SAFE Participant Manual

SAFE

Safe Accessible Forensic Interviewing for Elders

4-Day Advanced Certificate Training

Participant Manual

Authors:

Scott Modell, Ph.D.

Staci Whitney, L.M.S.W.

Kate Homan, M.S.

Dermot Whelan, Police Sergeant, Ret.

Candace Heisler, J.D.

Chris Dubble, M.S.W.

Misty Boldt, L.M.S.W.

Acknowledgement

This training was produced by the Modell Consulting Group, LLC pursuant to a

contract awarded by the Department of Justice’s Elder Justice Initiative.

Purpose

The goal of this project was to develop an accessible advanced forensic

interviewing certificate curriculum for established forensic interviewers with

previous basic training or certificate and extensive experience in forensic

interviewing and/or working with older adults. The advanced forensic

interview certificate curriculum is designed to support forensic interviewers to

gather information from alleged victims in the most reliable and legally

defensible manner. It is the hope of all involved that after attending this

training, professionals will feel better equipped to interview older adults who

are victims of crime and successfully investigate and prosecute the crimes

committed against them.

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Table of Contents 
 
Introduction  ........................................................................................................................................................ 8 
Forensic Interview....................................................................................................................................... 10 
Trauma-Informed Approach ............................................................................................................. 12 
Strength-Based Perspective .............................................................................................................. 14 
Pre-Assessment............................................................................................................................................... 16 
Question Types ............................................................................................................................................. 16 
The Recycling Funnel Model ............................................................................................................... 19 
Narrative Interview Mapping .............................................................................................................20 
Pre-Assessment Instructions ............................................................................................................ 23 
Elder Abuse Definitions...............................................................................................................................28 
Elder Abuse ....................................................................................................................................................28 
Proof in Elder Abuse Cases ................................................................................................................. 32 
Forms of Elder Abuse ..............................................................................................................................35 
Multiple Victimization Events/Polyvictimization ................................................................. 39 
Settings in Which Elder Abuse Occurs ....................................................................................... 40 
Abuse in Long-Term Care Settings ........................................................................................... 41 
Key Concepts: Competency, Capacity, and Consent ....................................................43 
Competency.............................................................................................................................................43 
Capacity ..................................................................................................................................................... 44 
Financial Decisional Capacity .................................................................................................... 45 
Consent ........................................................................................................................................................ 47 
History of Elder Abuse ................................................................................................................................ 49 
Statistics and Incident Rates ................................................................................................................ 54 
Impact of Elder Abuse ............................................................................................................................... 58 
Physical Health Impact ........................................................................................................................ 58 
Psychological Health Impact ........................................................................................................... 60 
Financial Impact ........................................................................................................................................62 
Biases and Assumptions About Aging .......................................................................................... 65 
Ageism ............................................................................................................................................................. 66 
Common Stereotypes of Aging...................................................................................................... 66 
Addressing Stereotypes and Ageism in Forensic Interviews With Older Adults
 ................................................................................................................................................................................ 67 
Older Adults and Abuse Dynamics ................................................................................................... 70 

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A Life Course Perspective on Older Adults ............................................................................... 70 
Elder Abuse Dynamics ........................................................................................................................... 72 
Reporting Impact .................................................................................................................................. 72 
Perpetrators, Risk Factors, Dynamics, and Justifications ......................................... 73 
The Aging Body ............................................................................................................................................... 84 
Biological Changes ................................................................................................................................. 86 
Vision .............................................................................................................................................................. 87 
Hearing ........................................................................................................................................................ 88 
Taste and Smell ..................................................................................................................................... 89 
Motor Function and Strength ....................................................................................................... 90 
Skin ................................................................................................................................................................. 90 
Problematic Injuries and Conditions Suggestive of Abuse ........................................ 90 
Bruises .......................................................................................................................................................... 90 
Pressure Ulcers ......................................................................................................................................... 91 
The Role of Medications ....................................................................................................................... 93 
The Aging Brain ............................................................................................................................................. 104 
Normal Changes in the Aging Brain .......................................................................................... 105 
Cognitive Decline....................................................................................................................................... 117 
Reversible Cognitive Decline ........................................................................................................ 117 
Irreversible Cognitive Decline...................................................................................................... 118 
Dementia ........................................................................................................................................................ 119 
Older Adults With Severe Impairment ...................................................................................... 123 
Older Adults with Mild to Moderate Impairments ............................................................ 124 
Strategies for Communicating with Individuals Living with Dementia ............. 127 
Critical Issues for Forensic Interviewing Victims Living with Dementia ............ 130 
Using Supportive Touch.................................................................................................................. 132 
Addressing Agitation ........................................................................................................................ 132 
Dealing with Reality Disorientation ......................................................................................... 133 
General Considerations for Communicating With Older Adults ............................... 104 
Interviewer Considerations for Communicating with Older Adults .................... 108 
Communication Style of Older Adults.................................................................................. 109 
Establishing Alternative Hypotheses .......................................................................................82 
Considerations for Interviewer Questioning Techniques ........................................ 110 
Leading and Suggestion ..................................................................................................................112 
Interviewing Older Adults ....................................................................................................................... 137 
 

6 
 
Establishing Rapport ............................................................................................................................. 138 
Establishing Interview Guidelines ................................................................................................ 143 
Establishing a Baseline ........................................................................................................................ 149 
Check In .......................................................................................................................................................... 157 
Transition to Allegation(s)................................................................................................................. 164 
Exploring Allegations ............................................................................................................................. 168 
Respectful Closure .................................................................................................................................. 183 
Post-Interview Considerations ...................................................................................................... 187 
APPENDICES........................................................................................................................................................ 191 
APPENDIX I ...................................................................................................................................................... 192 
APPENDIX II....................................................................................................................................................206 
APPENDIX III .................................................................................................................................................. 207 
APPENDIX IV .................................................................................................................................................. 213 
APPENDIX V …………………………………………………………………………………………………………………………………………. 216 
APPENDIX VI .................................................................................................................................................. 217 
APPENDIX VII …………………………………………………………………………………………………………………….………………… 218 
References ……………………………………………………………………………………………………………………………………………… 221

INTRODUCTION

“Elder abuse is not an easy problem to address: it can manifest itself in many

ways—an older parent isolated and neglected by an adult child or caregiver;

domestic violence by a partner (long-term or new), adult child or caregiver;

sexual assault by a stranger, caregiver, or family member; abuse or neglect

by a partner with advancing dementia; financial exploitation by a stranger,

trusted family member, or professional; or systemic neglect by a long-term

care provider that hires too few staff members, provides insufficient training

to its staff, and expends too few resources on resident care.” (Connolly et al.,

2014, p. 8)

Throughout the United States, the number of older adults is growing

significantly. With this rise in the population, the frequency of older adults as

victims of elder abuse requiring a criminal investigation is increasing.

Forensic interviewing has been an established evidence-based model of

obtaining non-leading, legally defensible information from victim and witness

interviews for children. It has not been used for older adults nearly as much.

The absence of the forensic interviewing model for elder abuse victims leaves

them at risk of not obtaining justice.

Victims of elder abuse are highly heterogenous in terms of their medical and

cognitive health; experience with trauma over their lifetimes; cultural,

religious, spiritual, and social values; length of time in the United States;

history of interactions with governmental agencies; language; and resilience.

Interviewing older adults will draw from proven effective practices used with

other adults and approaches that account for the unique differences that

accompany later life and the circumstances of each older adult being

interviewed.

This curriculum provides a guide to how the forensic interview model can be

applied to elder abuse cases. With a life-span perspective, the curriculum

transfers the effective techniques learned from use with younger victims to

older adults’ specific strengths and needs. Certainly, this is not to imply that

older adults are to be seen in any way as children.

This curriculum is designed to address the many members of an investigative

multidisciplinary forensic interviewing team, including law enforcement and

Adult Protective Services (APS). There are three key frameworks that the entire

team must understand: (a) the purpose of a forensic interview in relation to

other types of investigative interviews; (b) the necessity of using a trauma-

informed approach when working with older victims of abuse, neglect, and

exploitation; and (c) the importance of a strengths-based perspective when

working with older adults. Following this training, it will be essential for

interviewers to have continued training and participate in regular peer review

in order to utilize current best practices.

Forensic Interview

A forensic interview is a trauma-informed, victim-centered process of

information gathering that is neutral and fact-finding and typically

conducted for investigative purposes in the context of a multidisciplinary

team (MDT). An MDT may include the collaboration of APS, prosecutors,

investigators, other social and psychological services, medical professionals,

advocates, and other stakeholders assisting in acquiring justice for older

adult victims of abuse. Elder abuse MDTs exist throughout the United States

and can be found using the Elder Justice Network Locator Map. Sometimes,

members of different disciplines on MDTs have training in forensic

interviewing, and some MDTs will have a specific role for forensic interviewers.

Professionals who conduct forensic interviews focus on asking questions that

encourage narration and promote gathering reliable information that informs

investigative actions and case activities. MDTs should work together to reduce

the number of interviews that are conducted with an older adult to reduce

trauma and the possibility of conflicting information. In order to ensure best

practices are employed in interviews with older adults, it is important that

forensic interviewers engage in ongoing training and peer monitoring and

support.

Several different types of interviews have been utilized when interviewing

older adults. Understanding the different types of interviews (described in the

Table 1 below) and their goals will assist professionals in better understanding

when a forensic interviewing approach is best for interviewing older adults for

investigative purposes.

Table 1. Interview Types

Type of Interview

Motivational

Interview

Cognitive Interview

Forensic Interview

Goals

Engage a person to

make changes

such as taking

protective actions

to reduce future

risk

Gather reliable and

thorough testimony

from a victim or

eyewitness for civil

and criminal

investigations

Gather reliable,

relevant evidence

from a victim for a

criminal

investigation

Typically used by

APS investigators

and human service

professionals

APS and law

enforcement

investigators

conducting

investigative

interviews

MDTs conducting

criminal

investigative

interviews

Strategies

Questioning that

expresses

empathy, develops

discrepancy, rolls

with resistance,

and supports self-

efficacy

Questioning that is

open, contextual;

transfers control for

a free report to

witness

Questioning that is

non-leading, non-

suggestive, victim-

focused, and

victim-led

Trauma-Informed Approach

Trauma is an event, series of events, or set of circumstances experienced by

an individual as physically or emotionally harmful or life-threatening. Trauma

often has lasting adverse effects on the individual’s functioning and mental,

physical, social, emotional, or spiritual well-being (SAMHSA, 2014).

During a forensic interview, the interviewer will not know with certainty

whether the older adult has experienced a prior traumatic event or not.

However, research indicates that up to 90% of older adults have experienced

at least one traumatic event during their lifetime (Kuwert et al., 2013). These

events include military combat; unexpected death of a partner, child, or

someone close; severe injury or illness to themselves or someone in their life;

or history of abuse or neglect. In addition, it is important for interviewers not to

overlook the effects of trauma commonly experienced by older generations

such as historical trauma, racial trauma, and trauma resulting from

persecution (e.g., persecution of one’s sexual orientation or gender identity;

see “A Life Course Perspective on Older Adults” for more information on

historical trauma, racial trauma, and trauma resulting from persecution). It is

also important to recognize that the current victimization that is being

investigated may be experienced as a traumatic event. This level of

prevalence is why forensic interviewers must ensure all interviews are

conducted utilizing a trauma-informed approach for older adults.

To accomplish this, interviewers must incorporate an approach based on

their knowledge of trauma and the impact of trauma into the entire interview

process. A trauma-informed approach involves understanding that trauma

can always be present and requires a change in mindset from “what’s wrong

with you?” to “what happened to you?” This approach requires honing

empathy and compassion skills while appreciating another individual’s

emotions with understanding and without judgment. Without these

specialized skills, professionals risk reverting to the “what’s wrong with you?”

mindset and perhaps retraumatizing the older adult during the forensic

interview (National Council on Behavioral Health, 2016).

Forensic interviewers must also understand the impact of trauma on memory.

For example, memory components that may affect interviewing, such as free

and cued recall, can be different for older adult survivors of post-traumatic

stress disorder (PTSD; Golier et al., 2006). When asking questions, forensic

interviewers are trained to create trauma-informed opportunities so the older

adult can recount their experience in their own words, ask questions that

minimize suggestibility, and work to minimize any possible negative impact

on the older adult.

See additional information from the Centers for Disease Control and

Prevention (CDC) and Substance Abuse and Mental Health Services

Administration (SAMHSA)’s National Center for Trauma-Informed Care

(NCTIC) here: 6 Guiding Principles to a Trauma-Informed Approach.

Strength-Based Perspective

The perspective that interviewers take during a forensic interview will have

many effects when working with older adults who have experienced abuse.

Historically, professionals across disciplines have adopted a deficit-based

perspective that solely considers perceived risk factors and deficits of

individuals, ignoring their rich and varied life experiences, skill sets, knowledge,

and community resources. Older adults have lived through a lifetime of

achievements, new opportunities, lifespan milestones, and difficult and

traumatic events (Chapin et al., 2016). They have developed effective coping

strategies and resilience. Ignoring an older adult’s individual and

environmental strengths may ultimately affect the dynamics in the interview

and the quality of information gathered throughout the investigation process.

Therefore, conducting an effective forensic interview begins with a shift in

perspective from a deficit-based perspective to a strengths-based

perspective.

Adopting a strengths-based perspective requires an interviewer to focus on

the older adult’s positive traits and resiliency factors (Janssen et al., 2011). A

strengths-based perspective values fostering trust and respect between

interviewer and older adult in addition to reducing the inherent power

differential, which is critical to developing rapport with individuals being

interviewed. When interviewers focus on strengths rather than weaknesses in

their questioning, interviewers are more likely to ensure that the older adult is

heard more completely, which will allow for a more successful interview and

investigation.

PRE-ASSESMENT

PRE-ASSESSMENT

Question Types

When interviewing older adults, it is important to consider interviewer

questioning techniques. As with any forensic interview, interviewers should

focus on using question strategies aimed at eliciting reliable and accurate

information. In general, interviewers should focus on asking questions that

solicit free recall (i.e., open-ended questions). Research in interviewing adults

of any age has long supported the use of open-ended over close-ended

questions as it allows the individual to recall and report their experiences

reliably (Brubacher & Powell, 2019; Cassel, Roebers, & Bjorklund, 1996;

Geiselman & Fisher, 2014; Poole & White, 1991).

However, research has also demonstrated that although interviewers know it

is more desirable to ask open-ended questions, they often utilize more close-

ended questions instead (Oxburgh et al., 2010). When interviewers pose close-

ended questions, the focus of the interview shifts from what the older adult

knows to what the interviewer “needs” to know and may introduce the risk of

gathering inaccurate and/or influenced information. Interviewers should

instead focus on asking open-ended questions that will be more likely to

solicit information from the older adult as they remember it, allowing them to

be the expert in their experiences.

There are four categories of questions to consider when interviewing older

adults:

1. Narrative Prompt

2. Open-Focus

3. Choice

4. Yes/No

Narrative Prompt

Narrative prompts are statements that allow the older adult to report everything

they know. Prompts are considered more reliable than traditional open-ended

questions when interviewing older adults, as they solicit information through free

recall. When prompts are posed, older adults commonly respond utilizing more

than one word or short phrases.

Examples:

”Tell me everything about your pets.”

“You said that you went to the park on Wednesday. Tell me more about

going to the park.”

Open-Focused

Open-focused prompts are open-ended questions that direct the older adult’s

focus on a particular response category (e.g., person, place, time). Open-focused

prompts often are framed as “wh” questions that allow for a wide range of

responses from an older adult (e.g., one-word responses, short phrases, or narrative

responses).

Examples:

“What happened after you went to the movies?”

“Who was in the room?”

Choice

Choice questions are close ended that commonly include “or” in the question.

Choice questions are posed by giving two or three options in addition to a

“something else” option. The “something else” option is essential to reduce

influenced, inaccurate information.

Examples:

“Did it happen in the day room, the dining room, or someplace else?”

“Were your clothes on, off, or something else?”

Yes/No

Yes/No questions are closed-ended questions that encourage a one-word

response. Interviewers should not rely on yes/no questions alone during a forensic

interview with an older adult, as this type of prompt shifts the focus to what the

interviewer “needs” to know rather than focusing on the information the older adult

remembers. Many individuals will respond with additional information when a

yes/no question is posed “yes, and …”; however, interviewers should still limit this

type of question as it is not the most reliable way to obtain additional information.

Examples:

“Did they have a gun?”

“Did they say something?”

As with any interaction, interviewers are responsible for tailoring the interview to

meet the needs of each older adult. When asking questions during an interview, an

interviewer should tailor question types posed to match the individual's abilities and

needs while utilizing the most open-ended questions possible.

The Recycling Funnel Model

Interviewers should be mindful of the questions they are posing during a forensic

interview. To conceptualize this, interviewers may utilize the recycling funnel model.

Questions are placed on the funnel based on their openness and reliability in an

interview. Narrative prompts are placed at the top of a funnel, while yes/no

questions are placed at the bottom end of the funnel, as described by the graphic

below.

Each question type serves a purpose during a forensic interview. During an

interview, it may be necessary for interviewers to ask choice or yes/no

questions in order to obtain important investigative information not otherwise

gathered through narrative prompts and open-focused questions. In order to

maximize reliable information garnered through the interview process,

interviewers should utilize a technique called “recycling.” When interviewers

pose yes/no questions, they should immediately find opportunities to

“recycle” back up the funnel to open-ended questions (e.g., asking “Tell me

about that” following a yes/no question).

Narrative Interview Mapping

Narrative Interview Mapping is a technique developed by Dr. Mark Everson and

colleagues for visually summarizing the type and sequence of questions used in a

forensic interview. Interviewers may utilize this technique as a method of providing

feedback about question patterns during peer review and/or self-review. This

method of review places emphasis on assessing an interviewer’s use of forensic

interviewing best practice standards (e.g., use open vs. close-ended questions,

good recycling habits, etc.) and highlights an interviewer’s strengths and

weaknesses when asking questions throughout a forensic interview.

The four categories of questions are emphasized:

1) Narrative prompts (e.g., “Tell me about the knife.”)

2) Open-focus questions (e.g., “What color was his shirt?”)

3) Choice questions (e.g., “Were you in the day room, the dining room, or

someplace else?”)

4) Yes/no questions (e.g., “Did they say something?”)

Questions asked during an interview are numbered in sequence and recorded on

the Narrative Interview Mapping Funnel (Appendix II) under the appropriate

question category. When a yes/no question is posed, any “yes” or positive answer is

circled. Circling the yes/no questions that elicit a positive response allow the

interviewer to observe their recycling habits by examining what kind of question

they asked immediately following the yes/no question. Ideally, the interviewer would

employ good recycling habits and follow this question with a narrative prompt such

as, “Tell me about that.”

Example of Interview Mapping

Question 1

Interviewer: “Tell me about going out to dinner last night.”

Interviewee: “We went out to dinner for my daughter’s birthday. My

husband and I wanted to treat her to her favorite meal.”

Question 2

Interviewer: “Where did you go eat?”

Interviewee: “We went to a steakhouse called Johnny’s.”

Question 3

Interviewer: “Did anyone else go with you?”

Interviewee: “Yes, my daughter brought a friend named Tammy.”

Question 4

Interviewer: “Tell me about Tammy.”

Interviewee: “My daughter works with Tammy.”

Question 5

Interviewer: “When you were at Johnny’s, did you sit at a table, a booth, or

someplace else?”

Interviewee: “We sat in a booth.”

Question 6:

Interviewer: “Tell me everything that you saw from the booth where you sat.”

Interviewee: “They had lots of black and white photos on the wall. There was

one photo near our table that I could see a family dressed up

standing outside of the restaurant. It looked like it was from the

1960s.”

Question 7:

Interviewer: “Tell me what everyone in the family was wearing.”

Interviewee: “They were dressed up. There was a man wearing a suit, a

woman wearing a cocktail dress, and a young girl wearing a

dress with a big bow.”

Question 8:

Interviewer: “Do you remember anything about any other pictures on the

wall?”

Interviewee: “No.”

Sample Mapping Score

Narrative Prompt

1, 4, 6

Open-focus

2, 7

Choice

Yes/No

3, 8

Pre-Assessment Instructions

This pre-assessment practicum was developed and adapted from “Taking

AIM: Advanced Interview Mapping for Child Forensic Interviewers” (Everson et

al., 2020). The use of this tool does not mean that interviewing older adults is

exactly like interviewing children. While this tool was developed focusing on

children, the central tenants of utilizing non-leading, legally defensible

question types remain the same in any forensic interview, regardless of the

victim’s age. As previously stated, narrative interview mapping is one tool

interviewers may utilize as a method of providing feedback about question

patterns during peer review and/or self-review.

Materials:

• Case Scenarios (Appendix I)

o Participants will be assigned case scenarios before the pre-

assessment practicum. Participants will utilize this same case

scenario throughout the entire course.

• Narrative Interview Mapping Funnel (Appendix II)

o Each participant will have an opportunity to map another

participant’s interview utilizing the “Narrative Interview Mapping

Funnel.”

Instructions:

1. Each participant will be assigned a case scenario from Appendix I.

Case 1: May

Case 2: Allen

Case 3: Benny

Case 4: Camille

Case 5: Judy

Case 6: Kishan

2. Participants will be broken into groups of three, each participant in the

group will have a different case scenario.

3. There are three alternating roles (interviewer, interviewee, and

recorder):

• Interviewer:

o Assume that the interviewer and interviewee have

established rapport and completed the early stages of the

interview.

o Begin the interview after the interviewee makes an initial

disclosure statement.

o Obtain as much information as possible about the event or

events in question.

• Interviewee:

o Assume rapport has been established and narrative event

practice has taken place.

o Start by making the disclosure statement.

o Be cooperative, but only answer the specific question asked

(i.e., If a yes/no question is asked, answer only “yes” or “no”

and do not elaborate.)

o Make the interviewer work to get the information (i.e., do not

just volunteer information).

o Make up additional case details as needed (names,

locations, hobbies, etc.).

• Recorder:

o Pay attention to the type of questions that the interviewer

asks and assess where they belong on the map.

o Number each question asked on the provided interview

mapping funnel (Appendix II).

o Circle the question number of all yes/no questions

generating a “Yes” answer (or its equivalent).

4. Each group should decide who will be the first interviewer. This

interviewer will have 4 minutes to complete a pre-assessment

interview.

5. This process repeats until all participants have played each role (i.e.,

interviewer, interviewee, and recorder).

6. After all rounds of the pre-assessment are completed, teams will

provide feedback to the interviewer they recorded. Teams may discuss

the following:

• Funnel being top heavy or bottom heavy.

o Top Heavy: The majority of questions asked are open-

ended (e.g., Narrative Prompts and/or Open Focused

Questions). This approach is desirable.

o Bottom Heavy: The majority of questions asked are close

ended (e.g., Choice Questions and/or Yes/No Questions).

• Recycling habits

o Good recycling habits are demonstrated when an open-

ended question follows a close-ended question.

• Productivity of narrative prompts

o Narrative prompts are productive when a narrative prompt

is answered with a narrative response rather than single

words or short phrases.

• Length of yes/no strings

o Yes/no strings occur when more than one Yes/No question

is asked in a row. In general, for older adults who speak

using vocal-verbal communication, this approach is not

desirable.

ELDER ABUSE DEFINITIONS

Elder Abuse

Elder abuse is “a complex cluster of distinct but related phenomena involving

health, legal, social service, financial, public safety, aging, disability, protective

services, and victim services, aging services, policy, research, education, and

human rights issues. It, therefore, requires a coordinated multidisciplinary,

multi-agency, and multisystem response” (Connolly et al., 2014, p. 5).

