Elder abuse - AbsoluteAstronomy.com

Elder abuse is a general term used to describe certain types of harm to older adults. Other terms commonly used include: "elder mistreatment," "senior abuse," "abuse in later life," "abuse of older adults," "abuse of older women," and "abuse of older men."

One of the more commonly accepted definitions of elder abuse is "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." This definition has been adopted by the World Health Organization

World Health Organization

The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

from a definition put forward by Action on Elder Abuse in the UK.

The core feature of this definition is that it focuses on harms where there is "expectation of trust" of the older person toward their abuser. Thus, it includes harms by people the older person knows or with whom they have a relationship, such as a spouse, partner or family member, a friend or neighbor, or people that the older person relies on for services. Many forms of elder abuse are recognized as types of domestic violence

Domestic violence

Domestic violence, also known as domestic abuse, spousal abuse, battering, family violence, and intimate partner violence , is broadly defined as a pattern of abusive behaviors by one or both partners in an intimate relationship such as marriage, dating, family, or cohabitation...

or family violence.

The term elder abuse does not include general criminal activity against older persons, such as home break ins, "muggings" in the street or "distraction burglary", where a stranger distracts an older person at the doorstep while another person enters the property to steal.

The abuse of elders by caretakers is a worldwide issue. In 2002, the work of the World Health Organization

World Health Organization

brought international attention to the issue of elder abuse. Over the years, government agencies and community professional groups, worldwide, have specified elder abuse as a social problem.

In 2006 the International Network for Prevention of Elder Abuse (INPEA) designated June 15 as World Elder Abuse Awareness Day (WEAAD) and an increasing number of events are held across the globe on this day to raise awareness of elder abuse, and highlight ways to challenge such abuse.

Types

Although there are common themes of elder abuse across nations, there are also unique manifestations based upon history, culture, economic strength, and societal perceptions of older people within nations themselves. The fundamental common denominator is the use of power and control by one individual to affect the well-being and status of another, older, individual.

There are several types of abuse

Abuse

Abuse is the improper usage or treatment for a bad purpose, often to unfairly or improperly gain benefit. Abuse can come in many forms, such as: physical or verbal maltreatment, injury, sexual assault, violation, rape, unjust practices; wrongful practice or custom; offense; crime, or otherwise...

of older people that are generally recognized as being elder abuse, including:

Physical
Physical abuse
Physical abuse is abuse involving contact intended to cause feelings of intimidation, injury, or other physical suffering or bodily harm.-Forms of physical abuse:*Striking*Punching*Belting*Pushing, pulling*Slapping*Whipping*Striking with an object...

: e.g. hitting, punching, slapping, burning, pushing, kicking, restraining, false imprisonment/confinement, or giving excessive or improper medication
Psychological/Emotional
Psychological abuse
Psychological abuse, also referred to as emotional abuse or mental abuse, is a form of abuse characterized by a person subjecting or exposing another to behavior that may result in psychological trauma, including anxiety, chronic depression, or post-traumatic stress disorder...

: e.g. shouting, swearing, frightening, or humiliating a person. A common theme is a perpetrator who identifies something that matters to an older person and then uses it to coerce an older person into a particular action. It may take verbal forms such as name-calling, ridiculing, constantly criticizing, accusations, blaming, and general disrespect, or non verbal forms such as ignoring, silence or shunning.
Financial abuse: also known as financial exploitation. e.g. illegal or unauthorized use of a person’s property, money, pension book or other valuables (including changing the person's will
Will (law)
A will or testament is a legal declaration by which a person, the testator, names one or more persons to manage his/her estate and provides for the transfer of his/her property at death...

to name the abuser as heir). It may be obtained by deception
Deception
Deception, beguilement, deceit, bluff, mystification, bad faith, and subterfuge are acts to propagate beliefs that are not true, or not the whole truth . Deception can involve dissimulation, propaganda, and sleight of hand. It can employ distraction, camouflage or concealment...

, coercion
Coercion
Coercion is the practice of forcing another party to behave in an involuntary manner by use of threats or intimidation or some other form of pressure or force. In law, coercion is codified as the duress crime. Such actions are used as leverage, to force the victim to act in the desired way...

, misrepresentation, undue influence, or theft. The term includes fraudulently obtaining or use of a power of attorney. Other forms include deprivation of money or other property, or by eviction from own home
Scam by strangers: e.g. worthless "sweepstakes" that elderly persons must pay in order to collect winnings, fraudulent investment schemes, predatory lending, and lottery scams.
Sexual
Sexual abuse
Sexual abuse, also referred to as molestation, is the forcing of undesired sexual behavior by one person upon another. When that force is immediate, of short duration, or infrequent, it is called sexual assault. The offender is referred to as a sexual abuser or molester...

