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What is Elder Abuse?

Elder abuse is becoming an increasing field of research as the baby boomers reach old age. 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.

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.

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 3 times more often to women than men.^[4] 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 who display some form of mental illness, alcoholism, or financial dependence on he victim. ^[2] Also people who commit these sex offenses and are not spouses tend to exhibit antisocial behaviour and psychopathology. ^[2] Furthermore, there are cases in which adult children are the abusers and these children tend to be unmarried, unemployed, financially supported by the parent and often display mental illness or substance abuse.^[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]

Financial Abuse

Violent crimes may be decreasing in North America but the incidence of financial abuse involving the elderly are on a steady incline ^[6] This phenomenon is due to the increase in elderly population as well as the increase in wealth amongst the elderly.^[6] People are beginning to see the opportunity tin 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 humiliated, ashamed and fear their abuser.^[6] Furthermore, since family members or in-home caregivers conduct 60 – 90% of financial abuse, the victim feels helpless and will not report it.^[6]

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.^[2] This abuse often occurs when the abusers was not prepared to take on the responsibility of the 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.

Prevalence of Elder Abuse

Elderly abuse has been found worldwide, displaying that it is not a culturally specific occurrence found within the westernized society. Elder abuse is unfortunately very common within the older population, but studies have been done in north America providing evidence in an elevation of elderly abuse within older adults with care givers, but even greater with the patients with caregivers who have been diagnosed with dementia. It is reported that about 47% of patients with dementia have been victims of abuse ^[8]. While an estimated average of 36% of the elderly population over the age of 85 has encountered some form of abuse ^[9].

To help and try to prevent this doctors have tried to implement questionnaires for care givers and patients of dementia are better able to predict and report cases of abuse. To this date there has not been any formal form of evaluation to specifically be able to diagnose the abuse displayed by caregivers or other family members ^[8]. Future research is headed in that direction in order to have better accommodations for the older population.

Prevalence of Kinds of abuse

Elderly abuse is clearly a major problem, and just like any other form of abuse, it can be divided into many sub forms of discrimination:

Physical: Physical abuse directed toward older individuals in the hands of care givers is a very common, yet highly unreported. Many caregivers of the elderly individuals are family members, and can cause great stress on the relationship between the family member and the individual, as well as solely on the caregiver ^[9].
Alcohol abuse is often found within these relationships, causing aggression and violence towards the patient. This abuse can be psychically violent, as well as intentional over or under serving of prescription medication by the caregiver. Such abuse is most commonly found in long term care situations ^[10].

These types of aggression towards elderly individuals have been reported to be found within 30-60% of individuals being taken care of by a caregiver ^[8].

Verbal/Emotional: This form of elderly abuse is the most common, but often caused by stress and greed rather than frustration and anger. Verbal and emotional forms of abuse can often be related to financial problems, or financial greed ^[11].

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.

It wasn’t until the 1980’s that as a society we began to create awareness and fight back against this subset of abuse towards elders ^[10]. Within the past 20 years, there has been a greater promotion of awareness in caregiving, medical relations, as well as public awareness being displayed throughout different forms of media to fight against abuse displayed against the older adult population.

Elder Abuse in Media

It is only recently that elderly abuse has become a more popular topic in the media in order to bring awareness to the problem. Since 1980’s advertisements such as commercials have been more prevalent on the TV and radio concerning such abuse ^[10].

These types of cases have also been announced in prime time news and front page stories in big newspapers, such as the Toronto star: Abuse case in Toronto March of 2011 [1]

Risk Factors

Through becoming aware of risk factors, loved ones as well as elders themselves will be more equipped with the knowledge they need to ensure that they do not become victims of abuse.

Behavioural Problems

Behavioural Problemsare described as the resistance of care either verbally or physically by an elder individual^[12]. Behavioural problems are also one of the main risk factors for all types of elder abuse. 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 ^[12]. Caregivers in facilities are also physically assaulted by patients on a regular basis. These behaviours, paired with the lack of knowledge given to caregivers on how to handle conflict with a patient, may lead to an instance of abuse ^[13].

Physical Impairment

Two specific forms of physical impairments are incontinence as well as failure to maintain personal hygiene^[12]. This puts 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 these impairments may lead to neglect or abuse especially in a facility where staff is low, or overworked^[12]. Physical impairments may lead to verbal abuse through the belittling of the elder by their caregiver due to their inability to care for themselves.

Cognitive Impairment

Cognitive impairments are things such as problems with memory, thinking, and communication^[12]. However, cognitive impairment on its own is not found to be a significant risk factor for abuse towards the elderly^[12]. This may be because individuals with cognitive disabilities may have trouble communicating their experiences of abuse to others^[12]. However, Mental deficits such as disoriented or aggressive behaviours are found to be significant risk factors because they cause the most stress on the caregiver. ^[14]

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, leads to the increased risk of abuse^[14]. One example is the likelihood of care workers in long-term care facilities to abuse elder adults when they are overworked and overstressed ^[12].If a caregiver in a long-term care facility does not have many coworkers, they are less likely to find support in their time of need^[14].

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 perform abuse ^[14].

Other environmental factors include things such as poverty, homelessness, unsafe housing, lack of resources, and social isolation ^[14].

Why it's not reported

A lot of the abuse that occurs directed towards the elderly population goes left unreported. This often occurs because a lot of the elderly population is looked after by friends or family members, and by reporting these people, many elders would have no one to take care of them. Sadly this is a common occurrence within this population ^[10].

How often is it reported?

6% reported that they were abused in the last month ^[11].
¼ of care dependents reported psychological abuse ^[11]
10% is the average estimated population of elders that are being abused on a regular basis ^[11].

