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| == Environmental Factors == | == 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<ref name="Biroscak" />. 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<ref name="Acierno" | + | Environmental factors such as caregiver stress and caregiver-recipient conflict have been shown to be significant risk factors for abuse of the elderly<ref name="Biroscak" />. 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<ref name="Acierno">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.</ref> |
| = Types of Elder Abuse = | = Types of Elder Abuse = | ||
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| == Physical Abuse == | == Physical Abuse == | ||
| - | Physical abuse of elderly patients includes being hit, being restrained, or any type of physical act that results in injury<ref name="Acierno" />. 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<ref name="Austin" | + | Physical abuse of elderly patients includes being hit, being restrained, or any type of physical act that results in injury<ref name="Acierno" />. 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<ref name="Austin">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.</ref>. 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<ref name="Austin" />. 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<ref name="Acierno" />. 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<ref name="Acierno" />. |
| == Sexual Abuse == | == Sexual Abuse == | ||
Revision as of 21:37, 2 November 2011
Group Members:
-Alex Jackson
-Chris Ward
-Tammy Beauvais
Contents |
Elder Abuse
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.”[1] Here follows some warning signs of elderly abuse:
Behavioural Problems
Behavioral problems include being verbally or physically abusive towards caregivers or resisting care[2]. When caregivers are abused by patients, they are likely to be abusive in return[2]. Caregivers that are stressed because of poor working conditions or other personal problems are prone to reacting abusively towards patients with behavioural issues[2].
Physical Impairment
Physical functioning problems of older adults include incontinence and personal hygiene problems[2]. 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[2]. Increased demands of care for patients with physical impairments may lead to neglect and other types of abuse by overworked staff[2]. Patient’s higher functional disability was a predicting factor of deteriorated health and personal neglect[3].
Cognitive Impairment
Cognitive impairment itself has generally not been found to be significantly associated with elder abuse by long-term caregivers[2]. 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[2]. It has also been suggested that elderly patients with cognitive impairment have limited ability to communicate any mistreatment or abuse to others[2].
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[2]. 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[4]
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[4].
Physical Abuse
Physical abuse of elderly patients includes being hit, being restrained, or any type of physical act that results in injury[4]. 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[5]. 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[5]. 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[4]. 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[4].
Sexual Abuse
Sexual abuse of elderly patients includes forced intercourse, molestation, forcing the patient to undress, or photographing the patient nude[4]. The prevalence of sexual mistreatment is approximately 0.3%, with approximately 16% of incidents reported to police[4]. Significant risk factors included having experienced traumatic events previously and having low social support[4].
Emotional Abuse
Types of emotional abuse against elderly patients included verbal abuse, humiliation, harassment/coercion, and being ignored[4]. Prevalence of emotional abuse for elderly patients since reaching the age of 60 was approximately 13.5%, and approximately 7.9% of these abuses were reported to police[4]. Risk factors included 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[4].
Financial Abuse
Financial mistreatment by family included a family member spending an elderly patient’s money, not making good decisions, not giving copies of bills, forging signatures, forcing a respondent to sign a document, or a family member stealing money[4]. The overall prevalence of financial abuse of elderly patients was approximately 5.2%, with the risk factors including nonuse of social services and needing assistance with daily activities[4].
Potential Neglect
The specific unaddressed needs referred to by potential neglect 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[4]. Prevalence of neglect of elderly patients was approximately 5.1%, with the predicting factors including minority racial status, low income, poor health, and low social support[4].
The Effects of Elder Abuse
Physical Effects
Abuse that is inflicted on an elder person may compromise their physical health.[6] There is a strong association between experiencing elder abuse and suffering from a variety of physical ailments.[6] 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.[6] Additionally, some types of abuse when experienced multiples times, have a significantly greater physical impact.[6] For example, repeated psychological abuse from a spouse is more strongly related to a self reported poor health status than other less frequent but more intense forms of abuse.[6]
Experiencing abuse in late adulthood has an impact on how much longer the elder person will live.[7] Elderly persons who experience abuse may, as a result, die earlier than those who have not been abused.[7] This was discovered through a groundbreaking study involving 2812 individuals age 65 or older.[7] It was a long-term study which tracked their health across a thirteen year span.[7] 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 required no such intervention were still alive.[7]
Psychological Effects
Abuse has a profound influence on a person's psychological well being, and elderly persons are no exception.[6] Elderly persons who experienced abuse were significantly more likely to report symptoms of depression and anxiety, regardless of the the type of abuse they were subjected to.[6] Elder women that have been abused exhibit more chronic stress symptoms than elder women who have not experienced such abuse.[6] Psychological issues such as depression are especially relevant to elder persons, because elder persons are more prone to live socially isolated lives.[8]
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.[9] Some factors of primary prevention include educating people about what "normal aging" involve, so they may detect any abnormalities in an elder person's health.[9] Primary prevention also involves informing the public of what support systems exist in the community that cater to the elderly.[9]
There is an inherent difficulty in the detection of elder abuse: the regular effects of aging can make the identification of maltreatment difficult.[8] 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 preventing elder abuse, according to a sample of Ontario physicians, was denial of abuse by the patient or their family.[10] 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.[10] All three 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.[9] 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 may also be able 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.[11] 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.[11]
A significant issue associated with interventions of elder abuse is related to the regulations of mandatory reporting laws.[12] 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.[12] Alternately, every state, without exception, has enacted mandatory reporting laws for incidences of child abuse.[12] 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.[9] Tertiary prevention also includes rehabilitating family members of the victim of abuse.[9] This usually involves a dramatic change in care for the victim.[9] Supplying home support to the family and elder person is a common technique.[9] If the family can afford it, they may consider hiring a live-in caregiver.[9] 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.[9]
Notes and References
- ↑ 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.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 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.
- ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 4.12 4.13 4.14 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.
- ↑ 5.0 5.1 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.
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 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.
- ↑ 7.0 7.1 7.2 7.3 7.4 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.
- ↑ 8.0 8.1 Lachs, M.S. & Pillemer, K. (2004). Elder Abuse. The Lancet, 364(1), 1263-1272.
- ↑ 9.0 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 9.9 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.
- ↑ 10.0 10.1 Krueger, P. & Patterson, C. (1997). Detecting and managing elder abuse: Challenges in primary care. Journal of the Canadian Medical Association, 157(8), 1095-1100.
- ↑ 11.0 11.1 Kennedy, R.D. (2004). Elder abuse and neglect: The experience, knowledge, and attitudes of primary care physicians. Family Medicine, 37(7), 481-486.
- ↑ 12.0 12.1 12.2 Gelles, R.J. & Pedrick-Cornell, C. (1982). Elder Abuse: The status of current knowledge. Family Relations, 31(1), 457-465.
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