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[edit] Elder Abuse

[edit] Group Members

• Karolina Walczyk
• Krystyne Baker
• Phil Dallimore

The abuse and mistreatment of elderly adults is now being recognized as a growing social and medical problem.^[1] The prevalence of elder abuse is expected to continue increasing in the future as this vulnerable segment of the population increases in number. The number of people 60 years of age and older is predicted to grow to 1.2 billion globally, which is more than double the number that existed in 1995.^[2] Elder mistreatment has been defined by the World Health Organization 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,” (p. 126).^[2]

As they age, older adults become less independent and may require the assistance of a caregiver to assist them with various day-to-day tasks. In countries like the UK, Canada and Sweden there is an increasing rate of older adults needing full time care in nursing facilities. ^[3] For older adults who choose to remain in their own homes or in the home of a relative, family members, especially children and spouses, are likely to become designated caregivers.^[4] Caregivers, whether they are nurses at a nursing home or the elder's own family members, are entrusted to provide the best possible care for elderly individuals so that they may maintain the highest possible quality of life in their final years. Unfortunately, there is a rising number of situations where this is not the case. Elder abuse is becoming more and more prevalent in families and in nursing homes and extended care facilities. Here we will discuss physical and financial abuse of elders by family members and physical abuse of elders by professional care workers, potential risk factors that may have an influence on abusers and victims of abuse, and interventions that will help prevent future abuse.

[edit] Abuse and Mistreatment of Elderly Adults by Family Members

[edit] Physical Abuse

Often, the perpetrators of abuse are the ones that elderly individuals know the best and perhaps trust the most, members of their immediate family. In a study of over 3,000 older people (aged 57-85), spouses or romantic partners were reported as responsible for 26.2% of verbal and 19.2% of physical abuse, and children were reported to be responsible for 14.5% of verbal and 24.8% of physical abuse.^[4] An even more alarming statistic was found in a study of 41 cases of elder physical abuse, resulting in severe traumatic injury: 85% of those responsible for the abuse were family members or intimate partners.^[5] Elder abuse by family caregivers is clearly an area of concern. It is important to ask ourselves: Why is it happening? What can be done to prevent future abuse of this growing population?

[edit] Risk Factors for Becoming a Victim

[edit] Risk Factor: Low Social Support

Having low social support is a risk factor for almost every type of abuse for older individuals^[6] Low social support refers to the extent to which an elderly person believes they are cared for, respected and valued by others. Acierno and his colleagues (2010)^[6] believe that there is a reciprocal relationship between mistreatment and social support – not only does low social support put certain elders at higher risk for abuse, but mistreatment may cause victims to perceive less social support. Amstadter and colleagues (2011)^[7] suggested that victims of abuse may feel too ashamed to share their experiences of mistreatment with others, avoid or withdraw from contact with others due to a lack of trust, or fear retaliation from the abuser if they disclose information about mistreatment to others.

[edit] Interventions

• Funding for programs that allow elders with positive opportunities to interact with neighbours and family members^[7]
• Affordable and accessible public transportation^[7]
• Information about community resources available to them when they are in need^[7]

[edit] Risk Factors for Becoming an Abuser

[edit] Risk Factor: Anxiety and Depression

Family caregivers of elders with dementia who were more psychologically distressed (or had higher levels of anxiety and/or depression) were more likely to act in an abusive manner towards the elderly person they were caring for^[8] Psychological distress was explained by poor methods of coping with stress, such as blaming oneself, denial and substance use and by physical and psychological burden felt by the caregiver^[8]

When it was a spouse providing care for an elderly individual with dementia, the couple’s relationship before the illness was related depression experienced by the caregiving spouse.^[9] More specifically, if couples were more vs. less responsive to each other’s needs before the onset of illness, caregivers reported being less depressed and engaged in less abusive behaviour. These caregivers were more likely to view the role they were playing in the relationship as rewarding, and were less likely to experience burden in caregiving.^[9]

[edit] Interventions

• Physicians providing information, referrals to clinicians or support groups and monitoring caregiver health and wellbeing to ensure elder wellbeing^[10]
• Target caregivers who had less responsive relationships with spouse prior to spouses illness, provide therapies that will make them feel good about themselves which may in turn allow for more closeness in relationship with spouse^[9]

[edit] Other Risk Factors

The above risk factors appeared to be the most prevalent and well-supported in present research. Other risk factors that have been found include: care recipients being very dependent on their caregiver^[10] , older caregivers^[10] and previous traumatic or abusive experience.^[6]

[edit] Other Interventions

In a study by Selwood and her colleagues (2009)^[11], caregivers were asked what types of interventions they would find most helpful to them in caring for an elder with dementia. Caregivers suggested that medication to help the elder with memory loss, written information on memory loss and advice, and information and advice from professionals about memory loss would be the most helpful to them.