: e.g. forcing a person to take part in any sexual activity without his or her consent, including forcing them to participate in conversations of a sexual nature against their will; may also include situations where person is no longer able to give consent (dementia
Dementia
Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...

)
Neglect
Neglect
Neglect is a passive form of abuse in which a perpetrator is responsible to provide care for a victim who is unable to care for himself or herself, but fails to provide adequate care....

: e.g. depriving a person of food, heat, clothing or comfort or essential medication and depriving a person of needed services to force certain kinds of actions, financial and otherwise. The deprivation may be intentional (active neglect) or happen out of lack of knowledge or resources (passive neglect).

In addition, some U.S. state laws also recognize the following as elder abuse:

Rights abuse: denying the civil and constitutional rights of a person who is old, but not declared by court to be mentally incapacitated. This is an aspect of elder abuse that is increasingly being recognized and adopted by nations
Self-neglect
Self-neglect
Self-neglect is a behavioural condition in which an individual neglects to attend to their basic needs, such as personal hygiene, appropriate clothing, feeding, or tending appropriately to any medical conditions they have. Extreme self-neglect can be known as Diogenes...

: elderly persons neglecting themselves by not caring about their own health or safety. Self neglect (harm by self) is treated as conceptually different than abuse (harm by others).
'Abandonment
Abandonment
The term abandonment has a multitude of uses, legal and extra-legal. This "signpost article" provides a guide to the various legal and quasi-legal uses of the word and includes links to articles that deal with each of the distinct concepts at greater length...

': deserting a dependent person with the intent to abandon them or leave them unattended at a place for such a time period as may be likely to endanger their health or welfare.

Institutional abuse

Institutional abuse can typically occur in a care home, nursing home, acute hospital or in-patient setting and can be any of the following:Institutional abuse also refers to child abuse in institutions where children were placed for their education, welfare, rehabilitation, or even protection...

refers to physical or psychological harms, as well as rights violations in settings where care and assistance is provided to dependant older adults or others.

Signs

The signs of abuse vary considerably among older people and with the type of harm being experienced. An older person who is being abused may:

Say she or he is being harmed
Seem depressed and withdrawn; signs of depression in elders are not getting dressed, not performing basic care of themselves that they are able to do, never going out even if they can, inability to sleep or sleeping too much
Not accepting invitations to spend time away from their family or a caregiver
Seem afraid to make their own decisions
Seem to be hiding something about a caregiver
Not have any spending money
Put off going to the doctor
Feel anxious and fearful
Try to "run away," leaving their place of residence and not wishing to return
Seem to have too many household "accidents"

Any of these potential signs can indicate problems other than abuse or neglect, and none of these "prove" there is harms occurring. The presence of the signs simply indicate that further inquiry may be necessary.

Health consequences of elder abuse

The health consequences of elder abuse are very serious. Elder abuse can destroy an elderly person's quality of life in the forms of:

Declining functional abilities
Increased dependency
Increased sense of helplessness
Increased stress
Worsening psychological decline
Premature mortality and morbidity
Depression and dementia
Malnutrition
Death

The risk of death for elder abuse victims are three times higher than for non-vicitms.

Common abusers of older people

An abuser can be a spouse, partner, relative, a friend or neighbor, a volunteer worker, a paid worker, practitioner, solicitor, or any other individual with the intent to deprive a vulnerable person of their resources. Relatives include adult children and their spouses or partners, their offspring and other extended family members. Children and living relatives who have a history of substance abuse or have had other life troubles are of particular concern.

Perpetrators of elder abuse can include anyone in a position of trust

Position of trust

Position of trust is a legal term that is commonly used in the United Kingdom, the United States, and Canada. It refers to a position of authority over another person or within an organization, for example as a supervisor...

, control or authority. Family relationships, neighbors and friends, are all socially considered as relationships of trust, whether or not the older adult actually thinks of the people as "trustworthy". Some perpetrators may "groom

Adult grooming

Adult grooming is the adult equivalent to child grooming and applies to any behaviour where an adult is prepared so they unwittingly allow abusive behaviour or exploitation to occur later. The abuser typically befriends or builds a relationship with the victim in order to establish a relationship...

" an older person (befriend or build a relationship with them) in order to establish a relationship of trust. Older people living alone who have no adult children living nearby are particularly vulnerable to "grooming" by neighbors and friends who would hope to gain control of their estates.

The majority of abusers are relatives, typically the older adult's spouse/partner or sons and daughters, although the type of abuse differs according to the relationship. In some situations the abuse is "domestic violence grown old," a situation in which the abusive behaviour of a spouse or partner continues into old age.

