Abuse of Older Adults
Abuse comes in many forms: physical, mental, neglect, and more. It is endemic, particularly in developed cultures, and as the nuclear family unit disintegrates, it becomes more and more of a problem for older adults. The population globally is aging, and people are working even longer prior to retirement — thus causing a double bind — older adults needing care and older adults working an unable to provide that care. The risk of abuse, and especially neglect, becomes even more of a concern within the isolated confines of rural America. In these areas, there are less support services available, limited access to healthcare, and sometimes limited access to family members who have moved away, or can no longer be part of a care-giver paradigm (Jones, Holstege, & Holstege, 1997).
Literature Review — Elder abuse, in its most generic term, described harm to older adults. One common definition often appearing in the literature and legal findings, and adopted by the World Health Organization, 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” (What is Elder Abuse?, 2006). The core nature of this definition has been adopted because it implies, much like a child, that elders have a certain expectation of trust towards others — most especially when there is any diminished capacity for that adult. Further, elder abuse is part of the legal rubric of domestic violence; as opposed to crimes committed against elders at random (muggings, thefts, etc.). Instead, it is focused on particular types of abuse that radiate from a home environment, nursing or care facility, or any such location of care (Introduction, 1986). Although the problem is clearly global by nature, our discussion will focus on general issues, but on rural geographical areas in the United States.
There are roughly five types of elder abuse as noted by Public Health officials, and three additional recognized by U.S. State laws. Those that are part of the state legal system are:
Rights abuse – Indicates denying the civil or constitutional rights of an elder who is still considered by the Courts to be mentally competent.
Self-Neglect – Self abuse or neglect is treated more conceptually different than harm by others.
Abandonment – Desertion of an elderly person by intent in a setting in which care or assistance is provided by the person doing the abandoning (Hoffman, 2006).
The more sociological types of abuse that may also move into the legal definition are:
Physical abuse — for example, slapping, hitting burning, pushing restraining, imprisoning or over or under-dosing medication.
Psychological or Emotional — Shouting, swearing, frightening, or humiliating an older person using verbal action; verbal predation (identifying something important and using it to coerce an action); constant bickering, criticizing, blaming, ignoring, shunning or other forms of mental torture.
Financial abuse — really the exploitation of fiscal means — unauthorized use of an elder person’s property, money, pensions or other valuables — often obtained by deception or coercion, misrepresentation or theft. Typically this occurs by obtaining an unauthorized Power of Attorney.
Sexual — forcing an elder to participate in any sexual activity without their consent, even conversations of a sexual nature.
Neglect — One of the most common forms; depriving an elder of food, heat, clothing, medications or other essential living needs. This deprivation may be either intentional (active) or happen out of knowledge or concern (passive) (Hess & Orthmann, 2010; 209-10)
There are no genuine abuse statistics that are recognized as reliable, much abuse goes unreported or underreported, and like child abuse, much is hidden from law enforcement, even by social agencies. One study, however, that is often quoted, seems to indicate that about six percent of the elderly population experiences some form of abuse. Abuse does increase with age, and women are more likely to be abused than men — perhaps as a continuation of spousal or domestic abuse. Most elder abuse occurs in the family home (a little over sixty percent), followed by about 1/4 in residial and long-term care facilities (Cooper, Selwood, & Livingston, 207). This study was done through a comprehensive literature search of multiple databases, supplemented by a search of the references of relevant citations; clearly indicating that even with the under reporting, the issue is on the rise. The auhtors conclude noting that 1 in 4 older adults are vulnerable to some typr of abuse.
Given these alarming statistics that elder abuse has incresed over the last decade, should we be worried? or, is the increase in statistical numbers simply the result of more awareness, better communiation systems between concerned parties, and a general increase in the siphistical level of the abused population? Certainly, part of the issue surround the level of social and political attention given to the elder abuse issue, not that the attention is unmitigated. In America alone, over 2 million elders are the vitims of physical, psychological or other forms of abuse and neglect. Additionally, experts report that for every case of elder abuse reported there me be as many of 5-6 that are never reported. Of the 2003 cases, 47% of those reported were found to authentic in some ways; shockingly, 33% from adult children, 22% from family members; almost all (89%, occuring inside he home (Maastin, CHoi, Barboza, & Post, 2007).
