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From Aging Wiki 23
 Elder Abuse
The baby boom generation is approaching the elderly years of their lives. Understanding that elder abuse does happen, we can predict there will be an increase in the incidents of elderly abuse, based on numbers. According to Statistics Canada, eight million of us will be over the age of 65 by 2031. That's nearly 25 per cent of the population Anticipating that there will be more elders in the population in the near future should encourage us to understand the characteristics of the perpetrators and victims of elder abuse, as well as the circumstances of elder abuse.
 Characteristics of Perpetrators
Research and news reports seem to confirm that those who are most likely to abuse the elderly are family members or people who have a close relationship to the victim. A 2009 study by Aysan Sev’er estimates that 71% of physical offences are committed by close family members and overall 80% of all abusers are men. Spouse abuse is more prevalent than abuse by adult children. This suggests that spouses who abuse do not necessarily stop abusing because of old age.
There are three key characteristics of perpetrators that are known risk factors: a history of mental illness and/or substance abuse, excessive dependence on the elder for financial support, and a history of violence within or outside of the family.
 Substance Abuse
Substance abuse by the caregiver or the patient, especially the abuse of alcohol, significantly increases the risk of physical violence and neglect. Studies show that mental illness is more common among those who abuse as compared to the general population.
 Financial Dependence
Various researchers find that perpetrators are dependent on the elderly victim financially. The abuser is usually financially dependent on the elder and attempts to get resources from them. Children or grandchildren who are unemployed, depend financially and mentally on an elder, and live in social isolation have a high risk of becoming perpetrators. Abuse is more strongly correlated with the financial and emotional dependence of the caregiver on the older victim. Such dependence is usually the result of an underlying problem, such as alcoholism, legal difficulties, psychiatric condition, or deviant behaviour.
 History of Violence
Elsie Yan and Catherine Tang conducted a community study on Hong Kong Chinese to find the proclivity to elder abuse. Their findings suggest the Intergenerational Transmission Theory and the Ecological Theory explain reasons why the abuse may happen. Intergenerational Transmission of Violence is a learned behavior passed from generation to generation. Adult offspring who are abusive toward their aging parents may be victims of child abuse who have learned violence as a means to resolve conflicts. Sev’er also recognizes Intergenerational Transmission of Violence as a serious problem but, adds this doesn’t mean that all children who were abused or witnessed abuse will abuse.
The Ecological Theory links interpersonal violence to broader social structures, considering four levels ranging from individual characteristics of victim and abuser to the culture of the society. Their findings suggest a high level of childhood experience of abuse and negative attitudes toward elderly people are the two most salient predictors for proclivity to elder abuse.
 Relationship To The Victim
Relationship between the abuser and abused seems to be an important factor. In some circumstances physical and verbal abuse are present for a long time, often before the onset of disability. This indicates that an abusive relationship prior to care most likely will lead to abuse during care.
Maltreatment often occurs at times of stress with the perpetrator.A family tradition of using violence in times of stress is perpetuated with the stressed caretaker abusing the elderly victim. Caregiver burnout and frustration has also been shown to lead to elder mistreatment.
A study was conducted by Homer and Gilleard (1990) that compared the risk factors between abused and non-abused groups. Carers who admitted to physical and verbal abuse scored significantly higher on the depression subscales of the general health questionnaire than non-abusive carers. These findings indicate that depression is more common among abusive caregivers.
 Summary of Characteristics of Perpetrators
- Mental illness/Substance abuse – specifically alcohol consumption
- Financial dependence on victim
- Emotional dependence on victim
- Abusive spouse
- Intergenerational Transmission of Violence
- History of violence within or outside family
- Poor relationship prior to care
- Socially dysfunctional caregivers
- Burn out and frustration
- Stopped work to care for elderly
 Characteristics of Victims
The following are characteristics that research has indicated are likely of victims of elder abuse. A typical victim is older than 75 years, often older than 80 years. A survey conducted by Adult Protective Services in Washington in 2004 concluded that two thirds of the reported victims were women and 77% were white. The victim may live close to or with the perpetrator and usually has a personal relationship with their abuser. The victim is often dependent on the perpetrator.
Male victims are most often abused by their wives and female victims are most often abused by their children; the children more likely to be male. Research shows higher rates of physical abuse to victims with dementia than those without. This is likely due to the high rate of disruptive and aggressive behaviour which in turn causes stress to the caregiver and possibly provokes retaliation.
 Circumstances of Abuse
A shared living situation is a major risk factor for victims and people living alone are at the lowest risk. The exception to this would be in the case of financial abuse where the victim usually lives alone.