In some situations, an older couple may be attempting to care and support each other and failing, in the absence of external support. With sons and daughters it tends to be financial abuse, justified by a belief that it is nothing more than the "advance inheritance" of property, valuables and money.

Within paid care environments, abuse can occur for a variety of reasons. Some abuse is the willful act of cruelty inflicted by a single individual upon an older person. In fact, a case study in Canada suggests that the high elder abuse statistics are from repeat offenders who, like in other forms of abuse, practice elder abuse for the Schadenfreude

Schadenfreude

Schadenfreude is pleasure derived from the misfortunes of others. This German word is used as a loanword in English and some other languages, and has been calqued in Danish and Norwegian as skadefryd and Swedish as skadeglädje....

associated with the act. Nick Klassen, a practitioner of elder abuse involved in the above mentioned Canadian case study, described how some perpetrators of elder abuse tend to feel somewhat of an ecstasy, high, or sense of satisfaction while performing acts of abuse on the elderly. More commonly, institutional abuses or neglect may reflect lack of knowledge, lack of training, lack of support, or insufficient resourcing. Institutional abuse may be the consequence of common practices or processes that are part of the running of a care institution or service. Sometimes this type of abuse is referred to as "poor practice," although it is important to recognize that this term reflects the motive of the perpetrator (the causation) rather than the impact upon the older person.

With the aging of today's population, there is the potential that elder abuse will increase unless it is more comprehensively recognized and addressed.

Risk factors for elder abuse

There are several risk factors

Risk factors

A risk factor is a concept in finance theory such as the CAPM, APT and other theories that use pricing kernels. In these models, the rate of return of an asset is a random variable whose realization in any time period is a linear combination of other random variables plus a disturbance term or...

, which increase the likelihood that an elderly person will become a victim of elder abuse. Such risk factors for elder abuse include an elderly person who:

Has memory problems (such as dementia)
Has physical disabilities
Has depression, loneliness, or lack of social support
Abuses alcohol or other substances
Is verbally or physically combative with the caregiver
Has a shared living situation

There are also several risk factors

Risk factors

, which increase the likelihood that a caregiver will participate in elder abuse. Such risk factors for elder abuse include a caregiver who:

Feels overwhelmed or resentful
Has a history of substance abuse or a history of abusing others
Is dependent on the older person for housing, finances, or other needs
Has mental health problems
Is unemployed
Has a criminal history
Has a shared living situation

Barriers to obtaining elder abuse statistics

Several conditions make it hard for researchers to obtain accurate statistics on elder abuse. Researchers may have a hard time obtaining accurate elder abuse statistics for the following reasons:

Elder abuse is largely a hidden problem and tends to be committed in the privacy of the elderly person's home, mostly by his or her family members
Elder abuse victims are often unwilling to report their abuse for fear of others' disbelief, fear of loss of independence, fear of being institutionalized, fear of losing their only social support (especially if the perpetrator is a relative), and fear of being subject to future retaliation by the perpetrator(s), ,
Elder abuse victims' cognitive decline and ill health may prevent them from reporting their abuse
Lack of proper training of service providers, such as social workers, law enforcement, nurses, etc., about elder abuse, therefore the number of cases reported tend to be low

Elder abuse statistics

There has been a general lack of reliable data in this area and it is often argued that the absence of data is a reflection of the low priority given to work associated with older people. However, over the past decade there has been a growing amount of research into the nature and extent of elder abuse. The research still varies considerably in the definitions being used, who is being asked, and what is being asked. As a result, the statistics used in this area vary considerably.

One study suggests that around 25% of vulnerable older adults will report abuse in the previous month, totaling up to 6% of the general elderly population. However, some consistent themes are beginning to emerge from interaction with abused elders, and through limited and small scale research projects. Work undertaken in Canada suggests that approximately 70% of elder abuse is perpetrated against women and this is supported by evidence from the AEA helpline in the UK, which identifies women as victims in 67% of calls. Also domestic violence in later life may be a continuation of long term partner abuse and in some cases, abuse may begin with retirement or the onset of a health condition. Certainly, abuse increases with age, with 78% of victims being over 70 years of age.

The higher proportion of spousal homicides supports the suggestion that abuse of older women is often a continuation of long term spousal abuse against women. In contrast, the risk of homicide for older men was far greater outside the family than within. This is an important point because the domestic violence of older people is often not recognized and consequently strategies, which have proved effective within the domestic violence arena, have not been routinely transferred into circumstances involving the family abuse of older people.

According to the AEA helpline in the UK, abuse occurs primarily in the family home (64%), followed by residential care (23%), and then hospitals (5%), although a helpline does not necessarily provide a true reflection of such situations as it is based upon the physical and mental ability of people to utilize such a resource.

