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Elder Abuse and Neglect


... from child abuse legislation would improve the understanding of elder abuse as a phenomenon separate and unique from child abuse References Bratteli, M ... – PowerPoint PPT presentation

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Title: Elder Abuse and Neglect

Elder Abuse and Neglect
  • Barbara J. Chromy

What is elder abuse?
  • an all-inclusive term representing all types of
    mistreatment or abusive behavior toward older
    adults (Wolf, 2000, p.7)
  • further defined as acts of commission
    (intentional behavior) and omission (failure to
  • self-neglect is the most common form of elder
    abuse and the most difficult to detect and treat
    (Levine, 2003 and Reynolds Welfel et al., 2000)

Types of Abuse
  • Medical
  • Abandonment
  • Neglect
  • Self-neglect
  • Physical
  • Psychological
  • Sexual
  • Material
  • Violation of Rights

Forms of Abuse
  • Physical - hitting, pushing, slapping, punching,
    restraining, pinching, force-feeding, physical
  • Psychological - verbal aggression, intimidation,
    threats, humiliation
  • Sexual - any kind of non-consensual sexual contact

Forms of Abuse (continued)
  • Material - theft of cash or personal property,
    forced contracts, misuse of income or other
    financial resources
  • Violation of Rights - deprivation of any
    inalienable right such as voting, assembly,
    speech, privacy, personal liberty
  • Medical - withholding medication or

Forms of Abuse (continued)
  • Abandonment - desertion of an elderly person for
    whom one has agreed to care for, dumping a
    cognitively impaired elder at an emergency room
    with no identification
  • Neglect - failure to provide necessary physical
    or mental care of an elderly person
  • Self-neglect - behavior that threatens ones own
    health or safety

Indications of Abuse
  • Physical - multiple fractures or bruises at
    various stages of healing, burns, patterned
    injuries, patchy hair loss, frequent visits to
    ER, delay in seeking medical treatment for
  • Psychological - withdrawn behavior, wasting or
    failure to thrive, depression
  • Sexual - genital injury, vaginal or rectal
    bleeding, bruises, chipped teeth, sexually
    transmitted disease or infestations

Indications of Abuse (continued)
  • Material - unexplained loss of income, assets,
    possessions, not eating, missed utility payments
  • Violation of Rights - isolation, failure to
    attend church services or community events as one
    did previously
  • Medical - no improvement in condition for which
    one was prescribed medication, blood tests
    indicate greater or lower than expected levels of
    medications, sleepiness, groggy

Indications of Abuse (continued)
  • Abandonment - isolation, not seen outside home,
    disrepair or unkempt environment, missed medical
    or other appointments or engagements, wandering,
    being left somewhere to fend for self
  • Neglect - uncared for appearance, inappropriate
    clothing, failure to thrive, lack of medical or
    dental care, isolation
  • Self-neglect (similar to neglect)

Scope of the Problem
  • estimates of the occurrence of elder abuse vary
    widely due in part to the variability in the
    definitions used to measure and report abuse
  • mistreatment of adults, including abuse,
    neglect, and exploitation, affects more than 1.8
    million older Americans (Pavlik, Hyman, Festa,
    Bitondo, and Dyer, 2001, p. 45)
  • self-neglect accounts for one-third to one-half
    of all abuse cases (Gray-Vickrey, 2000, 2004
    Levine, 2003 Paris, 2003)

Distribution of Abuse
  • distribution of abuse according to sex was
    reported by Wolf (2000) to be almost equally
    divided between males and females
  • Some studies indicate that females are more often
    victims of elder abuse (Bratteli2003, Pavlik et
    al., 2001)
  • Patterns of abuse are similar among African
    Americans, Latinos, Caucasians, and Asians
    (Cavanaugh Blanchard- Fields cited in Etaugh
    Bridges, 2004)

Perpetrators of Abuse
  • elder abuse can be perpetrated by nearly anyone
    including paid or volunteer caregivers, medical
    and long-term care employees, family members,
    significant others, and in some cases strangers
    such as a person who befriends an elderly person
    for the purpose of exploiting them (Reynolds
    Welfel et al., 2000)

Greatest Risk Factors for Causing Abuse in North
  • being male
  • under age 60
  • being related
  • history of mental illness
  • recent decline in mental health
  • abusing alcohol
  • primary caregiver
  • lives with or has access to the adult they abuse
  • change in family roles from being cared for to
    being the care provider
  • prior history of violence
  • (Bratteli, 2003)

Theories Explaining Elder Abuse
  • repeated cycle of violence (social learning
  • power imbalance in relationships (feminist
  • marginalization of the elderly within society
    (political economic theory)
  • affects of caregiver stress (situational model)
  • dependency of elder on caregiver (exchange
  • mental or emotional disturbance of caregiver

Risk Factors for Being Abuses
  • Poor health
  • Inability to perform activities of daily living
  • Cognitive impairment
  • Living with others (living alone increases risk
    for financial and self-abuse)
  • Social isolation
  • Depression, confusion, substance abuse or
  • Mental or physical impairment (stroke,
    incontinence, Alzheimers)
  • Being female
  • Over age 85

Risk Factors for Perpetrating Abuse
  • History of family violence
  • Disruptive behavior on behalf of the care
  • Mental illness
  • Alcohol or drug abuse or dependence
  • Caregiver dependence

Perpetrating Risk Factors (continued)
  • Stress
  • Physical or emotional exhaustion
  • Low social integration and/or unemployment
  • Lack of community supports
  • Insufficient income for basic needs

