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[edit] What is Elder Abuse?

Elder abuse is becoming an increasing field of research in Canada as the baby boomers reach old age. Unfortunately, it isn't reported as often as it should be. It is important that Canadian's be aware of the risk factors and prevalence of elder abuse and report any form of it. The more identifiable the abuse is, the more we can do as a society to stop and prevent it. First of all, elder abuse is a complex term to define and is broken up into sub sections which include physical abuse, sexual abuse, financial abuse and neglect.

[edit] Physical Abuse

It is estimated that between 500,000 and 2.5 million cases of physical abuse towards elders occur each year [1] Physical elder abuse is defined as any use of physical force that may result in impairment, pain or bodily harm [2]. Characteristics of physical abuse are:

  • Beating
  • Hitting
  • Shaking
  • Kicking
  • Slapping
  • Burning
  • Inappropriate use of drugs
  • Inappropriate use of physical restraints
  • Force-feeding
  • Physical punishment. [2]

The most common physical abusers are family members with adult children being the highest perpetrators (32.6%), followed by other family members (21.5%) and spouses (11.3%).[1] Taking care of an aging family member can often leave people feeling frustrated and overworked, which is called the stressed caregiver hypothesis. The stressed caregiver hypothesis states that the likelihood of physical abuse occurring increases if the caregiver perceives the relationship as low in levels of satisfaction or being tedious.[3]

Women experience physical abuse more often than men and are also less likely to report it.[2] Physical abuse becomes an issue for both men and women as they age because their ability to fight off attacks decreases as they experience physical and mental declines.

[edit] Sexual Abuse

Elder sexual abuse is defined as any non-consenting sexual contact upon an elderly person.[2] This includes:

  • Unwanted touching
  • Sexual assault
  • Sexually explicit photographing with a person not capable of giving consent[2]

Sexual abuse occurs three times more often to women than men.[4] A Woman’s vulnerability to sexual abuse increases over men's because they experience a decrease in status after losing jobs, friends, partners and social support that leaves them unprotected. [2] They are also more likely to conceal the violence since they feel ashamed and threatened in their living conditions. [2] A majority of these abusers tend to be spouses of the abused who display some form of mental illness, alcoholism, or financial dependence on the victim. [2] Also people who commit these sex offences and who are not spouses tend to exhibit antisocial behaviour and psychopathology. [2] In cases where adult children are the abusers they tend to be unmarried, unemployed, financially supported by the parent and often display mental illness or substance abuse issues.[5] There are different forms of physical and psychological consequences that accompany sexual elder abuse including anxiety attacks, disrupted sleep patterns, weight loss, nausea, depression, stress, anger and problems with personal relationships.[5]

[edit] Financial Abuse

Violent crimes may be decreasing in North America but the incidence of financial abuse involving the elderly is steadily rising.[6] This phenomenon is due to the increase in the elderly population as well as the increase in wealth amongst the elderly.[6] People are beginning to see the opportunity to taking advantage of the elderly for financial gain. Victims tend to be females with some sort of mental impairment and 75% of them fall between the ages of 70 and 89.[6] These people are prime targets because they have little to no ability to fight off attacks and their mental impairments make it easy for them to be cheated. Elders are also unlikely to report financial abuse because they feel humiliated, ashamed and fear retaliation from their abuser.[6] Since family members or in-home caregivers conduct 60 – 90% of financial abuse, the victim feels helpless and will not report it because they are scared for their safety.[6]

[edit] Neglect

Neglect is the most common form of elder abuse representing 50 – 70% of reported cases.[7] Neglect is often described as the failure to fulfill a person’s obligation to an elder to supply them with basic life necessities.[7] Neglect can include:

  • Denial of food
  • Denial of water
  • Inadequate shelter
  • Failure to supply clothing
  • Low levels of personal comfort
  • Insufficient medication administration
  • Low levels of personal hygiene.[7]

Neglect can be both voluntary and involuntary on the part of the caregivers. Meaning that the caregiver can either intentionally withhold basic necessities or carelessly forget to meet those basic needs. Adult children tend to be the abusers in neglect situations and neglect often occurs because the abuser is not prepared to take on the responsibility of caring for an elder and is reluctant to do so.

Another form of neglect is self-neglect. Self-neglect can be defined as the inability or reluctance to take care of ones basic needs [7]. This form of neglect is specifically focused on the elder’s ability to take care of themselves. When they reach the point of self-neglect they often need to be placed in the care of a family member or a care facility.

