|
Elder
Abuse
...................................................................................................................
As I often do when creating a Resource Note, I stopped
first at MEDLINEplus,
and just entered “elder abuse” in the search box.
The first item on the page was “Report:
Elderly Are Abused, Ignored, Denied Rights,” by Patricia
Reaney, Reuters Health, Monday, April 8, 2002.
The United Nations is quoted as estimating that by 2050, there
will be close to 2 billion persons over age 60 around the
globe, but governments and international organizations are
not making the needed plans to accommodate the needs of this
group. Discussion of this impending crisis is on the agenda
of the
Second World Assembly on Aging, happening April 8 –12,
2002 in Madrid, Spain.
If just beginning to look into this subject, there is a helpful
paper on the web site of The National Center on Elder Abuse,
http://www.elderabusecenter.org/, titled, “The
Basics: What is Elder Abuse?” It discusses definitions,
types of abuse, categories of abusers, legal implications,
helping agencies, and other informational sources, including
a 44-page pdf file of a “Speakers
Kit for Elder Abuse Awareness,”
In 1998, the Administration on Aging published the final
report of its “National Elder Abuse Incidence Study.”
You can read the report or retrieve a pdf file at http://www.aoa.gov/abuse/report/default.htm.
“This first-ever National Elder Abuse Incidence Study
brings a severely under-reported problem out of the shadows.
This study estimates that at least one-half million older
persons in domestic settings were abused and/or neglected,
or experienced self neglect during 1996, and that for every
reported incident of elder abuse, neglect or self neglect,
approximately five go unreported.”
Here is a list of the warning signs of elder abuse to assist
in recognizing possible victims. It was copied on April 9,
2002 from the web site of the Tennessee
Bureau of Investigation.
Warning Signs:
In many cases, an abused or neglected person is totally dependent
on the abuser and is afraid to complain for fear of reprisal.
It is especially important, therefore, that other people watch
for these warning signs and call law enforcement if they appear:
Physical Abuse
• Frequent unexplained injuries
or complaints of pain without obvious injury
• Burns or bruises suggesting the use of instruments,
cigarettes, etc.
• Passive, withdrawn and emotionless behavior
• Lack or reaction to pain
• Injuries that appear after the person has not been
seen for several days
• Reports of physical abuse
Sexual Abuse
• Sexually transmitted diseases
• Injury to the genital area
• Difficulty in sitting or walking
• Fear of being alone with caretakers
• Reports of sexual assault
Neglect
• Obvious malnutrition
• Lack of personal cleanliness
• Habitually dressed in torn or dirty clothes
• Obvious fatigue and listlessness
• Begs for food
• In need of medical or dental care
• Left unattended for long periods
• Reports neglect
All of us have vulnerable family members, friends, and neighbors
who may need our help and our courage to follow through. The
National Center
on Elder Abuse, provides a
list of phone numbers to call to report suspected elder
abuse.
The American Association for Retired Persons, AARP, has a
Fact
Sheet directed at the elderly to help in preventing elder
abuse. The information is clear and non-threatening. Download
a copy to give to an elderly person in your life.
As in past Resource Notes, I am including a list of journal
articles to assist you in gathering information on the topic.
The first three were published in occupational therapy journals,
and the remaining are a selection of recent articles from
a search of MEDLINE/PubMed.
References:
1. Hasselkus, B.R. (1991). Ethical dilemmas in family caregiving
for the elderly: implications for occupational therapy. American
Journal of Occupational Therapy, 45(3), 206-12
ABSTRACT: An analysis of 60 ethnographic interviews with
family caregivers for frail community-based elderly persons
has suggested that ethical dilemmas are an important organizing
framework for family caregiving. The present paper explores
this conjecture as it relates to the practice of occupational
therapy with older clients and their families. Major themes
of ethical dilemmas in family caregiving, as derived from
the ethnographic data, are described. Verbatim interview data
are presented to illustrate the close ties between caregiving
activity and the caregiver's ethical convictions. Occupational
therapists are encouraged to seek understanding of their clients’
ethical beliefs in order to maximize the potential for a therapeutic
relationship built on mutual understanding and partnership.
2. Holland, L.R., Kasraian, K.R. & Leonardelli, C.A.
(1987). Elder abuse: An analysis of the current problem and
potential role of the rehabilitation professional. Physical
& Occupational Therapy in Geriatrics, 5(3), 41-50.
ABSTRACT: The detection, treatment and prevention of elder
abuse, although of concern to health care professionals, have
not received over the past several years the attention it
merits. While social service and health care dollars for elders
decline or are redistributed, elder abuse may be on the upswing.
As physical and occupational therapists move into home health
care settings they are in opportune positions to detect instances
of elder abuse and facilitate remedial or preventive services.
This article reviews the current problem of elder abuse and
describes some roles for the allied health professional in
addressing the need.
3. Stancliff, B.L. (1997). Recognizing Elder Abuse. OT Practice,
2(10), 22
4. Ayres, M.M. & Woodtli, A. (2001). Concept analysis:
abuse of aging caregivers by elderly care recipients. Journal
of Advanced Nursing, 35(3), 326-34.
