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[edit] Elder Abuse

For the past 20 years the issue of elderly abuse has remained a fairly private matter, however; a recent upsurge in the number of reported cases, along with the growing aged population has been a great cause for public concern[1]. The term elder abuse has been used to describe any harm caused to an elderly person[1]. Other terms include senior abuse, abuse of elder men and women or the mistreatment of elders [2].

According the World Health Organization, elder abuse is defined as “a single, or repetitive act,occurring within any relationship where there is an expectation of trust which results in grievance or misery to an older individual”[2].This definition acknowledges that a large majority of the abuse on elders is done by an individual whom they have a relationship with or depend on for care. With that being said, this is why it is so difficult to obtain a prevalence rate as many are reluctant to report these cases because the individual is both the abuser and primary caregiver, and the elder may fear for their safety and loss of independence[1]. In order to develop a critical knowledge base on this issue, it is important to understand the different forms of abuse that plague our elders.


[edit] Types of Abuse

Although the issue of elder abuse is seen as a collective issue, the ways in which an elder is abused comes in many different forms, and it is important to understand the different types of abuse that frequently occur in this population and what its form of abuse constitutes of[2]. Under the large umbrella of elder abuse there are five additional categories of abuse. These include, emotional and psychological, financial, physical, sexual and neglect[1]

Physical abuse: any physical assault such as slapping hitting or beating. This also includes forceful confinement to a room or wheelchair[3]

Sexual abuse: forcing the individual to partake in sexual acts or conversations. This also includes any unwanted or inappropriate touching of the individual against their will.[3]

Financial abuse: this includes the misuse of power of attorney, committing fraud by forging signatures on checks, stealing the person’s money, or forcing them to sell personal property in order to use profit for personal use.[3]

Neglect: neglect is better known as failing to provide adequate care that the elder needs to survive. This includes withholding food, clothes or shelter or access to health services[3].

Emotional/ Psychological abuse: this includes humiliating or insulting the elder. Emotional abuse can also take form in an individual using something important as a way to gain control by threatening to remove or destroy this object.[3]

[edit] Warning Signs

Elder abuse is a very serious issue and if an individual feel someone they know is a victim they should report it to the local authorities as soon as possible.

Some warning signs to looking out for are:

  • Multiple injuries such as unexplained bruises, scars, burns and lacerations. These injuries are usual in places hard to detect such as the bathing zone which include the trunk, abdomen, buttocks or upper thighs[1]
  • History of frequent visits to the emergency room, or lack of medical care when injuries or illness are apparent[1]
  • Dehydration or malnutrition[1]
  • being over or under sedated[1]
  • Fear of strangers[1]
  • Low self esteem[1]
  • Fear of caregiver. This is seen when the elderly individual becomes shy or awkward when the caregiver enters the room[1]
  • Hunger for socialization or company[1]

Some warning signs for financial abuse include:

  • lack of knowledge about their own financial records[1]
  • Checks being signed without their permission[1]
  • Unusual or excessive purchases or cash withdrawals[1]

[edit] Characteristics of the Abuser

It is important that one keeps a watchful eye on the elders in their lives, because many of these symptoms can be overlooked and considered to be signs of aging[4]. Sometimes this is the case, however, a thorough investigation should be done before jumping to these conclusions. A final way to determine if there is abuse taking place is to look at the behaviours and actions of the primary caregiver. Recognizing the warning signs in a caregiver is a great way to eliminate future abuse[4].

Watch for the caregiver:

  • Attempting to dominate the elder adult[5]
  • Being verbally or physically abusive[5]
  • Caregiver has a history of drug abuse or mental health [5]
  • Caregiver is financially dependent on the older adult[5]

Recognizing the warning signs of elder abuse is a good way to ensure putting a stop to the issue. Although warning signs are detrimental to putting a stop to elder abuse, having knowledge on what risk factors are associated with it will greatly eliminate an individual placing themselves in situations where they become vulnerable to abuse[5].

