Elder Abuse

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Elder Abuse

• Dr. Michelle L. Meloy

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Domestic elder abuse

• By the year 2030, the population over the age of
  65 will triple to nearly 70 million
• Violence or neglect that occurs in domestic
  settings is a serious complex social problem
• Victims are often invisible leading to
  tremendous under-reporting
• National Center on Elder abuse reports a 150
  increase in reporting since 1986
• Prevalence rates are estimated at about 500,000
  to 2 million victims (if self-injury included)
• Every case reported 5 unreported

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Categories of elder abuse

• Physical abuse
• Sexual abuse
• Emotional abuse
• Financial exploitation
• Neglect passive and active
• Abandonment
• Self-neglect

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Indicators of abuse Physical

• Overt signs of physical trauma
• Repeated "unexplained" injuries in inconsistent
  explanations
• A physical examination reveals that the older
  person has injuries which the caregiver has
  failed to disclose
• A history of doctor or emergency room "shopping"
• Repeated time lags between the time of any
  "injury or fall" and medical treatment

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Indicators of abuse Sexual Abuse

• Trauma to the genital area (e.g. bruises)
• Venereal disease
• Infections/unusual discharge
• Indicators common to psychological abuse may be
  concomitant with sexual abuse

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Indicators of abuse Emotional

• Psychological Signs
• Ambivalence, deference, passivity, shame
• Anxiety (mild to severe)
• Depression, hopelessness, helplessness, thoughts
  of suicide
• Confusion, disorientation
• Behavioral Signs
• Trembling, clinging, cowering, lack of eye
  contact
• Evasiveness
• Agitation
• Hypervigilance

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Indicators of abuse Financial

• Unusual banking activity
• Elder cannot understand financial documents they
  are being asked to sign
• Living situation does not match financial
  situation
• The caregiver only expresses concern regarding
  the financial status
• Personal belongings such as jewelry, art, furs
  are missing
• Signatures on checks and other documents do not
  match
• Care providers isolate the elder

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Indicators of abuse Passive and active neglect

• Evidence that personal care is lacking or
  neglected
• Signs of malnourishment (e.g. sunken eyes, loss
  of weight)
• Chronic health problems both physical and/or
  psychiatric
• Dehydration (extreme thirst)
• Pressure sores (bed sores)

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Most likely forms of abuse in domestic settings

• According to state adult protective services
• Neglect 55 of reports
• Physical abuse 15
• Financial exploitation 12.3
• Emotional abuse 8
• Sexual abuse less than 1
• When elders (over age 60) are murdered, their
  off-spring are the killers 42 of the time
  spouses 24 of the time

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Risk factors victim characteristics

• Elders may be more dependent on their abuser than
  victims of IPV
• Average age is 78
• elders over the age of 80 are 2 to 3 times more
  likely to be abused or neglected
• Most are female (67)
• females are overrepresented even when controlling
  for their larger population proportion
• Racial breakdowns
• White victims (66)
• Black victims (18.7)
• Hispanic victims (10.4)

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Victim-offender relationship

• In 90 of the cases where a known perpetrator,
  the abuser is a family member
• Grown child of the victim (53) or grandchild
  (19)
• Spouse (16) Domestic violence grown old many
  of the spouses who abuse their elder partners did
  so in their youth also
• Other family members or caregivers

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Risk factors

• Psychological strains
• Social isolation
• Economic stress
• Emotional and physical condition of the victim
  and the caregiver
• Elders who are emotionally or financially
  dependent on their caregiver, particularly in the
  case of grown children, have a greater risks

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Causes of elder abuse

• Caregiver stress theory suggests that well
  intentioned caregivers are so overwhelmed that
  they lose it and strike out against elder.
  Empirical evidence is weak.
• Personal characteristics of the elder these
  theories suggest that dementia, disruptive
  behaviors, problematic personality types and
  significant needs from caregiver increase odds of
  abuse. Evidence here is mixed.

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Causes of elder abuse

• Cycle of violence theory suggests that elder
  abuse is learned as a conflict resolution skill
  that is passed down through the generations.
  What goes around comes around in cases where
  adult caregiver is abusing parent after being
  abused in their childhood
• Evidence is strong on other domestic violence
  populations (intimate partner violence and child
  abuse but has never been tested as the cause of
  elder abuse)