There is no universal definition of elder abuse, and state and federal statutes

use diverse definitions. Frameworks for the phenomenon have been

developed for various purposes such as public health, benefits, eligibility for

APS programs, and civil and criminal actions. Similarly, there is no single

definition of elder or older adult.

Many definitions of elder abuse require “that some injury, deprivation, or

dangerous condition has occurred to the elder person and that someone else

bears responsibility for causing the condition or failing to prevent it” (Bonnie &

Wallace, 2003, p. 40). The context of the abuse includes a relationship in which

there is a societal expectation of trust, such as intimate partner, family

member, caregiver, or person who has a fiduciary relationship with an older

adult, such as an attorney-in-fact, guardian, or trustee.

Table 2. Definitions of Elder Abuse

Source

Definition

National Research

Council

“Intentional actions that cause harm or create serious risk of

harm, whether or not intended, to a vulnerable adult by a

caregiver or other person who stands in a position of trust to the

elder, or failure by a caregiver to satisfy the elder’s basic needs or

to protect the elder from harm” (National Research Council, 2003,

p. 1).

CDC

“Elder abuse is an intentional act, or failure to act, by a caregiver

or another person in a relationship involving an expectation of

trust that causes or creates a risk of harm to an older adult” (CDC,

2020, para. 1).

United States

Department of

Justice (DOJ)

Roadmap Project

“Physical, sexual or psychological abuse, as well as neglect,

abandonment and financial exploitation of an older person by

another person or entity that occurs in any setting (e.g., home,

community or facility), either in a relationship where there is an

expectation of trust and/or when an older person is targeted

based on age or disability” (Connelly et al.,2014, Appendix A, p. 2).

World Health

Organization

“A single, or repeated act, or lack of appropriate action, occurring

within any relationship where there is an expectation of trust

which causes harm or distress to an older person” (World Health

Organization, n.d., para. 1).

Elder Abuse

Prevention and

Protection Act of

“Includes abuse, neglect, and exploitation of an elder”; this is

further defined in Section 2011 of the Social Security Act (42 U.S.C.

1397j:

2017 (Public Law

115–70)

Abuse: “The knowing infliction of physical or psychological harm

or the knowing deprivation of goods or services that are

necessary to meet essential needs or to avoid physical or

psychological harm.”

Caregiver: “An individual who has the responsibility for the care of

an elder, either voluntarily, by contract, by receipt of payment for

care, or as a result of the operation of law, and means a family

member or other individual who provides (on behalf of such

individual or of a public or private agency, organization, or

institution) compensated or uncompensated care to an elder

who needs supportive services in any setting.”

Exploitation: “The fraudulent or otherwise illegal, unauthorized, or

improper act or process of an individual, including a caregiver or

fiduciary, that uses the resources of an elder for monetary or

personal benefit, profit, or gain, or that results in depriving an

elder of rightful access to, or use of, benefits, resources,

belongings, or assets.”

Elder: “An individual age 60 or older.”

Neglect: “The failure of a caregiver or fiduciary to provide the

goods or services that are necessary to maintain the health or

safety of an elder; or self-neglect.”

These definitions of elder abuse that describe both criminal and non-criminal

acts, provide a way to frame and distinguish elder abuse from other acts

(criminal or non-criminal) committed by and against older adults (e.g., self-

neglect, stranger crimes, and many scams and frauds). This framework

excludes some of these kinds of cases that are investigated by APS or eligible

for protective court proceedings, such as guardianship.

Note: Not all jurisdictions use the term guardianship. Some use

guardianship to refer to protective proceedings for the personal and

medical needs of a person requiring protection; others use the term

conservatorship to refer to protective proceedings for financial matters;

still others use conservatorship to refer to both. In this document, we will

use the term guardianship to refer to both kinds of proceedings—the person

and finances of a person requiring protection.

Just as there is no single definition of elder abuse, there is no single accepted

age when a person becomes an elder. For example, both the Elder Abuse

Prevention and Prosecution Act of 2017 and Older Americans Act of 1965 (42

USC §3002(38)) define an older adult as 60 years of age or older. The DOJ,

Office on Violence Against Women’s Enhanced Training and Services to End

Abuse in Later Life Program, defines its target population as persons 50 and

above. Many tribal communities define an elder as 50 or 55 or older. Social

Security and Medicare programs use the age of 65. Some states do not use

an age definition at all but include all adults (age 18 and older) who have a

physical, developmental, or intellectual disability that makes them unable to

meet their basic needs or protect their legal rights.

Proof in Elder Abuse Cases

Depending on the jurisdiction, responding system, and agency, various laws

and regulations will guide how elder abuse is reported and handled and will

establish the applicable standard of evidence or burden of proof required for

civil and criminal proceedings. Such criminal actions are usually subject to

the legal standard of guilt beyond a reasonable doubt.

Every state (except New York), the District of Columbia, and the territories and

possessions of the U.S. have enacted elder or vulnerable adult abuse

reporting statutes (APS Reporting Statutes) that mandate certain

professionals or all persons to report suspected abuse to an identified

protective services or criminal justice agency. The standard to report is

usually “reasonable suspicion.”

Allegations meeting eligibility criteria (which differ from jurisdiction to

jurisdiction) are investigated, usually by a protective services agency, to

evaluate risks and offer services and interventions to reduce risks and protect

clients. The standard of proof for founding an allegation is typically

preponderance of the evidence. If cases require civil interventions such as

guardianship or a restraining order, the legal standard is preponderance or

clear and convincing evidence, depending on local laws. These standards are

defined in the next section.

Standards/Burdens of Proof

There are four legal burdens of proof relevant to elder abuse matters. These

standards of evidence, also called burdens of proof, describe the quantum of

information required to take an action or make a legal finding of culpability.

Table 3. Standard of Proof

Standard/Burden

Definition

Reasonable

Suspicion or Belief

• The minimal amount of information sufficient to

initiate an inquiry or investigation

• Requires some information indicating a reason a

person is concerned that an older person is being

harmed that is reported to APS or a 911 call about a

suspected illegal action that is occurring or has

occurred

Preponderance of

Evidence and

Probable Cause

• The evidence makes the allegation more likely than

not

• The lowest burden of proof in the civil justice system:

o Amount of evidence to prevail in a civil

lawsuit, such as for negligence after a car

accident or a slip and fall in a business

o The standard for most APS programs to

confirm an allegation of abuse has occurred

• Called “probable cause” in criminal law and is the

amount of evidence required to make an arrest

Clear and

Convincing

Evidence

• Proof that establishes that the fact or element is

highly probable and leaves the fact finder with a

firm conviction or belief that the cause is true

• Standard often used when deciding if someone can

be placed on an abuser registry

• Frequently a state’s standard for a court to order

guardianship or conservatorship (American Bar

Association Commission on Law and Aging [ABA

COLA] Standard of Proof)

• Often used in fraud actions or when seeking

equitable relief

Beyond a

Reasonable Doubt

• Legal standard to convict someone of a crime

• The highest burden of proof in law

• Defined as proof that leaves the trier of fact with an

abiding conviction that the charge is true and there

is “no other reasonable explanation that can come

from the evidence presented at trial” (Cornell Law

School, 2020)

Forms of Elder Abuse

Interviewers should work with their team or community partners to become

familiar with local statutes to see which forms of abuse may be included in

their jurisdictions, including criminal and civil statutes, reporting laws, and

eligibility for APS assistance (these statutes can be found at Elder Justice

Statutes). Elder abuse typically encompasses several forms of conduct, which

are defined in different ways across jurisdictions. Not all instances of elder

abuse rise to the level of a crime.

These definitions of types of elder abuse come from The National Center on

Elder Abuse:

Physical: “Intentional use of physical force that results in illness, injury, pain or

functional impairment”

Physical abuse may include over- or under-medicating an older adult to

make them compliant, confused, less able to recognize or report, or keep

them quiet; forced feeding; and improper use of chemical and other

restraints. It also includes domestic violence and abuse in later life and

strangulation and suffocation committed against older adults. These actions

may be undetected and result in death when the victim would have survived

the assault in earlier life.

Sexual: “Non-consensual sexual contact of any kind”

Sexual abuse includes acts committed upon a person unable to give legal

consent to sexual contact. It includes the following:

• Hands-on conduct (e.g., various sex crimes, forced production of

pornography)

• Hands-off conduct (e.g., forced watching of pornography or sex acts)

• Harmful genital practices (e.g., painful, intrusive, and unnecessary

cleaning; inspection or handling for the perpetrator’s sexual

gratification; Ramsey-Klawsnik, 1996).

Older victims who are sexually abused by family members often have

dementia and are dependent on others for care and the management of

their assets. Sexual abuse may also be part of a pattern of complex,

multifaceted, intimate partner abuse (Ramsey-Klawsnik, 2003).

Neglect by a caregiver: “Caregivers or other responsible parties failing to

provide food, shelter, health care, or protection”

Neglect is the failure to act by one with a duty to act (duty of care) on behalf

of a person unable to provide for their own needs or to protect their legal

rights. While there are variations regarding the relationships that give rise to a

legal duty of care across jurisdictions, a person can be a caregiver because

they are paid to provide care (contractual relationship), because of a legal

relationship such as a spouse or guardian, or because they have assumed

care and are not free to simply abandon the care recipient.

Victims of neglect often have significant physical and mental impairments

and are dependent on others for care. Many neglected older adults are

unable to describe their victimization and, because of their condition, may be

easily isolated so that the conduct is not detected.

A caregiver may provide personal care or have the duty to arrange for and

compensate caregivers. Such a duty may arise through a power of attorney,

guardianship, contract, or other agreement.

Abandonment: Some jurisdictions include additional forms of abuse to their

laws, such as abandonment. Abandonment is the desertion of an elderly

person by an individual who has assumed responsibility for providing care for

an older person or by a person with physical custody of the older person

(National Center on Elder Abuse, n.d.). In jurisdictions that do not include

abandonment, the conduct is usually included in other forms, such as

neglect.

Financial: “Misappropriation of an older person’s money or property”

Financial exploitation includes the illegal or improper use of an elder’s funds,

property, or assets. These are some examples:

• Taking or selling things without permission

• Making older adults sign legal documents they do not understand

• Forcing an older adult to give away something that belongs to them

• Impersonating the older adult to obtain goods or money

• Keeping money that belongs to the older person, stopping the older

person from using their own money

• Keeping information about the person’s assets from the older person

(DOJ, Elder Justice Initiative, n.d.)

Some—but not all—victims have physical and cognitive deficits that interfere

with their ability to understand financial transactions or pay bills.

Financial exploitation is sometimes divided into two categories: financial

abuse and elder fraud. “Exploitation may also involve coercion, enticement,

intimidation, and/or undue influence for one’s own profit or benefit. As distinct

from fraud, financial abuse involves a breach of trust between a vulnerable

older person and a family member, close friend, caregiver, or person in a

position of trust who misuses the elder’s funds to serve his or her own needs

at the elder’s expense” (Deliema & Conrad, 2017, p. 141). In elder fraud cases,

scams are committed by perpetrators not personally known to their victims

(Deane, 2018; Deliema & Conrad, 2017).

Scams: Perpetrators have several ways of encountering and engaging with

their victims. Some meet their victim through face-to-face engagement,

online, via telephone, or through the mail. The majority of scams that

specifically target older adults focus on the following:

• Financial gain for the older adult (e.g., lottery scams)

• A desire for an intimate relationship (e.g., romance scams)

• Providing help (e.g., grandchild scam)

• Compliance with authority (e.g., warrant out for arrest scam)

• Fear of loss of benefits or safety (e.g., social security scam)

The interviewer should be aware that these scams are constantly evolving.

The names of scams are not as important to the interviewer as an

understanding of how they occur. The use of the name of a specific scam

with an older adult during an interview is often irrelevant. The interviewer

should understand that in each of these scams, the perpetrator has

convinced the older adult to trust that they have the victim’s best interest in

mind. Perpetrators build and then exploit that trust in almost all forms of

scams.

While many of these scam types target older adults, being a victim of the

scam does not indicate a cognitive deficit, a lack of intelligence, or a victim’s

weakness. Instead, it is possible that the older adult may not want to believe

they are the target of fraud or may not share possible fraud with their family

members due to feelings of embarrassment and guilt. A strengths-based

approach to the interview is critical to support the older adult who may be

embarrassed or ashamed that they were the victim of a scam. (More

information can be found about scams in Appendix VII).

Emotional/Psychological: “Inflicting mental pain, anguish, or distress on a

person”

Emotional abuse is accomplished through verbal and nonverbal acts, many

demeaning or degrading of the victim.

Examples include these:

• Stalking in later life

• Bullying

• Vandalism of the victim’s prized possessions

• Refusing to talk to an older adult

• Infantilizing an older person

• Isolation

• Threatening abuse of a pet/abuse of a pet

Emotional/psychological abuse, such as threats to place an older adult in a

nursing home, can be used to dissuade or prevent the reporting of physical

abuse or financial exploitation or to facilitate other forms of abuse. (See

“Multiple Victimization Events/Polyvictimization”.)

Multiple Victimization Events/Polyvictimization

Some perpetrators engage in a single form of abuse, though individual acts

may recur (i.e., multiple victimization events or multi-victimization).

Sometimes, multiple forms of abuse co-occur. Called polyvictimization, it is

defined in the elder abuse framework as follows: “when a person aged 60+ is

harmed through multiple co-occurring or sequential types of elder abuse by

one or more perpetrators, or when an older adult experiences one type of

abuse perpetrated by multiple others with whom the older adult has a

personal, professional or care recipient relationship in which there is a

societal expectation of trust” (Ramsey-Klawsnik et al.,2014, p. 15).

U.S. studies have estimated that 30% to 40% of older abuse victims reported to

APS experience multiple forms of victimization by the same offender. In one

study, 34% of investigated APS reports involved financial exploitation,

accompanied by either neglect or physical abuse. A study of APS cases in

Cleveland found that polyvictimization occurred in 89.7% of cases in which

psychological abuse or neglect occurred (Anetzberger, 1998, Dong et al.,

2014).

Rates of polyvictimization among persons living with dementia are significant.

One study of 129 community-dwelling persons living with dementia and their

caregivers found that elder abuse occurred in nearly half of the cases, with

more than one form of abuse committed in 31% of the cases. All physical

abuse victims were also psychologically abused, neglected, or both

(Wiglesworth et al., 2010).

Interviewers should always be aware that polyvictimization can happen in

any setting. One study that assessed polyvictimization in both community-

based and long-term care settings found that 15% of the older adults residing

in a long-term care facility experienced two or more forms of elder abuse

simultaneously. Residents who needed assistance with a larger number of

activities of daily living (ADLs) were at greater risk of being abused in multiple

ways. If a resident had been financially exploited, their risk for physical abuse,

emotional abuse, and neglect increased substantially (Post, et al., 2010).

Another study reviewed allegations of sexual abuse allegedly committed

against residents living in facilities: 45% reported they had been sexually

assaulted, 13% had been threatened by their abusers, and 19% had been

victims of other forms of abuse (Ramsey-Klawsnik et al., 2010).

See the “Considerations for Polyvictimization and Multiple Victimizations”

section for additional considerations for disclosure of polyvictimization or

multiple victimizations during a forensic interview.

Sometimes, as a result of abuse and neglect by another or other

circumstances, an older person may become unable or unwilling to provide

themselves with adequate necessities and resources for maintaining safety

and independence (Dyer et al., 2007). It can take the form of physical,

medical, and/or mental health neglect (Burnett et al., 2014).

Settings in Which Elder Abuse Occurs

Most older adults live in their homes in the community. Only about 1.5 million

adults (or about 3.4% of people aged 65 and older) live in long-term care

facilities such as nursing homes. Most abuse occurs in community (home)

settings rather than institutional settings (Acierno et al., 2010; Kosberg &

Nahmiash, 1996; Rosay & Mulford, 2017), which is not surprising given most

older adults reside in community settings. Some 89.3% of reports to APS

programs across the United States occur in domestic settings (Teaster et al.,

2006).

Abuse in Long-Term Care Settings

Because elder abuse can occur in any setting, it is useful for interviewers to

recognize that the response system for abuse occurring in long-term care

settings differs from that of elder abuse committed against community-

dwelling older adults (Daly, 2017). State regulation of long-term care facilities

imposed by federal regulation results in a different response system. Resident

abuse is within the jurisdiction of the state’s survey and certification entity

(with federal oversight) and the Medicaid Fraud Control Units, which are

federally funded but state entities typically housed in the state’s Office of the

Attorney General. The Long-Term Care Ombudsmen program provides

advocacy for residents but does not conduct investigations. Further, only

approximately half of APS programs have jurisdiction in long-term care

settings.

Although the extent and nature of abuse in long-term care settings are not

well studied, it is known that elder abuse is prevalent (Yon et al., 2019; National

Center on Elder Abuse, n.d.). Studies over the past several decades show

similar results: a survey of nursing home staff found in the year prior to the

study that 36% had witnessed at least one incident of physical abuse, and 81%

had seen at least one incident of psychological abuse (Pillemer & Moore,

1989). Remarkably, 19% acknowledged committing at least one act of physical

abuse, and 40% admitting committing one or more acts of psychological

abuse (Hearing, 2011). In a study that included 2,000 interviews with nursing

home residents, 44% said they had been abused, and 95% said they had been

neglected or seen another resident neglected (Broyles, 2000). In a third study,

more than 50% of nursing home staff admitted to mistreating (e.g., physical

violence, mental abuse, neglect) older residents within the prior year. Two-

thirds of those incidents involved neglect (Ben et al., 2010).

While the research and tracking are limited, there is increasing awareness of

the forms that elder abuse takes in long-term care settings. These include

“seclusion, withholding medication, over medicating resident to resident

aggression, under-treating pain, chemical or physical restraint, poor hygiene,

skin lesions, dehydration, malnutrition, pressure ulcers, urine burns and

excoriation, contractures, delirium, vermin infestation, and accelerated

functional decline” (Daly, 2017, p. 70). The risk of elder abuse is increased for

residents without family, friends, or advocates; those living on public

assistance; and those who are aggressive (Brandl et al., 2007).

Institutional factors also increase the risk for abuse and neglect of residents in

long-term care settings include the following:

• Stressful working conditions due to staffing shortages and other

factors (understaffing in nursing homes results in neglect of

residents and a 22% increase in hospitalizations; CMS, 2001)

• Staff burnout

• The combination of residents’ aggressive behaviors with inadequate

staff training on managing problematic behaviors (Hawes, 1989)

• Poor hiring and staff screening

• Lack of management oversight and supervision

Resident-to-Resident Aggression

Another form of abuse in long-term care settings is resident-to-resident

aggression (RRA), defined as “negative and aggressive physical, sexual, or

verbal interactions between long-term care residents that in a community

setting would be construed as unwelcome and have high potential to cause

physical or psychological distress in the recipient” (Rosen et al., 2008). RRA is

underreported but appears to be common (U.S. Government Accountability

Office, 2002). According to the National Center on Elder Abuse (2013), RRA

reports are the second most commonly reported type of abuse in long-term

care facilities, accounting for 22% of all reports.

Key Concepts: Competency, Capacity, and Consent

Key to any discussion of elder abuse are the concepts of competency,

capacity, and consent. Interviewers should be generally aware of these

concepts because they may arise in pre-and post-interview meetings. They

may be raised as reasons not to interview at all or when evaluating whether

an older person provided credible information during the interview.

Competency

Competency and capacity are often used interchangeably, but they are

separate and distinct concepts. Competency is a legal determination made

by a court pertaining to whether someone is able to do certain things. The

public is most familiar with competency to stand trial. For our purposes,

however, testimonial competency is most relevant—whether a witness can

give testimony.

All adults are presumed competent to testify unless and until a court

determines otherwise. The legal standard is quite low—can a witness

understand the duty to be truthful and communicate information so as to be

understood? “Witness (including the victim) competency to testify requires a

minimal ability to observe, recollect, and communicate information and

understand the duty to tell the truth” (Aequitas, 2017, p. 16).

In a legal context, the determination of competency is all or nothing; a person

cannot be almost competent—the person either is or is not competent at the

time a court makes its ruling. Because the determination is time-specific, a

person can be found incompetent today but be deemed competent on

another day.

Capacity

In contrast, capacity is a clinical term describing a person’s physical and/or

cognitive abilities (Falk & Hoffman, 2014). It focuses on a person’s functional

abilities (such as to drive, manage their finances, and perform ADLs).

Capacity may vary by the complexity of the act or decision, time of day,

medications, illness, fatigue, trauma, and grief. Capacity is not all or nothing;

rather, it is task-specific, so a person may have certain capacities while

lacking others.

Capacity is contextual and varies by the complexity of the task to be done or

the decision to be made. The more significant the decision and the

consequences of the decision, the higher the level of capacity required. “A

person may have deficits relating to functional capacity, but still be

competent to testify. A person may have certain functional capacities but be

found legally incompetent to testify or stand trial” (Aequitas, 2017, p. 16).

Similarly, a person can have functional deficits (vision, mobility) but be able to

report accurately and fully participate in an interview about what has

occurred. The interviewer may need to modify the interview process by

making changes to the interview setting, changing the interview location,

providing sound amplification, and otherwise accommodating the functional

needs of the older adult.

Capacity encompasses a broad range of concepts, but two particular types

of capacity are decision-making capacity, which includes both the ability to

make a decision, and executional capacity, which is the ability to implement

a decision.

Decision-making (also called decisional) capacity at the time of a critical

transaction or event is the most common legal issue in elder abuse cases. A

person’s decision-making capacity to make a gift, execute a will, manage

their financial affairs, accept or refuse medical treatment or services offered

by APS, drive, marry, or enter into a contract may all be challenged.

All adults are presumed to have decision-making capacity unless and until it

can be demonstrated otherwise. Decision-making capacity is determined by

a person’s ability to do the following:

• Understand the basic facts about a decision

• Appreciate how the decision relates to their personal situation,

including their strengths and limitations

• Be able to reason and rationally evaluate information by comparing

options and the consequences of alternative choices

• Be able to make an informed decision

Executional capacity requires that a person is able to do these things:

• Formulate a plan

• Make changes in response to novel or changing conditions

• Delegate tasks to appropriate others when personally unable to

implement the plan (Falk & Hoffman, 2014; Naik et al., 2008)

Financial Decisional Capacity

Given the extent of financial exploitation, cases often involve a person’s

financial decision-making capacity. This form of capacity is defined as “the

capacity to manage money and financial assets in ways that meet a person’s

needs, and which are consistent with his or her values and self-interest”

(Marson et al., 2011). It includes financial literacy and requires executive

function.

Financial capacity can decline in later life and may present as increasingly

rash and irrational financial decision-making and may be a sign of mild

cognitive impairment (MCI) or impending Alzheimer’s disease (Marson &

Sabatino, 2012). Declines in financial capacity can weaken a person’s financial

judgment and reduce their ability to understand the consequences of

financial decisions, protect themselves from exploitation, or recognize their

victimization (Deane, 2018). Declines in financial capacity or executive

functioning should not be viewed as indicators that an older adult cannot

provide reliable information during a forensic interview.

Executive function is the foundation for judgment and is essential for making

complex financial decisions. It includes the ability to plan; organize, sequence,

and process information; and regulate mood and affect. A person can have

deficits in executive function without having dementia or memory impairment

(Dyer et al., 2007; Institute of Medicine, 2015).

Consent

Consent is intertwined with capacity: a person cannot give legal consent if

they lack adequate decision-making capacity. Like capacity, consent is also

fluid and may change from day to day and moment to moment, depending

on the individual and their circumstances.

