Elder Abuse and Neglect

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Elder Abuse and Neglect

• Barbara J. Chromy

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What is elder abuse?

• an all-inclusive term representing all types of
  mistreatment or abusive behavior toward older
  adults (Wolf, 2000, p.7)
• further defined as acts of commission
  (intentional behavior) and omission (failure to
  act)
• self-neglect is the most common form of elder
  abuse and the most difficult to detect and treat
  (Levine, 2003 and Reynolds Welfel et al., 2000)

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Types of Abuse

• Medical
• Abandonment
• Neglect
• Self-neglect

• Physical
• Psychological
• Sexual
• Material
• Violation of Rights

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Forms of Abuse

• Physical - hitting, pushing, slapping, punching,
  restraining, pinching, force-feeding, physical
  restraint
• Psychological - verbal aggression, intimidation,
  threats, humiliation
• Sexual - any kind of non-consensual sexual contact

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Forms of Abuse (continued)

• Material - theft of cash or personal property,
  forced contracts, misuse of income or other
  financial resources
• Violation of Rights - deprivation of any
  inalienable right such as voting, assembly,
  speech, privacy, personal liberty
• Medical - withholding medication or
  overmedicating

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Forms of Abuse (continued)

• Abandonment - desertion of an elderly person for
  whom one has agreed to care for, dumping a
  cognitively impaired elder at an emergency room
  with no identification
• Neglect - failure to provide necessary physical
  or mental care of an elderly person
• Self-neglect - behavior that threatens ones own
  health or safety

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Indications of Abuse

• Physical - multiple fractures or bruises at
  various stages of healing, burns, patterned
  injuries, patchy hair loss, frequent visits to
  ER, delay in seeking medical treatment for
  injuries
• Psychological - withdrawn behavior, wasting or
  failure to thrive, depression
• Sexual - genital injury, vaginal or rectal
  bleeding, bruises, chipped teeth, sexually
  transmitted disease or infestations

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Indications of Abuse (continued)

• Material - unexplained loss of income, assets,
  possessions, not eating, missed utility payments
• Violation of Rights - isolation, failure to
  attend church services or community events as one
  did previously
• Medical - no improvement in condition for which
  one was prescribed medication, blood tests
  indicate greater or lower than expected levels of
  medications, sleepiness, groggy

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Indications of Abuse (continued)

• Abandonment - isolation, not seen outside home,
  disrepair or unkempt environment, missed medical
  or other appointments or engagements, wandering,
  being left somewhere to fend for self
• Neglect - uncared for appearance, inappropriate
  clothing, failure to thrive, lack of medical or
  dental care, isolation
• Self-neglect (similar to neglect)

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Scope of the Problem

• estimates of the occurrence of elder abuse vary
  widely due in part to the variability in the
  definitions used to measure and report abuse
• mistreatment of adults, including abuse,
  neglect, and exploitation, affects more than 1.8
  million older Americans (Pavlik, Hyman, Festa,
  Bitondo, and Dyer, 2001, p. 45)
• self-neglect accounts for one-third to one-half
  of all abuse cases (Gray-Vickrey, 2000, 2004
  Levine, 2003 Paris, 2003)

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Distribution of Abuse

• distribution of abuse according to sex was
  reported by Wolf (2000) to be almost equally
  divided between males and females
• Some studies indicate that females are more often
  victims of elder abuse (Bratteli2003, Pavlik et
  al., 2001)
• Patterns of abuse are similar among African
  Americans, Latinos, Caucasians, and Asians
  (Cavanaugh Blanchard- Fields cited in Etaugh
  Bridges, 2004)

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Perpetrators of Abuse

• elder abuse can be perpetrated by nearly anyone
  including paid or volunteer caregivers, medical
  and long-term care employees, family members,
  significant others, and in some cases strangers
  such as a person who befriends an elderly person
  for the purpose of exploiting them (Reynolds
  Welfel et al., 2000)

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Greatest Risk Factors for Causing Abuse in North
Dakota

• being male
• under age 60
• being related
• history of mental illness
• recent decline in mental health
• abusing alcohol
• primary caregiver

• lives with or has access to the adult they abuse
• change in family roles from being cared for to
  being the care provider
• prior history of violence
• (Bratteli, 2003)

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Theories Explaining Elder Abuse

• repeated cycle of violence (social learning
  theory)
• power imbalance in relationships (feminist
  theory)
• marginalization of the elderly within society
  (political economic theory)

• affects of caregiver stress (situational model)
• dependency of elder on caregiver (exchange
  theory)
• mental or emotional disturbance of caregiver
  (psychopathology)

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Risk Factors for Being Abuses

• Poor health
• Inability to perform activities of daily living
• Cognitive impairment
• Living with others (living alone increases risk
  for financial and self-abuse)

• Social isolation
• Depression, confusion, substance abuse or
  dependence
• Mental or physical impairment (stroke,
  incontinence, Alzheimers)
• Being female
• Over age 85

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Risk Factors for Perpetrating Abuse

• History of family violence
• Disruptive behavior on behalf of the care
  recipient
• Mental illness
• Alcohol or drug abuse or dependence
• Caregiver dependence

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Perpetrating Risk Factors (continued)

• Stress
• Physical or emotional exhaustion
• Low social integration and/or unemployment
• Lack of community supports
• Insufficient income for basic needs