[edit] Risk Factors

The issue of elder abuse and neglect is a complex one, composed of a combination of factors. Early studies stated that the typical mistreated elder was weak, highly dependent, and female.[6][7] However, successive studies found contradictory evidence and discovered a multitude of alternative risk factors such as caregiver risk factors[6][8][7][9], elderly characteristics[8][7][9][10], and the physician’s role in elderly care.[10]

An elderly individual who has been subjected to psychological abuse by their caregiver.
An elderly individual who has been subjected to psychological abuse by their caregiver.

[edit] Caregiver Risk Factors

Elder abuse often occurs within one’s own home, in the home of relatives or in long term care facilities,[10] usually within the context of a trusting relationship.[8] Older adults are commonly quite frail and depend heavily on caregivers which may result in elder abuse,[6] as the caregivers may be experiencing care- related stress, burden and personal problems.[8] This may lead to negative emotions or actions towards the elderly individual.[8][9] In one study, caregiver-related stress was strongly related to elder abuse as many individuals felt overwhelmed and strained especially if they they had limited resources or were socially isolated, making it harder to cope with the situation.[6]

Many caregiver characteristics have been reported to have a hand in the incidence of elder abuse such as the age of the caregiver, however literature has been inconsistent on this trait as some studies have found that the older the individual is, the more likely they are to be abused. Other studies have found that age itself is not necessarily a risk factor for abuse.[6] It is also possible that caregivers of cognitively impaired elderly blame them for the situation as communication may be difficult, and the caregiver may not be able to assess the older individual’s needs.[8]

Other risk factors involving the caregiver include substance abuse,[8][7] having a history of violence,[7] lack of social support or caregiving help,[8] inadequate geriatric knowledge and training, lack of education, and hours worked in the caregiving environment.[6]

[edit] Elderly Characteristics

In addition to caregiver risk factors, there are many characteristics of the older adult that could be risk factors for elder abuse including behavioural traits, physical impairment, and cognitive impairment.[9]

[edit] Behavioural Risks

It is important to note that elder abuse may be a reciprocal process between the caregiver and the older individual. Some older individuals may elicit provocative or aggressive behaviour (verbal or physical), usually in the presence of dementia, which results in the caregiver responding in a similar manner.[8][9] Furthermore, the elderly may also try to resist care which could put the caregiver in a difficult situation because if they do not force care, any accidents can be attributed to negligence. On the other hand, giving care against the individual’s wishes may elicit inappropriate behaviours from the older adult, resulting in reactive responses from the caregiver. Forcing care may also cause the elderly individual psychological distress.[9][10]

[edit] Physical Impairment

Those who are limited in their physical functioning are at a higher risk of elder abuse mainly because they need more contact with their care providers on a daily basis, providing more opportunities for elder abuse to transpire.[9] This occurs particularly if the provider is overworked from the higher demands that physical impairments bring.

[edit] Cognitive Impairment

Studies have shown mixed results on cognitive impairment as a risk factor for elder abuse.[8][7][9] Most researchers found that it was not the cognitive impairment but the path of rapid cognitive decline (the fact that the elderly individual's cognitive state was becoming progressively worse) which was correlated with elder abuse.[8][7] It is possible that cognitive impairment could become a risk factor when combined with behavioural factors or physical impairment.[9] Finally, cognitive disorders may create a communication barrier between the older individual and the caregiver, leading to unsuitable interactions.[8][9]

[edit] The Physician's Role

Physicians are in the best position to identify and report elder abuse. However, instances of mistreatment are often not caught or reported due to numerous reasons.[10] First, physicians may adapt an ageist bias in which the elderly are valued less. They may also be unwilling to become involved with the authorities. Furthermore, the elderly may not report abuse as they may fear a negative reaction from the abuser, who may insist on being present during the visit. Placement in long term care facilities may also be a factor as it is the physician's or health care provider's job to make sure the patient is safe. However, the elderly are more prone to injurious accidents, adverse drug reactions and cognitive disorders, and the emergence of these may result in blaming the health care workers and thereby the physician who placed the individual in the facility with abuse or neglect.

