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From Aging Wiki 12
 Group # 12
- 1. Angela Gilmour
- 2. Victoria Cowan
- 3. Lauren Bauer
 Elder Abuse
Over the last decade, elder abuse has become an increasing problem, which has earned a lot of attention from society internationally.  There are three main types of abuse in which vulnerable elders can become victims, and each of these types have varying prevalence rates, risks, and intervention and prevention strategies. These three types of abuse include physical abuse, psychological abuse, and through the neglect of the elders' basic needs.
 Physical elder abuse
A common form of elder abuse is Physical abuse. Physical elder abuse tends to receive the most attention from the media, which may be due to the fact that physical abuse tends to be the most commonly reported type of abuse.  This can be attributed to the fact that it is easier for people to notice signs of physical abuse than it is the other forms of abuse.  Physical abuse can be identified as intentional actions that cause bodily harm, or risk of bodily harm to an elder.  The perpetrator tends to be someone who is currently in a caregiver role for the elderly person.  In many studies physical abuse includes hitting, restraining, or deliberately injuring in some other way.  This increasing issue can be seen both internationally and Canada wide, but some elders are at a higher risk of abuse than others. 
 Who is at risk
There are certain characteristics which make certain elders more at risk of being physically abused than others.  First, many victims live in a shared living situation with their caregiver who is abusing them. Elders who do not live with their caregiver are at much lower risk of victimization.  This could be due to the stress caregivers may feel, caused by caring for the elder.  Secondly, studies demonstrate that elderly people are more likely to be victims of physical abuse if they are suffering from dementia. This too may be attributed to the stress this disease can cause on the caregiver.  Social isolation is a third variable that appears to be present in families in which elder abuse occurs.  Many elders socially isolate themselves from the outside world for many reasons, including fear of being injured from an accidental source, such as a fall.  This social isolation actually increases familial stress which can give rise to an abusive environment. It is also entirely possible that the abuser is harming the elder, and then isolating them from the outside world so that no one is able to find out about the abuse.  There are many other situations and characteristics which are theorized to contribute to elder abuse as well. Elders who live with a family member who misuses drugs or alcohol are also at a greater risk of being abused.  It is also important to note that most caregivers who abuse an elderly person tend to also be heavily dependent on this elder person. 
This video demonstrates an elder who is being abused by their caregiver. It is implied that the elder lives with their caregiver.
Prevalence rates on elder abuse vary between country, and type of abuse.  Specifically, a study on recent international physical elder abuse states that it is likely that 4.3% of elderly adults are physically abused in some way.  As mentioned previously, these rates are highest amongst elders who live with their caregiver.  In a Canadian based study,  data was collected from 2,008 elderly persons regarding physical abuse. Results indicated that of these 2,008, 80 elderly persons reported being abused in some way. Interestingly, physical abuse by the caregiver is reported more often by the caregiver than from the elderly person who is being abused. This suggests that those who are abusing an elder know that what they are doing is wrong.  It is also noteworthy that a second Canadian study found that 1.6% of elderly people were physically abused or physically mistreated in some way.  This study also demonstrated that only 31% of the abuse cases were reported to the police.  Although these studies provide important information to society, it is clear an abundance of the abuse goes unreported.  This makes it extremely important that as a society we are able to identify when abuse is occurring.
The two most important aspects in ending physical abuse are recognition and reporting. There are many systems in place that aim to do these two things, as well as prevent physical abuse from occurring at all. If abuse is taking place, one of the first lines of defence is recognition. Due to the fact that many elderly people have to visit a general practitioner (GP) more frequently than younger adults, the GP is someone who should be skilled in recognizing the signs of abuse.  One way that GP’s may do this is by looking at bruising on the elderly person. Bruising can be a sign that physical abuse is occurring. GP’s can differentiate between normal age related, or poor health related bruising by checking to see the size of the bruises. Bruises resulting from abuse have been documented as large, and are typically found on the face, on the torso, or on the arms.  A second important way to both prevent as well as recognize signs of abuse is by training all health care professionals to identify elderly who may be at a high risk.  These high risk cases were discussed previously in the “who is at risk” section. Lastly, having social support programs available to both the elderly person and their caregiver can also help alleviate the stress that may foster an abusive environment.  Physical elder abuse is only one type of abuse that occurs within the elderly population. Psychological abuse is another alarming issue that affects the elderly as well.