[edit] Useful Links

• http://www.who.int/violence_injury_prevention/violence/world_report/factsheets/en/elderabusefacts.pdf
• http://newoldage.blogs.nytimes.com/2009/02/04/elder-abuse-all-in-the-family/

--Kw09ke 14:08, 3 November 2011 (EDT)

[edit] Financial Abuse

[edit] What is Elder Financial Abuse?

-Elder Financial Abuse is the financial exploitation of the elderly generation. Financial exploitation refers to ways any way in which people trick, connive, or scheme to attain an older persons savings. ^[12] This is a huge problem in society not often talked about as it hides in the shadows with the shameful people who are taking advantage of the older folks. Another reason financial abuse is not talked about more often is the fact that the victims may have memory problems or other mental impairments such as Alzheimer’s Disease.^[13] A study released last summer showed that the elderly generation, was swindled out of 3 billion last year. The frightening part about this statistic is that as mentioned before this is only the tip of the iceberg, as most financial abuse cases go unreported. ^[12] Furthermore, this abuse is destined to increase so long as average age increases, technology improves enabling communication lines to be easier to tamper with. Such as using another person's email address or online banking account. ^[14]

[edit] Financial Abuse Statistics

The statistics on elderly financial abuse are truly jaw dropping. Here are some examples:

• Studies from 2010 found 1 in 5 elderly people over 65 had been ripped off.^[12]

• One third of people over the age of 71 have at least mild cognitive impairments which makes them more susceptible to investment swindles and other forms of financial abuse.^[12]

• It is suspected that only 1 out of every 25 elder financial abuse cases are ever reported. ^[15]

• The aging baby boomer generation controls more then 13 trillion in assets. As this group ages you can expect the amount of elder financial abuse to increase as well.^[16]

• The peak age for financial decision making seems to be 53.3 years old. Therefore, before this age it would be wise to have most important financial decisions already planned.^[12]

• Today over half a million Canadians are living with Alzheimer’s or other mental impairment, and within ten years this number will double. This is important to understand because as the number of people with mental impairments increases so will the number of people susceptible to financial abuse.^[17]

[edit] Risk Factors of Financial Abuse

Risk Factor: Power Of Attorney Abuse

One of the fastest growing types of elderly financial abuse is power of attorney abuse, or POA abuse^[16]. People doing this often have the senior in their care declared as incompetent in order to remove the senior’s right to make financial decisions for him or herself. POA abuse can happen in varying degrees, from small amounts being taken from a chequings account to whole multi-million dollar estates being snatched. ^[17]

Most POA documents give the person in power the ability to end any criminal investigation or prosecution by simply telling the investigators they felt as though they were doing the right thing and did not realize they were mismanaging the persons money. Thus, they can be overlooked by admitting they mismanaged the money as long as they claim it to be accidental. This is all based on the honor system in a society with so little honorable people around.^[17]

Other Potential Financial Abuse Risk Factors:

• Risk Factor: Annuities: These are investments in relatively safe things such as government securities and corporate bonds but only if the buyer knows exactly what they are doing and has a trust worthy investor.^[12]

• Risk Factor: Telephone Fraud: People often call house-to-house selling fake products or services. Most people get frustrated and hang up immediately, but women who are over 60 and live alone are often easy targets for this type of financial abuse.^[12]

• Risk Factor: Mortgage Fraud: People or fake firms that promise aid to gullible homeowners in financial trouble take fees for services that are never preformed.^[12]

• Risk Factor: Free Lunch Seminars: These are events pitched as information only. Yet can lead to high pressure follow ups by employees in which mentally impaired may not be able to withstand.^[12]

[edit] Interventions

There are multiple simple ways in which seniors can protect themselves from POA financial abuse. For one they can include a statement in the POA document stating that the POA must continue to use the same financial advisor the senior has been using. If it so happens this advisor is unable to continue, another predetermined advisor that the senior feels comfortable with, such as a lawyer or accountant, should choose another advisor. Although, the financial advisor would still need the POA’s approval for any proposed transactions^[17]. This is the safest scenario because all financial decisions must be made using a joint effort.