[edit] Physician's Neglect

As previously mentioned, health care providers may undertreat the older individual due to their ageist perspective, resulting in the patient being deprived of the necessary treatment despite the fact that it could improve their condition.[10] On the other hand, overtreatment can also occur, where the physician gives the older adult a form of therapy not yet tested in the elderly, which has no chance of improving the condition and may actually be harmful.

Unsuitable treatment may be a result of the physician’s uneasiness with the situation, lack of geriatric knowledge, and low reimbursement rate per visit.

[edit] Implications of Elder Abuse Risk Factors

It is evident that there are numerous risk factors for the ever-growing problem of elder abuse.[8][7][6][9][10] These risk factors often include the older individual’s direct environment and the people they learn to rely on most. These factors need to be considered in order create effective prevention methods and interventions.

[edit] Prevention Techniques

Elder abuse prevention advertising campaign
Elder abuse prevention advertising campaign

[edit] General Knowledge

Preventing elder abuse and neglect is becoming very important as people are living longer and current society is ending up with more older people than ever before.[11] Information is the most powerful tool a person can use to prevent elder abuse and neglect. First, individuals must be informed on proper care for the elderly. There are new "elderly care programs" being put into place where people with little to no training can take care of an elderly person in order to receive free room and board. This program is available mostly for underprivileged people. [12] These elderly people are labeled as an investment by the people who are supposed to be taking care of them. In certain cases the caretakers try to sell the elderly people they care for for nearly 100,000 dollars.[11] Ways to prevent these forms of neglect and abuse are seeking proper care, and taking documentation from the chosen elder's living facility to make sure they are qualified to care for an older person. Elder abuse and neglect has become a serious social problem especially with the growing number of elders. It is our responsibility as citizens to report any possible cases of abuse in order to prevent this growing social problem from getting any worse. [12] The time to prevent elder neglect and abuse is now.

[edit] Family

The family is crucial to the prevention of elder abuse and neglect. However, family members can also be responsible for these problems in some cases. One researcher's experiment tries to explain the reasons behind elder neglect and abuse, and this model gives us a good idea on how to prevent elder abuse. His model is called the ABCX model which shows that stressors such as physical impairments, cognitive impairments, and problematic behaviour cause "caregivers burden." If this burden builds up it can cause impulsive behaviour that results in elder abuse [13]. With this model, therapies and strategies have been created to better help the family caregiver deal with their stressors in order to avoid a crisis. Some of the strategies are putting the senior in an assisted living community for the day. This creates an opportunity for the senior to interact socially, and gives the family member a chance to relax and live without the burden of their responsibilities for the day. There are many responsibilities for the family that has decided to be an elder's caretaker. Responsibilities of the caretaker include:

  • They must make sure the senior is taking all of their medication at the proper times
  • Keep the elder intellectually stimulated
  • Give them social and emotional support
  • Try to incorporate a form of elder independence

Forms of independence can include, getting their own groceries, helping in the kitchen, easy chores, and anything else that makes them feel self sustaining. If these steps are ignored one could be subjecting the senior they are in charge of to improper care, and in some cases family members have been known to hit their elders because they were forgetful or disrupting the flow of their regular lives [14]. To prevent this from becoming a problem in ones reality one must either take responsibility for the elder in their care and follow the necessary steps to proper elder care listed above, or enroll your senior in an assisted living facility.

[edit] Physician/Caregiver

Older people spend a lot of time at the doctors or in assisted living facilities. In order to prevent neglect and abuse, knowledge and communication are vital once again. Older people tend to visit the doctor's office much more often than younger people, and this causes doctors to see them as less of a priority because they come much more often [10]. To prevent doctors from ignoring or neglecting the seniors in ones care it is important the family go with that elder to all of their appointments to make sure the doctor is not giving them mediocre treatment.[10] It is important to note that it is also important for the elder so visit the doctor sometime on their own to assert independance. The family and the physician must communicate concerning the health and behaviour of the senior because this is how diseases such as Alzheimer's and dementia are best diagnosed in the early stages, which allows for better treatment. Caregivers are also likely to neglect seniors in group homes or even personalized nurses in the seniors home [14]. Preventions techniques are as important as doctors communication with the family, but communication between the family and the senior is very important in this case as well. The family can keep in touch with the caregiver to make sure she is keeping the senior up to date with his medication and also to make sure she is keeping him intellectually and socially active. Knowledge is the most important thing when it comes to taking care of an elder in order to ensure prevention of neglect and abuse. The more one keeps themself informed, the more rewarding and easier it will be to enjoy the company of ones' elder.