 Psychological Elder Abuse
Psychological elder abuse (also know as emotional elder abuse) is a purposeful act that causes emotional or psychological harm or distress to an elderly person. Specific behaviours that have been studied are name calling, being criticized, and being possessed or controlled by someone else . Unnecessary stress is caused for elders who are psychologically abused. Elderly victims are often treated like children and isolated from their friends and family. Abusers see family and friends as threats and do not want the abused elders to confide in them. Victims are also often limited in their daily activities, and the abuser has total control over what they are allowed to do. Abusers mainly control the victim through fear, threats and insults.
 Who is at Risk
Verbal abuse is the most common form of psychological abuse; however various types of abuse often co-occur among the elderly. Psychological abuse is the most prevalent in women and is often accompanied by physical or sexual abuse . More than half of elderly women who have been abused psychologically have been repeatedly abused. In a survey of nearly 1000 women age 55 or older, nearly half of the women said that they had suffered from at least one form of abuse . Elderly women who experience psychological abuse are often dismissive about the abuse, as they are thankful that physical and sexual abuse are not occurring, or that the physical and sexual abuse has ended . Psychologically abused women are less likely to be as healthy as their elderly counterparts who are not abused.Negative health effects as a result of psychologically abuse include (but are not limited to) chronic stress, depression, anxiety, and cardiac problems . Another study showed that in the United States, African-American women are almost twice as likely to be abused psychologically than non African American women. The rates are 24.4 % versus 13.2 %, which suggests that racial differences are at play, and this information should be researched further by health professionals and psychologists alike.
 Signs of Psychological Elder Abuse
Psychological abuse is harder to spot than physical abuse because there are not any actual marks on the person, which is one of the most reliable signs of spotting other forms of abuse . One way to determine if an elderly person is being psychologically abused is by witnessing the act. A person may be verbally abusing an elderly person and not be aware that other people are listening or may not care that they are . Witnessing the abuse is not very likely, so it is important to look for more inconspicuous signs, such as fear of other people and the inability to make decisions alone. For instance psychologically abused elders will not make even the simplest decision of going to a dinner with friends without checking with their abuser, if they have the courage to do so. Abused elders are more likely to stay at home alone . If the abuse is occurring at a nursing home or retirement home, the elder victim may disconnect themselves from their family because their abuser told them to do so .
 Decreasing Abuse and Helping Psychological Abuse Victims
To help decrease psychological abuse, social service workers, registered nurses or anyone working with elderly people need to be properly trained to detect abuse. Detecting psychological abuse can be difficult as there is not any physical evidence . Cross training healthcare professionals with people experienced in domestic violence could be effective in abuse detection . In order to decrease psychological abuse it is important to understand the patterns and risk factors involved . To reduce psychological abuse in the elderly population, it is important that when the caregiver is a family member they take a break from watching their loved ones. In a nursing or retirement home different nurses and social workers take turns taking care of the elderly patients however at home, it is often a single person. By taking time away from the caregiving role, the caregiver is able to relax and recharge, ensuring that there is not an outburst brought on from stress of taking care of the elderly person . When dealing directly with an elder abuse victim, it is important to be subtle when trying to help them. Elderly people will likely be embarrassed that this is happening, and they may try to withdraw from people if they push to hard . Subtle attempts to find out who the abuser is would be more effective and help give the victim the confidence needed to talk to a social worker or domestic violence professional.
 Elder Neglect as Abuse
The phenomenon of abuse towards elders is an unfortunate crime in many countries, and yet some aspects of this problem are still unknown. Although research in this area is beginning to emerge more prominently, more research is needed to identify the main causes in each setting and appropriate actions that can be taken to prevent elder neglect in this ever-changing society.
Elder abuse has been defined by many 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 distress to an older person."  Although many different types of elder abuse exist, elder neglect as a form of abuse is a forthcoming problem, and is not very well recognized by the public. Elder neglect has been defined by many as any “failure to rotate or flip a person to prevent bed sores; failure to provide a person with food, water, shelter, hygiene, medicine, comfort, or personal safety; and ignoring requests for help.”
 Active and passive neglect
Research on neglect has shown that there are two different types of neglect seen in many cases. Active neglect is the first form and is distinguished by the purposeful harm or punishment of an individual through refusal or failure to provide the necessary requirements to meet the needs of the elderly individual.   This punishment and refusal is seen through the abandonment and/or denial of any life necessities such as food, shelter, medication and health services.   The second form of neglect has been identified as passive neglect where there is a lack of attention to the elder, which in turn results in a failure to fulfill the needs of the elder.  This form of neglect might stem from the inability to provide adequate care or from pure ignorance, resulting in the elder not receiving the necessities to survive. 
