various forms
of practice including “negative attitudes toward older people; the use of
a medical control model of practice; an unequal relationship with older
people; denying older people opportunities to participate in decision mak-
ing; and limiting older people’s choices and alternatives” (p. 161), which
contribute to older people’s sense of powerlessness, incompetence, and
low self-esteem. For professionals working with marginalized older adults,
such as the older gay and lesbian population, it is imperative to reflect on
how practices can be modified to empower disenfranchised communities
(Donahue & McDonald, 2005). Professionals need to seek appropriate train-
ing and supervision to adequately address issues of concern for vulnerable
older adults who are increasingly heterogeneous and culturally diverse.
Participants in this study had many suggestions for social workers,
health care providers, and policy makers about how to meet the needs
of elderly abuse victims. Older adults and their caregivers emphasized the
importance of providing more services specific to elders, shelters capable
of addressing the complex needs of older adults, peer support for victims
of elder abuse, and more respite care. Support groups were seen as helpful
by older participants. Elders also praised one agency that met a variety of
needs of older adults under one roof, such as recreation, support groups,
social workers, a shelter, and access to basic needs. Innovative programs
are being developed that provide a range of elder abuse shelter services
in combination with medical services, social services, legal services, and
community support services (Reingold, 2006). With more supports in place,
elders may begin to feel safe to disclose abuse. One theme was impor-
tant to the participants and is also highlighted in the literature (Nerenberg,
2008; Straka & Montminy, 2006; Tam, 2004; Zink, Regan, Jacobson, & Pabst,
2003); it involves encouraging older adults to decide whether they wanted
to involve the family in possible interventions, even if the family was per-
petrating the abuse. A response that divides family members and blames
the perpetrators does not seem to be what some of the participants wanted,
which raises concern given the current trends toward criminalization of fam-
ily perpetrators. However, in some cases, particularly in response to spousal
36 C. A. Walsh et al.

violence, participants requested more physical and emotional supports to

become independent.
Participants also focused on the need for policies and legislation to be
created to protect all elders, which echoes recent calls for an international
convention on the human rights of older people (Tang, 2007). Further, in
this study, many of the participants were eager to share their stories and
experiences. More studies conducted with older adults are needed to further
understand causal pathways for elder abuse and potential solutions.
In one focus group, participants had never disclosed their experiences
of abuse to workers because “nobody asked us” (FG4). Professionals work-
ing with the elderly in health care facilities and other services need to be
alert to signs and symptoms suggestive of elder abuse and be knowledgeable
about how to ask about exposure to violence and services where assistance
can be provided. Social workers and health care providers should be aware
of the multiplicity of oppression as a risk factor for elder abuse. For exam-
ple, when one type of oppression is detected, the impact of other forms of
oppression should be investigated.
One limitation of this study is that oppression was not a topic specifi-
cally targeted in the discussion groups. It is probable that a richer description
and other forms of oppression would emerge as a result of in-depth
examination of the impact of oppression on older adults.
A limitation to using focus groups as a methodology is that participants
may have withheld disclosing experiences or opinions due to the sensitive
nature of the topic (Rubin & Babbie, 2008). In particular, those participants
from diverse cultures may have been uncomfortable discussing elder abuse
openly in a group setting. A richer analysis may be obtained from individual
interviews or using a method offering anonymity to the participants.
The study also is limited by threats to cultural competency and could
have been improved by recruiting facilitators who are members of the target
population and using translators who are not familiar to the participants.
Gender of the facilitator and translator may have been an issue for some
of the focus groups; future focus group facilitation could be improved
by ensuring the facilitator and the translator are of the same sex as the
participants.
The study is limited in that only selected marginalized groups—women,
immigrants, Aboriginals, lesbians, people diagnosed with mood disorders,
or survivors of abuse—were included in the sample, and their perspectives
may differ from other marginalized groups. While this is clearly a limitation,
the findings from the present study may contribute to our understanding
of the association between elder abuse and oppression among elders in
general and among oppressed groups of older adults specifically. Further,
in this study older adults represented both those with known histories of
elder abuse and others chosen by their membership within marginalized
groups and thus they may differ in important ways in their experiences of
 Oppression and Elder Abuse 37