Consent requires these components:

• The person who allegedly gave consent must have the decision-

making capacity to make the decision and give consent as alleged

(e.g., whether the older adult had the decisional capacity to deed his

home to another, enter into a contract, or make a large gift).

• The person who allegedly gave consent must understand the true

nature of the transaction (what they are consenting to), so they were

not misled or deceived about or denied critical information.

• The person who allegedly gave consent did so freely and voluntarily

without duress, threats, manipulation, or undue influence.

Even when a person with decision-making capacity seems to have

consented, consideration should be given as to whether the consent was

obtained through the use of undue influence. If the older adult did not have

full knowledge of the true nature of what they agreed to or agreed because

they were manipulated, threatened, or forced, they have not given legal

consent. Interviewers should consider asking questions about conversations

to screen for fraud, coercion, misrepresentation, or manipulation because

these, too, vitiate consent. See “Undue Influence” for additional information on

this topic.

HISTORY OF ELDER ABUSE

In the United States, attention to addressing the needs of older adults

vulnerable to abuse and neglect can be traced back to the 1960s. The White

House Conference on Aging in 1961 recommended a multidisciplinary effort to

protect vulnerable older adults (NAPSA-Now.org, 2021). In 1962, amendments

to the Social Security Act authorized funding to states to develop protective

services units. Additionally, throughout the 1960s, the Administration on Aging

funded several projects that provided protective services to older adults.

APS offered a social service approach to addressing abuse and neglect that

remains in place today. Initially, protective services focused primarily on

supporting individuals in situations of neglect through social service and civil

legal remedies (Anetzberger & Thurston, 2021).

In the 1970s, attention to older adults’ vulnerability took the next step from a

primary focus on neglect to include physical abuse due to the first significant

national press about elder abuse and federal legislative public hearings

(Teaster et al., 2010). The terms “granny bashing” and “granny battering”

started in the U.K. in 1975 and were used in the United States after these press

articles and hearings. This conceptualization of abuse focused social service

interventions on the physical assault of older adults, particularly older adult

women, by family members in caregiving situations.

In contrast to child abuse interventions that included law enforcement as part

of the solution, elder abuse interventions during the 1970s and 1980s remained

focused almost exclusively on social service interventions. Even with the

introduction of physical abuse, the theory was that family caregivers were

abusers because of the natural stress of caregiving. This premise of why the

abuse occurred directed social service interventions that could decrease

stress to prevent abuse and did not include law enforcement intervention that

would punish the overburdened caregiver.

“Research in the 1980s and 1990s concluded that while abuse may be the

result of caregiver stress, it is often due to ‘abuser psychopathology’” (McNeal

& Brown, 2019, p. 100). As a result, interventions began to be based on

domestic violence models, with more criminal justice system involvement

(McNeal & Brown, 2019).

By the end of the 1980s, the concept of victimization of older adults began to

evolve even further. In 1987, amendments to the Older Americans Act

expanded the definition of elder abuse beyond neglect and physical abuse to

include sexual abuse, emotional/psychological abuse, abandonment, and

financial exploitation (Teaster et al., 2010). Despite this broad definition, abuse

and neglect in caregiving situations continued to be the primary focus of

protective services units during the 1990s, too often not involving law

enforcement. Neglect cases, especially self-neglect cases, often required

intensive and expensive social service interventions, leaving little funding for

other aspects of elder abuse.

During the 1990s, there was an emerging trend to include a criminal justice

framework for elder abuse (Connolly, 1997). Research had questioned the

caregiver stress model as an explanation for abuse. All caregiving is stressful,

and most caregivers successfully provide care without abusing the older

adult. The focus of why abuse occurs started to look at the characteristics of

the abuser that led to the violence, which was more closely aligned with a

family violence model.

While national legislation was scant in supporting criminal justice

interventions, more and more local jurisdictions started viewing elder abuse

with a criminal justice approach. During this time, many states passed laws

that criminalized the abuse and neglect of older adults and allowed for

sentence enhancements for perpetrators if the victim was an older adult or a

person with a disability.

In the early 2000s, elder abuse interventions started to be thought of as part

of a framework of elder justice. In 2002, the Elder Justice Act was introduced.

This act represented the first significant piece of legislation that added the

concept of criminal justice to the spectrum of elder abuse interventions. In the

executive summary for the act, Senator Breaux, the primary author of the bill,

defined elder justice as “assuring that adequate public–private infrastructure

and resources exist to prevent, detect, treat, understand, intervene in and,

where appropriate, prosecute elder abuse, neglect, and exploitation. From an

individual perspective, elder justice is the right of every older American to be

free of abuse, neglect, and exploitation” (Elder Justice Act, 2002).

The Elder Justice Act was passed 8 years later in 2010 as part of the Patient

Protection and Affordability Act. However, the enacted version still focused

primarily on public health and social services approaches to elder abuse

(Congressional Research Services, 2020). It did not include the criminal justice

responses to elder abuse contained in previous versions.

Throughout the 2000s to today, forensic techniques have started to become

part of the approaches to elder abuse in some states and communities.

Multidisciplinary fatality review and case review teams coordinate local

responses between the social service and criminal justice systems to address

gaps in responding to and preventing elder abuse in many jurisdictions

(Taylor & Mulford, 2015). States continue to enact statutes criminalizing elder

abuse, and in some cases, requiring training of law enforcement who respond

to elder abuse.

In 2017 the Elder Abuse Prevention and Prosecution Act became the first

significant piece of federal legislation to embrace the forensic issues involved

in addressing abuse (DOJ, 2020). This legislation focuses on the need for data,

calling on several federal agencies to work together to better understand

both the protective services and criminal elements of elder abuse. Notably, it

assigned specific requirements to the DOJ to investigate and prosecute elder

abuse crimes and to provide or make available training and resources for

state elder justice professionals.

Today, elder abuse prevention and response work continue with new

legislation being considered at the federal and state levels. Local jurisdictions

continue to put together multidisciplinary task forces to address elder abuse

in their communities. Law enforcement and APS are working together to

develop best practices to pursue both civil and criminal remedies, when

appropriate, to provide justice for older adult victims.

STATISTICS AND INCIDENT RATES

Elder abuse is a problem that is only beginning to be understood. With the

Elder Justice Act and Elder Abuse Prevention and Protection Act, there is a

commitment to gain a better national understanding of the issue similar to

what is learned from the data collected for child abuse. The following

statistics are a snapshot of what is currently known about some critical

components of elder victimization.

An aging U.S. population means there is a need for increased responses to

victimization (Administration for Community Living, 2020).

• In 2018, more than one in every seven people in the United States was

65 years of age or older.

• In 2060, the population aged 65 and over is projected to be 94.7 million,

more than twice its estimated population of 43.1 million in 2012.

• Racial and ethnic minority populations have increased from 19% of the

older adult population to 23% of older adults, with a projection of

reaching 34% of older adults by 2040.

• In 2018, there were more older women (29.1 million) than older men (23.3

million).

• In 2018, nearly 10% of older adults lived below the poverty level.

• The 85 years and older population is projected to increase by 123% by

2040 to 14.4 million people.

Elder abuse is prevalent worldwide (World Health Organization, 2021).

• A 2017 study, based on 52 studies in 28 countries, estimated that 15.7% of

people aged 60 years and older were subjected to some form of abuse

over the past year.

• The breakdown of abuse by type finds psychological abuse to be the

most reported at 11.6%, followed by financial abuse at 6.8% and neglect

at 4.2%. Physical abuse and sexual abuse are the least reported at 2.6%

and 0.9%, respectively.

Financial fraud/exploitation and neglect are the most common types of

abuse in the United States (DOJ, 2020).

• Financial exploitation by a family member affects 5.2% of older adults,

and neglect affects 5.1% of older adults in the United States.

• Psychological abuse is third at 4.6%.

• Physical abuse and sexual abuse account for a much smaller

percentage, 1.6%, and .6%, respectively.

Elder abuse is significantly under-reported in the United States (New York

State Elder Abuse Prevalence Study, 2011).

• The New York State Elder Abuse Prevalence Study found 24

unreported cases of abuse for every reported case.

• The same report found:

o Neglect (1:57)

o Financial (1:44)

o Physical/Sexual (1:20)

o Emotional (1:12)

Abuse and neglect are occurring against older adults in long-term care at

alarming rates (National Center on Elder Abuse, 2021).

• In a study of nursing home residents, 44% reported having been

abused, and 95% reported having been neglected or seeing another

resident neglected.

• In a nursing home staff study, more than 50% of nursing home staff

admitted to mistreating older residents within the last year, including

physical violence, mental abuse, and neglect.

IMPACT OF ELDER ABUSE

Like other aspects of elder abuse, we are only beginning to understand the

impact abuse, neglect, and exploitation have on victims’ lives. The

victimization experience can have devastating physical, psychological, social,

and financial effects on older adults.

Physical Health Impact

The acts of abuse can lead to immediate impacts on physical health

(National Center on Elder Abuse, 2021). Physical abuse can cause injuries,

including abrasions, lacerations, bruises, burns, fractures, head injuries, and

internal organ damage. Neglect can cause physical health issues, such as

skin breakdown, infections, and debilitation. Sexual assault often has similar

injuries associated with physical abuse and includes additional health issues

such as sexually transmitted diseases, urinary tract infections, and irritation or

pain of the anus or genitals.

Some effects occur months and years after the abuse occurred. Less

immediate physical health issues include general physical malaise, bone or

joint problems, digestive problems, chronic pain, high blood pressure, or

heart problems.

Any physical health impact can be incredibly detrimental to older adults

because of slower recovery rates due to the natural aging body and

sometimes preexisting medical issues (Podnieks, 2017). Even minor physical

injuries can require older adults to seek medical care to prevent or address

the potential of severe disabilities or death. Numerous studies have

demonstrated a connection between abuse and the need for emergency

department usage, hospitalization, hospice care, and nursing home

placement. This association has been shown for physical abuse, sexual

abuse, neglect, and even financial exploitation.

Older adults who are victims of polyvictimization experience multiple harms,

including increased hospitalization (Dong & Simon, 2013), physical injury,

psychosocial injury including depression and PTSD, financial loss, loss of

home, and placement in a long-term care facility (Ramsey-Klaswsnik, 2017).

Abuse can also result in death. Studies have demonstrated that victims of

abuse and neglect are at risk of early death up to three times higher than

older adults who are not victims (Dong et al., 2009; Lachs et al., 1998; Yunus et

al., 2017). A study that specifically looked at death rates within 5 years by

category of abuse found that caregiver neglect was the number one type of

abuse associated with early death; financial exploitation was second.

Regardless of the kind of abuse, the threat of premature death is real (Burnett

et al., 2016).

Implications for the Interview

Older adults who have experienced physical abuse may have physical

conditions or needs that require accommodations during an interview. For

instance, medication may hinder the person’s ability to focus, so identifying

an older adult’s most alert time of the day may be a consideration. Assistive

devices (wheelchair, walker, etc.) may be needed for the older adult to

ambulate, in which case the interview space must be able to accommodate

the device. Certain physical conditions may impede a person’s ability to sit for

prolonged periods of time or necessitate frequent changes in body position.

These needs and the appropriate solutions should be determined prior to the

interview. (See “Pre-Interview Considerations” for more information on

potential required accommodations.)

Additionally, understanding the etiology of the physical condition due to

physical or sexual abuse can prompt interviewers to establish a nexus

between incidents of abuse and an older adult’s current physical condition

during an interview.

Psychological Health Impact

While physical health consequences to victimization are more easily

identified and assessed, the impact on psychological health is often missed

and unaddressed (Dong et al., 2013). Studies on the psychological effects of

abuse have identified higher rates of depression, generalized anxiety disorder,

PTSD, and poor self-reported health (Acierno, 2019; Dong et al., 2013).

Social support is a crucial factor for older adults in dealing with the

psychological effects of abuse. In a key study, strong social support

diminished the impact of elder abuse for depression and eliminated it for

generalized anxiety disorder and self-reported poor health (Acierno, 2019).

Rates of PTSD were the exception and were unchanged based on social

support.

The psychological effects of abuse are not limited to physical abuse, neglect,

and sexual abuse. The effects from financial abuse occur at similar rates to

the other forms of abuse (Acierno, 2019). Even the risk of PTSD was more likely

among those reporting financial exploitation within the last year than those

reporting no mistreatment.

Implications for the Interview

When interviewing an older adult who is exhibiting symptoms of depression, it

will be prudent to express empathy, normalize events, and listen empathically

to increase rapport and subsequently increase engagement. The use of

narrower, more focused questions may also help increase the engagement of

the older adult in the interview process because they may be less inclined to

provide free narrative responses.

Older adult interviewees who are experiencing anxiety and/or PTSD because

of victimization may benefit when the interviewer does these things:

• Establishes the interview environment as a safe environment

• Addresses the concerns of the interviewee at the beginning of the

interview

• Explains the interview process

• Empowers the interviewee with the knowledge that the interview is

about helping them, they can elect to participate in the interview or not,

they can end the interview at any time, and, if they do participate in the

interview, they can decide whether they want to answer a question

The interviewer should be aware that avoidance behaviors are a hallmark of

trauma-related disorders and should be attentive to the symptoms that are

most prevalent as a means to guide the interview. The interviewer should be

prepared to take breaks as needed.

Interviewers should be aware of how the effects of abuse impact the

presentation of the older adult during a forensic interview. The older adult

may appear withdrawn, be slow to respond, or seem hesitant to answer

questions. Interviewers can work to overcome some of these barriers through

spending extra time engaging in rapport building to reduce anxiety and

increase familiarity with the interviewer and the interview process.

Interviewers can also give opportunities for the older adult to feel empowered

by offering choices throughout the interview, suggesting breaks, answering

questions, and emphasizing informed consent (See “Informed Consent” for

more information).

Social Impact

As a result of various forms of elder abuse, social relationships are impacted

families may be torn apart, and friends may stop visiting.

Implications for the Interview

Older adults who have been isolated from family and friends may exhibit a

higher degree of dependency on the offender and demonstrate a reluctance

to report acts of abuse. Further, they may minimize what occurred or blame

themselves for the abuse. (See “Elder Abuse Dynamics” for more information

regarding the social impact of elder abuse.)

Financial Impact

While the exact costs are not known, expenses associated with elder abuse

that impact the victim, family members, and the community are in the many

billions annually (Connolly et al., 2014). Many adverse events in long-term

care facilities result from neglect and abuse related to inadequate treatment,

care, and staffing. These impacts of elder abuse cost the government—and

ultimately the taxpayers who fund Medicare and Medicaid—some $2.8 billion

each year in Medicare hospital costs and additional significant Medicaid

costs (Office of Inspector General, 2014).

Financial exploitation results in tremendous losses to older adults. A recent

study concluded that older adults lose $36.48 billion annually to financial

abuse (True Link, 2015). These losses include the following:

• $16.99 billion to financial exploitation (defined as instances in which

misleading or confusing language is used, often with social pressure

and tactics to take advantage of cognitive decline and memory loss)

• $12.76 billion to identity theft and scams

• $6.67 billion to deceit or theft by someone in a trusting relationship with

the older adult

Implications for the Interview

Older adults who are victims of financial exploitation may demonstrate

reluctance to discuss their victimization due to shame and embarrassment.

(See “Elder Abuse Dynamics” for more information regarding the impact of

financial crimes on older adults.)

Small Group Activity: Elder Abuse Impacts

Instructions

1. Participants will get into groups of 3 or 4.

2. Participants will have 10 minutes to discuss an assigned impact of

elder abuse (below) and discuss the implications for the interview,

including some ideas for addressing those impacts.

a. Groups 1 and 4: Physical

b. Groups 2 and 5: Psychological and Social

c. Groups 3 and 6: Financial

3. Choose a designated group member to share with the large group

after small group discussions have ended.

4. After 10 minutes, debrief as a large group.

Notes:

BIASES AND ASSUMPTIONS

ABOUT AGING

BIASES AND ASSUMPTIONS ABOUT AGING

Class Activity: Bias and Assumptions

Case Synopsis:

Jenny is the reported victim of domestic violence. The police report

indicates the argument began when she accused her husband, Marty, of

having an affair. Jenny reports that Marty said she was “crazy”, and he

became angry. Marty tried to embrace her; she pushed him away and told

him to stay away from her. Marty came toward Jenny in an aggressive

manner, pushed her backwards into a wall and then began to strangle her.

Jenny reports that she saw stars and then things went dark. The next thing

she knew she was lying on the floor.

You are conducting an interview with Jenny. She tells you that her brain

feels like scrambled eggs and her mind is a blank, she is 25.

Notes:

Ageism

The World Health Organization defines ageism as “the stereotyping and

discrimination against individuals or groups on the basis of their age.” Ageism

is one of the most pervasive yet unrecognized types of bias and prejudice in

society. It is associated with “poor cognitive, functional, and mental health

outcomes, employment harassment and discrimination, financial harms, and

social marginalization” (National Center on Elder Abuse, n.d., p. 1). Forensic

interviewers must be aware of how ageism can play out during an interview.

The negative stereotypes that have dominated societal views about older

adults and aging can easily influence forensic interviews.

Common Stereotypes of Aging

Everyone is inundated with messages about aging and what it means to get

older. Some of these messages have been positive but unfortunately,

negative stereotypes are often predominant (Richardson & Shelton, 2006).

Here are some common negative stereotypes of older adults:

● All older adults will get dementia.

● Older adults are not sexually active.

● Older adults are set in their ways.

● Older adults are not capable of learning new information.

● Intelligence declines in old age.

● Most people end up in a nursing home.

● Older adults all act alike.

● Older adults grow increasingly irritable and angry as they age.

● Older adults are not tech-savvy.

Although none of these are accurate or evidence-based, all of these negative

stereotypes are common perceptions of younger adults about older adults.

And it is not just the interviewer who may bring biases and assumptions to the

interview—the older victim may also engage in ageist thinking about the

interviewer. If the interviewer is perceived as young, the older adult may not

see the interviewer as old enough to have the skills or maturity to conduct the

interview. The interviewer may remind the older victim of a younger family

member, which may inhibit their sharing details of what has happened.

Alternatively, the older person may be more trusting of the interviewer

because they resemble a beloved family member. An interviewer should be

prepared to address such biases and assumptions when they may be

hindering the interview.

Addressing Stereotypes and Ageism in Forensic Interviews With Older

Adults

Negative stereotypes can influence professional behavior. For example,

research has found that younger adults often change their speech patterns

when talking with an older adult (Corwin, 2018). Even when the person is

cognitively sharp and socially alert, younger adults may switch to a

condescending and patronizing language pattern or begin to speak loudly

and slowly. Acting on stereotypes can create numerous barriers to an

effective interview, including humiliation, embarrassment, shame, disinterest,

anger, fear, and distrust.

Critical to combatting negative stereotyping and ageism for forensic

interviewers is the use of a strengths-based perspective. In reality, older

adults are heterogeneous, and many are resilient having developed strong

coping skills from decades in which they accomplished achievements, dealt

with life changes, overcame adverse events, and survived trauma. When

appropriate, asking how an older adult dealt with a past life experience may

support a victim in responding to the current situation.

As noted earlier, when interviewers consider an older adult’s set of strengths

rather than weaknesses, interviewers are more likely to ensure that older adult

voices are heard and will allow the investigation to follow best practices. This

approach does not mean that the interviewer should ignore challenges or

barriers to a successful interview presented by the older adult witness;

instead, the interviewer should focus on their strengths to obtain accurate

and reliable testimony (Love, 2015, 2019).

To do this, forensic interviewers should approach every interview with an open

mind. Even when an interviewer thinks they have a lot of experience and

expertise in working with older adults, they can always learn and grow with

each new interview. All forensic interviewers need to honestly self-examine

their own beliefs, attitudes, assumptions, thoughts, and words regardless of

their level of experience. By doing this, forensic interviewers can convert

stereotypes into a strengths-based approach (see also “Strength Based

Perspective”).

A key piece to a strengths-based approach for interviewing older adults is

that dignity and worth are not defined by age but rather all the various rich

attributes of their lives. Everyone has a unique and rich life history. Everyone

has things about them that make them special. Everyone is a child of

someone; some are parents, siblings, cousins, grandparents. Everyone has a

history of hopes and dreams. Everyone has skills and talents. Everyone has

meaning and importance. Using a strengths-based approach will improve

interviews by decreasing the effects of negative stereotypes and ageism.

OLDER ADULTS AND ABUSE DYNAMICS

A Life Course Perspective on Older Adults

There are more older adults living today than ever before. Older adults may

include people over four or more decades, from age 60 or 65 to well past 100.

Their experiences will differ depending on their age, culture, race, ethnicity,

health, and other factors.

Older adults comprise three cohorts: the young-old, aged 60 to 74; the old,

aged 75 to 84; and the old-old, aged 85 and older. When thought of in this

way, the diversity of older adults becomes more evident. Some older adults

experienced World War II as children or young adults, the Holocaust, and the

Great Depression. Other older adults fled to the U.S. as refugees when children,

came as adults after helping the U.S. government in various foreign military

operations, or arrived as the aging parents of long-settled immigrants. Some

came for economic opportunities; others fled oppression, genocide, and gang

warfare.

In the United States, some older adults who identify as LGBTQ+ have lived

through a social and sexual revolution. Many were closeted for decades,

unable to live openly, marry their partners, adopt children, or openly serve in

the military. Many were ostracized by their families. Laws criminalized

consensual conduct, and some professions denied them. As they aged, many

people in the LGBTQ+ community could not visit their spouses and partners in

hospitals and long-term care facilities, could not file joint income tax returns,

and could be fired for who they are.

Some older adults of have faced discrimination and economic, health, and

job disparities based on their skin color and appearance across their lifespan.

Many have been targeted for race-based violence and mistreatment, and

institutions and entities that were supposed to protect them have histories of

unfair treatment. Some have been required to use separate

accommodations, and some have been denied equal education, opportunity,

and voting rights and otherwise denied the same rights and opportunities as

Whites.

Some American Indian and Alaska Native older adults lived through forced

removal from homes and communities to boarding schools where they were

forbidden to practice rituals, speak their native languages, or wear traditional

clothing. Some women were forcibly sterilized. Even if they did not personally

experience these practices, many of their parents and ancestors did. Later

generations carry these experiences and history through historical trauma.

For these and other groups who have been discriminated against, their

history and current relationships with local, state, and federal government are

fraught and often marked by distrust and hostility. Their experiences may well

affect their willingness to participate in a forensic interview, what questions

they will answer, and the kind of information and support they may need to

participate.

No one can be conversant with every group and culture. Even if the forensic

interviewer is familiar with a particular group, individuals experience cultural

practices and beliefs in their own ways, so generalizing about a person’s

culture can create impediments to an effective interview. A forensic

interviewer cannot assume they know how to address the older person (e.g.,

he/she/they), what the person’s experiences are, attitudes about government

and possible prosecution, and abilities and coping strategies. The interviewer

must practice cultural humility, be ready to ask for clarification, and apologize

if they inadvertently err.

Finally, older adults are a heterogeneous population with diverse conventions.

Therefore, it is best to begin interviews by asking older adults how they wished

to be addressed (e.g., Mr., Mrs. Dr., etc.) and using that title throughout the

interview. In general, interviewers should not use the person’s first name

unless asked to do so by the older adult. Then, the interviewer should follow

the older person’s lead on physical contact and avoid any physical contact

unless initiated by the interviewee.