Click on the #1 for the link for CTV Toronto's new report on elder neglect. 
Both active or passive neglect of elders is a serious problem in many developed countries. In 1996 the National Center on Elder Abuse at the American Public Human Services Association estimated that in domestic settings there were approximately 689,000 older Americans who were abused and/or neglected. Hudson (1986) and Wolf and Pillemer (1989)  further support this statement by showing that anywhere between 1 and 10 percent of elders have been abused either by family members or in institutions, and some estimates for elder neglect exceed those for abuse. Furthermore, Lowenstein (2010) has shown that neglect can range anywhere from 3 to 18 percent depending on the country. However, caution should be taken in light of the fact that the actual incidence of neglect of elders may be much higher due to the number of unidentified and unreported cases of neglect around the world. This theory is termed the “iceberg theory”, where we see only a small portion of neglect cases, when in fact many more cases are hidden and have not been identified. 
 Who is at risk?
The act of neglect seems to be more prominent in certain older adults compared to others.  There have been three health problems that have been identified as risk factors for elder neglect in long term and familial care settings. These risk factors include cognitive problems, physical impairments as well as behavioral problems. It has been suggested that the added stress from any one of these risk factors may lead to a greater chance of neglect. These stresses may include stress from added care, added expenses, added time and possibly in-cooperation from the elder. In one particular study, 16% of individuals identified times when neglect had occurred, and these cases of neglect were more likely to reoccur when the risk factors were involved, with behavioral problems being the highest risk factor for elder neglect.
Changing demographics push the issue of elder abuse and neglect to be an exceedingly important topic for future research. Decreasing birth rates and the increased life expectancy have resulted in a population trend where projections for 2030 suggest that the older adults will surpass 20% of the population. Moreover, the growth of those 75 and older will be even more dramatic. The result of average life expectancy for men and women ranging anywhere from 71 to 78, along with future aging trends we should expect to see a larger number of children being placed with the burden and/or responsibility of care, where the cases of neglect may increase further  These cases of neglect may increase because Schiamberg and Gans (2000) and Lowenstein (2010) have shown that the family members are the most frequent abusers of elders, mainly for the fact that they are most frequently in contact with the older adult, resulting in a greater number of opportunities for abuse and neglect.
 Prevention and Intervention
Elder neglect is a subject that is difficult to research because most elders who are neglected do not want to cause more problems for themselves and the abuser. This occurs because of fear of more abuse, dependence on the abuser and the love they have for the abuser if it is a family member. Furthermore, neglect is much harder to spot than any other form of abuse because neglect has so many different forms. Preventative measures that may be taken include collection of data of those over a certain age, establishing whether neglect occurs through follow-up visits. These measures could allow the elder to have many opportunities to get assistance if needed, as well as allow the caregiver time to talk about situations with professionals. Furthermore, training not only long term care workers, but also training the family members that will be taking on the full-time support of an elder. Training for family members may involve fatigue management, stress management, and medical and health courses in order to prepare the caregiver for any possible situations that may arise, as well as decrease the likely hood of neglect due to lack of knowledge in any of these areas.
Abuse is an ongoing and growing problem that affects many elderly individuals, and as noted earlier, society may only be seeing a very small portion of abuse cases. Any type of abuse, whether physical, psychological, or neglect may cause serious harm to the elder affected. With research continuing each day, knowledge of any type of abuse is growing along with societies knowledge of prevalence, risk factors and several signs of abuse. More research is needed to establish appropriate and effective prevention and intervention methods to keep the aging population safe.
 Notes and References
- ↑ 1.0 1.1 1.2 1.3 1.4 Lachs, M., Pillemer, K. (2004). Elder abuse. The division of geriatric medicine and gerontology, 364.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Acierno, R., Amstadter, A., Hernandez, M., Kilpatrick, D., Muzzy, W., Resnick, H., Keneth, S. (2010). Prevalence and Correlates of Emotional, Physical, Sexual, and Financial Abuse and Potential Neglect in the United States: The National Elder Mistreatment Study. Journal of Public Health, 100(2).
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 Lee, M. (2009) A Path Analysis on Elder Abuse by Family Caregivers: Applying the ABCX Model. Journal of family violence, 24.
