Understanding Elder Abuse

​Elder abuse is an “act of physical or mental maltreatment that threatens or causes harm to an elderly person whether by action or inaction. There are three categories of abuse (National center on Elder Abuse, 2011b; Sudbury Elder Abuse Committee, 2007):

1. Institutional elder abuse – occurs in the residential facility, and is perpetrated by paid caregivers, staff, and other healthcare professional. This form of abuse always takes the form of physical, sexual or financial abuse. The elderly living in institutions may 

experience subtle or covert abuse, which also includes actions such as, being harassed by staff, being controlled by drugs or restraints, having no control over-bathing or feeding times or what they wear, and being placed in isolation, especially if they are aggressive or difficult to care for.

1. Self-neglect - - is defined as “behavior of an elderly person that threatens his/her health or safety. This is not behavior in which a mentally competent person makes a conscious choice to engage in such acts that threaten his or her safety. Such behaviors may include, failure to take medication, inability to monitor or take care of personal affairs or self-destructive behaviors. The issue of self-neglect presents an ethical dilemma for health workers since they must find a balance between the rights of the older adult to be independent and exercise freedom of choice and the needs of the individual and the community
2. Domestic elder abuse – This type of abuse involves the maltreatment of an older person by someone who has a unique relationship to the elder. This relationship includes spouses, children, friends or caregivers. This type of abuse can include; physical abuse, Neglect, abandonment. Emotional or psychological abuse, financial or fiduciary abuse and sexual abuse.

Older adults today are vibrant, independent and living longer, and in better health than their ancestors. However, as the population grows, so does issues that concern their care. Caregivers must cope with the stressful economic and personal burdens when caring for the elderly. This burdens always put the elderly at risk of abuse, exploitation, and neglect.
Consider the following grim statistic;
(Acierno et al. 2010; American Psychological Association (APA), 2012; Grose & Caple, 2011; National Center for Victims of Crime, 2011; National Center for Elder Abuse, 2011a; Walsh, Olson, Ploeg, Lohfeld, & MacMillan, 2011)

1. An estimate that up to 9% (2-5Million people) annually are victims of various forms of elder abuse. Authorities report that only 1 in 4 cases are reported.
2. Almost 50% of the nonlethal violence takes against the elderly takes place inside or close to the home.
3. Majority of the elder abuse victims are women.
4. Disabilities such as depression, Dementia, and physical or mental disabilities are risk factors for elder abuse. Older adults with disabilities are less likely to report abuse, fear that they will not be believed, and they are often unable to resist their abuser.
5. Divorced or separated elderly6 persons have higher rates of abuse than those who are married or widowed.
6. Neglect is the most common form of elder maltreatment in a domestic setting, representing over 47% of the cases reported. Physical abuse accounts for 14.6% and financial abuse represents 12.3% of the cases reported.
7. More than 66 % of the victims are white, while approximately 18.7% are black. Hispanics account for 10
8. 5 of elder abuse victims, while the proportion of Native Americans and Asian
9. Americans are each less than 1 %.
10. There is no significant difference between the number of male vs. female perpetrators. Adult children and spouses, not paid caregivers, are the most frequent abusers.
11. Most elder abuse does not take place in the nursing home – it takes place at home.

Detecting abuse.
Since abused elderly individuals are often reluctant to report abuse, the incidences of abuse are likely to be under-reported, underestimated and not well documented. However, there are signs that may indicate neglect or abuse. These include;

1. Injuries
2. Weight loss
3. Depression,
4. Change in appetite.

In assessing an older adult for symptoms of abuse, it is also important to examine the relationship between the elder and the caregiver.

1. Do they chat and laugh with each other or sit in silence?
2. What tone of voice does the caregiver use with the elder? Is it harsh or soft?
3. Is the caregiver’s touch gentle or rough, or does the caregiver not touch the elder at all?
4. Does the caregiver overreact to any physical findings of the elder?
5. Is the client, family member, or caretaker uncooperative or doubtful that abuse occurred?

Acting against elder abuse.
Whenever abuse is detected, it is critical that the finder documents every finding, and make the necessary reporting to the relevant authorities. In most states, most physical abuse, sexual and financial abuses are criminal offenses.
Secondly, elder education is central in helping the elderly retain as much power over their lives as possible. The elderly must be educated in their rights to receive protective services in the least restrictive environment. They must retain the right to choose and the right to remain confidential.
Thirdly, health care providers must receive continued training, especially in the areas of seeking alternatives to the choices the elder person may resent. For example, the alternative to taking a shower may be a bath or changing the times the bath or showers are due.
Fourthly, clinical settings such as hospitals and physician offices should have a protocol for the detection and assessment of the elder mistreatment. Protocols should include a narrative, checklist or standardized forms that allow rapid screening and provide guidelines for documentation that withstand scrutiny in court.
Fifthly, family education and support is an essential factor in reducing elder abuse. Providing caregivers with respite care promotes increased social contact, providing support for families with dependent adults and encouraging counseling and treatment to cope with personal, financial and family problems that contribute to abuse are positive steps that can prevent abuse. Educating the family about understanding their health care reimbursement choices, investigating the services of community organizations and researching volunteer groups who may be able to help them can greatly ease their stress and concerns.
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Ibrahim Mabwa
 Angels of Central Alabama
Home care