Violence Against Older Adults in the U.S., 2002–2016: Assaults on Men Over 60 Up 75.4%

Since interpersonal violence was recognized as a public health problem in the 1970s, most prevention work has focused on young people and intimate partners. Violence against adults aged 60 and over has had far less attention — though this group is growing faster than younger ones. In 2017 older adults were 22% of the U.S. population, more than children aged 0–14 (19%), and they are expected to reach 28% by 2050. Many need care, and can be harmed by a caregiver or someone they trust.

CDC looked at nonfatal assaults and homicides of older adults from 2002 to 2016.

How

• Nonfatal assaults: the National Electronic Injury Surveillance System–All Injury Program (NEISS-AIP), run by the U.S. Consumer Product Safety Commission with CDC, which samples about 500,000 injury visits a year to a nationally representative set of emergency departments and weights them to national estimates. Physical assaults only — sexual assaults and legal intervention injuries excluded. The rates rest on 11,373 assault injuries among older adults.
• Homicides: death certificates in the National Vital Statistics System.
• Rates per 100,000 people, by sex and by age (60–69, 70–79, 80 and over), with trends tested by joinpoint regression.

What they found

Over the 15 years, an estimated 643,191 older adults were treated in emergency departments for assaults, and 19,059 were victims of homicide.

Men aged 60–69 had the highest rates of both (147.4 assaults, 3.58 homicides). The lowest assault rate was among women aged 70–79 (36.0), and the lowest homicide rate among women aged 60–69 (1.40).

Assaults are rising

• Overall, the rate did not change from 2002 to 2008, then rose 53.1% from 2008 to 2016.
• Men: up 75.4% over the whole period, from 77.7 to 136.3 per 100,000.
• Women: up 35.4% from 2007 to 2016, from 43.8 to 59.3.
• Aged 60–69: up 89.2% for men (100.5 to 190.1) and 37.5% for women (55.0 to 75.6), 2002–2016.

Nonfatal assault injury rates among adults 60 and over treated in emergency departments, observed and modelled, by sex, 2002–2016 (sexual assault excluded). CDC / MMWR

Homicide: falling, except for men in their sixties

• Overall, the rate fell 12.8% from 2002 to 2014 (2.42 to 2.11).
• Women: down 9.9% over the whole period.
• Men: down 16.7% from 2002 to 2010, then up 7.1% from 2010 to 2016 (2.95 to 3.16).
• Men aged 60–69: up 19.3% from 2013 to 2016 (3.31 to 3.95). Every other group of men declined, and the rate for women 80 and over fell 11.6%.

Homicide rates among adults 60 and over, observed and modelled, by sex, 2002–2016. CDC / MMWR

How people were hurt

• 86.6% of nonfatal assaults involved being struck or hit — by hand, foot or object.
• Firearms were the most common weapon in homicides (42.2%), followed by cutting or piercing (14.8%) and suffocation (6.4%).

What it means

The older population grew nearly 3% a year over this period, and the assault rate about 4% a year. The number of assaults nearly doubled, and could double again by 2030 if both trends continue.

Many attackers are people the victims know. One study of the same emergency data found about 58% of perpetrators of nonfatal assaults on older adults had a relationship with them, such as family or acquaintance; and in 32 states in 2016, about 46% of homicides of older adults (homicide–suicides excluded) were committed by a spouse or partner, parent, child, other relative, or friend or acquaintance. Such cases may meet CDC's definition of elder abuse, pointing to the need for prevention and support services.

Why the youngest, and presumably healthiest, older men face the most violence needs research — into the mechanisms, perpetrators and circumstances by age.

Few prevention strategies have been rigorously tested. Emergency medical services and emergency departments are well placed to spot assaults and refer victims for support — but one study found many emergency providers missed or did not act on abuse of older adults, lacking the knowledge or time to assess it, or unsure how to respond. Geriatric specialists in emergency departments might help connect care to services.

Limits

• Assaults are undercounted: only people treated in emergency departments are included.
• Coding by trained abstractors can be inaccurate when records vary — though the findings match other large databases such as the Healthcare Cost and Utilization Project.
• The data say little about circumstances, relationships or mechanisms.
• Assault trends could not be studied by race or ethnicity because so much was missing. Homicide rates for older adults were highest among non-Hispanic Black, non-Hispanic American Indian/Alaska Native and Hispanic people. Such inequities start early in life — from residential segregation, concentrated disadvantage, and limited education and jobs — and reducing them could lower violence at every age.

Violence against older adults is an emerging, underreported public health problem. CDC's fact sheet on elder abuse covers its types, signs and circumstances, and resources for victims.

Sources

Based on Logan JE, Haileyesus T, Ertl A, Rostad WL, Herbst JH, "Nonfatal Assaults and Homicides Among Adults Aged ≥60 Years — United States, 2002–2016," MMWR Morbidity and Mortality Weekly Report, volume 68, Centers for Disease Control and Prevention; a work of the United States government in the public domain.