both abuse and oppression. These apparent differences, however, may be

less evident according to literature that supports an association between
membership in marginalized groups and the increased likelihood of victim-
ization and in the spontaneous disclosures of elder abuse and other forms
of interpersonal violence made by members of the “non” abused group.
Finally, we chose to gather information from both service providers
and older adults to enrich our understanding of this complex phenomenon.
However, in doing so we may have lost some intergroup variation, due
to differences in social location. In examining the data of the two groups
independently, little variation was noted between groups with respect to the
findings presented here.
Future topics for exploration were generated from this study. It is
unknown whether particular forms of oppression are possible pathways to
elder abuse, which forms of oppression are more strongly correlated to each
other, and whether certain types of abuse are more linked to a particular
form of oppression than others.
Although this article targets the role of oppression within the lives of
older adults, an important finding is the resiliency of elder abuse victims.
Participants in this study were often marginalized on multiple levels, yet
demonstrated strength, insight, creativity, resourcefulness, and hope for the
future. A victim of elder abuse stated, “even though I was abused, I always
have had a mind of my own” (FG9). Another woman explained, “we are
strong. And we are so patient” (FG4). Common experiences of oppression
also created a deeper sense of trust and respect among some of the partici-
pants. Future policies, research, and clinical practice with older adults need
to balance an understanding of their increased vulnerability to victimization
due to the pervasiveness of oppression with awareness of their strengths,
wisdom, and resiliency.

REFERENCES

Anetzberger, G. J. (1997). Elderly adult survivors of family violence: Implications for

clinical practice. Violence Against Women, 3, 499–514.
Anetzberger, G. J., Ishler, K. J., Mostade, J., & Blair, M. (2004). Gray and gay: A
community dialogue on the issues and concerns of older gays and lesbians.
Journal of Gay & Lesbian Social Services, 17, 23–45.
Anetzberger, G. J., Korbin, J. E., & Tomita, S. K. (1996). Defining elder mistreat-
ment in four ethnic groups across two generations. Journal of Cross-Cultural
Gerontology, 11, 187–212.
Beaulaurier, R. L., Seff, L. R., Newman, F. L., & Dunlop, B. (2005). Internal barriers
to help seeking for middle-aged and older women who experience intimate
partner violence. Journal of Elder Abuse & Neglect, 17, 53–74.
Bergeron, L. R. (2001). An elder abuse case study: Caregiver stress or domestic
violence? You decide. Journal of Gerontological Social Work, 34, 47–63.
38 C. A. Walsh et al.