Circumstances for elder abuse can be social, situational, and structural. They include:
- lack of social networks
- level of dependence on abuser
- abuser dependent on aged
- high stress
- unemployment/stressful work conditions of caregiver
--Tb04bd 22:04, 14 November 2011 (EST)Tammy Beauvais
 Risk Factors for Elder Abuse
The World Health Organization has defined elder abuse as “a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or stress to an older person.” There are a number of possible warning signs to indicate that elder abuse is occuring, which may include:
 Behavioural Problems
Caregivers may be abusive to difficult patients, as patients who are physically or verbally aggressive towards their caregivers may provoke violent or inappropriate reactions. Caregivers that are stressed because of poor working conditions or other personal problems are prone to reacting abusively towards patients with behavioural issues. Such behavioral issues may include being verbally or physically abusive towards caregivers or resisting care .
 Physical Impairment
Physical functioning problems of older adults include incontinence and personal hygiene problems. Increased demands of care for patients with physical impairments may lead to neglect and other types of abuse by overworked staff. Older patients with limitations on their daily activities and/or problems functioning physically may need more care from the staff or come into contact with staff more often, thereby giving more opportunity for abuse. Elderly patient’s higher levels of physical impairment was found to be a predicting factor of deteriorated health and personal neglect.
 Cognitive Impairment
While cognitive impairment itself has generally not been found to be significantly associated with elder abuse by long-term caregivers, it has been found to be indirectly predictive of elderly abuse; it has been suggested that cognitive impairment becomes a risk factor for abuse of the elderly through other issues, such as behaviour problems or physical needs. It has also been suggested that elderly patients with cognitive impairment have limited ability to communicate any mistreatment or abuse to others.
 Environmental Factors
Environmental factors such as caregiver stress and caregiver-recipient conflict have been shown to be significant risk factors for abuse of the elderly. Low social support was shown to more than triple the risk of any type of abuse in elderly patients; however, it is not known whether low social support is a result of – rather than a cause of – mistreatment of elderly patients
 Types of Elder Abuse
There are several different types of elder abuse, including physical abuse, sexual abuse, emotional abuse, financial abuse, and neglect. Each type has different warning signs, with low social support being a strong indicator for each type of abuse.
 Physical Abuse
Physical abuse of elderly patients includes being hit, being restrained, or any type of physical act that results in injury. Physical mistreatment of elderly adults is not always easy to detect; signs of physical abuse may be difficult to distinguish from common age-related changes (for example, elderly patients bruise much more easily than younger patients, and it may be difficult to distinguish accidental bruises from signs of physical abuse). In general, however, elderly adults suffering from physical abuse are more likely to have injuries on the face than on other extremities of their body. The overall prevalence of physical mistreatment in the elderly population was found to be around 1.8%, with approximately 31% of incidents being reported to police. Only adults of the lower elderly age range (60+, as opposed to 70+ or 80+) and low social support have been shown to be significant risk factors of physical mistreatment.
 Sexual Abuse
Sexual abuse of elderly patients includes forced intercourse, molestation, forcing the patient to undress, or photographing the patient nude. The prevalence of sexual mistreatment is approximately 0.3%, with approximately 16% of incidents reported to police. Significant risk factors included having experienced traumatic events previously and having low social support.
 Emotional Abuse
Types of emotional abuse against elderly patients include verbal abuse, humiliation, harassment/coercion, and being ignored. Prevalence of emotional abuse for elderly patients since reaching the age of 60 has been found to be approximately 13.5%, and approximately 7.9% of these abuses are reported to police each year. Risk factors include being in the lower age range of elderly patients (60+ as opposed to 70+ or 80+), employment, having experienced a previous traumatic event, low social support, and – to a lesser extent – needing help with the daily activities of living.
 Financial Abuse
Financial mistreatment by family includes having a family member spending an elderly patient’s money, making poor financial decisions, not giving copies of bills, forging signatures, forcing a respondent to sign a document, or a family member stealing money. The overall prevalence of financial abuse of elderly patients is approximately 5.2%, with the risk factors including nonuse of social services and needing assistance with daily activities.
Within the category of neglect, there are specific unaddressed needs referred to, which includes family or staff neglecting needs of transportation, obtaining food or medicine, cooking/eating/taking medicine, house cleaning/yard work, getting out of bed/dressed/showered, or making sure that bills are paid for the elderly patient. Prevalence of neglect of elderly patients is approximately 5.1%, with the predicting factors including minority racial status, low income, poor health, and low social support.
