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The NYC Elder Abuse Center (NYCEAC) welcomes Dr. Veronica LoFaso, Associate Professor of Clinical Medicine, Weill Cornell Medical College and New York-Presbyterian Hospital within the Division of Geriatrics and Palliative Medicine. Dr. LoFaso provides geriatric medicine consultations to NYCEAC’s multidisciplinary teams, serving to help the teams evaluate and respond to the myriad medical issues that are presented to them. In addition, she has developed and conducted numerous elder abuse trainings for a variety of institutions throughout the greater New York City area and beyond.
Here Dr. LoFaso defines and provides an overview of the term polyvictimization. She highlights research done on this topic and discusses its prevalence and impact on health outcomes.
In 1997 I made my first housecall as the new medical director of the home visit program in the Division of Geriatrics at Weill Cornell Medical College. I directed that program for 13 years and over the course of those years became all too familiar with the world of elder abuse. Recently, I have had the opportunity to focus more on this important topic as a member of NYCEAC’s Brooklyn Multidisciplinary Team. As case after case is presented to the team at our weekly conferences it is clear to me that many of the unfortunate victims we discuss and help have lived a lifetime of traumas. As their stories unfold I see that the event that led to our involvement was only one of many over years of abuse.
When I look back on my earlier housecall experiences I certainly recognized individuals who had been subjected to repeated acts of victimization since childhood including domestic violence, bullying, financial abuse, sexual assault, and other stressful personal insults. Unfortunately I, like many of my medical colleagues, approached these individuals in a piecemeal fashion, addressing each form of abuse as it occurred but failing to link the pieces together into a mosaic of a lifetime of repeated traumas.
The Incidence of Polyvictimization
Many mechanisms have been postulated to explain why some individuals become polyvictims. Finkelhor, who has done the seminal work in this area and coined the term “polyvictimization,” suggested that victimization creates vulnerability for more victimization through mechanisms of lowered self-esteem, learned helplessness and distorted cognition. Mainly focusing on child victims, his work uncovered striking statistics showing half of young adults ages 2-17 experience two or more kinds of victimization with a mean of 3.7 in a lifetime. His analysis of the outcome of repeated, different intersecting forms of victimization suggests that the victims’ experience of trauma may be more related to the accumulation or combination of victimizations rather than any one individual victimization. What characterizes these individuals with the condition of polyvictimization is not completely understood. It appears that in addition to polyvictimizations, these individuals had more concurrent other life adversities like single or stepparent families, family substance abuse, etc. They also experienced more severe symptoms than those who were victims of repeated assaults of the only one type.
What is clear from Finkelhor’s work with children and adolescents is that polyvictimization is prevalent; victimization carries a high burden of psychological stress and puts these young victims at high risk for further victimization throughout their life.
Polyvictimization and Health Outcomes
As I became more interested in this construct I found an impressive study conducted by Felitti and Anda that builds on Finkelhor’s work and explores the relationship of multiple adverse childhood events (ACE) to a host of health outcomes in adults. The researchers began to correlate these exposures to poor health outcomes and found staggering results with linear increases in the number of ACE’s to both psychological outcomes (depression, alcoholism, smoking, drug use, suicidality, perpetrating domestic abuse, revictimization) and medical outcomes (increases in lung disease, liver disease, and heart disease).
A Call to Action
The frequency with which polyvictimization occurs and the significant deleterious health outcomes that result is a call to action for the field of elder abuse. Understanding that these insults may be considered a type of post-traumatic stress disorder and finding new and effective ways of intervening to help victims is critical. We clearly need more research to determine the best therapies and social programs for victims and their families.
Dr. LoFaso is an Associate Professor of Clinical Medicine at Weill Cornell Medical College and New York-Presbyterian Hospital within the Division of Geriatrics and Palliative Medicine. She provides geriatric medicine consultations to NYCEAC’s multidisciplinary teams, serving to help the teams evaluate and respond to the myriad medical issues that are presented to them. In addition, she has developed and conducted numerous elder abuse trainings for a variety of institutions throughout the greater New York City area and beyond.