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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.^[1][2] However, successive studies found contradictory evidence and discovered a multitude of alternative risk factors such as caregiver risk factors^[1][3][2][4], elderly characteristics^[3][2][4][5], and physician risk factors.^[5]

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

Caregiver Risk Factors

Elder abuse often occurs within one’s own home, in the home of relatives or in long term care facilities,^[5] usually within the context of a trust relationship.^[3] Older adults are commonly quite frail and depend heavily on caregivers which may result in elder abuse^[1] as the caregivers may be experiencing care- related stress, burden and personal problems.^[3] This may lead to negative emotions or actions towards the elderly individual.^[3][4] In one study, caregiver-related stress was strongly related to elder abuse as many individuals felt overwhelmed and strained especially if they had a limited resources or where socially isolated, making it harder to cope with the situation.^[1]

Although the personal characteristics of the elderly may be linked to abuse, risk factors related to the caregiver are more flexible and should be taken into consideration by health care providers.^[1]

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.^[1] 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.^[3]

Other risk factors involving the caregiver include substance abuse (making it difficult to provide adequate care)^[3][2], having a history of violence,^[2] lack of social support or caregiving help^[3], inadequate geriatric knowledge and training, education, and hours worked in caregiving environment.^[1]

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.^[4]

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.^[3][4] 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 be seen as abuse.^[4][5]

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. This occurs particularly if the provider is overworked from the higher demands that physical impairments bring.^[4]

Cognitive Impairment

Studies have shown mixed results on cognitive impairment as a risk factor for elder abuse^[3][2][4] Most researchers found that it was not the cognitive impairment but the pattern of cognitive deterioration which is correlated with elder abuse.^[3][2] It is possible that cognitive impairment could become a risk factor when combined with behavioural factors or physical impairment.^[4] Finally, cognitive disorders may create a communication barrier between the older individual and the caregiver, leading to unsuitable interactions.^[3][4]

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. 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 physicians’ or health care providers’ 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 providers with abuse or neglect.

Neglectful Treatment

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. 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.^[5]

Prevention Techniques

General Knowledge

Preventing elder abuse and neglect is becoming very important, and this is because people are living longer and we are ending up with more older people than ever before. Information is the most powerful tool a person can use to prevent elder abuse and neglect. The first thing you must be informed on is 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, mostly for under privileged people. These people are marked the elderly people they take care of as nothing but investments, in certain cases even trying to sell the elderly people the take care of for nearly 100,000 dollars^[6] . Ways to prevent these forms of neglect and abuse are seeking proper care taking documentation from the chosen elder living facility to make sure they are qualified to care for an older person. Elder abuse and neglect has become a social problem we not face with the growing number of elders, it is our responsibilities at citizens to report any possible cases of abuse in order to prevent this growing social problem to get any worse ^[7]. The time to prevent elder neglect is now.

Family

The family is crucial to the prevention of elder abuse and neglect, however, they can also be responsible for these problems in some cases. One researchers 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, this model shows that stressors such as physical impairments, cognitive impairments, and problematic behaviour cause a "caregivers burden" and this burden built up causes impulsive behaviour to commit elder abuse ^[8]. With this model therapies and strategies have been created to better help the family caregiver deal with their stressors avoiding a crisis. Some of the strategies are putting the senior in an assisted living community for the day, and 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 who has decided to be an elders caretaker, for example they must make sure the senior is taking all of their medication at the proper times, keep them intellectually stimulated, and give them social and emotional support and try to incorporate a form of elder independence. If these steps are ignored you could be subjecting your elder 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 ^[9]. To prevent this from becoming your reality you must either take responsibility for the elder in your care and follow the necessary steps to proper elder care listed above, or enrol your senior in an assisted living facility.

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. To prevent doctors from ignoring or neglecting the seniors in your 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]. 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. Preventions techniques are the same 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 coming to taking care of an elder and preventing neglect and abuse, the more you keep yourself informed the more rewarding and easier it will be to enjoy the company of your elder.

Notes and References

1. ↑ ^{1.0 1.1 1.2 1.3 1.4 1.5 1.6} 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
2. ↑ ^{2.0 2.1 2.2 2.3 2.4 2.5 2.6} 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.
3. ↑ ^{3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11} 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
4. ↑ ^{4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9} Post, L., Page, C., Conner, T., Prokhorov, A., Fang, Y. & Biroscak, B. Elder abuse in long-term care: Types, patterns and risk factors. Research on Aging, 32(3), 328-348. doi: 10.1177/0164027509357705
5. ↑ ^{5.0 5.1 5.2 5.3 5.4} 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
6. ↑ 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
7. ↑ Berens, M. (2011). Selling out seniors. IRE Journal, 34(2), 22-25. Retrieved from EBSCOhost
8. ↑ 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
9. ↑ SHEEHAN, P. (2011). Elder abuse: Zero tolerance. Long-Term Living: For the Continuing Care Professional, 60(6), 40-41. Retrieved from EBSCOhost.
10. ↑ O'Brien, J. G. (2010). A Physician's Perspective: Elder Abuse and Neglect Over 25 Years. Journal of Elder Abuse & Neglect, 22(1/2), 94-104. doi:10.1080/08946560903436379