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[edit] Emotional Elder Abuse

• Kelly Andrews
• Joanna Carr

Emotional abuse is defined as psychological mistreatment which negatively affects a person’s emotions.^[1] The majority of elder abusers are the elder's primary caregivers such as nurses and the elder's children^[2]. There are many characteristics that put an elder person at risk for emotional abuse. Some examples of these risk factors are: physical health, age, and gender^[3]. Elder emotional abuse is a serious issue and therefore great consideration needs to be placed in prevention methods ^[4]. Examples of these prevention methods are: collaboration of services^[5], further education on the topic ^[6], and using a case study apporach (looking at each elder abuse case on an individual basis)^[7].

[edit] What is Emotional Elder Abuse?

There are nine ways in which emotional abuse can be committed and they are described below.^[8].

1. Lack of Attention - This is lack of attention that was once provided to the elderly person. This makes the elder person feel isolated and alone. They also feel that their personal feelings are ignored especially in decision making processes.
2. Lack of Affection - This includes lack of any physical intimacy (hugging, kissing, holding hands, etc.) that once was provided to the elderly individual. This may cause elderly people to feel confused, agitated or guilty because they feel they have done something wrong to be treated this way.
3. Neglect - This is when the caregiver fails to fulfill everyday life necessities such as food, water and bathing. This may make the elder person feel unwanted or unneeded and increases depression because they are not being taken care of properly.
4. Derogatory Naming - This includes any name calling or labelling of the elder person. Many elder persons feel hurt and saddened when they are unnecessarily attacked through name calling.
5. Demeaning Commentary - These are comments that lessen the worth, value and dignity of the elder person. This makes the elder person more timid and causes emotional distress.
6. Exploitation - This is when the elder person is being taken advantage of for the caregiver's benefit. This can cause elder people to distrust many people and become hypervigilant in their social relationships.
7. Physical Threats - This includes threats of hitting, kicking, or punching the elder person. These threats increase the elder person’s fearfulness, helplessness and hopelessness because they worry that these threats will turn into actions.
8. Loud Talking - This includes yelling and screaming and can increase the anxiety of the elder person. The elder person may also become disoriented because of the loud talking.
9. Confinement - This includes not allowing the elder person out of their room or house. This can increase stress and depression in the elder person because they are confined to such a small area.

[edit] Who is Most Likely to Commit Emotional Elder Abuse?

If the primary caregiver is a family member, the family member may also abuse the elder person. The same criteria that lead caregivers at facilities to emotionally abuse residents can also be the criteria that lead a family caregiver to abuse the older adult^[3]. For example, if the family member is working long hours at work and then has to come home to look after the elder person, he or she may be feeling stressed and overworked. As well, if the family member feels as if they are being attacked by the elder person, they are more likely to commit abuse back to the elder person^[3].

[edit] Risk Factors of Emotional Elder Abuse

An elder person who has behaviour and/or physical problems is more at risk of being emotionally abused than those who do not have these problems^[9]. Elder people who have behaviour problems such as being abusive to others or restricting care by the caregiver are more likely to be victims of emotional abuse (such as confinement or neglect)^[9]. Elder people, who have physically debilitating problems, such as personal hygiene problems, incontinence, or who require a wheelchair, walker, or walking assistance, are also at an increased risk of emotional abuse. This is because they usually need more care and attention than others which can result in a stressed or overworked caregiver^[9]. As well, patients who have hygiene problems or incontinence are more likely to be belittled by their caregivers because of their problems^[9]. Some other risk factors identifed that may increase the likelihood of emoitonal abuse are stated below:^[3].

• Age - The older a person is, the more likely it is that they will need more attention from a caregiver. This is a risk factor because as mentioned before this can cause an overworked or stressed caregiver.
• Gender - This could either increase or decrease the likelihood of emotional abuse depending on the caregiver. If the caregiver perfers working with women over men, than an elderly man may become a victim of emotional abuse by that caregiver.
• Family Situation - If the elder person is in a long-term care facility and the family is not very involved in the elder's life, this may increase the risk of emotional abuse towards the elder because they are an easier target. They are an easier target because it is less likely that the emotional abuse will be detected by the family.
• Cognitive Decline - This may increase behavioural and/or physical problems, which can increase the likelihood of emotional abuse. Once again this type of elderly patient would need more attention which can cause the caregiver to become overworked or stressed.

For more information on Emotional Elder Abuse and other forms of Elder Abuse please click here.

[edit] Prevention of Emotional Elder Abuse

Prevention of emotional elder abuse is vital. Why?:

• One reason is that emotional elder abuse is one of the more difficult types of abuse to address or identify ^[5], and therefore can go on for a very long time.
• Another reason is that the elderly population is expected to rise drastically over the next 40 years. The elderly population is expected to increase to 25% by the year 2051 ^[4]. In addition to that, in the USA, reports state that general elder abuse occurs to 32 in every 1000 people, and these rates are suggested to be higher for those who have dementia ^[7]. Therefore, arguments have been made to suggest that along with the population increase, there will be an increase in the number of cases occurring ^[4].

Many researchers have looked into prevention of emotional elder abuse. Some have looked at the issue from the perspective of the practitioner, while some have considered the point of view of the public. This is relevant to the prevention of elder abuse as it represents the probability of a member of the public reporting elder abuse to a member of authority ^[6]. Others, look at prevention methods that are being used and evaluate their effectiveness.

[edit] Practitioners

Studies on the role of practitioners in preventing elder abuse have concluded that there is an increased need for professional training on how to be able to identify risk factors. Another view that has been found to be put forward by practitioners is that there is an increased need for collaboration between services in the field of elderly support and assistance, such as health services and Adult Protective Services^[10].