[edit] Prevalence of Elder Abuse

Elderly abuse has been found worldwide, and not a culturally specific occurrence within the westernized society. Through studies that have been performed elevating the relationshi between older adults and thier caregivers worldwide, these characteristics of abuse can be observed. These characteristics are shown to elevate even higher between patients of dementia and their caregivers.

  • 47% of patients with dementia have been victims of abuse. [8]
  • 36% of the elderly population over the age of 85 has encountered some form of abuse. [9]

To help and try to prevent these elder abuse statistics form ocuring, doctors have started to implement questionnaires for the care givers and patients of dementia. These are used to better evaluate the living conditions as well as the emotional state for these people and are better able to predict and report cases of abuse. To this date there has not been any formal evaluation to specifically be able to diagnose the abuse displayed by caregivers or other family members, [8] but future research is headed in this direction.

[edit] Prevalence of Different Types of Abuse

Elderly abuse can clearly be seen as a major issue, and just like any other form of abuse, there are many different forms in which it can present itself:

  • Physical: Physical abuse directed toward older individuals in the hands of care givers is very common, often resulting in cuts and bruises to the elderly. The most common forms of physical abuse reported in elders are bruises and lacerations in the upper arm found in over 25% of cases, and head injuries found in 10% of cases. [10]
  • Alcohol: Abuse through the use of alcohol is often found in the caregiver, causing aggression and violence towards the patient. Such abuse is most commonly found in long term care situations. [11] These types of aggression towards elderly individuals have been reported to be found within 30-60% of elderly individuals being taken care of by a caregiver. [8]
  • Verbal/Emotional: This form of elderly abuse is the most common, often caused by stress and greed rather than frustration and anger like the previous types of abuse. Verbal and emotional forms of abuse can often be related to financial problems, or financial greed. [12] This emotional abuse was found to be up to 40% more prominent in rural areas rather than that of those living in urban areas of Canada. [2]

[edit] Elder abuse in Canada

Elder abuse is not a new problem that has recently come about, but has only recently begun to be more aggressively monitored in North America. Within the past 30 years, there has been a greater promotion of awareness in caregiving, and medical relations, through different forms of media to fight against abuse towards the older adult population. Through multiple studies on Canadian seniors, four percent of elders have reported to experience one or more forms of elder abuse. Over half of these reports have been defined as material abuse such as taking advantage of the elder for their monetary possessions or personal belongings. [2] This displays that the issue of elder abuse is very much so prevalent in Canada even though often swept under the rug in hopes of displaying an illusion of a perfect life.

[edit] Risk Factors

Through becoming aware of the risk factors associated with abuse, loved ones as well as elders themselves will be more equipped with the knowledge they need to ensure that elders do not become victims of abuse. There are four risk factors that may increase an elder's risk of experiencing abuse: behavioural problems, physical impairment, cognitive impairment, and environmental risk factors. These risk factors will be discussed below.

[edit] Behavioural Problems

  • Behavioural problems are one of the main risk factors for all types of elder abuse.
  • Behavioural Problemsare described as the resistance of care either verbally or physically by an elder individual [13].
  • If an elder is displaying difficult behaviours or is acting abusively towards their caregiver, their caregiver is more likely to abuse the elder in return [13].
  • Caregivers in facilities are also physically assaulted by patients on a regular basis [14].
  • Difficult behaviours from an older adult such as physical assault towards their caregivers, paired with the lack of knowledge given to caregivers on how to handle conflict with a patient, may lead to an instance of abuse [14].

[edit] Physical Impairment

Physical impairments may also put an older adult at risk for abuse.

  • Two forms of physical impairments are incontinence as well as failure to maintain personal hygiene[13].
  • Physical impairments put an elder at risk for abuse because caregivers come into contact with them more often so there is an increased opportunity for abuse to occur.
  • The demand for attention and care due to physical impairments may lead to neglect or abuse, especially in a facility where staff is low or overworked[13].
  • Physical impairments may lead to verbal abuse through the belittling of the elder by their caregiver due to the older adult's inability to care for themselves.[13].

[edit] Cognitive Impairment

Cognitive impairments are another factor that puts an older individual at risk of abuse.

  • Cognitive impairments are things such as problems with memory, thinking, and communication [13].
  • Individuals with cognitive disabilities may have trouble communicating their experiences of abuse to others, which may therefore leave some cases of abuse unreported [13].
  • Mental deficits such as disoriented or aggressive behaviours are found to be significant risk factors because they cause the most stress on the caregiver [15].