Elder Abuse Dynamics

Reporting Impact

Only a small percentage of elder abuse cases are reported to officials. Those

incidents that are reported are rarely initiated by the older victim. For

example, in Federal fiscal year 2018, states received 1.7 million reports of adult

maltreatment. Of those reports, 45%, or 791,161, were accepted for

investigation based on the individual states’ program criteria. The majority of

those reports (57.2%) were referred to APS by professionals, 10.7% were

referred by relatives of the adult, and only 5.2% were self-referrals (Adult

Protective Services Technical Assistance Resource Center, 2019).

It is important to understand why cases are rarely reported by those who

have been victimized and to recognize that elder abuse tactics often inhibit

reporting.

These are some of the reasons for not self-reporting:

• Inability to report

• Victim’s fears

• Techniques of the abuser

• The victim’s feelings of guilt and shame

• Emotional attachments

Unwillingness to report should also be considered in addressing reluctance to

the interview. If the victimization was reported by someone else, the victim

might not want to cooperate with the interview for the same reasons they did

not report their victimization.

Perpetrators, Risk Factors, Dynamics, and Justifications

Elder abuse is committed by people in ongoing and trusted relationships with

older victims. These are people who are loved, trusted, and relied upon by the

older adult. In some cases, relationships may form quickly through a process

of grooming and befriending, such as romance or sweetheart scams.

The nature of the relationship separates elder abuse from other crime

victimizations of older people. It is also why investigating such cases and

interviewing older adults can be laden with impediments. The abuser knows

the victim’s vulnerabilities, dependencies, assets, and personal history and

may use that knowledge to commit illegal acts, avoid detection, and

undermine the victim’s credibility.

Perpetrators may be opportunists, predatory individuals, domestic abusers,

or, in the case of neglect and some emotional abuse, persons who are ill-

equipped to meet the needs of the older adults they are assisting. Others are

career criminals who target older adults for their real or perceived frailty,

cognitive limitations, or the likelihood they will not recognize their

victimization—or if they do, will not report or will not be believed if they do.

Abusers may quickly form a relationship with an older victim where one does

not yet exist or enhance an existing relationship for greater access and trust,

exploiting their loneliness and social isolation.

Data from the National Adult Maltreatment Reporting System (NAMRS) has

found that 29.1% of perpetrators are older than 60; about a third of

perpetrators are under age 40, and slightly more were between 41 and 59

years (Twomey, 2018). Common perpetrator motivations include greed, power

and control (see also “Power and Control/Coercive Control”), entitlement,

anger, and revenge. Considerable research has been conducted to identify

factors associated with elder abuse perpetration and victimization.

Risk Factors for Elder Abuse

Victim characteristics associated with elder abuse include the following:

• Gender: Among those age 65 and older, for every 100 men there are 125

women (Administration for Community Living, 2021). Although there are

more older women than men, both men and women can be victims of

physical, sexual, financial, and psychological abuse and neglect

(Acerino et al., 2010).

• Race: While the evidence is mixed, several studies have found racial

differences in prevalence of financial abuse, self-neglect, and caregiver

neglect (Chen & Dong, 2017). Compared with Caucasians, African

American older adults may be at increased risk of financial abuse and

psychological abuse, and Hispanic older adults have a lower risk of

emotional abuse, financial abuse, and neglect (Pillemer et al., 2016).

Non-White elders living in long-term care facilities are at increased risk

for abuse and neglect (Hawes, 2003).

• Marital status: Some studies have found that being single increases the

risk of psychological/emotional abuse, while being divorced or

separated is associated with increased psychological/emotional and

physical abuse (Chen & Dong, 2017).

• Relationships and prior abuse: Some types of elder abuse are

associated with previous traumatic experiences, including domestic

and other interpersonal violence (Acierno et al., 2010; Storey, 2020).

• Health and dependency: Increased risk of abuse is associated with the

following characteristics:

o Persons with intellectual disabilities have the highest rate of violent

victimizations, including sexual assault, compared to any other

disability type (Harrell, 2015)

o Physical and cognitive conditions that require assistance with ADLs

from others (the risk is unclear for financial abuse because study

findings are mixed; Gorbien & Eisenstein, 2005)

o Impaired ability to care for oneself, defend oneself, or escape the

situation (Heisler, 2017)

o Depression (includes risk of financial abuse; Dyer et al., 2000)

o Psychiatric illness (Friedman et al., 2011)

• Social isolation and low social supports: These are associated with

elder abuse victimization (Acierno et al., 2009).

• Income: Living in a low-income household is associated with increased

emotional/psychological and physical abuse (Chen & Dong, 2017).

• Age prejudice: This is another risk factor for elder abuse. Ageist

stereotypes can allow negative beliefs and attitudes toward older

adults to persist, resulting in neglect and abandonment along with

emotional, financial, and physical harm (Shepherd & Brichu, 2020).

Perpetrator Tactics and Motivations

The dynamics of elder abuse are complex; no single theory or model will

adequately explain it: “Depending on the victim–offender relationship and the

type of abuse, elder abuse may resemble domestic violence, child abuse, or

fraud. The phenomenon can stand on its own given the complexity of the

relationships, individual vulnerabilities, and contexts in which it occurs”

(Amendola et al., 2010, p. 2). Below 4 dynamics that help explain perpetrator

behavior are discussed.

Power and Control/Coercive Control

Most criminal justice professionals have dealt with cases of domestic violence

in their careers. Most of those cases involved younger adults. Domestic

violence, or coercive control, as it is sometimes called, occurs across the

lifespan. In younger life, it most often involves spouses and intimate partners.

In later life, it may also include children or grandchildren who have lived with

and learned domestic violence tactics throughout their lives and now use the

same tactics on an aging parent.

Domestic violence typically is accomplished through the use of power and

control tactics. Tactics such as intimidation, threats, economic control,

emotional abuse, use of children, isolation, and asserting privilege to set the

rules for how the relationship and household are run are used routinely to

control. Physical and/or sexual violence are used intermittently to exercise

power and reinforce that the abuser is in charge. Thus, it is important to

recognize that tactics are not used in a linear way but in various

combinations according to different situations.

Programs worked with increasing numbers of older victims of domestic

violence/abuse in later life, many of whom were victimized by adult children

using power and control tactics. Based on the experiences of older adults, the

National Clearinghouse on Abuse in Later Life (NCALL) created the “Abuse in

Later Life Wheel.” (See Appendix VI for a visual of the NCALL Wheel.)

In later life, abuser tactics may change from those seen in earlier decades.

The use of privilege pervades every other tactic. Commonly observed new

tactics include these:

● Abuse of dependency (e.g., taking away assistive devices such as

walkers, wheelchairs, glasses, dentures, hearing aids; denying or forcing

an older adult to wait for food, care, toileting, or medicine; causing the

older adult to miss medical appointments; failing to report medical

problems or seek care for medical problems; failing to fill prescriptions)

● Ridiculing the older person’s values (e.g., denying access to religious,

spiritual, or cultural observances; misusing or damaging ceremonial

regalia; making fun of a victim’s values)

● Using family (e.g., magnifying disagreements between family members,

putting the victim in the middle; misleading family members about the

extent and nature of illnesses or conditions; excluding or denying

access to family; forcing family to keep secrets)

● Isolating the victim (e.g., keeping them from human contact, trusted

advisors, and information; preventing the victim from being outdoors or

receiving or visiting others; destroying relationships with family and

friends; denying access to mail and/or phone)

● Financial exploitation (e.g., stealing money, titles, and/or possessions;

taking over accounts and bills; spending the victim’s money without

permission and not for their benefit; abusing authority under a power of

attorney, guardianship/conservatorship, or trust)

● Emotional and psychological abuse

o Emotional abuse (e.g., humiliating, degrading, yelling, insulting,

calling names, using silence or profanity, threatening to place the

victim in a nursing home against their wishes)

o Psychological abuse (e.g., making the victim think they are crazy,

called gaslighting)

Undue Influence

Undue influence is a means to perpetrate financial abuse, sexual abuse, and

sometimes neglect by which a perpetrator (the influencer) substitutes their

will for the true desires of the victim. Typically, the elements of undue

influence include a vulnerable victim, a perpetrator’s ability to influence

because of a confidential relationship or position of power or trust, the use of

tactics to assert this influence, and an unjust result. As an example, California

Welfare and Institutions Code Section 15610.70 defines undue influence as

“excessive persuasion that causes another person to act or refrain from

acting by overcoming that person’s free will and results in inequity.”

Common tactics include isolation from people and information, undermining

the victim’s confidence in themselves, creating victim’s dependence on the

influencer, creating fear and insecurity, exploiting vulnerabilities, and

gaslighting. Perpetrators may target their victim and engage in grooming

behaviors to develop trust and dependence (Brandl et al., 2005).

Older Parent–Adult Child Relationships

Sometimes an older parent may provide care for an adult child who becomes

dependent upon the older parent for finances, a place to live, and/or

emotional support. The adult child may be experiencing mental health issues,

substance abuse, and/or a criminal history, any or all of which can contribute

to long-term unemployment. As a result, some older parents may be isolated

with their abuser because the older adult is protective of their adult child. As

such, they may minimize or excuse the adult child’s behavior. Physical,

psychological, sexual abuse, and/or financial exploitation can be part of this

dynamic (though less so neglect because the parent is providing care for the

adult child rather than vice versa).

Stranger Becoming a Friend/Romantic Partner

In some cases of elder abuse, an opportunistic offender is or becomes

familiar with the older adult and ultimately befriends them. These offenders

have various backgrounds or roles, such as handyman, neighbor, friend of a

friend, server, cleaning person, etc. The offender engages in a course of

conduct, such as providing extra attention and/or services, and gradually

ingratiates themselves to the older adult. As a result of the offender’s

enhanced level of involvement in the older adult’s life, the older adult

eventually views this person as a best friend or potential romantic partner.

The offender then capitalizes on that trust and gains some type of access to

the older adult’s finances. The older adult, who often feels grateful for the

attention, may give the offender gifts or money to perpetuate and bolster the

relationship.

In friend or romantic partner types of scams, the offender often fills the

companionship void left by the death of a spouse. As the dependency

(physical, emotional, etc.) on the offender grows, the offender begins to

swindle money from the older adult by expressing a need for help to pay bills

or some other expense. They accomplish this by establishing themselves as a

kind, caring person who is experiencing a hard time with finances, which is

often an effective way for offenders to start having the older adult provide

them with money. As offenders gain greater access to the older adult’s

property and money, offenders will attempt to isolate the older adult from any

family or friends who may interfere with their plans. The offender may start to

make demands of the older adult, and if the demands are not met, the

offender often becomes more threatening.

Offenders who play the new best friend role often start to run errands for the

older adult and/or offer to handle the paying of monthly bills. In this process,

the older adult provides the offender with their debit card and PIN, bank

account information, and other asset information. The older adult is seldom

aware that the offender is stealing their money and not paying the bills as

promised. Offenders may not limit themselves to just money from bank

accounts—life insurance policies may be cashed in, collectables and jewelry

sold, retirement accounts emptied, and lines of credit maximized.

Caregiver-Related Motivations

Many older adults are self-sufficient. However, some do have a caregiver, a

relationship in which someone assumes, implicitly or explicitly, a duty to care

for another. Caring for an older person, especially one with underlying

medical and cognitive conditions is difficult. While most caregivers provide

good supportive care, caregivers in elder abuse situations may commit all

forms of elder abuse, including neglecting an older adult and causing pain,

emotional suffering, serious illness, and sometimes death. Neglect requires

that there be (a) a victim who is unable to meet their basic needs for such

things as food, clothing, shelter, medications, and bill paying and (b) a

caregiver who has a duty to provide needed care.

Reasons caregivers do not meet their caregiving responsibilities include the

following:

• They are unable to provide adequate care due to a lack of training,

support, financial resources, sufficient physical or mental health.

• They are the caregiver but are ignoring the needs of their parent living

with advanced dementia out of indifference while living off the parent’s

retirement income.

• They are stressed from the burdens of caregiving and as a result are

lashing out at the care recipient.

Anger

Anecdotally, direct service providers report encountering cases of abuse

resulting from anger and revenge. There is little research supporting this as a

cause of elder abuse.

Anger directed at an older parent may lead to physical and/or emotional

abuse or neglect and a belief that the abuser is entitled to a stolen or

embezzled asset.

• Adult children who neglect their aged parents may attribute their

neglect to anger from child mistreatment, domestic violence, sexual

abuse, and substance use at the hands of the parent who now requires

care.

• Adult children who physically or sexually abuse their elderly parent may

act out of anger for how they were themselves abused by the parent or

because the parent failed to protect them from an abusive situation.

Implications for Interviewers

Because of the personal relationship that underlies most elder abuse as well

as the tactics and behaviors the abuser employs, the interviewer may have to

overcome victim reluctance to participate in the interview, minimization of

what has occurred, recantation of earlier statements, and self-blaming for

events. This also suggests that interviewers generally should not denigrate

the abuser.

Establishing Alternative Hypotheses

As stated previously, when presented with a case referral involving an older

adult, interviewers should make an intentional effort to remain open-minded,

objective, and neutral. One method of doing so is through establishing

alternative hypotheses, considering other reasonable explanations for the

report pre-interview. An interviewer who engages in the process of

establishing alternative hypotheses prevents the interviewer from drawing

premature conclusions and allows the interviewer to take their role as an

unbiased gatherer of facts.

Once the interview begins, an interviewer must remain open to all possibilities

while the older adult interviewee provides information. In addition, the

interviewer must employ active reflective listening techniques that allow the

interviewer to be perceptive, adaptable, and capable of exploring new or

additional alternatives as the interviewee provides information.

Small Group Activity: Perpetrator Tactics and Establishing Alternative

Hypotheses

Instructions

1. Participants will get into scenario groups (participants assigned to

scenario 1 are a group, scenario 2, and so on).

2. Participants will have 10 minutes to discuss the perpetrator tactics

that may have been employed and how they might consider and

explore multiple hypotheses about the case.

3. Choose a designated group member to share with the large group

after small group discussions have ended.

4. After 10 minutes, debrief as a large group.

Notes:

PRE-INTERVIEW CONSIDERATIONS

Before any interview with an older adult, MDTs should discuss both the

interview environment and any needs specific to the older adult being

interviewed. The first step in preparing for a successful interview with an older

adult is to consider what information may be helpful or beneficial to know

ahead of time (as time and consents allow). It is recommended that the

interviewer or another member of the MDT utilize either the “Self-Reported

Pre-Interview Considerations Checklist” or “Caregiver Reported Pre-Interview

Considerations Checklist” (Appendix III). The Pre-Interview Considerations

Checklist comes in two forms: Self-Reported and Caregiver-Reported. Each

checklist asks information about the older adult, including information about

how the older adult communicates or prefers to be communicated with.

While not all questions on the checklists are appropriate to ask of every

individual, they serve as a guide for interviewers to gather information to be

as prepared for the interview as possible.

Note: Pre-Interview Consideration Checklists are not intended to be

presented as a questionnaire to the older adult being interviewed or their

caregiver; rather, they act as a conversation guide for the member of an

MDT gathering this information pre-interview.

When preparing to interview an older adult, consideration of any required

special accommodations should be made to ensure a successful interview.

Accounting for and meeting the needs of an older adult conveys that the

interviewer has respect for the older adult and intends to treat them with

dignity, which is the foundation of rapport building.

The Aging Body

Aging is a process that is different for every person. Older adults experience

unique changes in all bodily systems and functioning. These changes are

influenced by biological and environmental conditions as well as historical

and social contexts across the lifespan. When considering the effects of the

aging body on forensic interviewing, the interviewer must maintain a

strengths-based perspective that still addresses the specific

accommodations necessary for a successful interview. The interviewer must

understand the many physical changes associated with aging regarding

pre-interview considerations, interview strategies, and investigative

considerations. Unlike childhood development with standardized

developmental milestones, the effects of aging are rarely consistent.

When there is a concern that physical conditions may affect the interview, the

MDT can attempt to confer with medical personnel about the older adult or

the nature of the older adult’s conditions. By doing this, the interviewer can

better understand the older adult’s overall health status, the medications they

receive or should be receiving and their effects, and the standard of care the

older adult requires. This information will help the interviewer be aware of the

effect of the aging body on the interview process.

Biological Changes

In late adulthood, it is typical for people to experience a decline in

sensorimotor abilities, but these are not universal and vary from individual to

individual. It may take the brain longer to process information, make

assessments, and plan a course of action. The slowing of information

processing may cause the need for things that were presented quickly or not

clearly enough to be repeated.

Vision

Visual acuity can require correction at any age; however, as people age, they

may find they need correction, especially for reading or seeing things up

close. Depth perception and visual contrast sensitivity may also diminish as

age increases. Other age-related visual disorders include the development of

cataracts (cloudy areas form on the lens of the eye, causing blurred vision),

age-related macular degeneration (AMD; the central part of the retina

becomes unable to discern fine details), and glaucoma (buildup of fluid

within the eye causes damage to the optic nerve).

Interviewers should be aware of these potential biological changes to ensure

they are providing materials in the interview that the older adult is able to see

and read clearly. Aging also typically effects the amount of light required for

the eyes to focus. The interviewer should be aware of the amount of light in

the room during the interview, especially when asking the victim to review

documents as part of the interview.

If the interviewer notices difficulty with vision, such as the older adult

squinting, they should ask about the use of glasses or contacts. It is not

uncommon for glasses to become broken or contact lenses to be lost during

an incident of physical or sexual abuse. Perpetrators may also neglect to

provide these items to the older adult or even keep them from the older adult

as a form of punishment.

Vision impairment may also impact how an older adult experiences an event.

As such, when asking questions about what the older adult saw during an

alleged incident, interviewers should be aware of how senses can be

impacted later in life. The ability to observe specific features such as what the

perpetrator looked like or was wearing can be impacted by lighting.

Hearing

Age-related hearing loss results from the degeneration of the structures in

the inner ear. Damage to the auditory nerve, hearing pathways in the brain, or

other nerves of the inner ear are classified as sensorineural hearing loss,

which is the prevalent type of hearing loss for people over the age of 65. For

older adults, hearing loss can usually be mitigated by using hearing aids or

cochlear implants.

Interviewers should be aware of these biological changes during an interview.

The interviewer should not assume hearing loss but look for signs that the

person is having difficulty hearing, such as the person turning to one side to

listen, which may indicate that one ear is better for hearing than the other. If

the interviewer notices any behavior that would indicate concerns about

hearing, they should ask the older adult about any hearing issues and

preference.

Interviewers must consider and understand that signs of hearing loss are not

an indicator of the person’s cognitive abilities. Thus, the interviewer should not

automatically overenunciate or simplify words used during their interview.

When hearing loss is suspected, the interviewer should pay careful attention

to these things:

• Using a normal volume of voice

• Using a slightly lower tone of voice

• Slowing down the pace of speech

• Using clear enunciation and not overenunciation that distorts what is

being said

• Maintaining direct eye contact throughout all verbal communication

• Reducing nonverbal distractions such as hand movements

• Minimizing any background noise occurring during the interview

The interviewer should ask the older adult if they have a hearing aid and

would be willing to use it during the interview. Not all older adults routinely

wear their hearing aids. A study on use of prescribed hearing aids among

older adults found that only 55% use it daily, 27% use it more than 6 hours a

day, and 11% never use it (Saloren et al., 2013).

Changes in hearing may impact how an older adult experiences an abusive

event. When asking questions about what the older adult heard during an

alleged incident, interviewers should explore what, if anything, the person

heard. If an older adult has hearing loss, the interviewer should ask whether

they were using a hearing aid during the time of the incident.

Taste and Smell

Taste buds become less sensitive and decrease in number with age. This

decline generally starts during midlife and is not restricted to any one type of

taste. Some people will become less sensitive to salt, sugar, and bitter or sour

tastes while remaining sensitive to the other tastes (Stevens et al., 1995;

Whitbourne, 1999). Taste is often dependent on smell. As we age, the number

of olfactory receptors that transmit smells to the brain also decrease in

number. Some older adults will lose the ability to smell certain odors (e.g.,

spoiled food). Changes in taste may impact how an older adult experiences

an abusive event, so interviewers should be aware of how senses can be

impacted later in life when asking questions about what the older adult

smelled or tasted during an alleged incident.

Skin

As the skin ages, the nutrient support the epidermis gets from the dermis

decreases as surface points of contact between the two layers lessen. Less

sebum is produced by sebaceous glands in the skin. Sebum’s acidity protects

the skin against infection. This reduced output of sebum makes older adults’

skin more susceptible to disease and skin infections. Interviewers should be

aware that as skin ages, it becomes more vulnerable to tears from

victimization because of less surface contact between the epidermis and the

dermis. Interviewers should be mindful of the length of an interview when it

involves a person sitting or lying in the same position for a long period of time,

which could cause significant discomfort for an older adult with skin issues.

Problematic Injuries and Conditions Suggestive of Abuse

Bruises: Most often associated with physical or sexual abuse, bruises have

been studied in elder abuse situations. Two bruise studies, one of older adults

with accidental bruising and the other of older adults who had been abused,

yielded important distinctions. A key takeaway from these studies is that the

color of a bruise does not indicate its age. A bruise can be any color on the

day of injury (Mosqueda et al., 2005). Bruises received at the same time can

be of different colors.

An understanding of the findings can help the interviewer to evaluate

information from the older person and to guide in the development of

questions to be asked. These are some findings from the study of older adults

with accidental bruises (Mosqueda et al., 2005):

• The color of a bruise does not indicate its age. A bruise could have any

color from day one.

• 90% of accidental bruises were on the extremities rather than the trunk,

neck, or head.

• Less than a quarter of older adults with accidental bruises remembered

how they got them.

Older adults taking medications that interfere with coagulation were more

likely to have multiple bruises, but the bruises did not last any longer than the

bruises of those who did not take these medications. In contrast, when the

bruising was due to abuse (Wiglesworth et al., 2009), these were some of the

findings:

• Bruises were large. More than half of older adults with bruises who had

been physically abused had at least one bruise 5 centimeters (about 2

inches) in diameter or larger.

• While their location could be anywhere, bruises on the face, lateral

(same side as the thumb) or anterior (same side as the palm of the

hand) surface of the arm, or on the back are highly suggestive of

abuse.

• Older adults with bruises who had been abused had more bruises in

these areas than older adults whose bruises were accidental.

Pressure Ulcers: Primarily associated with cases involving neglect, pressure

ulcers, also called bedsores and decubitus ulcers, are injuries to the skin

resulting from persistent pressure that limits blood flow to the skin. They most

frequently occur to the skin that covers bony prominences of the body such

as the heels, ankles, hips, shoulder blades, spine, and tailbone. Pressure ulcers

are a particular risk for people who, due to medical conditions, are unable to

change their position, have limited mobility, or have compromised blood

circulation (e.g., from diabetes, vascular disease). Incontinence can cause the

skin to break down because it may expose the skin to urine or fecal matter for

an extended time. Poor nutrition and insufficient hydration may also

contribute to the development of these ulcers. Pressure ulcers may develop

within hours, or they can manifest over days, weeks, or months.

The friction of skin rubbing against clothing or bedding can make

compromised skin susceptible to pressure ulcers. Pressure ulcers may also

appear from shear, which happens when two surfaces move against each

other in opposite directions. For example, sliding a patient across bedsheets

or removing adhesive bandages from skin may result in significant skin

trauma, especially for older adults whose skin has become thinner and more

fragile.

Pressure ulcers cannot be precisely aged, so experts cannot say how long it

took for a pressure ulcer to reach a particular stage. Some generalities may

be attempted—stage 1 in hours, stage 2 in days, stage 3 in weeks, and stage 4

longer than weeks—but they cannot reliably indicate how many hours, days,

weeks or months. There are also unstageable pressure ulcers in which the

ulcer is filled with debris, bodily fluids, and dead skin. These are typically

infected and can result in death. It can take months with proper care to close

an ulcer that has reached stage 3 or 4.

