Elder Abuse and Neglect as a Health Problem

NB: We do not resell your papers. Upon ordering, we do an original paper exclusively for you.

NB: All your data is kept safe from the public.

Introduction

Mistreatment of the elderly population is a hidden and often overlooked problem in society. Many people in the public domain have probably heard of elderly abuse and neglect but know very little beyond that, other than the occasional news coverage of problems in elderly homes. Elder abuse and neglect, sometimes called Granny Battering is not a new phenomenon, however, society has been slow to recognize the magnitude of the problem, with continued opposition of the idea that such a problem could exist. Indeed, the term Granny Battering was coined in 1975, a further testament to the fact that mistreatment of the elderly is not a recent phenomenon.

Statistics from the National Center on Elder Abuse approximate that more than one million elderly Americans faced abuse and/or neglect in 1996, a sharp rise from the figures reported in 1991, which put the number at 735,000. At the same time, the reported cases of elders who were mistreated rose from 117,000 in 1986 to 293,000 in the year 1996. Statistics on the mistreatment of adults are set to rise further as the population ages and the number of persons in elderly homes increase.

The term elder abuse and neglect has been defined to refer to any act that causes or increases the risk of harm to the health or wellbeing of an elder. Action on Elderly Abuse, a body that fights for the rights of the elderly in the UK, defines elder abuse and neglect 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 (Perel-Levin, 2008). WHO has adopted this definition in recognition of the magnitude of the problem. Its various forms consist of physical, sexual, and emotional abuse; exploitation; and neglect. Mistreatment may be deliberate or accidental and it occurs across the socioeconomic divide.

Literature Review

A study undertaken by the Adult Protective Services (APS), the most detailed national study of state-based statistics, showed that there are 8.3 instances of abuse for every 1000 elderly Americans. The study concluded that in 2003, APS offices received 565,747 cases of suspected elderly abuse and neglect compared to 483,917 in 2000. In more than 89 per cent of these instances, the abuse was reported to have occurred in a household setting.

The first study on the abuse and neglect of the elderly was carried out in 1996. The report showed that only 21% of instances of abuse and neglect were reported to the APS, the remaining 79% were not reported. These statistics showed that almost 4 out of five instances of abuse and neglect of the elderly were not reported (National Center on Elderly Abuse, 1998).

In 2000, neglect of older adults was the most common form of elder mistreatment, making up 48.7% of all reported cases of elderly mistreatment. Psychological abuse ranked second (35.5%), followed by physical abuse (25.6%); financial/ material exploitation was third (25.6) and lastly abandonment (3.6%). Adult children made up the largest proportion of perpetrators of reported elder mistreatment at 47.3%, followed by couples (19.3%); then other relatives (8.8%) and lastly grandchildren (8.6%). The report also showed that female elders were more likely to be receive various forms abuse, except for abandonment. Although they comprised 58% of the total elderly population in 1996, 76.3% of psychological abuse victims, 71.4% of physical abuse, 63.0% of financial abuse, and 60% of neglect, which was the most common form of abuse. 37.8% of abandonment victims were women (National Center on Elderly Abuse, 1998).

Some experts believe that statistics on elder mistreatment are very much underreported. They estimate that only 1 out of 14 instances are reported to authorities (Tatara & Kuzmeskus, 1997). Using these estimates, approximately 820,000 and 1,860,000 elder suffered abuse and neglect in 1996, showing that a very high proportion of cases did not come to the knowledge of the authorities (Lithwick et al, 1999).

Mistreatment of the elderly is thought to go unnoticed and as a result, is unreported more than any other form of domestic violence. The federal government prohibits mistreatment of the elderly, and physicians are obligated to report incidents of suspected abuse or neglect to protection agencies. The problem has only been reported in medical writings. Despite studies and surveys documenting exposure to a rising of victims by medical personnel, the medical profession and government has been slow to act (DAvolio et al, 2001). Due to the lack of guidelines in reporting suspected cases of elderly mistreatment, lack of professional and public awareness, isolation of the victims, and the unwillingness of medical staff to report incidences, responses to elderly abuse and neglect by the medical community, government, and the public have been slow to cause any significant reduction in statistics relating to this problem. Such is the low level of public awareness that June 15 has been set as the World Elder Abuse Awareness Day (WEAAD) to raise global awareness of the elder mistreatment, and to highlight ways through which the vice can be fought (Nahmiash & Reis, 2000).