[edit] Notes and References

  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 Wahl , J., & Purdy, S. (2010). Elder abuse: the hidden crime. Advocacy Centre for the Elderly, 1-31.
  2. 2.0 2.1 2.2 Flannery , R. (2003). Domestic violence and elderly dementia patients . American journal of Alzheimer’s disease and dementia, 18(1), 21-23.
  3. 3.0 3.1 3.2 3.3 3.4 Gray-Vickery, P. (2000). Protecting the older adult. Combating Abuse: Nursing 2000, 30(7), 34-38.
  4. 4.0 4.1 Hall , R., Hall, R., & Chapman, M. J. (2005). Exploitation of Elderly: undue influence as a form of elder abuse. Clinical Geriatrics, 13(2), 28-35
  5. 5.0 5.1 5.2 5.3 5.4 Preventing elder abuse and neglect in older adult . Foundation For Health in Aging, Retrieved from
  6. 6.0 6.1 6.2 6.3 6.4 6.5 6.6 Wang, J., Lin, M., Tseng, H. & Chang, W. (2009). Caregiver factors contributing to psychological elder abuse behaviour in long-term care facilities: A structural equation. International Psychogeriatrics, 21(2), 314-320. doi: 10.1017/S1041610208008211
  7. 7.0 7.1 7.2 7.3 7.4 7.5 7.6 7.7 Lachs, M., Williams, C., O'Brien, S., Hurst, L. & Horowitz, R. (1997). Risk factors for reported elder abuse and neglect: A nine-year observational cohort study. The Gerontologist, (37)4, 469-474.
  8. 8.00 8.01 8.02 8.03 8.04 8.05 8.06 8.07 8.08 8.09 8.10 8.11 8.12 Pérez-Rojo, G., Izal, M., Montorio, I. & Penhale, B. (2009). Risk factors of elder abuse in a community dwelling Spanish sample. Archives of Gerontology and Geriatrics, 49, 17-21. doi:10.1016/j.archger.2008.04.005
  9. 9.00 9.01 9.02 9.03 9.04 9.05 9.06 9.07 9.08 9.09 9.10 Post, L., Page, C., Conner, T., Prokhorov, A., Fang, Y. & Biroscak, B. (2010). Elder abuse in long-term care: Types, patterns and risk factors. Research on Aging, 32(3), 328-348. doi: 10.1177/0164027509357705
  10. 10.0 10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 O'Brien, J. G. (2010). A physician's perspective: Elder abuse and neglect over 25 years. Journal of Elder Abuse & Neglect, 22, 94-104. doi: 10.1080/08946560903436379
  11. 11.0 11.1 Lowenstein, A. (2009). Elder abuse and neglect—“Old Phenomenon”: New Directions for Research, Legislation, and Service Developments. Journal of Elder Abuse & Neglect, 21(3), 278-287. doi:10.1080/08946560902997637
  12. 12.0 12.1 Berens, M. (2011). Selling out seniors. IRE Journal, 34(2), 22-25. Retrieved from EBSCOhost
  13. Lee, M. (2009). A path analysis on elder abuse by family caregivers: Applying the ABCX Model. Journal of Family Violence, 24(1), 1-9. doi:10.1007/s10896-008-9192-5
  14. 14.0 14.1 SHEEHAN, P. (2011). Elder abuse: Zero tolerance. Long-Term Living: For the Continuing Care Professional, 60(6), 40-41. Retrieved from EBSCOhost.
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