Elder Abuse

Elder Abuse

Introduction
Every person-every man, woman, and child-deserves to be treated with respect and with caring.
Every person-no matter how young or how old-deserves to be safe from
harm by those who live with them, care for them, or come in day-to-day
contact with them.
Older people today are more visible, more active, and more independent
than ever before. They are living longer and in better health. But as
the population of older Americans grows, so does the hidden problem of
elder abuse, exploitation, and neglect.

Definition
Elder abuse is the infliction of physical, emotional, or psychological
harm on an older adult. Elder abuse also can take the form of financial
exploitation or intentional or unintentional neglect of an older adult
by the caregiver

The US National Academy of Sciences defines elder abuse as follows:

• Intentional actions that cause harm or create a serious risk of harm
(whether or not harm is intended), to a vulnerable elder by a caregiver
or other person who stands in a trusted relationship to the elder
• Failure by a caregiver to satisfy the elder's basic needs or to protect the elder from harm.

Categories of elderly abuse
• Physical abuse - Any act of violence that causes pain, injury,
impairment, or disease, including striking, pushing, force-feeding, and
improper use of physical restraints or medication
• Psychological or emotional abuse - Conduct that causes mental anguish
including threats, verbal or nonverbal insults, isolation, and
humiliation. Some legal definitions require identification of at least
10 episodes of this type of behavior within a single year to constitute
abuse.
• Financial abuse - Misuse of an elderly person's money or assets for
personal gain. Acts such as stealing (money, social security checks,
possessions) or coercion (changing a will, assuming power of attorney)
constitute financial abuse.
• Neglect - Failure of a caretaker to provide for the patient's basic
needs. As in the previous examples of abuse, neglect can be physical,
emotional, or financial. Physical neglect is failure to provide
eyeglasses or dentures, preventive health care, safety precautions, or
hygiene. Emotional neglect includes failure to provide social
stimulation (leaving an older person alone for extended periods).
Financial neglect involves failure to use the resources available to
restore or maintain the well-being of the aging adult.
• Sexual abuse - Nonconsensual intimate contact or exposure or any
similar activity when the patient is incapable of giving consent.
Family members, friends, institutional employees, and fellow patients
can commit sexual abuse.
• Self-neglect - Behavior in which seniors compromise their own health
and safety, as when an aging adult refuses needed help with various
daily activities. When the patient is deemed competent, many ethical
questions arise regarding the patient's right of autonomy and the
physician's oath of beneficence.
• The miscellaneous category includes all other types of abuse,
including violation of personal rights (failing to respect the aging
person's dignity and autonomy), medical abuse, and abandonment.

Signs and symptoms :
Physical Abuse
• Bruises or grip marks around the arms or neck
• Rope marks or welts on the wrists and/or ankles
• Repeated unexplained injuries
• Dismissive attitude or statements about injuries
• Refusal to go to same emergency department for repeated injuries
Emotional/Psychological Abuse
• Uncommunicative and unresponsive
• Unreasonably fearful or suspicious
• Lack of interest in social contacts
• Chronic physical or psychiatric health problems
• Evasiveness
Sexual Abuse
• Unexplained vaginal or anal bleeding
• Torn or bloody underwear
• Bruised breasts
• Venereal diseases or vaginal infections
Financial Abuse or Exploitation
• Life circumstances don’t match with the size of the estate
• Large withdrawals from bank accounts, switching accounts, unusual ATM activity
• Signatures on checks don’t match elder’s signature
Neglect
• Sunken eyes or loss of weight
• Extreme thirst
• Bed sores