 The Effects of Elder Abuse
 Physical Effects
Abuse that is inflicted on an elderly person may compromise their physical health. There is a strong association between experiencing elder abuse and suffering from a variety of physical ailments. Elder persons who suffer psychological or emotional abuse are more likely to report experiencing bone or joint problems, digestive problems, chronic pain, high blood pressure or heart problems than those who do not report experiencing abuse. Additionally, some types of abuse, when experienced multiples times, have a significantly greater physical impact. For example, repeated psychological abuse from a spouse is more strongly related to self reported poor health status than other less frequent but more intense forms of abuse.
Experiencing abuse in late adulthood has an impact on how much longer the elder person will live. Elderly persons who experience abuse may, as a result, die earlier than those who have not been abused. This was discovered through a groundbreaking study involving 2812 individuals age 65 or older, of which 385 persons experienced abuse. This longitudinal study tracked their health across a 13 year span. Among those individuals who sought help from protective services regarding abuse, only 9% were still alive at the end of the study, whereas 17% of individuals who had not reported any abused were still alive.
 Psychological Effects
Abuse has a profound influence on a person's psychological well being, and victims of elder abuse are no exception. Elderly persons who experienced abuse are significantly more likely to report symptoms of depression and anxiety, regardless of the the type of abuse they were subjected to. Elder women that have been abused exhibit more chronic stress symptoms than elder women who have not experienced abuse. Psychological issues are especially relevant to elder persons, because elder persons are more prone to live socially isolated lives.  When they are abused, they may be more at risk to develop disorders such as depression, because they do not have the social support system to seek help.
 Prevention of Elder Abuse
Preventative measures may be classified within one of the three broad categories:
 Primary prevention
This category is related to providing the public with resources related to health promotion. Some factors of primary prevention include educating people about what "normal aging" involves, so they may detect any abnormalities in an elder person's health. By knowing the features of aging, and what healthy aging encompasses, persons are more able to detect the abnormal symptoms of aging that are associated with abuse. Primary prevention also involves informing the public of what support systems exist in the community that cater to the elderly.
There is an inherent difficulty in the detection of elder abuse because the regular effects of aging can make the identification of maltreatment difficult.For example, depressive symptoms resulting from abuse may be attributed to the normal feelings associated with aging. Because of this, primary preventative measures are always an important resource for the public so that they make educated observations about elder persons in their lives regarding their quality of treatment.
The greatest barrier in treating elder abuse, according to a sample of Ontario physicians, was denial of abuse by the patient or their family. The next two most significant barriers were: resistance to intervention after abuse had been identified by the patient or family, and a lack of knowledge about where to call for help. All of these factors directly relate to a lack of primary prevention measures that exist in the community.
 Secondary Prevention
This category encompasses measures for detecting elder abuse as well as intervention strategies that can be implemented if abuse is detected. Health care providers have the duty to properly assess the well being of their patients. Because of this, they are in an ideal position to detect abuse among the elder population. Elder persons are likely to interact with health care providers more than the rest of the population when seeking treatment for regular health issues related to aging. Unfortunately, screening procedures among physicians are usually rare. In a study of over 300 physicians, 63% claimed that they never or almost never asked their elder patients about mistreatment, and 82% said that they were not been trained to diagnose elder mistreatment.
A significant issue associated with interventions of elder abuse is related to the regulations of mandatory reporting laws. These laws can legally compel individuals to report elder abuse if they are aware of such occurrences taking place. Unfortunately, very few states in the US have enacted such laws. Alternately, every state, without exception, has enacted mandatory reporting laws for incidences of child abuse. More cases of elder abuse could potentially be reported and dealt with if such laws were more widespread.
 Tertiary Prevention
This category is related to lessening the impact of abuse after it has occurred, and rehabilitating the victim. Tertiary prevention also includes rehabilitating family members of the victim of abuse. This usually involves a dramatic change in care for the victim. Supplying home support to the family and elder person is a common technique. If the family can afford it, they may consider hiring a live-in caregiver. If the home environment can not be rehabilitated into a safe one, the only option for the elderly person is to be institutionalized in a professional caretaking facility.
 Notes and References
- ↑ 1.0 1.1 undefined. (March 1, 2011). CBCnews Canada. In Elder Abuse: A growing Dilemma in an aging population. Retrieved November 12, 2011, from http://www.cbc.ca/news/canada/story/2011/03/01/f-elder-abuse-trends.html.