Many care givers are also unaware that their actions are considered to be abuse; verbal or psychological ^[10].If there are concerns on personal awareness of a possibility of abusing elders, there are websites supported by the government in which there is information that can be found on help programs for the care givers in need of assistance in this area ^[15].[2]

Awareness

Awareness is a big problem, and with the help of institutes such as the center of excellence on elderly abuse and neglect, there will be greater awareness of the situations in which are very common and unfortunately kept quiet ^[15].

Elderly abuse is seen as socially constructed ^[15], culturally it is seen that as one gets older, one becomes less mentally there and so many think that this allows for people to treat these people with less respect than those with full mental ability and that are young and functioning. To be able to get rid of such behaviour towards elderly individuals, the social norms as a whole world wide must change, and this will most definitely not be an easy change ^[8].

Prevention of Elder Abuse

Elder abuse is included in both public health and medical boundaries, 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 ^[16]

Primary Prevention

Primary prevention is concerned with health promoton, and specific protection^[14]. Health promotion includes public education about normal aging, support for elders and caregivers, as well as community programs to help elders in their own home ^[14]^[17]. Caregivers in facilities are likely to abuse due to misunderstanding as well as a lack of skills or knowledge. Training caregivers and providing them with important knowledge about how to work with an elder will help reduce the risk of abuse^[13].

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 of abuse, and if it is necessary, the elder will be placed in a nursing home instead ^[14].

Secondary Prevention

This form of prevention is mainly concerned with detecting and stopping abuse as soon as possible ^[14]. One way to detect elder abuse, is through an assessment tool that can be used by caregivers which allows them to evaluate the home as well as the family where elder abuse is suspected ^[14]^[17]. In addition, 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, as well as a change in the psychological well being of the elder ^[14].

Tertiary Prevention

Tertiary prevention is concerned with the rehabilitation of an abused individual as well as the abuser, and the family of the abused ^[14]. This form of help for the family and elder is done through providing a live-in caregiver, placing the elder in a nursing home, as well as in-home support. In extreme cases, where the home cannot be rehabilitated, the elder will be placed into a home and an adult protective service agency may be involved ^[14].

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 correctly^[13] ^[17]. In addition, interventions for the caregiver and abused are aimed towards promoting awareness, which in turn will increase the reporting of elder abuse^[16].

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

Notes and References

↑ ^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.
↑ ^2.0 ^2.1 ^2.2 ^2.3 ^2.4 ^2.5 ^2.6 ^2.7 ^2.8 ^2.9 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.
↑ Gordon, R. M., & Brill, D. (2001). The abuse and neglect of the elderly. International Journal of Law and Psychiatry, 24(2-3), 183-197.
↑ Lobell, T. (2006). Predictors of reported elder sexual abuse: Analyses of Wisconsin's adult protective services report data. The Florida State University, 1 – 171.
↑ ^5.0 ^5.1 Ramsey-Klawsnik, H. (2003). Elder sexual abuse within the family. Journal of Elder Abuse & Neglect, 15(1), 43-58.
↑ ^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.
↑ ^7.0 ^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.
↑ ^8.0 ^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
↑ ^9.0 ^9.1 Mosqueda, L. (2011). Elder abuse overview. Retrieved from http://www.centeronelderabuse.org/education_overview.asp
↑ ^10.0 ^10.1 ^10.2 ^10.3 ^10.4 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
↑ ^11.0 ^11.1 ^11.2 ^11.3 Penhale, B. (2010). Responding and intervening in elder abuse. Aging International, 35(3), 235-252. doi: 10.1007/s12126-010-9065-0
↑ ^12.0 ^12.1 ^12.2 ^12.3 ^12.4 ^12.5 ^12.6 ^12.7 Biroscak, B.J., Conner, T., Fang, Y., Page, C., Post, 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
↑ ^13.0 ^13.1 ^13.2 Dana DeHart PhD, Jennifer Webb MA & Carol Cornman RNPA (2009): Prevention of Elder Mistreatment in Nursing Homes: Competencies for Direct-Care Staff, Journal of Elder Abuse & Neglect, 21:4, 360-378
↑ ^14.00 ^14.01 ^14.02 ^14.03 ^14.04 ^14.05 ^14.06 ^14.07 ^14.08 ^14.09 ^14.10 ^14.11 ^14.12 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.
↑ ^15.0 ^15.1 ^15.2 Government of Ontario. (2008). Ontario network for the prevention of elder abuse. Retrieved from http://www.onpea.org/english/elderabuse/faq.html
↑ ^16.0 ^16.1 Kim L. Alt MD, Annie L. Nguyen MPH & Linda N. Meurer MDMPH (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
↑ ^17.0 ^17.1 ^17.2 Jenny Ploeg RNPhD, Jana Fear MLIS, Brian Hutchison MD, Harriet MacMillan MD & Gale Bolan RNBScN (2009): A Systematic Review of Interventions for Elder Abuse, Journal of Elder Abuse & Neglect, 21:3, 187-210

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 * Force-feeding
 * Physical punishment<ref name="Brozowski" />
-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%).<ref name="Friedman" />
+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%).<ref name="Friedman" /> 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.<ref>Gordon, R. M., & Brill, D. (2001). The abuse and neglect of the elderly. International Journal of Law and Psychiatry, 24(2-3), 183-197.</ref>
-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.<ref>Gordon, R. M., & Brill, D. (2001). The abuse and neglect of the elderly. International Journal of Law and Psychiatry, 24(2-3), 183-197.</ref>
 Women experience physical abuse more often than men and are also less likely to report it.<ref name="Brozowski" /> 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.