[edit] Environmental Risk Factors

  • Any type of factor that reduces the amount of support available to the caregiver, as well as any factor that leads to a stressful home environment, lead to an increased risk of abuse [15].
  • An example of an environmental factor is the likelihood of care workers in long-term care facilities to abuse elder adults when they are overworked and overstressed [13].
  • If a caregiver in a long-term care facility does not have many coworkers, they are less likely to find support in times when their patients may be acting up and creating very stressful situations [15].
  • A family member who is also caring for dependent children, as well as working a full-time job and caring for their dependent elder, may be more likely to abuse the person they are caring for [15].
  • Other environmental factors include things such as poverty, homelessness, unsafe housing, lack of resources, and social isolation. These situations limit resources for good care and create limitations to facilities that older adults can use to get help when they may be experiencing abuse [15].

[edit] Why it's not reported

A lot of the abuse that occurs directed towards the elderly population goes left unreported. This often develops because much of the elderly population is looked after by friends or family members. Many eders beleive in the mind-set that by reporting thier reltives they would no longer have have somebody to take care of them. Sadly this is a common occurrence within this population. [11]

[edit] How often is it reported?

  • 6% of elders reported that they were abused in the last month. [12]
  • ¼ of care dependent elders reported psychological abuse. [12]
  • 10% is the average estimated population of elders that are being abused on a regular basis. [12]

[edit] Awareness

Elderly abuse is a socially constructed concept. This mentality unfortunately often includes stereotypes such as commonality of the deterioration of mental and physical abilities in the elderly population. Many care givers are therefore often unaware that their actions are considered to be abuse; either verbally or psychologically [11]. Through government funded support programs, caregivers are able to find information on programs that can assist in finding help in this area [16].[1].

These social norms as a whole must change worldwide in order to eliminate these stereotypes, but this will most definitely not be an easy nor quick change. [8] Awareness is teh key to this roblem, and with the help of institutes such as the Center of Excellence on Elderly Abuse and Neglect, elders and caregivers are provided with easy access to information about prevalent issues in this form of abuse. [16]

[edit] Elder Abuse Awareness Through Media

Elder abuse has only recently become a more publicized topic in the media, bringing awareness to the problem. Since 1980’s advertisements such as commercials have become more prevalent on the TV and radio stations concerning the issue of elder abuse in today's society. [11]

A recent incident was extremely publicized by the Toronto Star involving neglect of an elderly woman by her caregivers in March of 2010. [17] [2] This exposure further created the well needed awareness on the prevalence of elder abuse in Canada.

[edit] Prevention of Elder Abuse

Elder abuse is included in both public health and medical fields, as well as social work and criminal justice realms. This means that professional preventionand intervention can be set in place to help reduce the risk of elder abuse [18] Three forms of prevention that may be used in cases of elder abuse are; primary prevention, secondary prevention, and teritary prevention.

[edit] Primary Prevention

Primary prevention is concerned with stopping abuse before it starts.

  • Primary prevention is concerned with health promotion, and specific protection [15].
  • Health promotion includes public education about normal aging, support for elders and caregivers, as well as community programs to help elders in their own homes [15][19].
  • Caregivers in facilities are likely to abuse due to misunderstanding as well as a lack of skills or knowledge about how to care for a difficult, or challenging older adult [14].
  • Training caregivers and providing them with important knowledge about how to work with an elder can help reduce the risk of abuse [14].
  • Another form of prevention that may be set in place is screening by hospitals upon the discharge of elderly patients. The hospital staff evaluates families for their likelihood to abuse, and if it is necessary the elder will be placed in a nursing home instead [15].

[edit] Secondary Prevention

This form of prevention is mainly concerned with detecting and stopping abuse as soon as possible, once it has already started [15].

  • One way to detect elder abuse is through an assessment tool that can be used by an outside individual which allows them to evaluate the home as well as the family where elder abuse is suspected [15][19].
  • Careful monitoring of the family as well as the elder is important, including the monitoring of medical records. This is to look for indicators of abuse, such as burns, cuts, bruises, and lacerations that are not documented in their medical history, but can be observed by the individual assessing the environment [15].
  • The assessment also documents the changes in the psychological well being of the elder [15].

The image to the right is an example of an assessment tool that an older adult may use themselves to determine whether they are in an abusive situation

[edit] Tertiary Prevention

Tertiary prevention is concerned with the rehabilitation of an abused individual, the abuser, and the family of the abused, after abuse has already occurred [15].

  • This form of help for the family and elder is done through providing a live-in caregiver, placing the elder in a nursing home, or by providing in-home support [15].
  • In extreme cases where the home cannot be rehabilitated, the elder will be placed into a home and an adult protective service agency may become involved [15].
  • Caregivers may be helped and rehabilitated through education, awareness, and training towards how to care for an elder individual. This will provide the caregiver with the skills needed to resolve conflict and treat the patient or loved one Italic textcorrectly [14] [19].
  • Interventions for the caregiver and the victim are aimed towards promoting awareness, which in turn will increase the reporting of elder abuse[18].