Forms of Abuse and Neglect

Although the definition of elder varies between states, countries and jurisdictions as to what constitute an abuse, neglect, or exploitation of old adults, there are three basic categories of elder abuse:

Domestic elder abuse.
Institutional elder abuse.
Self-neglect of self-abuse.

In most cases, jurisdictions and organizations that address elder abuse provide the definition of these three categories with varying degrees of consistency. The first two forms of elder abuse can be placed into the following sub-groups:

Physical abuse

Physical abuse of the elderly is defines as any use of force that may result in bodily harm, physical pain, or impairment. It may include, but is not limited, acts of brutality such as striking (bare handed or using an object), hitting, beating, pushing, slapping, kicking, restraining, false imprisonment/ confinement, any form of physical punishment, or giving unnecessary medication (Lithwick et al, 1999).

Sexual Abuse

Sexual abuse refers to the non-consensual sexual contact of any form with the elderly, including coercing them to participate in a talk of sexual nature. It includes unwelcomed touching and all forms of forced sexual activity such as rape, forced nudity, and so on. Sexual abuse also includes situations in which a person is not able to give consent, for instance, due to dementia.

Emotional or Psychological Abuse

This form of abuse is defined as the infliction of suffering, pain, or misery through verbal or non-verbal actions. These actions may include verbal insults, threats, intimidation, humiliation, swearing, shouting or inducing fear. A common theme is an abuser who discovers something that is f of significance to the old adult and then uses it to force that person into a particular action.

Neglect

Neglect is the failure to accomplish any section of a persons roles or responsibilities. It may also constitute failure of a person who has fiduciary duties to give the required care to an elder, such as paying for home-care services, or the failure of the home-care provider to give the necessary care. Simply put, neglect means the refusal or failure to provide an elderly person with the basic requirements such as food, clothing, shelter, medical requirements, and other needs required by the elderly person (Lithwick et al, 1999). Neglect may occur intentionally or happen due to the lack of knowledge or resources to (unintentionally).

Financial Abuse/ Exploitation

This form of abuse is defined as illegal or unauthorized use of financial or material resources belonging to an elderly. This may include money, pension, or material wealth or even changing details of the persons will. It may be done through deceit, coercion, imposture, or stealing.

Response to Abuse and Neglect of the Elderly and Implications for Nursing Practice

Mistreatment of the elderly is a growing problem both in the developed and developing countries and if effective strategies are not implemented to curtail the situation, it may reach unmanageable levels. Society, caregivers and governments must make bold moves in highlighting the plight of the elderly population. The most important step toward preventing this problem is the recognition of the fact that no one, no matter the age, should be subjected to abuse or neglect of any form. Besides encouraging social attitude, constructive efforts include increasing awareness of elder mistreatment, increasing the number of resources required by this age group, promoting social contact and support for families that include an elderly person, and encouraging counseling and treatment to the elderly so that they can cope with the challenges of old age (Nahmiash & Reis, 2000).

Nursing professionals and caregivers are perhaps best placed to detect and report cases of elder abuse and neglect. In order to identify cases of elder abuse, there are signs that care providers must note. These symptoms include both visible signs and certain behaviors and when either of them is observed, a nursing professional must dig for further information in order to verify whether the older adult is being mistreated either at a domestic setting, institution or is suffering from self-neglect (Lithwick et al, 1999). Some of signs that nursing professionals should look out include:

Bruises, broken bones, burns or any other forms of physical injury on the persons body that may indicate physical abuse, neglect, or mistreatment;
Sudden withdrawal from normal activities, symptoms of depression, failing to take care of themselves as they used to, or lack of sleep may indicate emotional abuse;
Not having enough money to spend or a sudden lack of money may indicate exploitation;
Sores on the body, unattended medical requirements, and poor sanitation can indicate emotional abuse or neglect;
Bruises around private areas can indicate sexual abuse;
Attempting to run away from the care or foster home;
Seeming afraid to make their own decisions;

A caregiver can also display signs that can indicate abuse of the elder person, these include:

Taking of the older adult as a burden;
Keeping the elder in isolation and preventing them from talking freely to visitors;
Showing no compassion to the elder;
Anger, indifference or aggression towards elder;
Contradicting account of events;
A history of substance abuse and other criminal behaviors, among others.