ABSTRACT: PURPOSE: The purpose of this article is to clarify
the concept of abuse within the context of aging women who
are at risk for or experiencing physical or emotional injury
inflicted by elderly family members for whom they provide
care. BACKGROUND: The study of abuse of aging individuals
in family caregiving situations has traditionally focused
on abuse of the dependent care receiver. However, evidence
supports the health risks related to abuse of aging caregivers
as well. Women, usually spouses, daughters, or daughters-in-law,
most frequently assume the caregiver role. METHODS: A modification
of the strategies for concept analysis proposed by Walker
and Avant (1995) is used to clarify the concept of caregiver
abuse. Searches of the professional literature reveal that
caregiver abuse is rarely addressed; therefore, the broader
concept of elder abuse is reviewed and then placed within
the general context of family caregiving. Audiotapes of the
first session of a communi!
ty based intervention research study entitled Intervention
for the Abuse of Ageing Caregivers (Phillips et al., NIH Grant
No. R01 DA-AG11155-01, 1996), in which ageing women caregivers
described abusive caregiving situations, were analysed qualitatively
using the principles of concept analysis. The audiotapes serve
as a second source of data for the concept analysis process.
FINDINGS: Antecedents, defining characteristics, and consequences
of abuse of ageing caregivers were identified through the
process of concept analysis. Model, contrary, and borderline
cases are presented to illustrate the findings. CONCLUSIONS:
Findings supported the need for awareness that ageing caregivers
can be placed at risk by verbally and physically abusive behaviours
of the elders for whom they provide care. Use of the term
'abuse' by health care professionals has potentially negative
consequences for identification and intervention in cases
of potential or actual caregiver abuse.
5. Harrell, R., Toronjo, C.H., McLaughlin, J., Pavlik, V.N.,
Hyman, D.J. & Dyer, C.B. (2002). How geriatricians identify
elder abuse and neglect. American Journal of Medical Science,
323(1), 34-8.
ABSTRACT: BACKGROUND: Up to 2 million elderly persons are
abused or neglected in the United States each year. Although
elderly patients see their physicians an average of five times
per year, physicians make only a small percentage of reports
to Adult Protective Services (APS) agencies. The purpose of
this study was to learn how practicing geriatricians define,
diagnose, and address abuse and neglect to provide some guidance
to the busy general internist regarding this complex issue.
METHODS: Ten local geriatricians were interviewed with a standardized
set of open-ended questions. A team analyzed the verbatim
transcriptions using both quantitative and qualitative methods.
RESULTS: The average number of cases diagnosed per year was
8.7 (range, 2-20). The geriatricians were fairly consistent
in their definitions of elder abuse and neglect and how they
diagnosed it through the history and physical exam. The most
common findings in the history were rapport between the patient
and !
caregiver, medical noncompliance, activities of daily living
and instrumental activities of daily living assessments, and
loss of social activities. The most common findings on the
physical exam were bruising/trauma, general appearance/hygiene,
malnutrition, and dehydration. CONCLUSIONS: The geriatricians
emphasized keeping the diagnosis of abuse and neglect in mind
for every patient. A variety of interventions were employed
by physicians and ranged from automatically calling APS on
each case to addressing cases through work with an interdisciplinary
geriatrics team.
6. Jogerst, G.J., Dawson, J.D., Hartz, A.J., Ely, J.W. &
Schweitzer, L.A. (2000). Community characteristics associated
with elder abuse. Journal of the American Geriatrics Society,
48(5), 513-8.
ABSTRACT: OBJECTIVES: To help define the relationship between
elder abuse rates and counties' demographics, healthcare resources,
and social service characteristics. DESIGN: County-level data
from Iowa were analyzed to test the association between county
characteristics and rates of elder abuse between 1984 and
1993 using univariate correlation analysis and stagewise linear
regression. SETTING: Ninety-nine counties in Iowa. PARTICIPANTS:
Iowa residents aged 65 years and older. MEASUREMENTS: County-level
population-adjusted numbers of abused elderly, abused children,
children in poverty, high school dropouts, physicians and
other healthcare providers, hospital beds, social workers
and caseworkers in the Department of Human Services (DHS).
RESULTS: Community characteristics that had a positive association
with rates of reported or substantiated elder abuse at the
P < .001 level were population density, children in poverty,
and reported child abuse. Lower substantiated elder abus!
e rates were associated at P < .05 with higher community
rates of high school dropouts, number of chiropractors, and
number of nurse practitioners. After adjusting for number
of DHS caseworkers and reported child abuse rates (a surrogate
for workload) a district effect persists for substantiated
elder abuse cases (P = .002). CONCLUSION: County demographics
are risk factors for reported and substantiated elder abuse.
The strongest risk factor for reported elder abuse was reported
child abuse. The difference in districts may reflect differences
in resources and/or differing characteristics of caseworkers
who substantiate elder abuse. The risk factors may reflect
conditions that influence the amount of elder abuse or the
detection of existing elder abuse.