When interviewing older adults, interviewers should understand that pressure

ulcers are often a symptom of neglect but by themselves are insufficient to

prove neglect has occurred. They may not be universally preventable due to

underlying comorbidities. Medications such as corticosteroids can make the

skin even more fragile. As noted with other skin issues, the interviewers should

avoid long interviews that result in the person being in one position for an

extended time. The interviewer should provide breaks that allow for

repositioning the person.

Motor Function and Strength

Older adults who are sedentary experience atrophy of muscle, increasing the

risk of osteoporosis, and falls that can result in fractures of the hip, spine, and

wrist (American Medical Association, 1998). Interviewers should be aware of

these increased risks for injuries that may be sustained from a fall or

increased susceptibility to injury from abuse and neglect. There may be

situations where the injury and explanation do not seem to match but may be

realistic depending on the physical condition of the bones or muscles.

Additionally, interviewers should be aware of the layout of room and building

where the interview is taking place. The interview room should be arranged so

it is easy to navigate when entering and leaving. The building should be

accessible, including entrances, hallways, and bathrooms. (See “Pre-Interview

Considerations” for more information accommodations.)

Physical Accessibility

For the older adult population, interviewers should ensure that interview

rooms are physically accessible and can accommodate any needed mobility

devices (e.g., canes, walkers, wheelchairs). The room should be at a

comfortable temperature because some older adults have trouble regulating

body temperature. Comfortable, cushioned seating should be provided

because older adults may become distracted by physical discomfort if the

bony prominences of their hips and spine are pressed against a hard

surfaced chair. Sometimes, an older adult may need to be interviewed where

they live or sleep or in a hospital room, depending on the physical condition,

allegations, and urgency of the interview.

Interviewers should ensure that the older adult is in possession of any needed

eyewear or magnifying device and that the room is well lit to facilitate the

review of printed materials, photographs, etc. Ideally the area around the

outside of the interview room should be quiet and without distracting noises

inside the room. Older people with mild hearing loss will have difficulties

hearing words in the presence of background noise (noisy fan, buzzing light,

etc.). When asking questions, interviewers should look at the older adult and

maintain an unobstructed line of sight with the older adult. Interviewers

should also consider that if the older adult is not making eye contact with

them, it may be because of cultural reasons or a history of trauma. If the

interviewer is getting non-responsive answers, they should consider first

whether the interviewee can hear clearly without assuming cognitive

confusion.

Considerations for Scheduling

Deciding when to schedule an interview is another important individual factor

to consider when planning to interview an older adult. While it is often best to

schedule an interview as quickly as possible after an incident, some instances

may require a delay in interviewing the victim/witness (e.g., very traumatic

experiences). In addition, interviewers should consider other factors when

considering when to schedule an interview, such as medications, medical

needs, schedules/routines of the older adult, and cultural factors.

Ideally, a person should be scheduled for an interview during their typically

most alert/active part of the day, and the time of the interview should be

considerate of any potentially competing personal interests (e.g., special

event). Considerations include the older adult’s personal schedule,

medication schedule, medication effects, and the most alert/active time of

the day. Medication administration is also an interview consideration because

medication could positively or negatively affect a person’s ability to be

interviewed. The interviewer should strive to ascertain the effects of any

medication taken by the prospective older adult to determine when to

conduct an interview. Some medications may make the older adult tired and

unable to focus, or they may induce stupor or delirium. Information regarding

medication can be obtained from the older adult, a caregiver, adult

protective services, or a medical professional.

Teams should consider cultural factors when scheduling an interview as well.

Teams may consider asking questions such as, “Are there certain times of the

day, days of the week, or dates that are special and not to be interfered with?”

Considerations for Medications and Medical Issues

Certain medications can result in confusion or delirium and may be confused

with dementia or diminished capacity. The dosage of medications in older

adults may need to be less because an older body does not process the

medications as it did in younger life. Medications in older adults may react

differently in later life than in younger life when prescriptions, herbal

supplements, vitamins, and over-the-counter medications are used together.

Medications may be a tool to improve health, but it can also signify abuse (as

a “chemical straitjacket”) to obtain compliance, keep a person quiet, or cause

confusion so they will sign a legal document or make a significant gift. If the

older person knows, the interviewer should explore what medication has been

prescribed and for what, which medications have been given to the victim

and how they affect the older person, and what medications have been

prescribed but not given to the victim. Certain prescribed medications may

cause side effects or hinder an older adult’s communication during the

interview process.

If the person has medical or other personal needs, interviewers will need to

monitor for fatigue, the need for breaks, and the need to eat or take

medication on a schedule. When inquiring about medications, teams may

consider asking questions such as these:

● Does the older adult need to allow time for medications to take effect?

● Are there side effects that need to be considered after medication has

been taken?

Teams must consider the scheduling of an interview when an older adult has

medical issues that need to be monitored (e.g., diabetes, timed medication,

blood pressure, etc.). For example, if the older adult has diabetes,

consideration regarding the availability of drinks and snacks should be made,

and depending on the length of the interview, affording them time to check

their blood sugar may also become a factor.

Schedules should be considered to ensure the time does not interfere with the

older adult’s routine (e.g., wake time, rest time, or bedtime). For example, an

older adult with a form of dementia or cognitive decline will need to stick as

closely to their routine as possible. This is necessary to prevent confusion, fear,

and anxiety. Any change of routine can be disorienting, so ensuring the older

adult is properly rested and continuing to assess their needs is critical. An

older adult with a form of dementia may also experience sundowning, which

can present as restlessness, agitation, irritability, or confusion that increases

toward the end of the day. An interview earlier in the day should be

conducted when interviewing older adults living with dementia.

The timing of the interview is also critical. The interviewer should consider

whether the older adult may be affected due to when the interview is

occurring:

• Before or after a meal

• Before or after the adult has taken medication(s)

• Before or after certain daily routines

• Before or after physical exercise

In general, interviewers should consider mid to late morning for peak

cognitive abilities. For people living with dementia, the experience of

sundowning may be present, resulting in decreased cognitive abilities and

even agitation later in the day. Caregivers can be consulted about their

observation on when the older adult will be best able to participate in the

interview.

Interview Environment

As with any other interview, teams should strive to create an interview

environment that is neutral, private, comfortable, and non-shaming for the

older adult being interviewed. When choosing an interview location, it is

critical that teams select an environment that is both physically and

psychologically safe for the older adult. Any concerns regarding safety

should be resolved before the interview takes place. In order to establish a

safe and comfortable interview environment, teams must be mindful of the

level of authority represented within a location and should work to lessen this

dynamic. Teams should avoid interviews in intimidating locations (e.g.,

interrogation room) or non-neutral locations (e.g., the location where the

incident occurred) whenever possible. It is possible that the interviewee may

not be able to move to a new location to be interviewed. In these cases,

interviewers should be flexible with what is reasonable, safe, and preferred by

the older adult. In addition, teams may lessen the presentation of authority by

minimizing the number of individuals present during the interview and

providing choice to the older adult about the time and place of the interview.

For interviews occurring outside of the older adult’s home or facility, teams

should work to establish the interview location as a safe environment. It may

be beneficial to provide a tour of the location and/or the interview space prior

to the interview. If observers will be watching the interview from another room,

it is important the team plans for how this will be introduced to the older

adult.

Before interviewing an older adult, some of the more specialized information

the interviewer should attempt to establish includes the following:

• The older adult’s degree of mobility

• The older adult’s level of dependence upon caregivers to perform

frequent repositioning

• The older adult’s daily routine

• The expectations of care as outlined in a treatment/care plan or

doctor’s orders

• What medications are taken and whether any contribute to skin

vulnerability, loose stool, or elevated urination

• Toileting habits

• The caregivers’ body and/or incontinence underwear check routines

and recording methods

• Recent history of examination by a doctor or nurse

• Last doctor’s visit or nurse visit

As noted, many of the pre-interview considerations can come from

caregivers or family members. The interviewer must be cautious of asking

these questions from someone who could be the perpetrator or anyone who

may not be seeking the best interest of the older adult.

Informed Consent

Older adult interviewees should be treated with dignity, respect, and

transparency throughout the interview process. For this reason, teams should

consider obtaining informed consent from the older adult being interviewed.

Teams should ensure the individual is aware of each step of the process and

their rights. If materials are presented to the older adult, they should include

language and/or visuals that are inclusive (e.g., materials available in large

print font).

If applicable, these are some things older adults being interviewed should be

made aware of:

● The steps of the interview process

● The purpose of recording

● Who the information will be shared with (i.e., observers and who has

access to reports or recordings)

● Their ability to take breaks or end the interview

● Their right to revoke consent (e.g., consent to recording, consent to the

interview, etc.)

Individual Needs

The interview environment should be arranged to accommodate the unique

needs of the older adult. First and foremost, it is critical that the team

considers an older adult’s physical needs. The interview location and space

must be Americans with Disabilities Act (ADA)-compliant to accommodate

wheelchairs, walkers, canes, or other devices. These spaces should not only

be accessible but comfortable to the older adult. When considering

accessibility and comfort of the interview environment, teams should also

consider the furniture at the interview location (e.g., waiting room, interview

room, etc.), such as comfortable chairs for backaches/sciatica and/or

bariatric chairs for obese older adults who may have diabetes. Teams should

also ensure that bathrooms are accessible with ADA-compliant doors for

easy entering and exiting and toilets have a raised seat for easy sitting and

standing. Teams should also consider offering drinks and snacks in cases of

low blood sugar during and after the interview process.

In addition, teams should consider making modifications to the environment

to meet individual needs (e.g., emotional needs, psychological needs, etc.).

Making modifications takes preparation, and it is important to understand

each older adult’s needs prior to their arriving for the interview—the

interviewer’s role is to meet each individual where they are throughout the

interview process. Interviewers (teams) may inquire about information such

as safety concerns for the older adult or interviewer, diagnoses, trauma

history, known triggers, cognitive abilities, communication abilities/style, etc. It

is also important to gather information about what to do in situations when

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an older adult becomes triggered or agitated. Teams may consider asking

questions about maintaining a calm atmosphere and the forms of redirection

and/or de-escalation that are used in the interviewee’s daily life.

Although this information can be critical to meeting an older adult where they

are throughout the interview process, interviewers should be cautious of

drawing any conclusions from information gathered pre-interview.

Interviewers should utilize this information as a guide for the interaction but

not rely on this information alone. As the interviewer interacts with the older

adult, they should maintain objectivity and flexibility and continually adjust to

meet the older adult where they are. In addition, it is not the interviewer’s role

to diagnose or use labels when working with an older adult. Interviewers

should be cautious of using any labels the older adult does not self-identify

with because it may be damaging to rapport building and gathering reliable

information from the older adult being interviewed.

Comfort Items

In some instances, an older adult interviewee may bring comfort items with

them to the interview. These could include items such as weighted blankets,

pillows, or manipulatives (e.g., stress balls). Interviewers should not take away

any personal or comfort items during the interview, so they do not appear too

authoritative. Teams may also decide to make comfort items available. If an

item becomes a distraction during the interview process (e.g., a cell phone),

the interviewer may provide respectful redirection to the interviewee.

Use of Victim Advocates, Support Persons, or Support/Therapy Animals

Older adult victims may desire to utilize support persons (e.g., family

members) or professionals (e.g., victim advocates) as they navigate the

criminal justice process. These individuals may assist in fostering interviewee

comfort, so consideration should be given to their use to remain trauma-

informed and victim-centered throughout the interview process. Some older

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adults may also have a support or therapy animal that will need to be

accommodated during the interview process.

Before their inclusion, it is important that teams consider the role a victim

advocate or support person will play during the interview and discuss how

they will be introduced. Teams may consider adding written

policies/procedures regarding working with victim advocates or support

persons during forensic interviews while being mindful of victim’s rights within

a particular jurisdiction.

As discussed previously, teams should limit the number of individuals present

during a forensic interview because additional individuals increase the

potential of bias being during an interview. However, if a victim advocate or

support person is requested to be present during the interview, interviewers

should work together with the interviewee when deciding whether they will be

included in the forensic interview. Interviewers should explore the

interviewee’s desire to include the additional party in the interview and

discuss both potential risks and benefits to their inclusion.

In general, victim advocates or support persons should be seated out of the

line of sight of the interviewee. Interviewers and support persons should not

speak about the interviewee as though they are not in the room; they should

speak directly to the interviewee. And it is imperative that the role of the

support person in the interview process is clearly established so the forensic

interview is not negatively impacted by their presence. This can be

accomplished by the interviewer meeting with the advocate/support person

before the interview to clarify their role and understand what the expectations

for their involvement are.

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It is important that victim advocate/support person do not speak or interject,

which includes the following:

● Asking or clarifying questions

● Answering questions on behalf of the person being interviewed

● Reacting to what is discussed during the interview

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GENERAL CONSIDERATIONS FOR

COMMUNICATING WITH OLDER ADULTS

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GENERAL CONSIDERATIONS FOR COMMUNICATING WITH

OLDER ADULTS

The Aging Brain

The aging process affects the brain across the lifespan. These changes

influence how people remember, plan, organize, make decisions, learn, and

apply new information. A functional perspective views the brain as always

being focused on the tasks necessary to meet and maintain physical,

psychological, social, and spiritual needs. Older adults are not different than

younger adults or children in this aspect. Even infants cry because the brain

triggers that behavior to get their functional needs met. A functional

perspective helps the forensic interviewer understand that all responses and

behavior by the older adult during the interview are not coming just from their

ability to remember facts but also how the brain perceives that sharing those

facts will serve their needs at that time.

Forensic interviewers must realize that older adults, like all other victims, must

rely on their brain functioning to deal with the wide array of needs that are

present. As victims of abuse, they must often navigate a variety of complex

systems using their brain functioning to successfully meet these needs. For

example, older adults will use their brain functioning to decide whether the

forensic interviewer is a person who can help them meet their needs after the

abuse. In other words, the brain will attempt to figure out how the interviewer

and the interview serve the older adult’s needs, such as the need for justice,

emotional well-being, or even the help with ADLs.

The brain will also prioritize these needs. If the brain prioritizes the need for

daily care over justice and the perpetrator is a caregiver, the results of a

forensic interview may have nothing to do with the person’s ability to recall

information about the incident.

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In comparison to younger adults, the brains of older adults have more

experience functioning to meet these needs. Older adults are much more

sophisticated at this than younger adults and children. This does not mean

they always make the best choices for themselves or even for the purposes of

the interview, but it does mean the aging brain’s experience at meeting needs

is complex and difficult to fully understand because a lifetime of variables

play a part.

Having a strengths-based functional perspective of how the brain works will

help improve the quality of an interview with older adults by not simply

focusing on cognitive deficits but rather addressing the abilities and needs of

each older adult victim of abuse. The interviewer can focus on assessing

those needs relevant to the interview and the older adult’s strengths (skills,

abilities, language, and resources) that can help meet those needs.

Normal Changes in the Aging Brain

The aging brain means some changes in brain functioning for all older adults.

For some individuals, it means very minimal changes, whereas others will

experience more significant changes in the brain and how it works to meet

their needs.

Normal aging of the brain can lead to decreased speed in finding words and

recalling names, difficulty with multitasking, and decreases in the ability to

pay attention (National Institute on Aging, 2020). These are due to the slower

processing speed of aging brains and underlie attention impairments among

older adults (Suchy, 2016). For example, selective attention (the ability to focus

on specific information while ignoring irrelevant information) declines with

age. Engaging in a conversation in a noisy restaurant becomes more difficult

with age because the ability to selectively attend to relevant information is

increasingly impaired. For interviewers, this underscores the importance of a

quiet area to conduct the interview free of distractions to ensure the older

interviewee is able to attend to the interview.

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Divided attention (the ability to focus on multiple tasks simultaneously) also

declines with age. For example, the ability to talk on the phone while

preparing a meal becomes increasingly difficult because it requires

cognitively switching between tasks. The implication for interviewers is to

have the older interviewee focus on one task at a time and avoid multitasking

(e.g., filling out paperwork while being asked questions).

Not all effects of aging on the brain are negative, though. Older adults often

have more extensive vocabularies and a greater understanding of the depth

of meaning of words than younger adults and children. According to Harvard

Health (2015), older adults also often get better at inductive reasoning,

accentuating the positive, attaining contentment, and verbal abilities.

Understanding that there are normal changes that will affect functioning

such as memory is critical to conducting a strengths-based quality forensic

interview. The older adult victim of abuse being interviewed is not just

forgetful—they forget things because the brain is not storing and/or recalling

information as it did when it was younger due to the natural changes that can

affect how it functions.

At the core of forensic interviewing is the older adult’s ability to recall and

describe clearly and accurately what happened to them. If an interviewer

does not account for some of the natural changes in the aging brain, they

may not be able to achieve this goal.

As noted, there are also many strengths in brain functioning gained over the

lifespan. Many of these positives will affect the interview with older adult

abuse victims. Take inductive reasoning for example—older people don’t rush

to judgment as quickly as people who are younger. They are more likely

to take more time to make a decision, but they are more likely to make the

right conclusions based on the information they have. The interviewer can use

this information as a reason to allow more time for interviews of elder abuse

victims. It is not because they are old or slow that more time is necessary

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but rather because the older adult is taking their time to make an accurate

conclusion about what the interviewer is asking and saying.

Another example may be accentuating the positive. The amygdala, the area

of the brain that consolidates emotion and memory, is less responsive to

negatively charged situations in older people than in younger people. So even

the experience of victimization and trauma may not cause the same types of

emotional reactions or negative feelings about the offender that the

interviewer may see from younger victims. This is important for the interviewer

to keep in mind when the older adult does not seem to have emotions that

they would expect to see from a victim.

Addressing Normal Aging Brain Changes in Older Adults

There are three practical approaches to older adults based on the

general characteristics of the aging brain. These can be considered basic

approaches without overgeneralizing.

First, don’t treat older adults just like younger adults. This doesn’t mean that

the interviewer should assume that the older adult is forgetful or

cannot handle multitasking, but the interviewer does need to be aware that

there may be differences. These differences aren’t simply because the person

is old but because the brain is naturally changing and affecting behavior.

Second, when the interviewer or a member of the MDT notices differences, ask

the older adult what they might need to help them. The team can also check

with a trusted family member or other people who are accompanying them,

with permission from the victim. Some older adults may need things in writing.

Some may need the interviewer to repeat something a few times. Some

people may need to focus on one task at a time. Ask the person and

accommodate their specific individualized needs whenever you can.

Third, and maybe most important, be patient and give sufficient time for the

interview. When working with older adults, the interviewer should make sure

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they have time to account for any of these issues that may arise. Rushing an

interview and not making time for accommodations will almost never result in

an effective interview.

Interviewer Considerations for Communicating with Older Adults

Throughout the forensic interview process, an interviewer and the older adult

being interviewed must function as a dynamic unit. When asking questions,

the interviewer must allow the older adult interviewee to be an expert on their

lived experiences while the interviewer acts as a guide for the flow of

information throughout the interview process. Keeping this perspective will

allow for the interviewer to create a victim/witness-centered environment

that prioritizes gathering information the older adult interviewee knows rather

than placing emphasis on what the interviewer or MDT needs to know.

The interviewer’s qualities and habits can have a significant effect on the

quality of information gathered throughout a forensic interview with an older

adult. For example, poor questioning techniques affect an older adult’s ability

to recall and report information during an interview (Love, 2015; Yarmey,

2000).

Interviewers must strive to remain open-minded, objective, and neutral

throughout the forensic interview process. As discussed previously in “Biases

and Assumptions about Aging,” in order to remain open-minded, objective,

and neutral, the interviewer must acknowledge and challenge any biases and

assumptions about the older adult population, the credibility of older adults,

and the dynamics of cases involving older adults. Interviewers must

acknowledge that how they perceive the older adult being interviewed may

skew an older adult’s ability to recall and report information during the

forensic interview process (Allison & Brimacombe, 2014).

To challenge these biases, interviewers should obtain a basic understanding

of the communication style of older adults to engage in establishing

alternative hypothesis, focus on meaningful rapport development, and work

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to establish a thorough baseline for the older adult being interviewed. (See

also “Establishing Rapport” and “Establishing a Baseline.”)

Communication Style of Older Adults

When entering a forensic interview with an older adult, it is important for

interviewers to have a basic understanding of the communication style of

older adults. Interviewers may notice the use of the following when

communicating with an older adult:

• Negative Qualifiers (e.g., “I think,” “I’m not sure,” etc.)

o Older adults commonly use negative qualifiers when

communicating.

• Pacing

o In general, older adults may speak slower (Allison & Brimacombe,

2014).

• Language (Tangalos & Peterson, 2018)

o Common among older adults are occasional problems with

expressive language such as word finding and tip-of-the-tongue

phenomena.

• Details and Narrative Organization

o In general, older adults may provide fewer details spontaneously

than in interviews with younger adults. (Allison & Brimacombe,

2014.)

o Older adults may relay information out of chronological order

(Allison & Brimacombe, 2014).

o Older adults tend to go beyond the details. They may provide

information that is considered superfluous (e.g., subjective

impressions, moral judgments, etc.) or off-topic information

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(Allison & Brimacombe, 2014).

In considering all of these common features when assessing the

communication style of older adults, interviewers and MDTs should be mindful

of assigning any meaning or value to the manner in which older adults

communicate. When interviewers and MDTs perceive the communication

behaviors of older adults in a negative light, this is likely to create a situation

where the older adult is dismissed (Allison & Brimacombe, 2014). The way an

interviewer perceives an older adult affects the way that they speak—they

may adopt a more condescending or patronizing tone that is damaging to

rapport with the older adult interviewee and information gathering

throughout the interview (Allison & Brimacombe, 2014).

Considerations for Interviewer Questioning Techniques

Interviewers should be mindful of how questions are worded when

interviewing older adults. Interviewers must word their questions with the

individual older adult’s ability to understand in mind. (See “Leading and

Suggestive Question Types” section.)

Interviewers should avoid all of the following:

• Leading and suggestive language (e.g., “The night-nurse stole your

money, didn’t he?”; see also “Leading and Suggestion”)

• Negative language (e.g., “Didn’t you see Frank?”)

• Figurative language (e.g., metaphors, analogies, hyperbole, idioms, etc.)

• Professional jargon/technical terms (e.g., “The incident that occurred…”)

• Vague language (e.g., “dementia” can have many different

interpretations for the older adult, such as insanity or forgetfulness;

interviewers should avoid using terms that may mean different things

or potentially upset the older adult)

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• Compound or complex questions (e.g., “What was the brown-haired

woman with the knife doing when her husband was rifling through the

car?”)

• Stacked questions (i.e., asking more than one question at a time, e.g.,

“Tell me about the place where this occurred. What did the place look

like? Were there items in the room?”)

• Questions that begin with “why” (these may come across as blaming)

• Patronizing style speech or tone of voice (Allison & Brimacombe, 2014;

Love, 2015)

Interviewers should instead utilize the following:

• Strengths-based language (see Strength-Based Approach for

suggestions on the “strengths-based approach”)

• Questions posed in a neutral manner using language that would be

used in interviews with a younger adult (Allison & Brimacombe, 2014)

• Clear and concrete language

• Prompting cues that incorporate the older adult’s words (e.g., “You said

you went to the store. What happened next?”)