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Protective Measures

• Stay sociable and active
• Stay involved with neighbors, friends, church or
  community activities
• Get regular medical and dental care
• Open and post your own mail
• Increase social network as you age
• Have friends visit you at home
• Have a best friend with whom you can confide in
• Keep in touch with old friends if you move

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Protective Measures (continued)

• Keep your possession organized
• Tell someone you trust where your important
  paperwork and bank account information is kept
• Have checks direct deposited into your account
• Use an answering machine to screen phone calls
• Dont leave cash or valuables visible
• Notify the police if you will be away from home
  for an extended time period

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Protective Measures (continued)

• Consult with an attorney
• Make arrangement for the future such as power of
  attorney
• Get legal advise before making/signing agreements
  regarding your care or possessions
• Be aware of your financial situation

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Protective Measures (continued)

• Know where to ask for help
• Find out about community resources before you
  need them such as rape and abuse hotlines, senior
  centers, and adult protective services
• mental health service centers
• crisis centers
• private counselors
• clergy
• local police

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Detection and Treatment Barriers

• detection of elder abuse is difficult because
  denial is an integral feature of abuse, victims
  may feel too ashamed to disclose maltreatment or
  believe they are to blame for or deserve the
  abuse
• dependence on an abuser can make a victim
  reluctant to report for fear of how he/she will
  survives without the perpetrators help

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Detection/Treatment Barriers (continued)

• victims may not define their situation as abuse
  especially in a dysfunctional family environment
  where violence or mistreatment has been
  normalized (Brown et al., 2004, Levine, 2003)
• cognitive, auditory, speech, visual impairments,
  isolation or restraint may make reporting
  impossible for the victim of elder abuse

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Detection/Treatment Barriers (continued)

• ageism can negatively affect detection of elder
  abuse as it is common to view the elderly as
  confused or demented, to trivialize elders
  complaints, and to adhere to the perception that
  elder abuse doesnt exist
• physical injuries may be masked by clothing or by
  isolating the victim

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Detection/Treatment Barriers (continued)

• fast paced medical services and heavy caseloads
  of social service providers may not allow time
  for adequate assessment
• basic lack of information of where to turn for
  help impedes the intervention and treatment for
  both perpetrator and victim of abuse

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Recommendations

• further research using standardized definitions
  and subtypes of elder abuse would provide a
  better picture of the scope of the problem
• improved reporting guidelines along with
  increasing the number of agencies and their
  funding is essential.

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Recommendations (continued)

• Greater understanding of the causation of elder
  abuse could lead to the development of effective
  treatment programs for abusers
• defining elder abuse in its own terms rather that
  modifying guidelines from child abuse legislation
  would improve the understanding of elder abuse as
  a phenomenon separate and unique from child abuse
  

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References

• Bratteli, M. (2003). Caregiver abuse, neglect and
  exploitation The journey through caregiving.
  North Dakota State University.
• Brown, K., Streubert, G., Burgess, A. (2004).
  Effectively detect and manage elder abuse. The
  Nurse Practitioner, 9 (8), 22-33.
• Etaugh, C. Bridges, J. (2004). The psychology
  of women A lifespan perspective (2nd Ed.).
  Boston, MA Pearson Education, Inc.
• Gray-Vickrey, P. (2000). Protecting the older
  adult Learn how to assess the visible and
  invisible indicators and what to do if you
  recognize abuse in an older patient. Nursing, 30
  (7), 34-38.

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References (continued)

• Gray-Vickrey, P. (2004). Combating elder abuse
  Heres what to look for, what to ask, and how to
  respond if you suspect that an older patient is a
  victim. Nursing, 34 (10), 47-51.
• Kapp, M., (2004). Family caregivers legal
  concerns. Family Caregiving, (winter) 2003-2004,
  49-55.
• Lachs, M., Pillemer, K. (2004). Elder abuse
  Seminar. www.thelancet.com, 364 (October),
  1263-1272.
• Levine. J. (2003). Elder neglect and abuse A
  primer for primary care physicians. Geriatrics,
  58 (10), 37-45.
• Paris, B. (2003). Abuse and neglect So prevalent
  yet so elusive (editorial). Geriatrics, 58 (10),
  10.

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References (continued)

• Pavlik, B., Hyman, D., Festa, N., Bitondo Dyer,
  C. (2001) Quantifying the problem of abuse and
  neglect in adultsanalysis of a statewide
  database. Journal of the American Geriatrics
  Society, 49, 45-48.
• Reynolds Welfel, E., Danzinger, P., Santoro, S.
  (2000). Mandated reporting of abuse/maltreatment
  of older adults A primer for counselors. Journal
  of Counseling Development, 78 (summer),
  284-292.
• Wolf, R., (2001). Introduction The nature and
  scope of elder abuse. Generations, Summer, 6-12.

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Resources

• Aitken, L. Griffin, G. (1996). Gender issues in
  elder abuse. Thousand Oaks, CA Sage
  Publications, Ltd.
• Journal of elder abuse neglect. Haworth
  Maltreatment Trauma Press.
• Quinn, M. Tomita, S. (1997). Elder abuse and
  neglect Causes, diagnosis, and intervention
  strategies (2nd Ed). New York, NY Springer
  Publishing Company.
• Tatara, T. (1999). Understanding elder abuse in
  minority populations. Philadelphia, PA
  Brunner/Mazel (a member of the Taylor Francis
  Group).