Brotman, S., Ryan, B., & Cormier, R. (2003). The health and social service needs
of gay and lesbian elders and their families in Canada. The Gerontologist, 43,
192–202.
Brown, J. B. (1999). The use of focus groups in clinical research. In B. F. Crabtree &
W. L. Miller (Eds.), Doing qualitative research (2nd ed., pp. 109–124). Thousand
Oaks, CA: Sage.
Brozowski, K., & Hall, D. R. (2004). Growing old in a risk society: Elder abuse in
Canada. Journal of Elder Abuse & Neglect, 16, 65–81.
Buchbinder, E., & Winterstein, T. (2003). “Like a wounded bird”: Older battered
women’s life experiences with intimate violence. Journal of Elder Abuse &
Neglect, 15, 23–44.
Buchwald, D., Tomita, S., Hartman, S., Furman, R., Dudden, M., & Manson, S. M.
(2000). Physical abuse of urban Native Americans. Journal of General Internal
Medicine, 15, 562–564.
Burke, L. K., & Follingstad, D. R. (1999). Violence in lesbian and gay relationships:
Theory, prevalence, and correlational factors. Clinical Psychology Review, 19,
487–512.
Calasanti, T. (2005). Ageism, gravity, and gender: Experiences of aging bodies.
Generations, 29, 8–12.
Carson, D. K. (1995). American Indian elder abuse: Risk and protective factors
among the oldest Americans. Journal of Elder Abuse & Neglect, 7, 17–39.
Chang, J., & Moon, A. (1997). Korean American elderly’s knowledge and perceptions
of elder abuse: A qualitative analysis of cultural factors. Journal of Multicultural
Social Work, 6, 139–154.
Cohen, C. A. (2006). Consumer fraud and the elderly: A review of Canadian
challenges and initiatives. Journal of Gerontological Social Work, 46,
137–144.
Cook-Daniels, L. (1997). Lesbian, gay male, bisexual and transgendered elders:
Elder abuse and neglect issues. Journal of Elder Abuse & Neglect, 9,
35–49.
Cooney, C., & Howard, R. (1995). Abuse of patients with dementia by carers: Out
of sight but not out of mind. International Journal of Geriatric Psychiatry, 10,
735–741.
Cooper, C., Selwood, A., & Livingston G. (2008). The prevalence of elder abuse and
neglect: A systematic review. Age and Ageing, 37, 151–160.
Crichton, S. J., Bond, J. B., Harvey, C. D. H., & Ristock, J. (1999). Elder abuse:
Feminist and ageist perspectives. Journal of Elder Abuse & Neglect, 10, 115–130.
Cyphers, G. C. (1999). Out of the shadows: Elder abuse and neglect. Policy &
Practice of Public Human Services, 57, 25–30.
Del Bove, G., Stermac, L., & Bainbridge, D. (2005). Comparisons of sexual assault
among older and younger women. Journal of Elder Abuse & Neglect, 17, 1–18.
Denzin, N., & Lincoln, Y. (Eds.) (2000). Handbook of qualitative research (2nd ed).
Thousand Oaks, CA, Sage.
Dimah, A., & Dimah, K. P. (2001). Racial differences in abused older African
American males, Caucasian males, and their abusers. Journal of African
American Men, 6, 47–61.
Dimah, A., & Dimah, K. P. (2002). Gender differences among abused older African
Americans and African American abusers in an elder abuse provider agency.
Journal of Black Studies, 32, 557–573.
 Oppression and Elder Abuse 39