Protective Measures
  • Stay sociable and active
  • Stay involved with neighbors, friends, church or
    community activities
  • Get regular medical and dental care
  • Open and post your own mail
  • Increase social network as you age
  • Have friends visit you at home
  • Have a best friend with whom you can confide in
  • Keep in touch with old friends if you move

Protective Measures (continued)
  • Keep your possession organized
  • Tell someone you trust where your important
    paperwork and bank account information is kept
  • Have checks direct deposited into your account
  • Use an answering machine to screen phone calls
  • Dont leave cash or valuables visible
  • Notify the police if you will be away from home
    for an extended time period

Protective Measures (continued)
  • Consult with an attorney
  • Make arrangement for the future such as power of
  • Get legal advise before making/signing agreements
    regarding your care or possessions
  • Be aware of your financial situation

Protective Measures (continued)
  • Know where to ask for help
  • Find out about community resources before you
    need them such as rape and abuse hotlines, senior
    centers, and adult protective services
  • mental health service centers
  • crisis centers
  • private counselors
  • clergy
  • local police

Detection and Treatment Barriers
  • detection of elder abuse is difficult because
    denial is an integral feature of abuse, victims
    may feel too ashamed to disclose maltreatment or
    believe they are to blame for or deserve the
  • dependence on an abuser can make a victim
    reluctant to report for fear of how he/she will
    survives without the perpetrators help

Detection/Treatment Barriers (continued)
  • victims may not define their situation as abuse
    especially in a dysfunctional family environment
    where violence or mistreatment has been
    normalized (Brown et al., 2004, Levine, 2003)
  • cognitive, auditory, speech, visual impairments,
    isolation or restraint may make reporting
    impossible for the victim of elder abuse

Detection/Treatment Barriers (continued)
  • ageism can negatively affect detection of elder
    abuse as it is common to view the elderly as
    confused or demented, to trivialize elders
    complaints, and to adhere to the perception that
    elder abuse doesnt exist
  • physical injuries may be masked by clothing or by
    isolating the victim

Detection/Treatment Barriers (continued)
  • fast paced medical services and heavy caseloads
    of social service providers may not allow time
    for adequate assessment
  • basic lack of information of where to turn for
    help impedes the intervention and treatment for
    both perpetrator and victim of abuse

  • further research using standardized definitions
    and subtypes of elder abuse would provide a
    better picture of the scope of the problem
  • improved reporting guidelines along with
    increasing the number of agencies and their
    funding is essential.

Recommendations (continued)
  • Greater understanding of the causation of elder
    abuse could lead to the development of effective
    treatment programs for abusers
  • defining elder abuse in its own terms rather that
    modifying guidelines from child abuse legislation
    would improve the understanding of elder abuse as
    a phenomenon separate and unique from child abuse

  • Bratteli, M. (2003). Caregiver abuse, neglect and
    exploitation The journey through caregiving.
    North Dakota State University.
  • Brown, K., Streubert, G., Burgess, A. (2004).
    Effectively detect and manage elder abuse. The
    Nurse Practitioner, 9 (8), 22-33.
  • Etaugh, C. Bridges, J. (2004). The psychology
    of women A lifespan perspective (2nd Ed.).
    Boston, MA Pearson Education, Inc.
  • Gray-Vickrey, P. (2000). Protecting the older
    adult Learn how to assess the visible and
    invisible indicators and what to do if you
    recognize abuse in an older patient. Nursing, 30
    (7), 34-38.

References (continued)
  • Gray-Vickrey, P. (2004). Combating elder abuse
    Heres what to look for, what to ask, and how to
    respond if you suspect that an older patient is a
    victim. Nursing, 34 (10), 47-51.
  • Kapp, M., (2004). Family caregivers legal
    concerns. Family Caregiving, (winter) 2003-2004,
  • Lachs, M., Pillemer, K. (2004). Elder abuse
    Seminar. www.thelancet.com, 364 (October),
  • Levine. J. (2003). Elder neglect and abuse A
    primer for primary care physicians. Geriatrics,
    58 (10), 37-45.
  • Paris, B. (2003). Abuse and neglect So prevalent
    yet so elusive (editorial). Geriatrics, 58 (10),

References (continued)
  • Pavlik, B., Hyman, D., Festa, N., Bitondo Dyer,
    C. (2001) Quantifying the problem of abuse and
    neglect in adultsanalysis of a statewide
    database. Journal of the American Geriatrics
    Society, 49, 45-48.
  • Reynolds Welfel, E., Danzinger, P., Santoro, S.
    (2000). Mandated reporting of abuse/maltreatment
    of older adults A primer for counselors. Journal
    of Counseling Development, 78 (summer),
  • Wolf, R., (2001). Introduction The nature and
    scope of elder abuse. Generations, Summer, 6-12.

  • Aitken, L. Griffin, G. (1996). Gender issues in
    elder abuse. Thousand Oaks, CA Sage
    Publications, Ltd.
  • Journal of elder abuse neglect. Haworth
    Maltreatment Trauma Press.
  • Quinn, M. Tomita, S. (1997). Elder abuse and
    neglect Causes, diagnosis, and intervention
    strategies (2nd Ed). New York, NY Springer
    Publishing Company.
  • Tatara, T. (1999). Understanding elder abuse in
    minority populations. Philadelphia, PA
    Brunner/Mazel (a member of the Taylor Francis
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