- ↑ 4.0 4.1 4.2 4.3 Austin, R., Corona, M., Gibbs, Liao, S., L., Mosqueda, L., Schneider, D., Wigleworth A. Bruising as a Marker of Physical Elder Abuse. Journal of geriatrics, 57 (7).
- ↑ Fraser, A. (2010). Preventing abuse of older people. Journal of nursing management, 17 (6).
- ↑ 6.0 6.1 Franch J., Juvina, D., Olmo, J., Pousa, S., Pujol, X., Villa, A. (2009). Prevalence and Risk Factors of Suspected Elder Abuse Subtypes in People Aged 75 and Older. The American geriatrics society, 57.
- ↑ Zeranski,L., &Halgin,R. (2011) Ethical issues in elder abuse reporting: A professional psychologist’s guide. Professional Psychology: Research and Practice, 42(4), 294-300. Retrieved from : http://search.proquest.com.proxy.library.brocku.ca/ psycarticles/docview/864787121/132AC4DBDF517B9FB5D/1?accountid=9744.
- ↑ 8.0 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 Fisher,B., Zink,T., & Regan,S., (2010) Abuse against older women: Prevalence and health effects. Journal of Interpersonal Violence, 26 (254),254-268. DOI: 10.1177/0886260510362877
- ↑ 9.0 9.1 American Psychological Association, 2011. Elder Abuse and Neglect, In Search of Solutions. Retrieved from : http://www.apa.org/pi/aging/resources/guides/elder-abuse.aspx
- ↑ Beach.S., Schulz,R.,Castle,N., & Rosen,J. (2010) Financial exploitations and psychological mistreatment among older adults: differences between African Americans and non-African Americans in a population-based survey. Gerontologist ,50(6), 744-746. DOI:10.1093/geront/gnq053
- ↑ 11.0 11.1 11.2 11.3 Myers, Wyatt (2010, July 14) Spotting the signs of emotional abuse. Retrieved from: http://www.everydayhealth.com/emotional-health/spotting-the-signs-of-emotional- abuse.aspx
- ↑ 12.0 12.1 12.2 12.3 12.4 12.5 12.6 12.7 12.8 12.9 Post,L., Page,C., Connor,T., Prokhorov,A., Fang,Y. & Biroscak,B., (2010) Elder abuse in long-term Care: types, patterns, and risk factors. Research on Aging 32 (323), 323-348. DOI: 10.1177/0164027509357705
- ↑ Wolf, R., L., Daichman, & G. Bennett. (2002). “Abuse of the Elderly.” Pp. 123-46 in World Report on Violence and Health, edited by E. G. Krug, L. L. Dahlberg, J. A. Mercy, A. B. Zwi, and R. Lozano. Geneva, Switzerland: World Health Organization.
- ↑ 14.0 14.1 14.2 14.3 14.4 Wolf, R. S., & Pillemer, K. A. (1989). Helping elderly victims: The reality of elder abuse. New York: Columbia University Press.
- ↑ 15.0 15.1 15.2 15.3 Pillemer, K. A., & Finkelhor, D. (1988). The prevalence of elder abuse: A random sample. The Gerontologist, 28 (1), 51–57.
- ↑ 16.0 16.1 Lachs, M. S., & Pillemer, K. (1995). Abuse and neglect of elderly persons. New England Journal of Medicine, 332 (7), 437–443.
- ↑ 17.0 17.1 17.2 Hudson, M. F. (1986). Elder mistreatment: Current research. In K. A. Pillemer & R. S. Wolf (Eds.), Elder abuse: Conflict in the family (pp. 125–165). Dover, MA: Auburn House Publishing Company.
- ↑ 18.0 18.1 18.2 18.3 Lowenstein, A. (2010). Caregiver and elder abuse and neglect: Developing a new conceptual perspective. Aging International, 35, 215-227.
- ↑ 19.0 19.1 Zarit, S. H., & Reid, J. D. (1994). Family caregiving and the older family. In C. B. Fisher & R. M. Lerner (Eds.), Applied developmental psychology (pp. 237 264). New York: McGraw-Hill.
- ↑ 20.0 20.1 20.2 Schiamberg, L., B., & Gans, D. (2000). Elder abuse by adult children: An applied ecological framework for understanding contextual risk factors and the intergenerational character of quality of life. International Journal of Aging and Human Development, 50 (4), 329-359.