Dominelli, L. (2003). Anti-oppressive social work theory and practice. New York, NY:
Palgrave Macmillan.
Donahue, P., & MacDonald, L. (2005). Gay and lesbian aging: Current perspectives
and future directions for social work practice and research. Families in Society,
86, 359–366.
Drabenstott, K. M. (1992). Focused group interviews. In J. D. Glazier & R. R.
Powell, (Eds.), Qualitative research in information management (pp. 85–104).
Englewood, CO: Libraries Unlimited.
Dumont-Smith, C. (2002). Aboriginal elder abuse in Canada. Ottawa: Aboriginal
Healing Foundation.
Dunlop, B. D., Rothman, M. B., Condon, K. M., Hebert, K. S., & Martinez, I. L.
(2000). Elder abuse: Risk factors and use of case data to improve policy and
practice. Journal of Elder Abuse & Neglect, 12, 95–122.
Dyer, C. B., Pavlik, V. N., Murphy, K. P., & Hyman, D. J. (2000). The high prevalence
of depression and dementia in elder abuse and neglect. Journal of American
Geriatrics Society, 48, 205–208.
Erlingsson, C. L. (2007). Searching for elder abuse: A systematic review of database
citations. Journal of Elder Abuse & Neglect, 19, 59–78.
Fulmer, T. (2002). Elder mistreatment. Annual Review of Nursing Research, 20,
369–395.
Fulmer, T., Guadagno, L., & Bolton, M. M. (2004). Elder mistreatment in women.
Journal of Obstetric, Gynecologic, and Neonatal Nursing, 33, 657–663.
Fulmer, T., Paveza, G., VandeWeerd, C., Fairchild, S., Guadagno, L., Bolton-Blatt, M.,
& Norman, R. (2005). Dyadic vulnerability and risk profiling for elder neglect.
The Gerontologist, 45, 525–534.
Griffin, G., & Aitken, L. (1999). Visibility blues: Gender issues in elder abuse in
institutional settings. Journal of Elder Abuse & Neglect, 10, 29–42.
Grossman, S. F., & Lundy, M. (2003). Use of domestic violence services across race
and ethnicity by women aged 55 and older: The Illinois experience. Violence
Against Women, 9, 1442–1452.
Guba, E. G. (1981). Criteria for assessing the trustworthiness of naturalistic inquiries.
Education, Communication and Technology Journal, 29, 75–91.
Harbison, J. (1999). Models of intervention for “elder abuse and neglect”: A Canadian
perspective on ageism, participation, and empowerment. Journal of Elder Abuse
& Neglect, 10, 1–17.
Hightower, J., Smith, M. J., & Hightower, H. C. (2006). Hearing the voices of abused
older women. Journal of Gerontological Social Work, 46, 205–227.
Hudson, M. F. (1997). Elder mistreatment: Its relevance to older women. Journal of
the American Medical Women’s Association, 52, 142–147.
Hudson, M. F., Armachain, W. D., Beasley, C. M., & Carlson, J. R. (1998). Elder
abuse: Two Native American views. The Gerontological Society of America, 38,
538–548.
Hudson, M. F., Beasley, C. M., Benedict, R. H., Carlson, J. R., Craig, B. F., &
Mason, S. C. (1999). Elder abuse: Some African American views. Journal of
Interpersonal Violence, 14, 915–939.
Jönson, H., & Åkerström, M. (2004). Neglect of elderly women in feminist studies of
violence—a case of ageism? Journal of Elder Abuse & Neglect, 16, 47–63.
Kam, P.-K. (2002). From disempowering to empowering: Changing the practice of
social service professionals with older people. Hallym International Journal of
Aging, 4, 161–183.
40 C. A. Walsh et al.