7. Marshall, C.E., Benton, D. & Brazier, J.M. (2000).
Elder abuse. Using clinical tools to identify clues of mistreatment.
Geriatrics, 55(2), 42-4, 47-50, 53.
ABSTRACT: Elder abuse occurs most commonly in residential
rather than institutional settings, and the most likely perpetrators
are known by the victim. Although a defined set of risk factors
has not been developed, careful questioning and assessment
can help determine whether a patient is at increased risk.
The common types of elder maltreatment include caregiver and
self-neglect, emotional and psychological abuse, fiduciary
exploitation, and physical abuse. Assessment consists of comprehensive
physical examination, including scrutiny of the musculoskeletal
and genitourinary systems, neurologic and cognitive testing
and detailed social and sexual histories. Clues that cannot
be explained medically may signal elder abuse. To properly
intervene, clinicians should be familiar with state laws governing
reporting procedures and patient privacy.
8. Ortmann, C., Fechner. G., Bajanowski, T. & Brinkmann,
B. (2001). Fatal neglect of the elderly. International Journal
of Legal Medicine, 114(3), 191-3.
ABSTRACT: Maltreatment of the elderly is a common problem
that affects more than 3% of the elderly. We report on two
cases of fatal neglect. Risk factors of victims and caregivers
were analysed in the context of the social history. In both
cases, the victims had a dominant personality and the abusers
(the sons) had been strictly controlled and formed by the
parent. The victims showed typical risk factors such as living
together with the abuser, isolation, dependence on care, income
and money administration. Initially, the victims declined
help from outside and self-neglect occurred. The unemployed
perpetrators lived in social isolation and depended financially
and mentally on the victims. In both cases no mental illness
was present but there was a decrease of social competence.
Legal medicine is predominantly involved in fatal cases in
connection with external post-mortem examinations and autopsies.
Also in the living, the medico-legal expert can assist in
the identification o!
f findings in elderly persons in cases of suspected abuse.
9. Reay, A.M. & Browne, K.D. (2001). Risk factor characteristics
in carers who physically abuse or neglect their elderly dependants.
Aging & Mental Health, 5(1), 56-62.
ABSTRACT: This study investigates the prevalence of, and
differences in, risk factor characteristics in a sample of
two select populations of carers, one of which physically
abused their elderly dependants and one of which neglected
them. Nineteen carers (nine who had physically abused and
10 who had neglected their elderly relatives), who were referred
to clinical psychology by either their general practitioner
or their psychiatrist, were invited to take part in this study.
A detailed history of risk factors was obtained, including
history of alcohol dependency, type and history of mental
ill health, history of maltreatment earlier in life, who they
were caring for, how long they had been a
carer and whether they felt isolated as a carer. Subjects
were then given five assessments to determine whether there
were any differences between the two groups. These were the
Conflict Tactic Scale, Strain Scale, Beck Depression Inventory,
Beck Anxiety Inventory and Cost of Care Index. An
examination of the risk factors suggests that heavy alcohol
consumption and past childhood abuse by fathers were likely
to lead to physical abuse. Significantly higher conflict and
depression scores were also present in the physical abuse
group, while the neglect group had significantly higher anxiety
scores. It is suggested that these findings should be incorporated
into an assessment of future risk of abuse or neglect by the
carer.
10. Schiamberg, L.B. & Gans, D.M. (2000). Elder abuse
by adult children: an applied ecological framework for understanding
contextual risk factors and the intergenerational character
of quality of life. International Journal of Aging & Human
Development, 50(4), 329-59.
ABSTRACT: Elder abuse in family settings has increased in
recent years for a variety of reasons, including the increasing
proportion of older adults in the total population, the related
increase in chronic disabling diseases, and the increasing
involvement of families in caregiving relationships with elders.
Future trends indicate not only continued growth of the older
population but suggest, as well, an increased demand for family
caregiving which may, in turn, be accompanied by increasing
rates of elder abuse. It is important to consider issues associated
with such caregiving and elder abuse in families from an ecological
perspective as a basis both for framing conceptually relevant
and effective prevention strategies as well as for understanding
the specific character of the broader issue of the intergenerational
nature of the quality of life in an aging society. Using an
applied ecological model, the article focuses on the contextual
risk factors of elder abuse. Specifically, five levels of
environment--microsystem, mesosystem, exosystem, macrosystem,
and chronosystem--will be utilized to organize and interpret
existing research on the risk factors associated with elder
abuse (Bronfenbrenner, 1979, 1986, 1997). The configuration
of the risk factors provides a useful framework for understanding
the intergenerational character of the quality of life for
older adults, for developing recommendations for empirically-based
action research, and for the development of community-based
prevention and intervention strategies. The application of
a contextual perspective to the development of intervention
and prevention programs will be addressed, the latter in relation
to primary, secondary, and tertiary prevention.
Compiled by Mary Binderman, MLS
Director of Information Resources
The American Occupational Therapy Foundation
Bethesda, MD.
April 10, 2002
|