We have noted that it is often difficult to detect elder abuse, particularly when families now live so far apart, and in the case of rural areas, are not necessarily in touch with neighbors or friends on a regular basis. In addition, many older people often need help with certain aspects of their lives — finances, for instance. One study focused on how there is a fine line between helping an older person manage their finances and abusing that trust and the use of those funds. While the study was basically qualitative, and certainly not longitudinal or a large enough population base to extrapolate definitive data, there appears to be a real reluctance on the part of the elderly to even report financial abuse from rural elders than urban elders. The primary reasons for this appear to be fear of stigmatization, protecting the good family name, or even the concern for their remaining assets. It is, of course, primarily family members who take over checkbokos, bank accounts, retirenment funds, and property management that are guilty of this, but it also appears that the lack of social and financial services in rural areas contributes greatly to this problem. While offering no direct conclusions, the authors do suggest that rural populations could benefit from an increasing focus from asset companies, some of which could conceivbably specialize in rural populations (Tilse, Roseman, Peut, & Ryan, 2006).
Another surprising study was done on rural aging women populations. Many sociological studies over the past few decades have found very little statistical difference in intimate partner violence (IPV) in rural or urban areas — it is a complex social phenomenon that certainly cuts acorss age, ethnic, racial, religious, and socioeconomic categories. However, aging women living with IPV may be at increased risk because they are more invisible in rural communities. This is because geographic isolation combines with economic constraints, social and cultural pressures, and again, lack of available social services. Tester, et.al. (2006) found that there was very little research on this particular subject area. Conceptually, they designed a research plan as a two-layer approach, grounded in an ecological community framework. The first layer uses individual women who were abused; the second group using focus groups from service and care agencies in a rural Kentucky area. The study was fairly limited; 3 focus groups involving 24 professionals and in-depth qualitative interviews with 10 women, ranging in age from 50-69 within the same georgraphical area. The study unveiled a complex web of macro and micro cultural issues; spiderwebs of control, decipt and expectations going back generations. Rural women, for instance, who seek to escape from violence face difficulties not encountered by urban women. For instance, there are few shelters, few places for the women to hide, and even fewer that seem sympathetic to their cuse. There are few affordable transitional centers, very few legal advocates who will help them, and even a general malaise with some rural law-enforcement on the private lives of individuals. This research only touches a very limited research question, and begs for follow up. Its clear conclusion, though, is that the greatest need in the rural area is some sort of educational program designed specifically for this population, and dissemenated in a manner that they can effectively use (Teasler, Dugar, & Roberto, 2006).
This issues with IPV are compounded again, in rural areas, when the older woman needs or seeks medical treatment. Since the 1960s, women’s rights have continued to focus on struggles and abuses, and there is no denying that legislation and cultural / social issues are better for women than they were 50-60 years ago. Even with under reporting, approximately 5% of elder women are likely abused to the point where they seek medical attention at least annually. These women are often well-known in their communities, so when they come into the emergency room with some story of malady, they know everyone will want to about what happened. In some cases, the trend is becoming more supportive, though. As educational programs transend economic barriers; more rural women are believed to have access to community services that are less than judgemental. They may have to travel to the next community, but there are still services that will, at the very least, intercede and find them a safer environment. This research concludes, based on qualitative and literature analysis, that it is even more difficult for rural women to get into the system. The women who go to their local clinics or Regional Medical Centers are seriously enough hurt that medical attention was required, nnot donated. and, because of their pyschologically vulnerable state, they are also more at risk for HIV infection middle aged urban women (Sormanti & Shibusawa, 2008).