Kosberg, J. (1998). The abuse of elderly men. Journal of Elder Abuse & Neglect, 9,
69–88.
Kosberg, J. I., Lowenstein, A. Garcia, J. L., & Biggs, S. (2003). Study of elder abuse
within diverse cultures. Journal of Elder Abuse & Neglect, 15, 71–89.
Lachs, M. S., Williams, C., O’Brien, S., Hurst, L., & Horwitz, R. (1997). Risk factors
for reported elder abuse and neglect: A nine-year observational cohort study.
The Gerontologist, 37, 469–474.
Lundy, M., & Grossman, S. F. (2004). Elder abuse: Spouse/intimate partner abuse
and family violence among elders. Journal of Elder Abuse & Neglect, 16, 85–102.
Maxwell, E. K., & Maxwell, R. J. (1992). Insults to the body civil: Mistreatment
of elderly in two Plains Indian tribes. Journal of Cross-Cultural Gerontology,
7, 3–23.
McCabe, K. A, & Gregory, S. S. (1998). Elderly victimization: An examination beyond
the FBI’s index crimes. Research on Aging, 20, 363–372.
McLaughlin, E. M., & Rozee, P. D. (2001). Knowledge about heterosexual versus
lesbian battering among lesbians. Women and Therapy, 23, 39–58.
Merrill, G. S., & Wolfe, V. A. (2000). Battered gay men: An exploration of abuse,
help seeking, and why they stay. Journal of Homosexuality, 39, 1–30.
Montminy, L. (2005). Older women’s experiences of psychological violence in their
marital relationships. Journal of Gerontological Social Work, 46, 3–22.
Moon, A. (2000). Perceptions of elder abuse among various cultural groups:
Similarities and differences. Generations, 24, 75–80.
Moon, A., Tomita, S. K., & Jung-Kamei, S. (2001). Elder mistreatment among four
Asian-American groups: An exploratory study on tolerance, victim-blaming and
attitudes toward third-party intervention. Journal of Gerontological Social Work,
36, 153–169.
Moon, A., & Williams, O. (1993). Perceptions of elder abuse and help-seeking
patterns among African-American, Caucasian-American, and Korean-American
elderly women. The Gerontologist, 33, 386–395.
Mouton, C., Rodabough, R. J., Rovi, S. L. D., Hunt, J. L., Talamantes, M. A., Brzyski,
R. G., et al. (2003). Prevalence and 3-year incidence of abuse among post-
menopausal women. American Journal of Public Health, 94, 605–612.
Mouton, C. P., Larme, A. C., Alford, C. L., Talamantes, M. A., McCorkle, R. J., &
Burge, S. K. (2005). Multiethnic perspectives on elder mistreatment. Journal of
Elder Abuse & Neglect, 17, 21–44.
Mullaly, B. (1997). Structural social work: Ideology, theory and practice (2nd ed.).
Toronto, ON: Oxford University Press.
Mullaly, R. (2002). Challenging oppression: A critical social work approach. Toronto,
ON: Oxford University Press.
Nahmiash, D. (2002). Powerlessness and abuse and neglect of older adults. Journal
of Elder Abuse & Neglect, 14, 21–47.
National Center on Elder Abuse. (2006). Abuse of adults age 60+: The 2004 survey
of Adult Protective Services. Washington, DC: Author.
National Indian Council on Aging. (2004). Elder abuse in Indian country: A
review of the literature. Research, policy and practice. Albuquerque, NM:
Author.
Nelson, T. C. (2005). Ageism: Prejudice against our future aged self. Journal of Social
Issues, 61, 207–221.
 Oppression and Elder Abuse 41

Nerenberg, L. (2008). Elder abuse prevention: Emerging trends and promising

strategies. New York, NY: Springer Publishing Company.
Otiniano, M., Herrera, C., & Teasdale, T. (1998). Hispanic elder abuse.
Archstone Foundation Understanding and Combating Elder Abuse in Minority
Committees, 194.
Patterson, M., & Malley-Morrison, K. (2006). A cognitive–ecological approach
to elder abuse in five cultures: Human rights and education. Educational
Gerontology, 2, 73–82.
Patton, M. Q. (1990). Qualitative evaluation and research methods (2nd ed.).
Newbury Park, CA: Sage.
Penhale. B. (1999). Bruises on the soul: Older women, domestic violence, and elder
abuse. Journal of Elder Abuse & Neglect, 11, 1–22.
Penhale, B. (2003). Older women, domestic violence, and elder abuse: A review of
commonalities, differences, and shared approaches. Journal of Elder Abuse &
Neglect, 15, 163–183.
Podnieks, E. (2006). Social inclusion: An interplay of the determinants of health—
New insights into elder abuse. Journal of Gerontological Social Work, 46,
57–79.
Ramsey-Klawsnik, H. (2003). Elder sexual abuse within the family. Journal of Elder
Abuse & Neglect, 15, 43–58.
Reingold, D. A. (2006). An elder abuse shelter program: Build it and they will come,
a long term care based program to address elder abuse in the community.
Journal of Gerontological Social Work, 46, 123–135.
Rennison, C., & Rand, M. R. (2003). Nonlethal intimate partner violence against
women: A comparison of three age cohorts. Violence Against Women, 9,
1417–1428.
Rubin, A., & Babbie, E. R. (2008). Research methods for social work (6th ed.).
Belmont, CA: Thomson Brooks/Cole.
Sanchez, Y. M. (1996). Distinguishing cultural expectations in assessment of financial
exploitation. Journal of Elder Abuse & Neglect, 8, 49–59.
Schaffer, J. (1999). Older and isolated women and domestic violence project.
Journal of Elder Abuse & Neglect, 11, 59–77.
Schope, R. D. (2005). Who’s afraid of growing old? Gay and lesbian per-
ceptions of aging. Journal of Gerontological Social Work, 45, 23–38.
doi:10.1300/J083v45n04_03
Simpson, A. R. (2005). Cultural issues and elder mistreatment. Clinics in Geriatric
Medicine, 21, 355–364. doi:10.1016/j.cger.2004.11.003
Spangler, D., & Brandl, B. (2007). Abuse in later life: Power and control dynamics
and a victim-centered response. Journal of the American Psychiatric Nurses
Association, 12, 322–331.
Statistics Canada. (2001). A profile of disability in Canada, 2001. Ottawa, ON:
Statistics Canada. Available at: http://www.statcan.ca/english/freepub/89-577-
XIE/pdf/89-577-XIE01001.pdf
Statistics Canada. (2002). Profile of the Canadian population by age and sex: Canada
ages. Ottawa, ON: Statistics Canada. Available at: http://www12.statcan.ca/
english/census01/Products/Analytic/companion/age/contents.cfm
Stones, M. J. (1995). Scope and definition of elder abuse and neglect in Canada. In
M. J. MacLean (Ed.), Abuse & neglect of older Canadians: Strategies for change
(pp. 111–115). Ottawa, ON: Canadian Association on Gerontology.
42 C. A. Walsh et al.