• Interview pacing the older adult sets

• Polite language to redirect the older adult appropriately and

respectfully if they become distracted or withdrawn from the topic

• Culturally appropriate language and cultural humility that respect the

aspects of cultural identity that are most important to the older adult

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Leading and Suggestion

Individuals of all ages are susceptible to leading and suggestive questions.

Memory is not a complete copy of events as they transpired. Instead, memory

of an event depends on the information that is encoded at the time of an

event (Howe & Knott, 2015). This encoding is affected by what an individual

pays attention to or is focused on during the event, which can be affected by

a variety of different circumstances (Howe & Knott, 2015). Every time a

memory is retrieved, it is reinforced, but it may experience slight alterations

due to intrusions of similar memories (Hines, 2018). The memory retrieved is

not of the original event but rather the memory of the last time the event was

thought about (Hines, 2018). These are some of the many reasons

interviewers must consider the suggestibility of their questions when

interviewing alleged victims and witnesses of all ages.

Leading and suggestive questions, by definition, are questions that imply their

answer within the given question. While suggestive prompts imply their

answer within the question, they do not always encourage agreement in

response (e.g., “Did they pull out a gun?”). Leading questions, however,

encourage an older adult to respond in an expected way (e.g., “They took your

money, didn’t they?”). Leading and suggestive prompts may be closed-

ended (e.g., “Did it hurt?”) or open-ended prompts (e.g., “What did your

nephew do to break your arm?” when the victim has not previously disclosed

having their arm broken) that introduce new information to the person being

interviewed that was not previously disclosed. Thus, as interviewers consider

the suggestibility of questions they ask an older adult, it is critical to

remember how memories are encoded and retrieved.

Similar to children and young adult eyewitnesses, research into the

suggestibility of older adult eyewitness suggests that older adults may be

susceptible to the effects of misinformation following an event (Memon et al.,

2013). In addition, research indicates that older adults may have difficulty

identifying the source of the information (e.g., something they witnessed, or

something heard from someone else; Memon et al., 2013; Mitchell et al., 2003).

Older adults tend to have impaired source monitoring, which means when

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they are being asked where or from whom they learned a piece of

information, they may not be able to provide the source, but this does not

mean they are lying or hiding something. Thus, interviewers should consider

the suggestibility of their questions when interviewing older adults.

Interviewers should be mindful not to contaminate memories through asking

leading and/or suggestive questions intentionally because this may skew

memories/details provided throughout the interview and the criminal justice

process. In general, leading and suggestive questions decrease the

opportunity for independent responses while increasing the risk of inaccurate

information.

Interviewers must be aware of their own biases and how they could

potentially affect an older adult’s memory through their line of questioning

(e.g., preconceived ideas about a situation, preconceived ideas about

victim/witness behaviors, confirmation bias, etc.). When interviewers are not

aware of their biases and use suggestive questioning, they run the risk of

receiving influenced, inaccurate information and increasing the risk of

skewing an older adult’s memory of the details of an event. This could be

potentially problematic when attempts are made to corroborate the

accounting of an incident. To combat this, interviewers should place

emphasis on gathering information that is known by the older adult rather

than emphasizing what the interviewer needs to know.

In addition to being aware of biases, interviewers must be intentional about

the type of question that is asked (i.e., open-ended vs. closed-ended

questions; see “Question Types”), the words used in each question (i.e., not

introducing information through questions), and their tone of voice when

asking questions (e.g., not questions that intentionally or unintentionally

convey judgment or blame). Providing narrative prompts to encourage the

accurate retrieval of episodic memories will provide the older adult being

interviewed a greater opportunity to access memories more fully and

completely. As discussed in “The Recycling Funnel Model,” it is important to

follow all closed-ended questions with an open-ended question to allow the

older adult an opportunity to elaborate. This will help the interviewer avoid

assumptions about the response.

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For interviewers who have been trained in some interview and interrogation

techniques, leading and suggestive questions are often encouraged to

identify deception or inconsistencies in the accounting of a suspect. While this

has been considered a useful interrogation technique, it is less useful when

interviewing victims and witnesses of crime.

Leading and Suggestive Question Types

Leading and suggestive questions may be reflective of interviewer bias. An

interviewer might assume they know what the older adult is referring to (e.g.,

making assumptions about what is meant when the older adult says “sex”), or

the interviewer might make assumptions or have expectations based on how

the older adult behaves (e.g., making assumptions about an older adult’s

reliability because they did not cry during the interview). Interviewers must

continue to be aware of their own biases and not intentionally or

unintentionally change the outcome of an interview though leading and

suggestion because the judicial system relies heavily on memory evidence to

determine whether a crime has or has not occurred (Howe & Knott, 2015).

Suggestive Questions

Suggestive questions are prompts that are framed in a way that implies their

answer. When posed, suggestive questions often introduce new information

to the older adult that in fact was not a true aspect of what they are reporting.

Suggestive questions range from mildly suggestive, with minimal new

information introduced, to highly suggestive, with multiple, explicit pieces of

new information introduced. Suggestive questions are often framed as

closed-ended, yes/no questions.

Examples:

• Did they have a knife? (Mildly suggestive)

• Did they threaten you with a knife? (Moderately suggestive)

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• Did they threaten you with a knife if you didn’t do what they asked?

(Highly suggestive)

Leading Questions

By definition, a leading question is a confirmatory question that prompts an

individual to respond in a way that the interviewer expects. In other words,

leading questions are suggestive prompts where the interviewer pushes the

older adult to respond in a particular or expected way.

Tag Leading Questions: One type of leading question is known as a tag

leading question. Tag leading questions are confirmatory statements that are

preceded or followed by an interrogative phrase. Formatting a question in this

manner is assumptive; it seeks only endorsement (i.e., instructing the answer

that is expected), allowing little room for alternative answers. While this type

of question is not unusual in general conversation, interviewers should work to

keep forensic interviews free of tag leading questions.

Examples:

• You ran away, didn’t you?

• You don’t remember what they said, do you?

• Didn’t they make you scream?

Presumptive Leading Questions: Another form of leading questions known as

presumptive leading questions introduces information based on

presupposition. Presumptive leading questions tend to be based on

information the interviewer presumes to be true or involve misinformation.

When posed, presumptive leading questions assume information, then

encourage confirmation of that assumption. Presumptive leading questions

may take many forms and are sometimes disguised as open-ended

questions (e.g., asking “What did your husband hit you with to make that

bruise?” when the victim has not previously reported being hit by their

husband). Presumptive leading questions may also be presented in a closed-

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ended format, with forced choice or otherwise limited response options.

Examples:

• Tell me about being attacked with the knife.

• Did they come after you with the knife before or after hitting you

in the face?

Note: The above questions are considered presumptive leading questions

only when no details of an assault or a knife had been previously provided.

Depending on the individual and the circumstances, additional patterns or

alterations in inquiry may be perceived as leading and/or suggestive. For

example, repeated questions might indicate to the older adult that the first

answer they gave was not good enough, and they might change their answer

to please the interviewer. One way to remove this type of suggestion is to

indicate to the older adult a need to clarify by saying, “I need to ask some

questions to make sure I understand.”

Video Activity: Flossie

Notes:

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Cognitive Decline

There are two major types of cognitive decline: reversible cognitive decline

and nonreversible cognitive decline. The difference between these two types

is extremely important because while their symptoms often look similar, the

approach of the interviewer and the quality of the forensic interview are

affected differently, depending on which type of decline is involved.

Reversible Cognitive Decline

Not all cognitive decline is due to irreversible conditions such as dementia.

Depression and delirium are two medical conditions commonly

misdiagnosed as dementia. Disturbances in body chemistry, infection,

endocrine disorders, medication reactions, medication overdose, illicit drugs,

or alcohol can present similarly to dementia. In addition, many over the

counter and prescription medications may affect mental acuity.

If the interviewer at any stage of the interview assesses that the older adult is

having difficulty with the interview that may be due to cognition, the MDT

should encourage a further assessment by a physician to see whether there

is a reversible reason the person is presenting in that way.

Even when someone has a diagnosis such as Alzheimer’s disease, these other

factors should be ruled out to ensure the older adult can participate to the

greatest extent possible. As noted previously, a perpetrator may

overmedicate an older adult to purposely keep them from being able to

report the victimization. An older adult in early stages of the disease may

present as in later stages due to overmedication by the perpetrator. If

addressed by a medical professional, the interviewer can attempt an

interview at a time when the older adult is properly medicated. This is part of

the importance of the MDT for forensic interviewing of older adults to pull in a

wide array of resources to assess and address these types of issues.

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Irreversible Cognitive Decline

Some conditions cause irreversible cognitive decline. While treatment can

slow the progression of these conditions, they are chronic, with an increasing

decline in the cognitive processes of the aging brain. These conditions are

called neurocognitive disorders (NCDs) in the DSM-V. They are more

commonly referred to as dementia. An NCD is a deficit in cognitive

functioning that represents a decline from a previous level of functioning not

caused by a psychiatric condition. Symptoms include memory impairments,

deficits in attention, visual-spatial ability, social cognition, and, importantly,

executive functioning.

This curriculum uses the term dementia because it is still the term used by

many professionals in the medical field. Forensic interviewers should address

any bias they have in the use of this term. For example, the term dementia is

often used in a way that equates memory loss with forgetfulness, but some

types of NCDs do not present until later (or at all) as memory loss.

The forensic interviewer should never use the term demented to refer to an

older adult. This is not strengths-based or people-first and labels a person in

a way that is not medically based. The forensic interviewer should use “an

older adult living with dementia.” Even better for the purposes of a forensic

interview is to focus on the symptoms and not a diagnostic label. The forensic

interviewer can refer to the person as “an older adult with signs of

forgetfulness.” The diagnostic label is less important than the symptoms that

affect the interview.

Finally, the forensic interviewer should be careful of using the term dementia

in the interview questioning. The term as used in general society is vague and

does not provide the forensic interviewer the level of detail necessary to truly

understand the cognitive state of the person and how that affects their

testimony. It is better to ask older adults about specific symptoms.

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Consider this example in asking about an older adult’s family member during

pre-interview considerations:

Do not ask: Does your husband have dementia?

Instead say: Tell me about any times your husband has been forgetful.

If the response includes symptoms of forgetfulness, it is appropriate to follow

up to see whether the person they are describing has been medically

assessed or diagnosed and is receiving treatment.

Dementia

Dementia is a general term for the impaired ability to remember, think, or

make decisions that interferes with doing everyday activities. There are a

number of subtypes of dementia. The DSM-V lists these subtypes of NCDs,

when you hear “dementia” or “NCD” they can have many different meanings:

• Alzheimer’s disease

• Vascular NCD

• NCD with Lewy bodies

• NCD due to Parkinson’s disease

• Frontotemporal NCD

• NCD due to traumatic brain injury

• NCD due to HIV infection

• Substance/medication induced NCD

• NCD due to Huntington’s disease

• NCD due to prion disease

• NCD due to other medical conditions

• NCD due to multiple etiologies

• Unspecified NCD

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Video Activity: What is Dementia?

Notes:

As should be clear from this list, having an NCD or dementia is not simply a

matter of aging. An older adult can experience cognitive decline due to a

traumatic brain injury or HIV infection that would not have occurred otherwise.

Forensic interviewers should keep in mind that dementia is not an inevitable

part of aging. When it does occur, the onset can be slow or sudden. Because

of the nature of victimization as described previously, forensic interviewers

must be aware of the effects of dementia and how to effectively

communicate with older adults living with dementia because it is a significant

risk factor for elder abuse when present.

Dementia may affect the ability to recall old information or learn new

information. As noted previously, not all dementias affect memory, especially

in earlier stages. To be diagnosed, people will experience significant deficits in

at least one of the following areas: writing and speech, recognition of people

or objects, motor activities, planning, execution of plans, and monitoring of

their own behavior. The deficits must be significant enough to affect a

person’s ability to work or perform daily activities of living or cause problems

in social relationship to qualify as dementia. In short, the illness must affect a

person’s functioning.

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Inability to complete simple tasks, poor judgment, unrealistic plan making,

violent behavior, suicidal ideation, frequent falls or stumbling, disregarding

social conventions, and levying accusations against loved ones are some

behavioral characteristics of people living with dementia. People living with

dementia may be unaware of their condition. Dementia is experienced

individually, so while some commonly appearing behaviors are listed, not

everyone will demonstrate the same disease trajectory.

Common Subtypes of Dementia

Alzheimer’s disease is the most common type of dementia, affecting

approximately 5.8 million people in the United States (The Journal of

Alzheimer’s Association, 2021) and ranking as the fifth leading cause of death

for older Americans (“Alzheimer’s Disease, Part I,” 1998; The Journal of

Alzheimer’s Association, 2021). Its onset is gradual, followed by progressive

degeneration. Memory impairment, language deficits, and declines in visual

and spatial processing are typical symptoms of Alzheimer’s disease

(Cummings, 2004).

In early stages, symptoms typically include the inability to take in new

information or recall past events and personality changes, including rigidity,

apathy, egocentricity, and impaired emotional control (Balsis et al., 2005). As

the disease progresses, symptoms including irritability, depression, delusions,

delirium, and wandering are observed. In more advanced stages, language,

recognition of loved ones, mobility, and the ability to perform ADLs are lost.

Vascular dementia results from damage to the brain that restricts blood flow,

including a series of small strokes, a single major stroke, or other chronic

conditions that damage blood vessels in the brain (Mayo Clinic, n.d.).

Functional and cognitive deficits are determined by the location of the stroke

or strokes or damaged blood vessels. Most people with vascular dementia

also have other types of dementia, often Alzheimer’s.

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Lewy body disease (LBD) is marked by sleep disturbances, visual

hallucinations, and visuospatial impairment. These symptoms may occur

without memory impairment. Most people with LBD will also develop

Alzheimer’s, and when that happens, memory loss will occur.

Frontotemporal dementia (FTD) is an umbrella term for several diseases that

affecting the frontal and temporal (side) parts of the brain. Early symptoms

include changes in personality and behavior, and language in early stages

memory is not affected. “Some people with frontotemporal dementia have

dramatic changes in their personality and become socially inappropriate,

impulsive or emotionally indifferent, while others lose the ability to use

language properly” (Mayo Clinic, 2021). In some cases, movement is affected

leading to tremors, rigidity, muscle spasms, loss of coordination, swallowing

problems, and inappropriate laughing or crying (Mayo Clinic, 2021). Scientists

believe that FTD is the most common cause of dementia in people younger

than age 60 and that the majority of people with FTD develop symptoms

between the ages of 45 and 60.

Stages of Alzheimer’s Disease

Regardless of the type of NCD, people will present on a continuum ranging

from no symptoms to very advanced symptoms. When working with

someone with Alzheimer’s Disease, the person will fall onto a continuum of

stages based on level of functional impairment. Again, these levels are not

solely based on memory or recall but rather signs and symptoms of how the

brain’s functions are impaired to meet the older adult’s needs.

The stages range from no impairment, which occurs when clinical tests

(biomarkers) show that Alzheimer’s disease is present, but the older adult is

experiencing no impairment in functioning, to very severe symptoms

impairing functioning, which is often marked by the older adult being

unresponsive and in need of care for most functions. The names of the stages

can vary depending on the reference source, but they all follow a general

pattern from little to no impairment to severe impairment toward the end of

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life. The progression of these stages will vary significantly from person to

person.

Older Adults With Severe Impairment

While a forensic interviewer should attempt to obtain the facts from all older

adults, people within the categories of severe decline may not be able to

participate in the forensic interview process. The signs and symptoms of later

stages of dementias are often quite apparent. Most often the interviewer will

notice the significant memory loss. The person may no longer be able to

recognize other people who are close to them or even themselves. They may

believe they are in a different place or even time period. Gentle redirection by

the interviewer will not result in getting them to understand or focus on the

purpose of the interviewer.

If the interviewer believes the individual can participate in the interview, they

should proceed with caution. The interviewer must be sure they are

conducting the interview legally and ethically. The interviewer should be

careful the older adult understands why they are being asked questions and

is consenting to being part of the interview. The MDT should gather

information about concerns regarding the older adult’s capacity to give

consent from non-offending family, caregivers, and medical professionals,

and in some cases, they may even need to obtain a capacity assessment.

The interviewer must also be aware if the older adult with severe impairments

from dementia is experiencing a high level of distress from the interview

process. Agitation will be discussed later, but the interviewer should monitor

the individual for any nonverbal signs of increasing anxiety, fear, frustration,

agitation, and disorientation. If any of these are occurring, the forensic

interviewer should stop the interview and consult with the MDT and non-

offending caregivers regarding whether it is possible to interview the older

adult who is experiencing severe symptoms without causing distress.

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Older Adults with Mild to Moderate Impairments

For the most part, the forensic interviewer will be interviewing older adults with

mild to moderate impairment levels due to the symptoms associated with

dementia. More mild impairments can be harder to detect and will not always

be apparent, especially in earlier stages of the interview. Characteristics may

include being more forgetful of details of recent events, being more likely to

repeat themselves or lose the thread of a conversation, being slower to grasp

complex ideas, taking longer to complete routine tasks, having difficulty

handling money, showing poor judgment and making poor decisions,

losing interest in hobbies or activities, being unable to adapt to

change, and appearing more apathetic.

The challenge for the forensic interviewer is that these characteristics can be

difficult to detect even for people who know the person well. Because the

forensic interviewer will often not have the ability to compare the person to a

baseline, they need to look for some other signs that can provide an

indication in the moment of a concern, especially if the older adult has not

been diagnosed.

One sign could be that the interviewee is disoriented to time and place. If the

interviewer notices this as a concern, they can use a prompting statement

like “where are you right now?” Questions about place and time should not be

routine, but they can be used when trying to identify if there is a concern that

cognitive functioning may be affecting the interview.

The interviewer is not looking necessarily for perfect answers to questions

about place and time. For example, consider this example from an interview

conducted by law enforcement at an advocacy center for victims in an office

complex:

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Interviewer: Tell me about the place you are at right now.

Interviewee: I am at a police station.

This would not necessarily be a red flag of dementia. Someone from law

enforcement is interviewing them in a building that is not their home or a

place they are familiar with. This simply may be a detail that is not relevant to

the functioning going on within the brain for this experience. However, if the

response is significantly different, there may be a concern, such as in this

example from the same place as above:

Interviewer: Tell me about the place you are at right now.

Interviewee: I am at your house.

This would most likely be a concern because the context of the interview

doesn’t suggest in any way that the interview would be in someone’s home.

Sometimes, though, the indicators are not as clear. Even in the first example,

the interviewer can follow the question funnel in order to assess the reasoning

of their answer:

Interviewer: Tell me about the place that you are at right now.

Interviewee: I am at a police station.

Interviewer: Why do you think you are at a police station?

Interviewee: Because you are a police officer and that is where you

work.

This response makes sense. But if they say something like “because my dad

brought me here yesterday and they tried to lock me up,” the reasoning is not

consistent with the conclusion.

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It is important when following up that the interviewer does not immediately

correct the older adult before letting them offer their reasoning. Older adults

with even moderate levels of impairment can often react to the cues of the

interviewer to anticipate how they are supposed to answer.

Sometimes interviewees will also talk about people who are not present or

even deceased as if they are there with them or currently in their life. This can

also be a sign of being disoriented due to dementia.

People living with dementia can also have poor judgment and an inability to

explain a logical reason for their actions, such as wearing a heavy coat on a

hot summer day or no jacket and a short-sleeved shirt during the winter. If the

interviewer is able to identify behavior that shows questionable judgment, ask

the person about it. If the answer to a question regarding a heavy coat on a

hot summer day is that they get cold often in air conditioning and they knew

they were going to be interviewed inside, the selection of the coat, of course,

would be of less concern. If their answer does not provide a logical

explanation, this may be a sign of a dementia.

Other signs you may be able to observe include wandering or becoming

lost easily; not knowing where they live; rapid mood swings due to anxiety,

suspiciousness, or agitation; or a slow walking gait that features sliding

movements (shuffling) due to the person not lifting their feet. Interviewers

should also be aware that any of these symptoms could also be a sign of a

reversible cognitive condition as well. The significance here for an interview is

not to guess at a diagnosis but to be aware of the effect of cognitive decline

on an interview and determine when further assessment may be necessary.

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Interview Challenges

People living with dementia may experience changes in their ability to

communicate. However, it is important not to make assumptions about a

person’s communication ability or memory based only on their diagnosis or

initial presentation. Dementia affects each person differently. Additionally, the

changes in communication ability will vary based upon how far the dementia

has progressed. As the disease progresses, an older adult’s ability to

communicate becomes increasingly impacted. They will follow patterns such

as these:

• Have difficulty finding the right word to use

• Repeat stories

• Feel overwhelmed in the presence of excessive stimuli

• Extensively use familiar words

• Describe familiar objects instead of referring to them by name (e.g., the

thing that tells you what time it is vs. clock or watch)

• Lose track of their general ideas when speaking

• Be unable to answer a question that asks them to describe multiple

events (e.g., “Tell me everything that happened once you got up on

Tuesday”)

• Be able to provide a linear or chronological answer

• Struggle with the logical organization of words

• Revert to speaking their primary language if they are multilingual

• Verbally communicate less often and rely more on gestures to

communicate

Strategies for Communicating with Individuals Living with Dementia

In general, the forensic interview should use the same techniques that are

used with all adults to show interest, listening, and respect. The following is a

list of considerations for when the interviewer is aware of a diagnosis or

behaviors that may indicate the older adult has impairments from dementia

that could affect the interview.

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Pre-interview considerations:

• Plan for more time than normal to conduct the interview.

• Attempt to schedule the interview at a time of day that is best for the

interviewee.

• Make water available because people living with dementia may be

more susceptible to dehydration.

• Remove possible distractions (e.g., hallway traffic, busy pictures on

walls, television or radio noise, etc.) from the interview location.

• Anticipate medical conditions that may require treatment or the need

to take a prescription during the time the older adult is away from their

home for the interview.

• Try to minimize the amount of time people are around larger groups of

people (i.e., a waiting room).

Utilize Pre-Interview Considerations Checklist (Appendix III) for additional

considerations related to the setting of the interview.

Strategies for Communicating with Individuals Living with Dementia:

• Physical Approach

o Approach victims from the front. Don’t come up from the side or

from behind.

o Face the person you are speaking to and refer to them by their

formal title or preferred name, if known. Utilizing their name will help

ensure that you have and keep their attention.

o Establish and maintain eye contact at eye level as much as possible.

Do not require the older adult to look you in the eye. Lack of eye

contact may be due to culture, preference, neurodiversity, etc.

o Minimize speaking with hands.

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o Try to avoid any sudden movements.

• Verbal Approach

o Introduce yourself and explain that your job is to help them.

o Develop rapport to decrease anxiety; diminished cognitive

functioning does not take away a person’s ability to feel anxious or

fearful.

o Do not infantilize the person living with dementia (i.e., using a high-

pitched tone).

o Speak slowly and clearly while using simple words.

o Be prepared to reintroduce yourself and your role several times.

o Keep conversations brief.

o Keep questions short.

o Pause between questions as needed.

o Explain all of your actions prior to doing them. Repeat why you are

doing something if necessary.

• Style/Affect

o Be warm, friendly, and conversational.

o Use a low-pitched reassuring tone.

o Do not shout or yell.

o Try using nonverbal communication along with verbal instructions.

For example, if you want someone to sit down, show them by sitting

down yourself first.

o Take breaks as needed.

o Do not argue with a person or try to orient them to reality.

o Gently redirect if the individual becomes anxious.

o Become aware of any triggers (use the Pre-Interview Considerations

Checklist in Appendix III) and avoid them.

• Question Structure

o Don’t get into the exact details of everything you do right away or all

at once.

