Use of a single page elder abuse assessment and management tool: a practical clinician's approach to identifying elder mistreatment

Elder abuse is a growing, alarming public health issue. As health care professionals, our challenge is to balance our duty to protect the safety of the vulnerable elder with the elder's right to self-determination. Clinicians in busy practice settings across the continuum of care as well as community-based social workers, emergency medical system, police, and banking personnel are collaborative partners needing tools that focus on early recognition, assessment, intervention, and management of elder abuse. A simple one-page tool that provides principles of assessment and management, best practice guidelines and screening questions will hopefully serve to raise awareness of this important public health issue and maintain a high index of suspicion for elder abuse, neglect and financial exploitation.     

Hearing the Voices of Abused Older Women

Summary

This paper focuses on a qualitative research process that gathered responses from 64 older women aged fifty and older on their experience of violence and abuse. What older women said about abuse in their lives supports the use of a feminist framework as well as the age based analysis of the elder abuse field. Some respondents spoke of abuse from childhood into their later years. Some spoke of partners witnessing or experiencing abuse as children. Some women express concern about possible abuse by their adult children of their own children.

Abused older women like younger women need a safe environment, emotional support, advocacy, information, and peer support. While it is important to consider the perspectives and knowledge of service providers when developing policy and practice on abuse of older women, it is critical to ask the women survivors of abuse or neglect what they believe would benefit them, and others in similar situations.     

Psycho-educational support groups for older women victims of family mistreatment: a pilot study

Few programs for domestic violence victims have been evaluated for effectiveness. This gap is even more pronounced for elder abuse service interventions. The study presented here is intended to address this gap by using an experimental research design to evaluate outcomes of an elder mistreatment psycho-social support group pilot for cognitively unimpaired older female victims of mistreatment by family members and significant others for whom they are providing care or support. The support group model used for the study adapts amodel designed by NOVA House, an elder abuse shelter program in Manitoba, Canada. The study was funded by the Hartford Foundation Geriatric Social Work Faculty Scholars Program. While the significance of study findings is limited by the small number of pilot participants, the model intervention and evaluation instrument developed for the study may be utilized for study replication.     

An Elder Abuse Case Study

Abstract

This article explores elder abuse from the perspective of caregiver stress and domestic violence theories. The author proposes that the theory of caregiver stress has shaped the elder abuse laws and the practice field, raising some important questions for examination. The need for policymakers and practitioners to evaluate their applied theory(ies) so they may better advocate for needed changes in policies and laws is examined by using a case example. In conclusion, the author suggests that the elder abuse protection field must consider the underutilized concepts of domestic violence theory for policy development, case assessments, and intervention strategies.     

Self-Neglect and Neglect of Vulnerable Older Adults: Reexamination of Etiology

Using assessment and investigation data from the reported APS cases in Texas, this study examines the types of elder self-neglect and neglect, including medical neglect. It then examines the association between self-neglect and neglect and individual economic resources as well as health care and social service programs for the poor. The findings show that elder self-neglect/neglect is, in large part, attributable to frail older adults' and their families' lack of resources to pay for essential goods and services and the inadequate healthcare and other formal support programs for the older adults and their caregivers. This inadequate public policy coverage, rather than individual and intrafamily risk factors per se, needs to be considered as a significant cause of elder self-neglect/neglect.     

Hearing the voices of abused older women

This paper focuses on a qualitative research process that gathered responses from 64 older women aged fifty and older on their experience of violence and abuse. What older women said about abuse in their lives supports the use of a feminist framework as well as the age based analysis of the elder abuse field. Some respondents spoke of abuse from childhood into their later years. Some spoke of partners witnessing or experiencing abuse as children. Some women express concern about possible abuse by their adult children of their own children. Abused older women like younger women need a safe environment, emotional support, advocacy, information, and peer support. While it is important to consider the perspectives and knowledge of service providers when developing policy and practice on abuse of older women, it is critical to ask the women survivors of abuse or neglect what they believe would benefit them, and others in similar situations.     

Elder abuse and neglect among veterans in Greater Los Angeles: prevalence, types, and intervention outcomes

This study examined the prevalence, types, and intervention outcomes of elder abuse/neglect among a veteran population. A review of medical records of 575 veterans who had received services from the Veteran's Affairs Geriatric Outpatient Clinic in Los Angeles during a three-year period found 31 veterans (5.4%) who had an elder abuse report filed on their behalf. Prevalence of elder abuse/neglect was higher among older (80+) and Caucasian and African American veterans. Eight of 31 victims suffered from more than one type of elder abuse including self-neglect. Financial abuse and self-neglect were the most commonly reported types. Family members were perpetrators in the majority of the cases, excluding self-neglect. However, three-quarters of financial abuse cases were committed by non-family members. Almost one-half of the victims had dementia and eight were clinically depressed. The most common intervention was to move victims from their unsafe home into a nursing home or board and care facility, followed by conservatorship arrangement. These interventions were most frequently used for victims with dementia, and conservatorship was often arranged with another type of intervention, such as a move to a nursing home. Victims who remained at home received conservatorship or outside supportive services or a combination of both. This study calls for more comprehensive and systematic research on elder abuse/neglect at multi-settings in order to generate useful information for prevention and detection of, and effective intervention in elder abuse and neglect in the veteran population.     

