Identify attitudes towards the elderly in this society and examine cross-cultural variations. (TD)
Discuss the different forms of elder abuse. (CA)
Describe the characteristics of abusers and abused. (CA)
Describe reporting and consequences of a specific type of violence (SLP)
It is estimated that elder abuse and neglect affects 700,000 to 1.2 million elders in the US every year. It is assumed there is large scale under-reporting of cases.
The most likely victims of elder abuse are women, persons age 75 or older; and individuals who are isolated and dependent on others for care and protection. Adult children are the most frequent abusers of the elderly (30%), followed by other family members (15%) and spouses (14%). Neglect is the most common form of elder maltreatment in domestic settings.
Forms of abuse may be (1) PHYSICAL, which includes direct beatings, lack of food, lack of medical care or overmedication, sexual exploitation, and neglect (2) PSYCHOLOGICAL/EMOTIONAL, with verbal assaults, threats, fear, isolation, and withholding emotional support (3) MATERIAL, including theft, misuse of funds or property, extortion, duress and fraud (4) VIOLATION OF RIGHTS, with coercion, locking up, forced removal from home or forced entry into a nursing home (5) DENIAL OF BASIC NEEDS, including food, clothing, shelter and healthcare, and (6) ABANDONMENT.
Click here for a PowerPoint presentation on abused/abuser characteristics and indicators of physical abuse.
We are now aware of some of the personal characteristics of an abused adult/abuser and indicators of physical abuse. Its important that we now turn our attention to other factors relating to either intentional or unintentional elder abuse.
The proportion of elderly people in the U.S. is increasing, thus American families are being called upon in increasing numbers to care for elderly members of their families. Women are clearly at increased risk in this situation because they are involved with elder care more than men.
When you discuss these problems with people, it is often dismissed as Selfishnessand Lack of family valuesto bring up the stress that such care-giving may endure. We have a very short historical hindsight; most people dont realize that the human lifespan has virtually doubled in about 150 years (47 was the average in 1900, the current life expectancy is 77.8 years). This is a NEW problem. For most of human history, there just werent that many infirm elderly people around. Most died, the few that had longevity were more likely to have respect and even elevated status in some world cultures. With families more isolated due to our treasured American social mobility, and this increasing number of elderly members requiring care, this real problem (having nothing to do with people being Selfishor Evil”) is just getting worse by the decade. We need social support and solutions, not blaming and moralizing.
Caregivers may also be impaired themselves. Since women live longer and usually marry older men, they are much more likely to care for their aged and ill spouses. Society exerts tremendous pressure on women to fulfill her Natural nurturing roleand women, in turn, may not be aware of the price they may be paying. Elderly care-giving spouses may be suffering from chronic or acute health problems. Advanced in years themselves, they are taxed by physical demands such as feeding, toileting, bathing and waiting on the patient plus household responsibilities. The demands and stress can effect their physical health and mental well-being.
This poignant quote by an elderly care-giving wife illustrates an important point. Even in my worst dreams, I could never imagine that caring for my husband, a man whom I have loved and shared my life with for 39 years, could cause me to feel such anger and resentment.
There are socio-economic considerations in the assessment of neglect/abuse. There are large segments of our society that due to poverty, and the inaccessibility of modern medical care, have come to depend on and have faith in traditional remedies. In addition, lack of resources may also result in an over-reliance on over-the-counter medications, which may be given without reading the conditions of use. This can lead to serious consequences. Also, limited income can effect ability to obtain in-home paid care-giving assistance, which is not inexpensive. Contrary to popular belief, Medicare does not pay for custodial care (help with bathing, dressing, toileting, and eating) at home or in a Nursing Home. Unless one can financially qualify for a joint federal and state funded program for those with low incomes and limited resources, care-giving expenses would have to be paid out of pocket. These expenses are extremely burdensome, even for a middle-class family.
Issues of patient cooperation/compliance, self-abuse and mental status can give the impression of neglect/abuse. For example, a patient with dementia may refuse to discontinue self-abusive behavior, such as smoking (burning themselves with lighted cigarettes) and drinking (to the point of incapacity). They may display an uncooperative and combative nature. Abuse, in these cases may be self-inflicted.
Religious beliefs, for a great number of people, are effecting decisions as to the efficacy of, and necessity for, medical intervention in illness. There are a considerable number of movements in the United States that believe in the power of prayer and the ability of a healing ministry to cure. Whether one considers these beliefs valid or not, they are certainly a consideration in the determination of elder abuse for caregivers who fail to obtain medical intervention for their charges.
Finally, there has been a large influx of immigrants into the United States from many different nations with very different cultures. We must be aware of how culture determines our world view and what constitutes appropriate or even rational behavior. For example, many Southeast Asians, who live in the United States, may continue to rely on a Shaman, Priest or Sorcerer (Traditional Healer) because they better meet their emotional and psychological needs. The framework of illness is viewed as supernatural in nature, and proper rituals will be considered necessary for a cure. Traditional methods of healing may include the use of herbal remedies. These cultures also practice dermabrasion which is used to treat fever, chills, muscle-ache, headache, and symptoms of cold and respiratory infections. Techniques such as Coining”, Pinching”, and Cuppingproduce welts and superficial bruises that can easily be mistaken for signs of physical abuse. There may also be a reluctance to access health care providers, outside the cultural envelope, as they may be viewed with suspicion.
Culture will also have an impact on the incidence of elder abuse and the reporting of abuse. The more industrial and egalitarian the society, the less the aged are valued. Within a culture, like the United States, that celebrates youth, old age signifies a decline in status and in contribution to society. What is not valued, is more easily abused and discarded. Also, families that have immigrated to this country are under tremendous stress. Marginalization and exclusion may create grounds for a solidarity and bonding that would not necessarily exist in the home culture and country. Unwarranted loyalties and uncritical acceptance, in these cases, may decrease the tendency to report elder abuse.
The Adult Protective Service (APS) laws require mandatory reporting of suspected abuse of older persons by health and social service professionals. Mandatory reporting laws require disclosure of the abuse despite the wishes of the adult victim. Most states have resource hotlines through APS or Area Agencies on Aging. The victim must be at least 60 years
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