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o Avoid slang and figures of speech (e.g., idioms, axioms, hyperbole).

o Avoid pronouns as they may become confusing.

o Use real names for people and objects.

o Avoid finishing an older adult’s sentences.

o Repeat statements and questions if necessary.

o Give simple, step-by-step instructions, and, whenever possible, a

single instruction at a time.

o Avoid saying “I’ve already told you that” or “Like I said before . . .”

o Consider exceptions to funnel question order based on needs of

older adult. Choice or yes/no questions may be necessary because

the person may not be able to answer questions that

require them to recall and recite a sequence of events.

Video Activity: Kids Interview People with Dementia

Notes:

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Critical Issues for Forensic Interviewing Victims Living with Dementia

Interviewers may not always know whether an interviewee is a person living

with Alzheimer’s disease and related dementias (ADRD). But if their status is

known, there may be some hesitation about interviewing persons with ADRD.

Alzheimer’s disease and other dementias are progressive conditions that lie

along a continuum of severity (Alzheimer’s Association, 2021). Persons with

ADRD should be interviewed, particularly in the earlier stages of the disease.

Further, research confirms that persons with ADRD can report on emotionally

meaningful events, such as the experience of elder abuse (Wiglesworth &

Mosqueda, 2011). Ensuring persons with ADRD are interviewed as part of a

criminal investigation is an access to justice issue. Therefore, regardless of

stage—which likely will be unknown—interviewers should always try to

interview persons with ADRD and let the courts determine the credibility of the

information obtained. Further, the interview may reveal a need for services

that otherwise may remain unknown.

With this in mind, there are three critical issues that require attention for

forensic interviewers during the interview in addition to the general steps

listed in the preceding section: (a) using supportive touch, (b) addressing

agitation, and (c) dealing with reality disorientation. Each of these issues are

extremely complex and require the forensic interviewer to work with their MDT

and outside expert consultation as needed to address for each individual.

When using caregivers to help determine the best course of action, the

interviewer needs to be confident the caregiver is not an offender and that

they are truly using effective techniques. The interviewer should also be aware

that just because the techniques work for the caregiver, who has an existing

relationship with the older adult, it doesn’t mean that the techniques will work

for the interviewer who is a new person in the older adult’s life.

Each of these issues is covered below with some general considerations for

forensic interviewers.

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Using Supportive Touch

Knowing how a person living with dementia responds to physical touch is

important. The decision for an interviewer to engage in physical touch should

consider the person being interviewed, how they are doing in the moment,

and what the allegations are. Physical touch should only be considered

when initiated by the interviewee and should be an intentional decision

made by the interviewer that they should be fully prepared to defend, if

necessary. Touch can be utilized as a rapport-building strategy and/or for

redirecting the individual back to the conversation.

Addressing Agitation

Like all people, individuals living with dementia read and interpret verbal and

nonverbal communication during a conversation. Interviewers should be

aware that an individual living with dementia may become distressed or

agitated by sudden movements, tone of voice, or a tense facial expression,

despite the words spoken. Interviewers should make sure their body language

and facial expression match what is being said by the older adult, even if this

might feel a bit forced at times. Interviewers should also pay close attention

to the body language of the older adult they are speaking with because it will

convey interest/disinterest, calmness/anxiety, and aggression.

Persons living with dementia can become quickly agitated and even

aggressive, even when talking about non-triggering topics. Interviewer and

interviewee safety should always be paramount during an interview. Use

language that implies doing an activity together as opposed to language

conveying that the person living with dementia must perform the activity

alone (e.g., “Let’s talk” vs. “Do you want to talk with me?”). Joint activities tend

to be more enjoyable, and this technique has success in generating

participation in individuals living with dementia (Alzheimer’s Society, 2020). If

the older adult becomes increasingly agitated, interviewers should utilize de-

escalation techniques such as keeping their body language soft and open,

using a calm tone of voice, using simple language, asking questions that

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require a shorter response, redirecting the conversation to a new topic,

avoiding arguing with the older adult, and providing supportive statements.

Dealing with Reality Disorientation

When an individual living with dementia introduces difficult questions or

becomes distracted by thoughts that are not oriented to the current

conversation or what the interviewer believes to be their current situation,

employ redirection techniques, and do not directly attempt to reorient them

to reality (e.g., telling them that their loved one has died, that they can’t go

home, etc.). Be as honest as you can be with the individual while you are

working on reducing their anxiety and directing them back to the topic that

you were talking about before their attention became focused on a different

topic.

Example 1:

Interviewee: Where’s my father? I’m looking for my father!

Interviewer: I have not seen him. Tell me about your father.

Interviewee: My father is a good man. I miss him.

Interviewer: Thank you for telling me about your father. I’m not sure

where he is but let me ask someone to find out. Now I’m

going to ask you more about _________________.

Example 2:

Interviewee: I want to go home!

Interviewer: Tell me about your home.

Interviewee: I want to go home!

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Interviewer: I hear you saying you want to go home. I’ve never seen

your home before—what does it look like?

If this type of redirection is unsuccessful, consider engaging in an activity that

still allows the person to answer questions. If communication stops working,

be aware that something grounded in the comfort level may be causing the

older adult difficulty participating in the interview. This includes hunger,

temperature, having to use the toilet, or pain. Offering to get them a snack,

adjusting the room temperature or providing a blanket, or taking a bathroom

break may help. If the older adult is observed rubbing part of their body and

grimacing, they may be experiencing pain. A person living with dementia may

not recognize what is causing them discomfort and simply become unable or

unwilling to participate.

The interviewer may need to make the decision to take a break, come back a

different day to continue with a multisession interview, or determine an

interview may not be appropriate for this individual. These decisions should

be made by the MDT and always with the best interest of the individual being

interviewed.

Video Activity: Living with Dementia

Notes:

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Small Group Activity: Pre-Interview Considerations

1. Participants will be placed in groups based on your scenario.

2. Work together to discuss which pre-interview considerations checklist

would be most appropriate to use based on the case example (i.e.,

Caregiver or self-reported checklist).

3. As a group, discuss which considerations might need to be made

based on the information provided.

4. Choose a representative from your group to share what was

discussed with the large group after the activity.

5. After 10 minutes, participants will come back together to discuss as a

large group.

Notes:

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INTERVIEWING OLDER ADULTS

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INTERVIEWING OLDER ADULTS

Interviewing older adults successfully takes time, patience, and the ability to

meet the older adult where they are at in the moment. To accomplish an

interview with an older adult, several semi-structured steps are

recommended. It is important for interviewers to remember that no two

interviews will look the same, just as no two people are the same.

SAFE Model Semi-Structured Steps

• Establishing rapport

• Establishing interview guidelines

• Establishing a baseline

• Check-in

• Transition to allegation(s)

• Exploring allegations

• Respectful closure

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Establishing Rapport

During an interview, victims and witnesses are often asked to disclose

personal experiences and provide detailed information about potentially

traumatic or embarrassing experiences to complete strangers. When working

with all victims, it is important that interviewers work to create a

psychologically safe environment where victims are comfortable. This

environment is critical because when older adults feel comfortable, they

provide a great amount of and higher-quality information (Marche et al.,

2014). This requires investing time to develop meaningful rapport with the

older adult.

Establishing meaningful rapport serves to accomplish the following:

• Create a relaxed and supportive environment

• Reduce the older adult’s anxiety

• Establish trust between the interviewer and older adult

• Help the interviewer get to know the older adult and create a baseline

for the interviewer to measure these things:

o Identify strengths

o Identify cognitive and social issues

o Identify cultural considerations

o Assess the older adult’s comfort level

o Assess the older adult’s mode of communication

It is important to note that rapport is a state, not a step. Rapport begins with

the first encounter, but it does not stop there. Rapport must be built upon and

maintained throughout the entire interview, even if the interview takes place

over multiple sessions. This level of rapport is different than the conversations

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an older adult might have casually or socially in their daily life. The primary

focus is to ensure and demonstrate to the older adult that the interviewer is

focused solely on the older adult and values what they have to say. When

performed successfully, this connection aids in establishing the interview as a

safe environment, reducing anxiety and establishing trust between the older

adult and interviewer. This combination creates an environment where older

adults feel safe to talk about their experiences and offers the best opportunity

for them to share what happened more completely and with the greatest

amount of detail.

To establish this level of rapport, interviewers must work to find something

interesting about the older adult and/or work to learn something new or

interesting about the interviewee. When an interviewer takes the time to

genuinely learn something new or interesting, it demonstrates that the

interviewer is genuinely interested in the things the older adult has to say and

values them as an individual. Having a conversation with the older adult in

this manner sets the tone for the conversation going forward and is critical to

conducting trauma-informed, victim-centered interviews.

A critical rapport-building step for older adults is asking how they would like

to be addressed. Unlike most interviews with children and even some adults,

the preferences of older adults on how to be addressed can range

significantly. The interviewer should not assume calling an older adult “sir.”

Sometimes this may be appropriate, but other times the older adult will

respond that sir is their father, as that is how they were to refer to their father

during certain times. Even the use of nicknames may be appropriate to use

for older adults. For example:

Interviewer: Hi, Martha Jones. My name is ____________. How would

you prefer I address you as we are talking here today?

Martha Jones: All my friends call me Marty.

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Interviewer: Do you mind if I call you Marty?

Martha Jones: Just don’t call me Martha. My parents and teachers were

the only ones to call me that.

Introduction

The first step in developing rapport is through informing the older adult about

the interviewer’s role. Being upfront and honest with the older adult will assist

in breaking down potential barriers or concerns. There should not be any

need for the older adult to guess why the interviewer is there, what their job is,

or what their intentions are. The purpose of this introduction is to orient the

older adult, including sharing information about the interview environment

(e.g., camera, observers, taking notes, interpreters, etc.).

Sample Language

Interviewer: Hi, my name is ____________, and I am a

_____________ (forensic interviewer, police officer,

social worker, etc.). My job is to ____________.

Make It Personal

One simple way to establish rapport is to let the older adult lead the

conversation by asking them about themselves in an open-ended way. Once

topics have been offered by the older adult, the interviewer should follow the

older adult’s lead and ask open-ended follow-up questions about the topics.

It is important to ensure each question is personalized to the older adult’s

experience, rather than learning about topics in general. One effective way

interviewers can personalize this conversation is through using prompting

cues that repeat the end of the previous statement (i.e., repeating the older

adult’s words in the question) and ensuring the question is personalized to the

individual’s experience. This type of questioning will also assist the

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organization of the conversation as the older adult is recalling details about

their experiences.

Sample Language

Interviewer: I’m looking forward to talking with you today and before we

get started, I’d like to get to know you better. Tell me about

yourself.

Interviewee: I play cards and bingo on the weekends; I also enjoy

crocheting.

Interviewer: You said that you play cards on the weekends. Tell me

more about playing cards.

Another purpose of engagement and rapport is to establish a baseline and

common understanding between the interviewer and older adult for the

conversation ahead. This will be discussed in more detail during the

“Establishing a Baseline” section.

Establishing Rapport Summary

• Be friendly, warm, and conversational.

• Body language should remain neutral, not cold.

• Engage in conversation about topics of the older adult’s choosing (e.g.,

activities or interests) and personalize.

• Consistently pose open-ended questions (e.g., “Tell me about your

family”).

• Use prompting cues that repeat the end of the previous statement (e.g.,

“You said you like to play cards; tell me about playing cards”).

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• Do not move away from engagement and rapport until you are

engaged with the older adult and the older adult is demonstrating that

they are comfortable, and that anxiety is reduced.

• Depending on the needs of the older adult, it may be appropriate to

take a break or consider a multisession interview after any of the semi-

structured steps.

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Establishing Interview Guidelines

Interviews are structurally different from a conversation and may be

unfamiliar to older adults. Therefore, it is important to introduce interview

guidelines to orient an older adult to the expectations of the interview. Setting

guidelines for both the interviewer and the older adult being interviewed will

decrease suggestibility and empower the older adult. Interview guidelines

should be considered in the context of the individual’s strengths and the

potential impact each guideline might have on the process.

Interview guidelines should be introduced conversationally by the interviewer

and should avoid just listing the guidelines. As the guidelines are being

presented to the older adult, the interviewer should consistently be assessing

the older adult’s verbal cues and/or body language to ensure the older adult

is tracking what is being presented. If an individual does not understand a

particular guideline, it may be beneficial to follow up the guideline with a

concrete example. As the interview progresses, if the older adult uses any of

the guidelines, the interviewer may verbally reinforce the guideline (e.g.,

“Thanks for letting me know that you don’t know.”).

There are five guidelines to consider when interviewing older adults:

• Don’t know/don’t guess

• Don’t understand/doesn’t make sense

• Correct me

• Don’t want to talk about it

• Say it when you remember it

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Don’t Know/Don’t Guess

During the interview process, the interviewer may ask questions the older

adult does not know the answer to. It is important that the interviewer convey

that it is okay that if the older adult does not know the answer to a question,

they can simply state they do not know. When an older adult says, “I don’t

know,” during the interview, the interviewer is encouraged to provide

reinforcement to the older adult for not guessing.

The guideline should be stated clearly and simply. Example:

Interviewer: If I ask you a question and you don’t know the answer, tell

me you don’t know. I don’t want you to guess.

Don’t Understand

The “don’t understand” guideline empowers the older adult to let the

interviewer know when a word, concept, or question doesn’t make sense.

While the interviewer should work to use clear language, certain phrases may

be confusing to the older adult and need to be reworded by the interviewer.

Interviewers should keep in mind that some older adults might not want to

admit that they don’t understand because they want to be liked or respected

by the interviewer.

The guideline should be stated clearly and simply. Example:

Interviewer: If I ask you a question that is confusing or does not make

sense, please tell me, and I will try to make the question

more clear.

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Correct Me

The “correct me” guideline directly relates to the minimization of

suggestibility. If an interviewer inadvertently repeats something inaccurately

or says something wrong, the older adult is then empowered by this guideline

to correct the interviewer throughout the interview.

The guideline should be stated clearly and simply. Example:

Interviewer: If I get something wrong, please correct me. I want to make

sure I understand everything you tell me.

This guideline is not intended for interviewers to conduct a suggestibility or

competency test during an interview. In other words, interviewers should not

misspeak on purpose later in the interview just to check whether the older

adult will correct the interviewer or change their response.

Interviewers should reinforce what the older adult says by repeating their

exact words. The interview is not meant to shape or change the language of

the older adult. It is essential that the older adult feel empowered to report or

disclose in their own words throughout the interview process.

Don’t Want to Talk About It

During an interview, there may be one or more topics that the older adult is

not ready to discuss with the interviewer. Addressing this possibility when

providing the guidelines empowers the older adult that they are only being

asked to discuss topics they are ready to talk about. This will provide more

accurate information during the interview than when the older adult feels

they need to leave certain details out. This empowers the older adult and is

also trauma-informed by reinforcing choice to the older adult about what

information is shared, when, and with whom. It also reduces risk of a selective,

edited, incomplete, and less than accurate report.

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The guideline should be stated clearly and simply. Example:

Interviewer: If I ask a question that you do not want to answer, just tell

me, and I will ask you about something else. We will only

discuss what you want to talk about.

Interviewers can also let the older adult know that they would prefer that the

older adult say, “I don’t want to talk about it” than to lie or be untruthful.

Interviewer: If I ask a question you don’t want to answer, it is okay to let

me know that. I would rather you tell me you don’t want to

talk about a topic than to make up details or say that

nothing happened.

Say It When You Remember It

Older adults should play a critical and active role in a forensic interview.

Therefore, it is important that an older adult understand upfront that a

successful interview requires considerable effort on their part. The older adult

should be prepared to access memory in various ways to provide as many

details as possible. An older adult is most efficient at retrieving memory if the

context of the event is re-created during the interview.

Generally, recalling details becomes most achievable when the details are

perceptually related to the current mental image of the event under

discussion. The more the memory of an event is recalled, the more details

they will remember. To maximize the details shared and amount of

information provided, older adults should be encouraged to report everything

they remember, even if the memory is out of chronological order, seems

trivial, or contradicts an earlier statement. An older adult should be

empowered to share memories as details are recalled and while the memory

is temporarily accessible.

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The guideline should be stated clearly and simply. Example:

Interviewer: If you remember information about something we have

already talked about, please share that with me as soon as

you think of it.

Interview Guidelines Summary

• Guidelines should be conversational and agreed upon.

• Guidelines should not just be listed to the older adult.

• The interviewer should consistently take notice of the verbal cues

and/or body language to see whether the older adult is following along

with the guidelines as they are presented.

• Depending on the needs of the older adult, it may be appropriate to

take a break or consider a multisession interview after any of the semi-

structured steps.

• If a follow-up interview is needed, the interviewer should revisit the

guidelines in each session.

• The interviewer should watch for and address any signs that presenting

a guideline may have created a block or barrier in communication with

the older adult.

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Small Group Activity: Introduction, Engagement and Rapport, and

Interview Guidelines

1. Participants will be placed in groups of 2.

2. Decide who will be the first interviewer and interviewee.

3. The first interviewer will have 15 minutes to introduce themselves, their

role, the setting, develop rapport, and interview guidelines with the

interviewee.

4. The interviewee should share things about themselves (e.g., hobbies,

hometown, food, sports music, etc.)

5. Then the participants will switch roles. The interviewee now becomes

the interviewer and will have 15 minutes to introduce themselves,

develop rapport, and establish interview guidelines with the

interviewee.

6. After everyone has had an opportunity to practice, instructors will

lead participants in a discussion as a large group.

Notes:

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Establishing a Baseline

Establishing a baseline for communication with an older adult helps

interviewers continue rapport development with the older adult and set a

mutual understanding for how questions will be asked. Through this process,

the older adult learns the level of detail expected throughout the interview

process by practicing narrating about a neutral event (e.g., an activity or

recent event of interest to the older adult). Baseline development provides an

opportunity for the older adult to demonstrate their abilities through the

providing of information about a specific episode (i.e., event) by accessing

episodic memory, as they will be asked to do later in the interview.

In addition, baseline development lets the interviewer assess how the older

adult responds to questions posed. During this phase of the interview, it is

important that interviewers are consistent with their use of open-ended

prompts (e.g., “Tell me more . . .”) and consistent in the use of language that

accesses the older adult’s episodic memory (e.g., “You said you ate breakfast

this morning. What happened next?”).

Topic Selection

Interviewers may choose from a variety of different topics when establishing

a baseline with an older adult victim or witness. One method of choosing a

topic for baseline development is by continuing the conversation about

topics of interest as established when first establishing rapport with the older

adult. In order to effectively establish a baseline with an older adult, it is

important for the interviewer to choose a topic that is likely to be rich in details

and sensory information and is a manageable event to recount (e.g., playing

a game vs. reading books, the last time they did an activity vs. all types of

activities over the last six months). Another method of choosing a topic to

establish a baseline is to ask the individual about a neutral event that

occurred during their day from beginning to end. This may mean discussing

the morning, afternoon, or evening, depending on the time of day that the

interview takes place. When choosing to ask about a particular time of day,

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keep the case specifics in mind because it is not the intention of baseline

development to lead to discussing the allegations. It may also be effective to

utilize information that was gathered during the pre-interview considerations

about interests or hobbies of the older adult interviewee.

Introducing a topic of interest in a neutral way can help guide and direct the

interviewee into talking about something they enjoy. Example:

Interviewer: I understand you enjoy baking. Tell me about a time that

you baked one of your favorite dishes.

Organization of Accounting

When interviewing an older adult who is an alleged victim or witness, it is

important to keep in mind that the older adult controls the information (i.e.,

the older adult is the expert in their experiences), while the interviewer guides

the flow of information during an interview. Establishing a baseline through

this process serves several purposes, the first of which is to make the older

adult feel successful when sharing their experiences. Organization of their

accounting also demonstrates to the older adult that the interviewer really

wants to know everything and familiarizes them with the types of questions

that will be asked. The interviewer accomplishes gathering a narrative and

establishing a baseline by asking questions that help the older adult provide

information from free recall (as much as possible) and by remaining

organized through the information-gathering process.

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While engaged in baseline development during organization of accounting, it

is important to keep in mind the ICE acronym:

• Identify an event.

• Continue through accounting.

• Elicit additional information.

Identify

While establishing a baseline with an older adult, it is important to first work to

isolate a single event that will be the topic of discussion. This is accomplished

by first prompting the older adult to provide information about a single event

from beginning to end without interrupting them or asking for additional

details. For many older adults, it will be beneficial to provide bookends to this

prompt to provide clear direction regarding the information the interviewer is

seeking.

Bookending prompt example:

Interviewer: Think about your morning this morning. When you’re ready,

tell me everything that happened from the time you woke

up until the time you left your home.

For events that the older adult has experienced multiple times, interviewers

should prompt older adults to recount an event that the older adult

remembers the most/best. As discussed in “Topic Selection” above, an

interviewer may take a number of routes, depending on the older adult being

interviewed.

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Continue

When discussing an event, some people have a tendency to stop in the

middle of their accounting. If the older adult stops partway through their

account of an event before reaching the stopping point identified by the

interviewer, it is important that the interviewer ask the older adult to continue

until the end of the event (i.e., until the final bookend is reached). Interviewers

can do this by resounding (i.e., repeating back the last piece of information

gathered from the older adult using their words), then asking, “What

happened next?” Resounding acts as an effective springboard to keep an

older adult narrating an event. Repeating what was last said and then asking,

“What happened next?” or “Then what happened?” reorients the older adult to

the place in the event where they left off and helps them start narrating again

from that spot. Interviewers may need to do this more than once, depending

on the individual being interviewed. This may also be a point when the older

adult recalls information out of order.

Again, the interviewer should allow the older adult to recall experiences as

they are remembered and to continue the flow of information without

interrupting the older adult. This may result in more resounding of information,

which also allows opportunity for correction and clarification throughout the

narrative event being shared. While a baseline is being established,

interviewers should continually pay close attention to the types of questions

that the older adult is answering and offer as many narrative prompts as

possible and as appropriate through this process.

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Sample Language:

Interviewer: When I ask questions about something that happened, I

want you to tell me everything about it from beginning to

end, even things that may not seem important. Think about

your morning this morning, and when you’re ready, tell me

everything that happened, starting with when you woke up

and ending when you left your home.

Interviewee: I was woken up by staff to take my medicine and eat my

breakfast. After that I just started getting ready for my day.

Interviewer: You said you started getting ready for the day. What

happened next?

Interviewee: I went to the bathroom to comb my hair and brush my

teeth, and then I left the bathroom.

Interviewer: You said you left the bathroom. And then what happened?

Interviewee: I went back into my room to get dressed, grabbed my

wallet, and went to go meet my ride outside so I could

come here.

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Elicit

After the older adult has provided an initial accounting of what happened,

circle back to the beginning and elicit additional details about the discussed

event. When eliciting details, interviewers should ask questions similar to the

types of details that will be asked later in the interview when gathering

information about the allegations. Interviewers may elicit information not

initially disclosed about the location of the event, other parties present,

sensory details, conversations, thoughts, feelings, etc. It may be helpful for

interviewers to think of eliciting details about a neutral event in a similar

manner as they would if a crime had occurred there. Interviewers should use

open-ended questions and move to more direct questions, if needed. If

interviewers ask a direct question, they should always follow up with an open-

ended question so the older adult can elaborate. Many details can be elicited

through the use of open-ended follow-up questions that repeat the older

adult’s words (e.g., “You said______. Tell me about _____.”)

Typically, shorter periods of time (short events throughout the day) will help

the older adult provide more information; longer periods of time (an entire

day) will result in fewer details as the older adult sorts through greater

information to access what they feel is important or what they think may be

important to the interviewer.