Most of the studies under review point out that there are a number of disconnects in rural areas regarding agencies that will work with the elderly on issues such as this. Research shows that older people actually respond quite well to traditional practice intervention; but that is not always possible in a robust way within rural America. There are, however, resources that may be provided for older people, regardless of demographic or psychographic issues, that will at least help elders get some care (Roberts, 2007).
Finally, we must not forget the thousands of elder rural Americans who, while not necessarily part of a drastic physical abuse situation, are, in fact, part of a psychological depressive issue and, because of finances, stigma from rural communities and health professionals, and fear of exclusion, do not get the care they need. Depression is often difficult to diagnose, and the health care industry contributes to the overlooking of depression in the elderly because of the overwhelming desire to keep costs down. The factors of depression are open for interpretation, which results in different doctors looking for different things. In addition to that, elderly people may not exhibit the traditional symptoms of depression. Aged individuals may have symptoms of depression that go unnoticed due the fact that those symptoms are being attributed to a different ailment. In addition, there appear to be a few fundamental differences between depression in the young and old. Elderly people tend to have more ideational symptoms, which are related to thoughts, ideas, and guilt. Elderly depressed individuals are also more likely to have psychotic depressive and melancholic symptoms such as anorexia and weight loss. Finally, older people tend to have more anxiety present in their depression than younger patients. For the elderly, as with other population groups, depression is far more common than initially thought. Depression is an illness just like any other one, and it should be treated as soon as possible. Depression is diagnosed when a person has the depression symptoms for over two weeks. The two main ways two treat it are; drug therapy, which antidepressant medication is given, and psychotherapy, where psychotherapist use different types of therapy, including cognitive behavior, and others to treat depression (Bergeron & Gray, 2003). Both antidepressants and psychotherapy are about equally effective in treating mild, moderate and even severe depression. The treatments are given to people depending on what the person want to take or what the doctor suggests. Antidepressants and psychotherapy both have their advantages and disadvantages, and the people that suffer from depression select what is best for them (Zalaquett & Stens, 2006).
(1986). Introduction. In K. Pillemar, & R. Wolf (Eds.), Elder Abuse: Conflict in the Family (pp. 1-3). Boston, MA: Auburn House.
What is Elder Abuse? (2006, March). Retrieved from Action on Elder Abuse: http://www.elderabuse.org.uk/About%20Abuse/What_is_abuse%20define.htm
Bergeron, L., & Gray, B. (2003). Ethical Dilemmas of Reporting Suspected Elder Abuse. Social Work, 48(1), 96+.
Cooper, C., Selwood, a., & Livingston, G. (207). The prevelence of elder abuse and neglect: a systemematic review. Age and Ageing, 37(2), 151-60.
Hess, K., & Orthmann, C. (2010). Criminal Investigation. Clifton Park, NY: Cenage.
Hoffman, a. (Ed.). (2006). Elder Abuse: A Public Health Perspective. Washington, DC: American Public Health Association.
Jones, J., Holstege, C., & Holstege, H. (1997). Elder abuse and neglect: Understaning the causes and potential risk factors. The Journal of Emergency medicine, 15(6), 576-583.
Maastin, T., Choi, J., Barboza, G., & Post, L. (2007). Newspapers’ Framing of elder abuse. Journalism and Mass Communications Quarterly, 84(4), 777+.
Roberts, J. (2007). Resources for Working with Older Couples. The Generations, 31(3), 70+.
Sormanti, M., & Shibusawa, T. (2008). Intimate Partner Violence among Midlife and Older Women: A Descriptive analysis of women seeking medical attention. Health and Social Work, 33(1), 33+.
Teasler, P., Dugar, T., & Roberto, K. (2006). Intimate Partner Violence of Rural Aging Women. Family Relations, 55(5), 636+.
Tilse, C., Roseman, L., Peut, J., & Ryan, J. (2006). Managing Older People’s Assets: Does Rurality Make a Difference? Rural Society, 16(2), 169+.
Zalaquett, C., & Stens, a. (2006). Pscyhosocial Treatment sof rMajor Depression in Older Adults. Journal of Counseling and Developement, 84(2), 192-205.
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