Causes and risk factors
There is no one explanation for elder abuse and neglect. Elder abuse is
a complex problem that can emerge from several different causes, and
that often has roots in multiple factors. These factors include family
situations, caregiver issues, and cultural issues.
Many theories have been developed to explain abusive behavior toward
elderly people. Clearly, no single answer exists to explain behavior in
an abusive relationship. A number of psychosocial and cultural factors
are involved.
Theories of the origin of mistreatment of elders have been divided into
4 major categories, as follows: physical and mental impairment of the
patient, caregiver stress, transgenerational violence, and
psychopathology in the abuser.
• Physical and mental impairment of the patient
o Recent studies have failed to show direct correlation between patient
frailty and abuse, even though it had been assumed that frailty itself
was a risk factor for abuse.
o Physical and mental impairment nevertheless appear to play an
indirect role in elder abuse, decreasing seniors' ability to defend
themselves or to escape, thus increasing vulnerability.
• Caregiver stress
o This theory suggests that elder abuse is caused by the stress
associated with caring for an elderly patient, compounded by stresses
from the outside world.
o The effect of stress factors (eg, alcohol or drug abuse, potential
for injury from falls, incontinence, elderly persons' violent verbal
behavior, employment problems, low income on the part of the abuser)
may all culminate in caregivers' expressions of anger or antagonism
toward the elderly person, resulting in violence.
o This theory, however, does not explain how individuals in identically
stressful situations manage without abusing seniors in their care.
Stress should be seen more as a trigger for abuse than as a cause.
• Transgenerational violence: This theory asserts that family violence
is a learned behavior that is passed down from generation to
generation. Thus, the child who was once abused by the parent continues
the cycle of violence when both are older.
• Psychopathology in the abuser: This theory focuses on a psychological
deficiency in the development of the abuser. Drug and alcohol
addiction, personality disorders, mental retardation, dementia, and
other conditions can increase the likelihood of elder abuse. In fact,
family members with such conditions are most likely to be primary
caretakers for elderly relatives because they are the individuals
typically at home due to lack of employment.
• Other risk factors in abuse are (1) shared living arrangements
between the elder person and the abuser, (2) dependence of the abuser
on the victim, and (3) social isolation of the elder person

Prevention
The first and most important step toward preventing elder abuse is to
recognize that no one-of whatever age-should be subjected to violent,
abusive, humiliating, or neglectful behavior. In addition to promoting
this social attitude, positive steps include educating people about
elder abuse, increasing the availability of respite care, promoting
increased social contact and support for families with dependent older
adults, and encouraging counseling and treatment to cope with personal
and family problems that contribute to abuse. Violence, abuse, and
neglect toward elders are signs that the people involved need
help-immediately.
Education is the cornerstone of preventing elder abuse. Media coverage
of abuse in nursing homes has made the public knowledgeable about-and
outraged against-abusive treatment in those settings. Because most
abuse occurs in the home by family members or caregivers, there needs
to be a concerted effort to educate the public about the special needs
and problems of the elderly and about the risk factors for abuse.
Respite care-having someone else care for the elder, even for a few
hours each week-is essential in reducing caregiver stress, a major
contributing factor in elder abuse. Every caregiver needs time alone,
free from the worry and responsibility of looking after someone else’s
needs.
Respite care is especially important for caregivers of people
suffering from Alzheimer’s or other forms of dementia or of elders who
are severely disabled.
Social contact and support can be a boon to the elderly and to the
family members and caregivers as well. When other people are part of
the social circle, tensions are less likely to reach unmanageable
levels. Having other people to talk to is an important part of
relieving tensions. Many times, families in similar circumstances can
band together to share solutions and provide informal respite for each
other. In addition, when there is a larger social circle, abuse is less
likely to go unnoticed. Isolation of elders increases the probability
of abuse, and it may even be a sign that abuse is occurring. Sometimes
abusers will threaten to keep people away from the older person.
Counseling for behavioral or personal problems in the family can play a
significant role in helping people change lifelong patterns of behavior
or find solutions to problems emerging from current stresses. If there
is a substance abuse problem in the family, treatment is the first step
in preventing violence against the older family member. In some
instances, it may be in the best interest of the older person to move
him or her to a different, safer setting. In some cases, a nursing home
might be preferable to living with children who are not equipped
emotionally or physically to handle the responsibility. Even in
situations where it is difficult to tell whether abuse has really
occurred, counseling can be helpful in alleviating stress

Special Concerns
• Barriers to recognizing and reporting elder abuse also must be
addressed. The lack of uniform definitions has been a major obstacle.
Conceptual problems in defining elder abuse have hampered clinical,
educational, and research efforts.
• Various factors serve as barriers to reporting elder abuse. These
include lack of knowledge, denial, ageism, fear of making the situation
worse, desire to maintain family relationships, fear of ending up in
court, or lack of belief that the situation will improve. The key to
eradicating these barriers is education that increases both public and
professional awareness.
• Increasing awareness is considered instrumental in the prevention of
elder abuse. Services for seniors, such as meals on wheels, home health
care, homemaker, and chore services, are thought to aid in abuse
prevention, although preventing elder abuse needs further study

Conclusion

Through all of the requirements and guidelines already provided by the
law and through the individual nursing homes policies it would seem as
though the issue of elderly abuse would be seriously limited. But as in
any other instance individuals and companies do not always follow the
law and/or negligently or willfully violate it therefore elder abuse
remains a prevalent issue within the nursing home setting and society.

References
• http://www.usd.edu
• http://www.apa.org
• http://www.emedicine.com

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