Apart from these symptoms, nursing professionals can use one of the numerous tools that have been designed to detect elder abuse. However, not all these tools have been widely accepted in clinical practice. They are thought of as being inaccurate, or not applicable in a wider setting, or sensitive or not reliable enough to be adopted by mainstream bodies (WHO, 2008). One of the tools that has received modest publicity is the Hwalek- Sengstock Elder Abuse Screening Test (HSEAST). This tool focuses on the various forms opf abuse and is self-report initiative. HSEAST has 15 entries in each in three domains: abuse of personal right; forms of exposure; and potentially abusive environments. Other tools include the Brief Abuse Screen for the Elderly (BASE), the Caregiver Abuse Screen (CASE), and the Elder Assessment Instrument (EAI) (Nahmiash & Reis, 2000).

Despite the lack of a standardized tool, the American Medical Association calls on its members to follow a routine screening procedure (DAvolio et al, 2001). This mainly involves early detection of elder abuse by observing the above-mentioned symptoms of the problem and undertaking further investigations. Since older adults may exhibit symptoms of a multiplicity of factors due to their age, such as frail skin, or falls (causing bruises), or confusion, it is important that the physician considers a variety of factors in order to avoid making false accusations that may strain the relationship of the elder and the caregiver. An expanded comprehension of the psychology of the elderly patient will also help in predicting abuse or mistreatment. Besides, some other potential signs of abuse may due to the persons medical condition, for instance, Alzheimers disease may cause weight loss. It is also important that the relationship between the caregiver and the older be ascertained before further investigations commence. There are situations where the caregivers are making the best out a very obstinate elder.

If a physician observes the above-mentioned symptoms of abuse of the elderly, then further investigation should commence. Such an investigation would include patient screening and biological procedures. However, the debate on whether to screen patients has been ongoing as physicians battle with the debate on the benefits and potential harms. Notwithstanding whether screening has been done or not, if a health professional suspects that an elder is being mistreated or neglected, then persons living with the elder must be assessed due to the high risk of co-occurrence of abuse or neglect.

Conclusion

Elder abuse and neglect is an ignored social and health problem that society would deny rather than confront. Indeed, the problem is comparable to that of child abuse and violence against women three decades ago. Awareness of elder abuse has only began to surface recently due to strong campaigns backed up by tangible evidence of its prevalence. Despite these campaigns, denial prevails and it will take some more time before society realizes the full scale of elder abuse. The situation is compounded by the fact that instances of elder abuse and extremely underreported, making it difficult to assess its full extent. However, a few studies have shed some light on the situation and this has increased awareness, but not to the level that can reduce the prevalence rates by a significant margin.

Early detection of elder abuse by a physician can aid in fighting the vice. Physicians must be on the lookout for signs that may indicate elder abuse and neglect, and commence further investigations to ascertain the truth. However, recommending physician investigation of suspected cases of elder abuse and use of abuse detection tools will not be enough. It takes collaborative efforts among the community, authorities, and organizations to help combat elder abuse.

References

DAvolio D. et al. (2001). Screening for abuse:barriers and opportunities. Health Care for Women International, 22:349362.

Lithwick M. et al. (1999). The mistreatment of older adults: perpetratorvictim relationships and interventions. Journal of Elder Abuse and Neglect, 11:95112.

Nahmiash D., Reis M. (2000). Most successful intervention strategies for abused older adults. Journal of Elder Abuse and Neglect,12:5370.

National Center on Elderly Abuse. (1998). The National Elder Abuse Incidence Study. Final Report. September 1998.

Perel-Levin, S. (2008). Discussing Screening for Elder Abuse at Primary Health Care level Discussing Screening for Elder Abuse at Primary Health Care level. Geneva: WHO Document Production Services, Geneva, Switzerland.

Tatara T., Kuzmeskus L. B. (1997). Summaries of the statistical data on elder abuse in domestic settings for FY 95 and FY 96. Washington, DC: National Center on Elder Abuse, vii-ix.

Click Here To Order Now!