Interventions for Detecting and Preventing Elder Financial Abuse:

• Education and Outreach: We must work towards raising awareness in the following groups of people, persons 65 and older, care providers, family members, and the general public. ^[15]

• Screening and Early Detection: We must use universal screening as it can detect indicators of financial abuse at early stages. Therefore, we can prevent financial and emotional damage before any is done. ^[15]

• Legal Interventions: We must bring in legal assistance right away when assets have been misused. Cases must be brought forth to the police and court systems too ensure no more abuse is done.^[15]

• Multidisciplinary Teams: We must create partnerships within professionals in which expertise is used to protect elders. For example physicians and family member should work together to determine the mental capabilities of the elderly to prevent any future abuse.^[15]

--Pd08to 20:58, 30 November 2011 (EST)

[edit] Professional Abuse of Elders

Elderly abuse within nursing homes is becoming a serious problem globally because physical abuse, mental abuse, financial abuse and neglect can all occur within the same nursing care facility. This has inspired researchers to study the characteristics that make staff vulnerable to committing maltreatment, and the characteristics of elderly patients that may make them vulnerable to being abused.

[edit] Patient to Staff Ratio

[edit] Risk Factor: Low Nurse to Patient Ratio

Research has shown that there tended to be a risk for elderly abuse in facilities with a large number of patients and a low number of staff. It is believed that this happens because lack of staff can lead to poor management and decision making, for example a nurse may lift an elderly patient improperly because there is not enough staff to properly carry her ^[18] Natan and Lowenstein (2010) found a strong link between the number of nursing staff and the number of cases of abuse and neglect. Its important for older adults and the families of older adults to be aware of this risk.

[edit] Interventions

• Selecting nursing facilities that have greater nurse per patient ratios

[edit] Training Level

[edit] Risk Factor: Less than 5 years Experience

The amount of training and education received on how to treat older adults in nursing care plays a strong role in abuse. It is important for nurses and staff members to have the proper amount of education and training to make the right decisions. Buzgova and Ivanova (2011) examined data from 454 employees from 12 nursing homes and found that employees at risk for being abusive tended to be employed for less than 5 years without proper training.

[edit] Interventions

• Programs that teach nurses to treat elderly patients with ethical principles
• Awareness of the education level of nurses when selecting a nursing home for yourself or a loved one

[edit] Burnout Effect

[edit] Risk Factor: Long Shifts and Low Social Support

Nurses can feel lots of stress at the work place through working long shifts, dealing with death and illness and being overwhelmed with responsibilities. They may no longer function at a normal level and start to feel numb, this is referred to as burnout effect. Nurses affected with burnout are at risk for abusing patients because they may no longer feel compassion or responsibility. Natan, Lowenstein and Eisikovits (2010) measured the effects of burnout in nurses. As they predicted, there was a strong relationship found between the amount of stressed felt by nurses and the cases of abuse. ^[19] Hasson and Arnetz (2006) were interested in the factors related to work satisfaction.

They compared nurses working in home-based elderly care and nurses working in nursing home care. A questionnare was used which measured how well they believed they preformed on job related tasks and the level of stress and satisfaction they felt at work ^[3] Hasson and Arnetz (2006) found that nurses working in home-based elderly care felt less competent; however, they tended to feel less stressed and more satisfied with their job than nurses working in nursing home care.

[edit] Interventions

• Social support groups
• Stress and time management classes

[edit] Traits of the Abused

[edit] Risk Factor: Dementia and Depression

Research has found that older adults with certain personality traits, mental disorders or behavioural problems are more vulnerable to abuse. Malmedal, Ingebrigtsen and Saveman (2009) found that elders tended to be more vulnerable to abuse when they were very dependent on nursing staff. ^[20] This might be due to the fact that when a nurse has to focus all of his or her attention on a patient, they can experience frustration and stress more often. Buzgova and Ivanova (2011) measured responses from patients and nursing staff and found that both personality and mental state of the patient were related to the likelihood of being abused. Older adults that have an aggressive or depressive temperament and those suffering from mental problems such as dementia are vulnerable to being abused. They are more likely to be abused because they may disobey the nurses such as not taking their medication, or may behave strangely such as repeating words or movements^[21]

[edit] Interventions

• Stress and anger management classes offered to nurses to help them manage difficult patients
• Classes that teach nurses to be more aware and tolerant of patients with disabilities

--Kb09ou 18:31, 29 November 2011 (EST)