Mickey Rooney speaks about his experience with elder abuse. One of the many ways to spread awareness is through speaking about it publicly.

[edit] Notes and References

  1. 1.0 1.1 Friedman L. S., Availa, S., Tanouye, K., & Kimberly, J. (2011). A case-control study of severe physical abuse of older adults. Journal of the American Geriatrics Society, 59(3), 417 – 434.
  2. 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 Brozowski, K. & Hall, D. R. (2010). Aging and risk: Physical and sexual abuse of elders in Canada. Journal of Interpersonal Violence, 25(7), 1183 – 1199.
  3. Gordon, R. M., & Brill, D. (2001). The abuse and neglect of the elderly. International Journal of Law and Psychiatry, 24(2-3), 183-197.
  4. Lobell, T. (2006). Predictors of reported elder sexual abuse: Analyses of Wisconsin's adult protective services report data. The Florida State University, 1 – 171.
  5. 5.0 5.1 Ramsey-Klawsnik, H. (2003). Elder sexual abuse within the family. Journal of Elder Abuse & Neglect, 15(1), 43-58.
  6. 6.0 6.1 6.2 6.3 6.4 Malks, B., Buckmaster, J., & Cunningham, L. (2003). Combating elder financial abuse: A multidisciplinary approach to a growing problem. Journal of Elder Abuse & Neglect, 15(3), 55 – 70.
  7. 7.0 7.1 7.2 7.3 Dyer, C. B., Toronjo, C., Cunningham, M., Festa, N. A., Pavlik, V. N., Hyman, D. J., et al. (2005). The key elements of elder neglect: A survey of adult protective service workers. Journal of Elder Abuse & Neglect, 17(4), 1-1-10.
  8. 8.0 8.1 8.2 8.3 Wiglesworth, A. (2011). Screening for abuse and neglect of people with dimentia. Journal of the American Geriatrics Society, 58(3), 494-500. doi: 10.1111/j.1532-5415.2010.02737.x
  9. Mosqueda, L. (2011). Elder abuse overview. Retrieved from http://www.centeronelderabuse.org/education_overview.asp
  10. Raciela, A., (2009). Bruising as a marker of physical elder abuse. The American Geriatrics Society, 57(7), 1191-1196. doi: 10.1111/j.1532-5415.2009.02330.x
  11. 11.0 11.1 11.2 11.3 Cooper, C., Selwood, A., & Livingston, G. (2008). The prevelance of elder abuse & neglect: a systematic review. Age and Aging, 37(2), 151-160. doi: 10.1093/ageing/afm194
  12. 12.0 12.1 12.2 12.3 Penhale, B. (2010). Responding and intervening in elder abuse. Aging International, 35(3), 235-252. doi: 10.1007/s12126-010-9065-0
  13. 13.0 13.1 13.2 13.3 13.4 13.5 13.6 13.7 Post, C., Biroscak, B.J., Conner, T., Fang, Y., Page, C., & Prokhorov, A. (2010). Elder abuse in long-term care: Types, patterns, and risk factors. Research On Aging, 32, 323-348. doi:10.1177/0164027509357705
  14. 14.0 14.1 14.2 14.3 14.4 DeHart,D.,Webb, J., & Cornman, C. (2009): Prevention of elder mistreatment in nursing homes: Competencies for direct-care staff. Journal of Elder Abuse & Neglect, 21:4, 360-378
  15. 15.00 15.01 15.02 15.03 15.04 15.05 15.06 15.07 15.08 15.09 15.10 15.11 15.12 15.13 15.14 Hackbarth, D.P., Andresen, 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.
  16. Cite error 8; No text given.
  17. Fedio, C. (2011, October 30). o bail for couple charged in elder abuse case. The Toronto Star, Retrieved from http://www.thestar.com/news/crime/article/946531--no-bail-for-couple-charged-with-elder-abuse
  18. 18.0 18.1 Kim, L., Nguyen, A., & Linda, N.(2011): The effectiveness of educational programs to improve recognition and reporting of elder abuse and neglect: A systematic review of the literature. Journal of Elder Abuse & Neglect, 23:3, 213-233
  19. 19.0 19.1 19.2 Ploeg,J., Fear,J., Hutchison, B., MacMillan, H., & Bolan, G. (2009): A systematic review of interventions for elder abuse. Journal of Elder Abuse & Neglect, 21:3, 187-210

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