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Sample Language

Interviewer: The first thing that you told me is that you woke up. Tell me

more about waking up this morning.

Interviewee: I woke up because my dog was barking at my bedroom

door. He really needed to go outside. So, I walked to our

backdoor and let him out in the yard. I waited there until he

was finished and shut the door when he came back inside.

Then I went to the bathroom and started getting ready for

the day.

In order to establish an effective baseline for the older adult being

interviewed, which can vary from day to day and time of day, interviewers

should use all of the different question types while continuing to employ good

recycling habits and taking note of the responses. Interviewers should not

spend too much or too little time establishing a baseline with older adults.

Interviewers may need to make adjustments or accommodations to the

questions they ask to determine the questions the older adult is able to

answer, and the amount of information provided. For example, if the older

adult does not answer when asked about their entire morning, the interviewer

may need to ask about a shorter segment of time or repeat the last thing the

older adult said and follow up with asking about the very next thing that

happened. Interviewers should use this portion of the interview to ask different

types of questions within the funnel (narrative prompt, open focus, multiple

choice, and yes/no) to establish a baseline for the types of questions the

older adult answers and the amount of information they are likely to provide

throughout the interview.

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Establishing a Baseline Summary

• Spend an appropriate amount of time, depending on the individual and

any information that was gathered during the pre-interview

considerations.

• Ask assorted question types and pay attention for most productive

responses.

• Choose a topic of discussion:

o Something they did, like to do, experienced (e.g., an activity on

vacation)

o Their day (e.g., their morning)

o Topics should follow these guidelines:

▪ Neutral

▪ Likely to be rich in details

▪ Active

▪ A manageable event to recount

o ICE

▪ Identify an event

▪ Continue through the narrative

▪ Elicit details

o Ask questions and solicit details to the same depth you would if a

crime had occurred during the neutral event being discussed.

• Be consistent in your use of episodic language (e.g., “What happened

after you got home?”).

• Use prompting cues that repeat the end of the previous statement.

• Depending on the needs of the older adult, it may be appropriate to

take a break or consider a multisession interview after any of the semi-

structured steps.

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Small Group Activity: Establishing a Baseline

1. Participants will be placed in groups of 2.

2. Decide who will be the first interviewer and interviewee.

3. The first interviewer will have 10 minutes to establish a baseline with

the interviewee by discussing a neutral/positive event.

4. The interviewee should share things about themselves (e.g., hobbies,

hometown, food, sports music, etc.)

5. Then the participants will switch roles. The interviewee now becomes

the interviewer and will have 10 minutes to establish a baselines with

the interviewee by discussing a neutral/positive event.

6. After everyone has had an opportunity to practice, instructors will

lead participants in a discussion as a large group.

Notes:

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Check In

Before moving on with the next phases of the interview, it is important to

check in with the older adult. The interviewer may check in about how the

older adult is feeling so far and whether they have any questions about the

interview process. They may respond with questions or potential blocks and

barriers; interviewers should work to assess the reasoning behind the

question and/or any blocks and barriers and provide legally defensible

responses and/or reassurance to the older adult as needed.

Sample Language

Interviewer: Before we keep going, I’d like to know how you are feeling

so far about talking with me today.

Interviewee: I feel okay.

Interviewer: Do you have any questions for me about the interview?

Interviewee: No.

Overcoming Barriers and Blocks

At any point during the interview, the older adult may express they are or

appear nervous, scared, apprehensive, or withdrawn. In some cases, these

barriers in the interview may present due to a variety of tactics employed by

alleged offenders when perpetrating abuse against older adults (for more

information see “Reporting Impact”). The interviewer can work on removing or

reducing any potential blocks or barriers by identifying what the older adult

might be concerned about, then reassuring them in a way that is legally

defensible, jurisdictionally appropriate, and appropriate for their role.

Depending on the concern, interviewers may provide reassurance (without

making promises) that the older adult is in a safe place, that they are not in

trouble with the interviewer, and they can say anything to the interviewer. It is

important that the interviewer not assume what the barrier is. Sometimes

older adults may feel or appear frustrated at their inability to remember

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words or events. In that case, the interviewer should reassure the older adult

that it is okay to not remember every detail, and the interviewer can also

consider slowing down the pace of the interview, taking a break, continuing

the interview on a different day (multisession interviewing), or revisiting topics

from earlier in the interview to return to a conversation where the older adult

feels empowered and successful prior to asking additional questions.

It is possible that the older adult will express barriers in a non-vocal manner.

Interviewers may notice that interviewees:

● Stop answering questions

● Have a change in body language

● Have a change in voice, volume, or tone

Interviewers should first acknowledge the change by noting the behavior

rather than assigning feelings to the change in behavior. Once the interviewer

has gained a better understanding of the change, interviewers should provide

reassurance to the older adult in a way that is legally defensible,

jurisdictionally appropriate, and appropriate for their role.

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Sample Language

Interviewer: I noticed that you stopped answering questions. Tell me

about not answering questions.

Interviewee: I don’t want to talk about it.

Interviewer: It’s okay with me if you don’t want to talk about it. I want to

understand how you are feeling right now—how are you

feeling?

Interviewee: I’m scared.

Interviewer: Tell me about feeling scared.

Interviewee: I’m scared because they said if I told anyone they would

hurt me.

In some cases, barriers/blocks cannot be broken down within an interview. If

an older adult is too emotionally compromised and tactics for overcoming

blocks and barriers are not helping reorient them, consider taking a break

(bathroom, water, etc.). If after a break the older adult is still unable to

proceed, present the older adult with options for proceeding and let them

choose an option, or ask the older adult how they would like to proceed. This

may mean ending that session and returning later in the day or on a different

day, depending on the needs and strengths of the individual.

Similarly, if the older adult at any time indicates they want to leave or end the

interview session, it is important to honor their request in a safe manner.

Before the older adult leaves the interview, interviewers should check in with

the older adult regarding their desire to leave because it may be possible that

there are additional feelings, blocks, or barriers to discuss. To accomplish this,

interviewers may need to ask about how the older adult is feeling in addition

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to asking about any current concerns. Once the interviewer has gained a

better understanding of the desire to end the interview, they should provide

reassurance to the older adult in a way that is legally defensible,

jurisdictionally appropriate, and appropriate for their role. Following the

interview, it may be appropriate to set up additional interview sessions as

needed. As the process of checking in is distinct from conducting therapy, it

may also be appropriate to refer to MDT members for follow-up services (e.g.,

counseling/therapeutic services).

Sample Language

Interviewer: Thank you for letting me know you don’t want to talk any

more today. Before we finish, I want to check in with you.

How are you feeling right now?

Supportive Statements

During an interview, an interviewer must be empathetic and should be able to

appropriately express concern for the older adult as needed. Interviewers

must adeptly address an older adult’s feelings and reorient them to the

conversation as needed. If an older adult becomes emotional, the interviewer

should not ignore the change in affect. The interviewer should provide legally

defensible and jurisdictionally appropriate reassurance to the older adult to

provide them an opportunity to reconcile their emotions and continue with

the interview. These emotions can come as sadness, anger, fearfulness,

tearfulness, or any other expression.

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It may not be a comfortable situation for interviewers when an older adult

begins to express grief, distress, or other emotions by crying, sobbing, or

becoming withdrawn. While these emotions can be expected, especially if the

older adult becomes overwhelmed by the number of questions or the topic is

difficult to recount, the interviewer is in a tenuous position where a balance

between remaining neutral and being supportive must be found. The

interviewer should not express anger at the alleged offender, call the alleged

offender names, or promise they will see the alleged offender suffer the

consequences of their actions (e.g., be placed in jail). However, being

supportive can expose the interviewer to claims of bias by the alleged

offender and undermine a subsequent investigation. Additionally, the older

adult may have complex and conflicting emotions toward the alleged

offender (love/hate, protect/expose). The older adult may become

uncomfortable or unwilling to provide additional information if the interviewer

projects a negative attitude toward the alleged offender. Instead, the

interviewer could employ statements that are not leading, suggestive, or

inherently biased against the alleged offender.

Sample Language

• From what you have told me, I can understand how you would be

(stated emotion).

• I really appreciate you helping me understand what happened.

• Take your time—you are doing good job providing information about

______.

• Lots of people that I listen to tell me that they feel ______ when we

are talking—it is okay to feel ______.

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Acknowledging the emotional toll of the event as well as the struggle and

effort involved in the retelling of the experience is empathetic and enhances

the rapport that has been attained. Normalization of an older adult’s

emotions and recognition of their efforts conveys they are being seen as a

person by the interviewer, not as just a possible supplier of evidence. This type

of validation often provides the needed support for the person to continue

with the interview.

Small Group Activity: Overcoming Blocks and Barriers

1. Participants will be placed in groups based on your scenario.

2. As a group, participants will have 10 minutes to identify and discuss at

least 3 barriers based on your assigned case scenario.

3. Choose a representative from your group to share what was

discussed with the large group after the activity.

4. After 10 minutes, participants will come back together to discuss as

large group.

Notes:

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Transition to Allegation(s)

Transitioning the conversation to the reason for the interview, typically

allegations of abuse or neglect, can happen in a variety of ways. It is essential

for the interviewer to start with the most open-ended option, taking into

consideration the strengths, established baseline, and communication style

of the older adult. The jurisdiction and input of the investigative team should

also be carefully considered. The transition should start with acknowledging

what has happened during the rapport phase.

Sample Language

• Thank you for telling me about . . .

• Now that I have learned about you . . .

• Now that I have learned about some things you like to do. . .

• Now that I have learned more about your family. . .

• Now that you have told me about your job. . .

Then, offer a statement that will prompt the older adult to the topic of

exploring the allegations. There are two different proposed options for

transitioning the interview to the matter at hand. It is important to note that

interviewers are not likely to use both transition options in a single interview

session. Interviewers should select a transition option based on the case

information and needs of the older adult. In general, interviewers should start

with the most open-ended option.

Transition Options:

• Open invitation

• Externally verifiable information/context

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Open Invitation

If baseline development has been completed and the older adult knows the

reason for the interview/appointment, the open invitation typically offers an

opportunity for the older adult to continue to take the lead and to report

everything they know.

Open Invitation Examples:

• Tell me the reason you’re here today.

• Tell me about being here today.

• Tell me about the reason we are talking today.

If following an open invitation, the older adult does not start discussing the

allegations, the interviewer may choose to utilize externally verifiable

information/context to successfully transition the interview to discussing the

allegations. Sometimes older adults may not know the exact reason for the

interview or may not realize that the interviewer is asking about something

specific. It may also be appropriate to ask the older adult if there is anything

that they are worried or concerned about or anything they want the

interviewer to know, given the role of the interviewer or their desire to assist

the older adult in feeling and being safe.

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Externally Verifiable Information or Context

If the interviewer attempts to transition to the allegation through an open

invitation and the conversation does not lead to discussing the allegations, it

may be necessary for the interviewer to be more focused or direct and ask

about information that is known, such as a doctor or hospital visit, an injury

(visible or not), a police report, a disclosure, or a conversation that the older

adult had with another professional (preferably a documented conversation).

Any introduction of information or context should be carefully considered by

the investigative team and presented cautiously. In order to remain trauma-

informed, it is important that the interviewer avoid presenting information in a

way that would be interrogative in nature. The interviewer should not make

the older adult feel as though the interviewer has more information or that

makes the older adult seem like they have been lying. An interviewer should

instead use this transition in a manner that is respectful and transparent. Be

sure that anything the interviewer says can be verified by an external source

or evidence. To prevent being leading or suggestive during this transition

option, never link any person to any specific act or allegation. Interviewers

should consider using a statement like “I understand . . .” to inform the older

adult of some known information and then request them to provide

additional details about the presented topic.

Externally verifiable transition examples:

• I understand you went to the hospital yesterday. Tell me about going to

the hospital.

• I see you have a cast on your arm. Tell me about the cast.

• I understand you told your daughter that you don’t feel safe at the

place where you live. Tell me more about not feeling safe.

• Tell me everything you saw yesterday when Samuel was in the hallway

with Sally.

• I understand the police came last night. Tell me more about the police

coming.

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Small Group Activity: Transition to Allegation(s)

1. Participants will be placed in groups based on your scenario.

2. As a group, discuss any transition options.

3. Choose a representative from your group to share what was

discussed with the large group after the activity.

4. After 10 minutes, participants will come back together to discuss as

large group.

Notes:

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Exploring Allegations

Once the allegation(s) or concerns have been identified through one of the

transition options, interviewers should continue to gather reliable information

about the allegations through the same format used during baseline

development. It is important that interviewers continue to ask open-ended

questions to avoid assumptions about what did or did not happen, and they

should have multiple hypotheses and explanations in mind prior to the

interview to remain as objective and neutral as possible.

In the same way that was used while establishing a baseline, the interviewer

must remember that the older adult controls the information as the expert of

their experiences, while the interviewer guides the flow of information. An

interviewer’s purpose is to make the individual being interviewed as

successful as possible by asking questions that help the older adult provide

information through free recall and by asking questions that help the older

adult’s thoughts remain as organized as possible.

When exploring allegations, it is important to keep in mind the following when

building a narrative:

• General overview

• ICE

o Identify an event

o Continue through accounting

o Elicit additional information

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General Overview

There are a number of routes an interviewer may take, depending on the case

referral and the individual being interviewed. In order to become oriented to

discussing the allegations, it may be beneficial to provide an opportunity for

the older adult to give a general overview of the situation before discussing

the event from beginning to end. This general overview allows the interviewer

to get a sense of the abuse or maltreatment overall, and it helps the

interviewer and older adult work together to identify the first topic to discuss.

Abuse/Neglect Sample Language

Interviewer: You told me you aren’t feeling safe at the place where you

live. Tell me more about that.

Interviewee: Everything started off okay when I first moved in; everyone

was really nice. As I got to know people more, and as staff

changed, things have not been so good. I am afraid to ask

staff for anything because they make me feel like a burden,

and it takes them forever to even show up. It’s only been

bumps and bruises so far—they don’t seem to care about me,

but I’m afraid all the time that things will get worse.

Financial Crime Sample Language

Interviewer: You told me you have concerns about someone taking money

from your bank account, tell me more about that…

Interviewee: My bank called to say that I was overdrawn on my checking

account. I have plenty of money, there is no reason why my it

should be overdrawn. I keep plenty of money in there. Either

the bank put my deposits in someone else’s account by

mistake or the bank is stealing my money.”

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Identify

Once a topic or allegation has been identified by the older adult, the

interviewer should encourage the older adult to identify a specific event.

When discussing an incident, interviewers should start by prompting the older

adult to provide information about a single event from beginning to end

before soliciting any other information (Geiselman & Fisher, 2014; Roberts &

Higham, 2002). As discussed, when developing a baseline, it will be beneficial

to provide bookends to this prompt, which provides clear information about

the information the interviewer is seeking (e.g., “from the time you got in the

car to the time you got out of the car”). Providing this open-ended prompt

allows the older adult to report their experiences as they remember them. As

discussed previously, interviewers should be aware that the older adult may

report their experiences out of order or prompt themselves to recall details

from what was previously shared as they narrate through an event. The

interviewer should not make determinations or judgments about the

information provided based on the order of events that the older adult

provides during this process.

Abuse/Neglect Sample Language

Interviewer: You told me that staff was rough with you and caused the

bumps and bruises. When you’re ready, tell me everything

that happened from the beginning to the end.

Financial Crime Sample Language

Interviewer: “You told me that the bank told you that your account was

overdrawn. When you are ready, please tell me everything

about the call from the bank from beginning to end.”

As the older adult accesses their memory of an event, it is possible that they

will recall further details. The interviewer may choose to remind the older

adult of the “say it when you remember it” guideline when isolating an event

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and encourage them to report everything that they remember, even if the

memory is out of chronological order, seems trivial, or contradicts an earlier

statement in order to maximize the information that is gathered.

Continue

While describing events, older adults may stop sharing details in the middle of

telling what happened, especially when discussing abusive events. If the older

adult stops part of the way through their account of an event, it is important

that the interviewer ask them to continue through until the end of the event

(i.e., until the final bookend is reached). Interviewers can do this by

resounding the last piece of information that the older adult said, using their

words, then asking, “what happened next?” Interviewers may need to do this

more than once, depending on the individual being interviewed.

Elicit

After the older adult has provided a complete initial accounting of what

happened, think back to the beginning of the allegation they are discussing

and elicit additional details as needed about the allegation. Interviewers may

elicit information not initially disclosed about the location of the event, other

parties present, sensory details, conversations, thoughts, feelings, etc.

Interviewers should use the most open-ended question types and move to

more direct questions if needed. If interviewers ask a direct question, they

should always follow up with an open-ended question to have the older adult

elaborate as much as they can. Many details can be elicited through the use

of open-ended follow-up prompts that repeat the older adult’s exact words

(e.g., “You said______. Tell me about _____.”)

Sensory Questions

In addition to asking for more information about what happened, older adults

who experience a stressful or traumatic event encode the memory in

conjunction with a certain stimulus (e.g., the smell of perfume, the music that

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was playing). Because of this pairing, interviewers should incorporate

questions about sensory details, which may help the older adult reinstate the

context of the event memory and improve event memory.

Sample Questions

• Tell me everything you saw when ________.

• Tell me about everything you heard when ________.

• Tell me about everything you smelled when ________.

• Tell me about everything you tasted when ________.

Questions About Thoughts and Feelings

Because they do not often come up naturally when sharing about an event,

older adults should be encouraged by the interviewer to communicate the

emotional states they experienced and thoughts they had during the incident

being described. Correlating thoughts and emotions the older adult felt

assists them in recalling details and sharing additional information in the

context of the original event. When an interviewer asks questions about

feelings, it demonstrates to the older adult that feelings are an important

aspect of the information provided, and it conveys dignity and respect for

them as a person. This type of validation can empower the older adult to

continue sharing about the allegations.

Sample Questions

• How were you feeling when _______________?

• What were you thinking about when ___________?

Witnesses and Corroboration

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Asking individuals to recall conversations, both what the individual said and

what they heard, may elicit accurate and unique information not otherwise

obtained through interviews. The interviewer should ask the older adult if they

have talked with anyone else about the allegations and explore everything

said in that conversation. This can be accomplished by asking who knows,

how that person found out, and what their response was. Finding out who else

knows about an allegation or someone else that the older adult may have

talked to can lead an investigation to a possible eyewitness, outcry witness,

corroborating witness, or other victims. This type of information is also helpful

because it may identify supportive or safe people as the investigation

progresses. Asking about who has been told and the context of those

conversations also explores any concerns of outside influence (promises,

threats, coercion) on the older adult’s statement or disclosure. Asking about

who the first person was that they told and the reasons they felt safe or

comfortable telling that person will also help build out a timeline of the event

and potentially identify additional witnesses.

Sample Questions

• What made you decide to tell about ____________?

• How did people find out about ____________?

• Was there someone who helped you decide to tell?

o (If yes) Tell me more about __________.

• Who was the first person that you told about ____________?

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Interview Adaptations

As discussed previously in “General Considerations for Communicating with

Older Adults,” older adults might not be able or ready to explain everything

that happened, so breaking it down may be necessary. When a narrative

prompt is posed, it requires a higher level of thinking that requires the

interviewee to sort through multiple pieces of information and retrieve only

perceived observer-deemed relevant information. In this situation,

interviewers can adapt to the interviewee’s needs by using prompting cues

that break down the content of the original inquiry.

Consider the following prompts:

Interviewer: Think about what happened when staff was rough with

you. When you’re ready, tell me everything that happened

from the beginning to the end.

vs.

Interviewer: Tell me about the first thing that happened when staff got

rough with you.

If appropriate, the interviewer may break time segments into smaller chunks.

For example:

Interviewer: Think about what happened when staff got rough with you.

When you’re ready, tell me everything that happened from

the time staff came into your room to when they started

getting rough with you.

For some individuals, it may be necessary to break down questions further.

Interviewers should remember the takeaways from the recycling funnel

model. For example:

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Interviewer: What was the first thing staff did when they got rough with

you?

Interviewer: When staff first got rough with you, were you sitting,

standing, or something else?

Interviewers should adapt to the needs of the interviewee and ask the types of

questions that are most appropriate for the interviewee based on their

baseline in answering questions up to this point in the interview.

Considerations for Multiple Events/Incidents

As with single events/incidents, interviewers should work to isolate an event.

However, it is important with multiple events/incidents that interviewers work

to isolate a single event/incident that is salient or most memorable to the

older adult. While providing a general overview of events, if a single

event/incident comes up, interviewers should start by prompting the older

adult to discuss this event from beginning to end, using words presented by

the older adult during their description of the allegations. If the older adult

does not isolate an event naturally, the interviewer may prompt the older

adult to think about a time that they remember most or best.

Sample Language

Interviewee: Everything started off okay when I first moved in; everyone

was really nice. As I got to know people more, and as staff

changed, things haven’t been so good. I’m afraid to ask

staff for anything because they make me feel like a burden,

and it takes them forever to even show up. It’s only been

bumps and bruises so far—they don’t seem to care about

me, but I’m afraid all the time that things will get worse.

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Interviewer: You told me that you have gotten bumps and bruises so

far. Think about the time you remember the most when you

got bumps and bruises. When you’re ready, tell me

everything that happened from the beginning to the end.

As described in “Single Event/Incident,” the interviewer will then need to

continue through the narrative provided by the older adult and then elicit

details accordingly. As the older adult continues to provide details about the

isolated event, it may be possible that they have memories about other

events as well.

Interviewers should be careful not to jump from incident to incident because

this may introduce confusion on both the part of the interviewer and the older

adult. If topics shift quickly, interviewers should pay special attention to what

was disclosed, resound and go back to the event or detail that was being

discussed. This is essential to help keep the flow of information as organized

as possible. This should be done without correcting or interrupting the older

adult. The interviewer may need to reassure the older adult that they are

asking questions in a certain way to make sure that the interviewer

understands what happened in an attempt to gather as much information as

possible. The interviewer will also need to reassure the older adult that they

will ask more about the other events once they are done asking about this

one.

Finally, for some individuals, it may not be possible to isolate a single

event/incident due to the nature of their experience. In this case, interviewers

may need to have conversations about what would usually occur and gather

as much detail as possible about the events experienced.

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Sample Language

Interviewee: Everything started off okay when I first moved in; everyone

was really nice. As I got to know people more, and as staff

changed, things haven’t been so good. I’m afraid to ask

staff for anything because they make me feel like a burden,

and it takes them forever to even show up. It’s only been

bumps and bruises so far—they don’t seem to care about

me, but I’m afraid all the time that things will get worse.

Interviewer: You told me that you have gotten bumps and bruises so

far. Think about the time you remember the most when you

got bumps and bruises. When you’re ready, tell me

everything that happened from the beginning to the end.

Interviewee: I don’t remember a specific time.

Interviewer: Thanks for letting me know that you don’t remember a

specific time you’ve gotten bumps and bruises. Let’s talk

about what would usually happen. Think about what

usually happens when you get bumps and bruises, and

when you’re ready, tell me what would usually happen

from beginning to end.

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Considerations for Polyvictimization and Multiple Victimizations

As mentioned in the section on “Forms of Elder Abuse,” interviewers should be

cognizant that adults who present for forensic interviews may be a victim of

multiple incidents. When interviewing older adults, screening for multiple

victimization and polyvictimization should be considered during pre-interview

planning. However, it should be noted that during an interview it may become

clear that further screening may be necessary. When screening, interviewers

may ask questions such as these:

• Has something like what happened with __________ happened on a

different day?