In the thirty-something years I’ve worked in the field of elder abuse prevention, I’ve seen abuse framed and re-framed as a medical syndrome, a caregiving issue, domestic violence, and a public health epidemic. The Elder Justice Act (EJA), enacted in 2010, enshrined abuse as a matter of social justice and individual rights. Although the new frame has been widely embraced, the EJA is narrowly focused and fails to address the myriad other threats (besides abuse) to older Americans’ rights. I wrote Elder Justice, Ageism, and Elder Abuse (Springer, 2019) to explore these threats and what our field can do about them.
I use the ecological model as a framework for promoting elder justice. The model, which is used extensively in the field of public health, tackles problems at 4 levels: 1) individual, 2) interpersonal, 3) community, and 4) systemic.
The Elder Justice Act (EJA), enacted in 2010, enshrined abuse as a matter of social justice and individual rights...but...the law is narrowly focused and fails to address the myriad other threats (besides abuse) to older Americans’ rights.
The ecological model prioritizes community and systemic interventions that have the greatest impact. It further employs the hierarchy of preventative approaches, which are also used in the public health field: “Primary prevention” refers to circumventing problems by identifying factors that predispose people to problems (called “risk factors”) and, when possible, reducing the risk. Identifying problems in their early stages (called secondary prevention) is second best, and tertiary prevention involves reducing the harm of existing problems and preventing them from recurring or getting worse.
The ecological model of elder justice suggests a wide array of preventative interventions at the individual, interpersonal, community, and systemic levels. Examples include:
The ecological model of elder justice addresses threats to individual rights, including such fundamental rights as privacy and due process, as well as rights pertaining to special groups. Users of long-term services and supports, for example, have rights as consumers, and those with disabilities have rights protected under the Americans with Disabilities Act. Other groups with special rights include crime victims, immigrants, workers, nursing home residents, and jail and prison inmates.
The ecological model was designed to stimulate discussion and planning by agencies, advocacy groups, professional networks, multidisciplinary teams, and others. For more information and tools, including our “Principles of Elder Justice” handout and video, and “From Blueprint to Benchmarks: Building a Framework for Elder Justice,” visit CEJC’s website.
Lisa Nerenberg is CEJC's executive director. Her new book Elder Justice, Ageism, and Elder Abuse (Springer, 2019) provides an agenda for elder justice.