Elder Abuse and Neglect

Barbara J. Chromy

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)

Types of Abuse

Physical

Psychological

Sexual

Material

Violation of Rights

Medical

Abandonment

Neglect

Self-neglect

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

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

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 one’s own health or safety

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Psychological - withdrawn behavior, wasting or failure to thrive, depression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

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

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)

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)

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)

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)

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)

Theories Explaining Elder Abuse

affects of caregiver stress (situational model)

dependency of elder on caregiver (exchange theory)

mental or emotional disturbance of caregiver (psychopathology)

repeated cycle of violence (social learning theory)

power imbalance in relationships (feminist theory)

marginalization of the elderly within society (political economic theory)

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, Alzheimer’s)

Being female Over age 85

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

Perpetrating Risk Factors (continued)

Stress

Physical or emotional exhaustion

Low social integration and/or unemployment

Lack of community supports

Insufficient income for basic needs

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

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

Don’t leave cash or valuables visible Notify the police if you will be away from home

for an extended time period

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

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

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

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

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 doesn’t exist

physical injuries may be masked by clothing or by isolating the victim

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

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.

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

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.

References (continued)

Gray-Vickrey, P. (2004). Combating elder abuse: Here’s 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.

References (continued)

Pavlik, B., Hyman, D., Festa, N., & Bitondo Dyer, C. (2001) Quantifying the problem of abuse and neglect in adults—analysis 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.

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).