What is elder abuse an allinclusive term representing all types of mistreatment or abusive behavior toward older adults Wolf 2000 p7 further defined as acts of commission intentional behavior and omission failure to act ID: 917019
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Slide1
Elder Abuse and Neglect
Barbara J. Chromy
Slide2What 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
Slide4Forms 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
Slide5Forms 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
Slide6Forms 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
Slide7Indications 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withdrawn behavior, wasting or failure to thrive, depression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
Slide9Indications 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)
Slide10Scope 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)
Slide11Distribution 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)
Slide12Perpetrators 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
)
Slide13Greatest 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)
Slide14Theories 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)
Slide15Risk 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
Slide16Risk 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
Slide17Perpetrating Risk Factors
(continued)
Stress
Physical or emotional exhaustion
Low social integration and/or unemployment
Lack of community supportsInsufficient income for basic needs
Slide18Protective 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
Slide19Protective 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
Slide20Protective 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
Slide21Protective 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 counselorsclergylocal police
Slide22Detection 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
Slide23Detection/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
Slide24Detection/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
Slide25Detection/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
Slide26Recommendations
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.
Slide27Recommendations (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
Slide28References
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 (2
nd
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.
Slide29References (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.
Slide30References (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.
Slide31Resources
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 (2
nd
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
).