- ↑ 2.0 2.1 2.2 Sev’er, Aysan. (Spring 2009). More than wife abuse that has gone old: A conceptual model for violence against the aged in Canada and the United States. Journal of Comparative Family Studies, 40.2, 282.
- ↑ MacDonald, P.L. (1996). Abuse and neglect of elders. In J.E. Birren (Ed). Encyclopedia of Gerontology: Age, Aging, and the Aged. Vol. 1. San Diego, CA: Academic Press
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 Collins, Kim A. (2006). Elder maltreatment: A review. Archives of Pathology and Laboratory Medicine, 130 (9), 1291.
- ↑ 5.0 5.1 Swaggerty, DL, Takahashi, PY, Evens, JM. (May 15, 1999). Elderly mistreatment. American Family Physician, 59, 2804-8. doi: 234310196.
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 Lachs, Mark S., Pillemer, Karl. (October 2,2004). Elder abuse. The Lancet, 364, 1265. doi:10.1016150140-6736(04)17144-4.
- ↑ 7.0 7.1 7.2 Akaza, K., Bunai, Y., Tsujinaka, M., at al. (2003). Elder abuse and neglect: social problems revealed from 15 autopsy cases. Legal Medicine, 5, 7-14.
- ↑ 8.0 8.1 8.2 8.3 Tang, Catherine, Yan, Elsie. (1999). Proclivity to elder abuse: a community study on Hong Kong Chinese. Journal of Interpersonal Violence, 18(9), 999 – 1017.
- ↑ 9.0 9.1 Gilleard, C, Homer, Ann C..(December 15, 1990). Abuse of elderly people by their carers. British Medical Journal, 301(6765), 1359 – 1362. doi:29709829.
- ↑ Lithwick, M., Wolfson, C., Yaffe, M. J. (2009) Professions show different enquiry strategies for elder abuse detection: Implications for training and interprofessional care. Journal of Interprofessional Care, 23(6), 646-654.
- ↑ 11.0 11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.8 Biroscak, B. J., Conner, T., Fang, Y., Page, C., Post, L., Prokhorov, A. (2010) Elder Abuse in Long-Term Care: Types, Patterns, and Risk Factors. Research on Aging, 32(3), 323-348.
- ↑ Cohen, M. (2008) Research assessment of elder neglect and its risk factors in a hospital setting. Internal Medicine Journal, 38, 704-707.
- ↑ 13.00 13.01 13.02 13.03 13.04 13.05 13.06 13.07 13.08 13.09 13.10 13.11 13.12 13.13 13.14 Acierno, R., Amstadter, A. B., Hernandez, M. A., Kilpatrick, D. G., Muzzy, W., Resnick, H. S., Steve, K. (2010) Prevalence and Correlates of Emotional, Physical, Sexual, and Financial Abuse and Potential Neglect in the United States: The National Elder Mistreatment Study. Research and Practice, 100(2), 292-297.
- ↑ 14.0 14.1 Austin, R., Corona, M., Gibbs, L., Liao, S., Mosqueda, L., Schneider, D., Wiglesworth, A. (2009) Bruising as a Marker of Physical Elder Abuse. JAGS, 57(7), 1191-1196.
- ↑ 15.0 15.1 15.2 15.3 15.4 15.5 15.6 15.7 Fisher, B.S. & Regan, S.L. (2006). The extent and frequency of abuse in the lives of older women and their relationship with health outcomes. The Gerontologist, 46(2), 200-209.
- ↑ 16.0 16.1 16.2 16.3 16.4 Charlson, M.E., Lachs, M.S., O'Brien, S., Pillemer, K.A. & Williams, C.S. (1998). The mortality of elder mistreatment. Journal of the American Medical Association, 280(5), 428-433.
- ↑ 17.0 17.1 17.2 17.3 17.4 17.5 17.6 17.7 17.8 17.9 Andresen, P., Hackbarth, D.P. & Konestabo, B. (1989). Maltreatment of the elderly in the home: A framework for prevention and intervention. Journal of Home Health Care Practice, 2(1), 43-56.
- ↑ 18.0 18.1 Krueger, P. & Patterson, C. (1997). Detecting and managing elder abuse: Challenges in primary care. Journal of the Canadian Medical Association, 157(8), 1095-1100.
- ↑ 19.0 19.1 Kennedy, R.D. (2004). Elder abuse and neglect: The experience, knowledge, and attitudes of primary care physicians. Family Medicine, 37(7), 481-486.
- ↑ 20.0 20.1 20.2 Gelles, R.J. & Pedrick-Cornell, C. (1982). Elder Abuse: The status of current knowledge. Family Relations, 31(1), 457-465.