[edit] Notes and References

1. ↑ Lachs, M. S., & Pillemer, K. (2004). Elder abuse. Lancet, 364, 1263-1272.
2. ↑ ^{2.0 2.1} Krug, E. G., Dahlberg, L. L., Mercy, J. A., Zwi, A. B., & Lozano, R. (2002). World report on violence and health. Retrieved from World Health Organization website: http://whqlibdoc.who.int/hq/2002/9241545615.pdf
3. ↑ ^{3.0 3.1} Hasson, H. H., & Arnetz, J. E. (2006). Nursing staff competence, work strain, stress and satisfaction in elderly. Journal of Clinical Nursing, 17, 468-481.
4. ↑ ^{4.0 4.1} Laumann, E. O., Leitsch, S. A., Waite, L. J. (2008). Elder mistreatment in the United States: Prevalence estimates from a nationally representative study. Journal of Gerontology, 63B(4), S248-S254.
5. ↑ Friedman, Lee S., Avila, S., Tanouye, K., & Joseph, K. (2011). A case-control study of severe physical abuse of older adults. Journal of the American Geriatrics Society, 59, 417-422.
6. ↑ ^{6.0 6.1 6.2} Acierno, R., Hernandez, M. A., Amstadter, A. B., Resnick, H. S., Steve, K., Muzzy, W., & Kilpatrick, D. G. (2010). Prevalence and correlates of emotional, physical, sexual, and financial abuse and potential neglect in the United States: The national elder mistreatment study. American Journal of Public Health, 100(2), 292-297.
7. ↑ ^{7.0 7.1 7.2 7.3} Amstadter, A. B., Zajac, K., Strachan, M., Hernandez, M. A., Kilpatrick, D. G., & Acierno, R. (2011). Prevalence and correlates of elder mistreatment in South Carolina: The South Carolina elder mistreatment study. Journal of Interpersonal Violence, 26(15), 2947-2972.
8. ↑ ^{8.0 8.1} Cooper, C., Selwood, A., Blanchard, M., Walker, Z., Blizard, R., & Livingston, G. (2010). The determinants of family carers' abusive behaviour to people with dementia: Results of the CARD study. Journal of Affective Disorders, 121, 136-142.
9. ↑ ^{9.0 9.1 9.2} Williamson, G. M., & Shaffer, D. R. (2001). Relationship quality and potentially harmful behaviors by spousal caregivers: How we were then, how we are now. Psychology and Aging, 16(2), 217-226.
10. ↑ ^{10.0 10.1 10.2} Beach, S. R., Schulz, R., Williamson, G. M., Miller, S., Weiner, M., & Lance, C. E. Risk factors for potentially harmful informal caregiver behaviour. Journal of the American Geriatrics Society, 53(2), 255-261.
11. ↑ Selwood, A., Cooper, C., Owens, C., Blanchard, M., & Livingston, G. (2009). What would help me stop abusing? The family carer’s perspective. International Psychogeriatrics, 21(2), 309-313.
12. ↑ ^{12.0 12.1 12.2 12.3 12.4 12.5 12.6 12.7 12.8} "The crime of the 21st century." Kiplinger's Personal Finance Nov. 2011: 11.
13. ↑ Garre-Olmo, J., Planas-Pujol, X., López-Pousa, S. & Vilalta-Franch, J. (2009) Prevalence and risk factors of suspected elder abuse subtypes in people aged 75 and older. Journal of the American Geriatrics Society 57(5) 815-822.
14. ↑ Black, J. (2005) The not-so-golden years: Power of attorney, elder abuse, and why our laws are failing a vulnerable population. St. John's Law Review 82(1) 289-314.
15. ↑ ^{15.0 15.1 15.2 15.3 15.4} Reeves, S., & Wysong, J.(2011) Strategies to address financial abuse. Journal of Elder Abuse & Neglect, 22(3/4), 328-334.
16. ↑ ^{16.0 16.1} Kemp, B, & Mosqueda, L. (2005) Elder financial abuse: An evaluation framework and supporting evidence. Journal of the American Geriatrics Society, 53(7)1123-1127.
17. ↑ ^{17.0 17.1 17.2 17.3} Gotlieb, R. (2011) Stealing from mom and dad. Macleans, 124.(27): 27-288
18. ↑ Natan, M. B., & Lowenstein, A. (2010). Study of factors that affect abuse. Nursing Management, 17(8), 20-24.
19. ↑ Natan, M. B., Lowenstein, A., & Eisikovits, Z. (2010). Psycho-social factors affecting elders’maltreatment in long-term care facilities.International Nursing Review, 57, 113-120
20. ↑ Malmedal, W., Ingebrigtsen, O., & Saveman, B. (2009). Inadequate care in Norwegian nursing homes – as reported by nursing staff. Scandinavian Journal of Caring Sciences, 23, 231-242
21. ↑ Buzgova, R., & Ivanova, K. (2011). Violation of ethical principles. Nursing Ethics, 18(1), 64-78