[edit] Public Opinions

One study looked at the public's opinion of reporting of elder mistreatment were investigated. The current elderly generation see discussing any kind of abuse as taboo, in the sense that they do not feel that they could or should discuss the issue ^[6]. This is an issue because if they are not willing to discuss the issue, preventing it will be difficult ^[6]. However, this may be likely to change as around a third of the population of young-middle adults were in favour of mandatory reporting. Note that these generations will soon make up the elderly generation. Therefore prevention and awareness may be on the increase as the elderly population increases. This suggests that population increases do not necessarily mean an increase in those being abused as previously mentioned.

[edit] Other Cultures

Other cultures have laws in place regarding mandatory reporting of elderly emotional abuse. For example, Japan has enacted the Elder Abuse Prevention and Caregiver Support Law^[11]. This law has made an impact in that rates of reported cases have increased. As well cases of elderly emotional abuse have started to decline and intervention is able to take place in the earlier stages ^[11].

[edit] Prevention Methods of Elderly Emotional Abuse

• Media coverage is an important way in which emotional elder abuse could be prevented ^[6]. Awareness needs to be raised about the risk factors and of the ways in which prevention can occur. There are two fields this needs to take place in. The first is in the general public and the second is within staff training. An example of media coverage being taking place is the case of Mickey Rooney who experienced elderly abuse and whose court hearing on his emotional abuse made onto the television. A video of Mickey Rooney's case can be found here
• Using case studies such as these have also been found to be effective in staff training sessions with existing organisations. Staff were found to feel more secure in their ability to identify and intervene in emotional elderly abuse after having survivors of the abuse as guest speakers, and seeing videos and photographs of those who had experienced emotional abuse ^[7].
• Another tactic of raising awareness and educating the public and the professionals in the organisations that currently exist, is through Public Service Announcements. To see an existing PSA click here Through further educating people about emotional elder abuse. the possibility of changing the attitudes towards the elderly may occur. Ageism may be eliminated which contributes to elderly abuse. Cultural norms about elderly individuals and their need to remain independent may also contribute towards prevention, as prejudice and stereotypes may be less likely to occur ^[4].
• A prevention strategy which involved the collaboration of multiple programs and services, such as Adult Protective Services, Canadian Health Services and retirement homes, was found to be effective mainly due to the fact that one association does not have enough resources and knowledge to cover every aspect of emotional elderly abuse ^[5]. For example, the Elder Abuse Diagnosis and Intervention model (EADI) has two stages. Stage one deals with assessment and stage two deals with intervention. Those using the EADI model will have the resources to assess the situation however will need associations with other services such as Adult Protective Services to deal with the intervention of the case ^[5].
• Overall, research on the prevention of emotional elderly abuse suggests that the effective methods of preventing the abuse are collaboration of services, increasing awareness and using interpersonal training techniques.For further information on resources that are available for the prevention of elder abuse please click here

[edit] Notes and References

1. ↑ ^{1.0 1.1 1.2} Post, L., Page, C., Conner, T., Prokhorov, A., Fang, Y., Biroscak, B. (2010). Elder abuse in long term care: Types, patterns and risk factors. Research on Aging, 32, 323-348. doi: 10.1177/0164027509357705.
2. ↑ ^{2.0 2.1 2.2 2.3} Gibbs, L., & Mosqueda, L. (2004). Confronting elder mistreatment in long-term care. Annals of Long-Term Care, 12, 30-35.
3. ↑ ^{3.0 3.1 3.2 3.3} Cohen, M., Halevi-Levin, S., Gagin, R., & Friedman, G. (2006). Development of screening tool for identifying elderly people at risk of abuse by caregivers. Journal of Aging and Health, 18, 660-685. doi: 10.1177/0898264306293257.
4. ↑ ^{4.0 4.1 4.2 4.3} Peri, K., Fanslow, J., Hand, J., & Parsons, J. (2009). Keeping older people safe by preventing elder abuse and neglect. Social Policy Journal of New Zealand, 35, 159-172.
5. ↑ ^{5.0 5.1 5.2 5.3} Imbody, B., & Vandsburger, E. (2011). Elder abuse and neglect: Assessment tools, interventions, and recommendations for effective service provision. Educational Gerontology, 37, 634-650.
6. ↑ ^{6.0 6.1 6.2 6.3 6.4} Stieber Roger, K., & Ursel, J. (2009). Public opinion on mandatory reporting of abuse and/or neglect of older adults in Manitoba, Canada. Journal of Elder Abuse and Neglect, 21, 115-140.
7. ↑ ^{7.0 7.1 7.2} Alt, K. L., Nguyen, A. L., & Meurer, L. 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 and Neglect, 23, 213-233.
8. ↑ Peretti, P., & Majecen, K. (1991). Emotional abuse among elderly: Affecting behaviour variables. Social Behaviour and Personality, 19, 255-261.
9. ↑ ^{9.0 9.1 9.2 9.3} Shugarman, L., Fries, B., Wolf, R., & Morris, J. (2003). Identifying older people at risk of abuse during routine screening practices. JAGS, 51, 24-31.
10. ↑ Pillemer, K., Breckman, R., Sweeney, C. D., Brownell, P., Fulmer, T., Berman, J., Lachs, M. S. (2011). Practitioners' views on elder mistreatment research priorities: Recommendations from a research-to-practice consensus conference. Journal of Elder Abuse and Neglect, 23, 115-126.
11. ↑ ^{11.0 11.1} Nakanishi, M., Nakashima, T., & Honda, T. (2010). Disparities in systems development for elder abuse prevention among municipalities in Japan: Implications for strategies to help municipalities develop community systems. Social Science and Medicine, 71, 400-404.