Abandonment

Elder abuse can also include deserting an elderly, dependent person with the intent to abandon them or leave them unattended at a place for such a time period as may be likely to endanger their health or welfare.

Self-abuse and neglect

Older adults may neglect themselves by not taking care of or caring about their own personal health and well-being. Elder self-neglect can lead to illness, injury, or even death. Common needs that older adults may deny themselves, or ignore are the following:

Sustenance (food or water)
Cleanliness (bathing and personal hygiene)
Adequate clothing for climate protection
Proper shelter
Adequate safety
Clean and healthy surroundings
Medical attention for serious illness
Essential medications

Self neglect is often created by an individual's declining mental awareness or capability.

Some older adults may choose to deny themselves some health or safety benefits, which may not be self-neglect. This may simply be their personal choice. Caregivers and other responsible individuals must honor these choices if the older adult is sound of mind. In other instances, the older adult may lack the needed resources, as a result of poverty, or other social condition. This is also not considered as "self neglect".

Research

Research conducted in New Zealand

New Zealand

New Zealand is an island country in the south-western Pacific Ocean comprising two main landmasses and numerous smaller islands. The country is situated some east of Australia across the Tasman Sea, and roughly south of the Pacific island nations of New Caledonia, Fiji, and Tonga...

broadly supports the above findings, with some variations. Of 1288 cases in 2002–2004, 1201 individuals, 42 couples, and 45 groups were found to have been abused. Of these, 70 percent were female. Psychological abuse (59%), followed by material/financial (42%), and physical abuse (12%) were the most frequently identified types of abuse. Sexual abuse occurred in 2 percent of reported cases.

Age Concern New Zealand found that most abusers are family members (70%), most commonly sons or daughters (40%). Older abusers (those over 65 years) are more likely
to be husbands.

In 2007, 4,766 cases of suspected abuse, neglect, or financial exploitation involving older adults were reported, an increase of 9 percent over 2006. Tragically, 19 incidents were related to a death, and a total of 303 incidents were considered life-threatening. About one in 11 incidents involved a life-threatening or fatal situation.

Prevention of elder abuse

Doctors, nurses, and other medical personnel can play a vital role in assisting elder abuse victims. Studies have show that elderly individuals, on average, make 13.9 visits per year to a physician. Although there has been an increase in awareness of elder abuse over the years, physicians tend to only report 2% of elder abuse cases. Reasons for lack of reporting by physicians include a lack of current knowledge concerning state laws on elder abuse, concern about angering the abuser and ruining the relationship with the elderly patient, possible court appearances, lack of cooperation from elderly patients or families, and lack of time and reimbursement. Through education and training on elder abuse, health care professionals can better assist elder abuse victims.

Educating and training those in the criminal justice system, such as police, prosecutors, and the judiciary, on elder abuse, as well as increased legislation to protect elders, will also help to minimize elder abuse and will also provide improved assistance to victims of elder abuse.

In addition, community involvement in responding to elder abuse can contribute to elderly persons' safety. Communities can develop programs that are structured around meeting the needs of elderly persons. For example, several communities throughout the United States have created Financial Abuse Specialist Teamshttp://www.coaoc.org/html/services_fast_description.htm, which are multi-disciplinary groups that consist of public and private professionals who volunteer their time to advise Adult Protective Services (APS), law enforcement, and private attorneys on matters of vulnerable adult financial abuse.

Where to get help

For those over the age of 60, help is available through local Area Agencies on Aging (AAA) that include older adult protective services as an important component of their aging services. The phone number for local AAA offices can be found in the phone book blue pages under Abuse/Assault.

National Center on Elder Abuse
The National Center on Elder Abuse (NCEA) serves as a national resource center dedicated to the prevention of elder mistreatment. First established by the U.S. Administration on Aging (AoA) in 1988 as a national elder abuse resource center, the NCEA was granted a permanent home at AoA in the 1992 amendments made to Title II of the Older Americans Act.

National Committee for the Prevention of Elder Abuse (NCPEA)
The National Committee for the Prevention of Elder Abuse is an association of researchers, practitioners, educators, and advocates dedicated to protecting the safety, security, and dignity of America’s most vulnerable citizens. It was established in 1988 to achieve a clearer understanding of abuse and provide direction and leadership to prevent it.

The Center for Elders and the Courts (CEC)
The Center for Elders and the Courts serves as a national resource center dedicated to serving courts throughout the United States on issues related to aging, probate, and elder abuse. The Center for Elders and the Courts provides information on current legislation on elder abuse in each state throughout the United States.

External links

The source of this article is wikipedia, the free encyclopedia. The text of this article is licensed under the GFDL.