Straka, S. M., & Montminy, L. (2006). Responding to the needs of older women
experiencing domestic violence. Violence Against Women, 12, 251–267.
Tam, D. (2004). Culturally responsive advocacy intervention with abused Chinese-
Canadian women. British Journal of Social Work, 34, 269–277.
Tang, K.-L. (2007). Taking older people’s rights seriously: The role of international
law. Journal of Aging & Social Policy, 20, 99–117.
Tauriac, J. J. (2006). Elder abuse among African Americans. Educational Geron-
tology, 32, 37–48.
Teaster, P. B., & Roberto, K. A. (2003). Sexual abuse of older women living in
nursing homes. Journal of Gerontological Social Work, 40, 105–119.
van Wormer, K. (2005). Concepts in contemporary social work: Globalization,
oppression, social exclusion, human rights etc. Social Work & Society, 3,
267–286.
VandeWeerd, C., & Paveza, G. J. (2005). Verbal mistreatment in older elders: A look
at persons with Alzheimer’s Disease and their caregivers in the state of Florida.
Journal of Elder Abuse & Neglect, 17, 11–30.
Vinton, L. (1999). Working with abused older women from a feminist perspective.
Journal of Women & Aging, 11, 85–100.
Walsh, C. A., Ploeg, J., Lohfeld, L., Horne, J., MacMillan, H., & Lai, D. (2007).
Violence across the lifespan: Interconnections among forms of abuse as
described by marginalized Canadian elders and their caregivers. British Journal
of Social Work, 37, 491–514.
Ward, D. (2000). Ageism and the abuse of older people in health and social care.
British Journal of Nursing, 9, 560–563.
Weeks, L. E., Richards, J. L., Nilsson, T., Kozma, A., & Bryanton, O. (2004). A
gendered analysis of the abuse of older adults: Evidence from professionals.
Journal of Elder Abuse & Neglect, 16, 1–15.
Whittaker, T. (1995). Violence, gender, and elder abuse: Towards a feminist analysis
and practice. Journal of Gender Studies, 4, 35–45.
WHO/INPEA. (2002). Missing voices: Views of older persons on elder abuse. Geneva,
CH: World Health Organization.
Zink, T., Regan, S., Jacobson, C. J., & Pabst, S. (2003). Cohort, period, and aging
effects: A qualitative study of older women’s reasons for remaining in abusive
relationships. Violence Against Women, 9, 1429–1441.