Social inclusion: an interplay of the determinants of health - new insights into elder abuse

Social and economic exclusion and inclusion are receiving growing attention and study in North America for their usefulness as a conceptual framework that addresses the many dimensions of poverty and inequality in our society. A discussion of social and economic exclusion/ inclusion flows naturally out of the population health field in which the social determinants of health have become well-established over the last twenty years or more. The determinants of health provide a broad and inclusive outline within which to situate prevention, early detection and effective intervention of the abuse of older persons. A Social Inclusion Lens offers exciting possibilities for addressing the issue of elder abuse and neglect.     

Contextualising the ‘Crisis in Aged Care’ in Australia : A Demographic Perspective

Australia's ‘old‐old’ population is growing even faster than the total aged population and despite improved incomes, living conditions, health risk behaviours and health care this will result in a concomitant increase in the numbers of older people with disabilities. This paper examines ABS 2003 survey data on the incidence of disability among older Australians and their need for, and utilisation of, formal and informal care. It uses this as a basis for projecting the incidence of disability among older Australians and the need for informal and formal care up to 2031. These indicate there is a major challenge since the aged care workforce has grown only slowly in Australia and is concentrated in the older working ages presaging a loss of workers through retirement. There needs to be a significant effort put into attracting workers to both the skilled and unskilled parts of the aged care industry.     

Elder Abuse in Turkey and Associated Risk Factors

Abstract

Elder abuse is one of the most important problems encountered by the elderly. Health, economical and psychological dimensions of the experience of aging also pose risk for elder abuse. This study aims to determine the abuse to which elder people are exposed based upon their own evaluations and to investigate the risk factors associated with elder abuse. This is a cross-sectional study among quantitative designs. Population of the study comprises 309 outpatient elders over the age of 65 referring to Ayd?n Do?an Geriatrics Clinic of Ankara University, Turkey. Collected data were analyzed by chi-square test and logistic regression. In total, 70.9% of the elderly participating in this study experienced abuse more than once. Majority of the participants were victims of emotional abuse (64.1%), followed by neglect and abandonment (26.9%) and economic abuse (12.6%). There was significant relation between sex, marital status, health status of the elderly and being abused (p?p?相似文献   

“A game of two halves?” Understanding the process and outcomes of English care home closures: Qualitative and quantitative perspectives

With care services increasingly delivered via a market there is always a risk that care homes could fail financially or struggle in terms of quality, ultimately having to close. When this happens, the received wisdom is that subsequent relocation can be detrimental to the health and well‐being of older residents (possibly even culminating in increased mortality). However, there is very little formal evidence in the United Kingdom (UK) or beyond to guide policymakers and local leaders when undertaking such sensitive work. Against this background, this article reports findings from an independent evaluation of what is believed to be the largest care home closure program in the UK (and possibly beyond). This consisted of qualitative interviews with older people, families, care staff, and social work assessors during the closure process in one case study care home and one linked day center, as well as self‐reported health and quality of life data for older people from 13 homes/linked day centers at initial assessment, 28 days after moving and at 12‐month follow up. The study is significant in presenting public data about such a contested topic from such a large‐scale closure process, in its focus on both process and outcomes, in its mixed‐methods approach, and in its engagement with older people, families, and care staff alongside the use of more formal outcome measures. Despite significant distress part‐way through the process, the article suggests that outcomes either stayed the same or improved for most of our sample up to a year after moving to new services. Care homes closures may thus be a “tale of two halves”, with inevitable distress during the closure but, if done well, with scope for improved outcomes for some people in the longer term. These findings are crucial for current policy and practice given that the risk of major closures seems to be growing and given that there is virtually no prior research on which to base local or national closure processes. While some of this research is specific to England, the underlying issue of care home closures and lessons learned around good practice will also apply to other countries.     

Broadening constructions of family violence: mothers' perspectives of aggression from their children

This qualitative study used feminist insights to explore experiential aspects of the phenomenon of child‐to‐mother violence from the perspectives of six women survivors. Participants took part in conversational style audiotaped interviews lasting between two and four hours. Feminist analysis revealed that fear and violence had become a feature of mothering for these women. Three themes were identified: It was only a matter of time: feeling intimidated and under threat; He just punched me: physical violence from child to mother; and Other men in the house: violence directed to the mothers by friends and associates of their children. Currently the literature overwhelmingly constructs family violence as elder abuse, spousal/partner violence, or child abuse, and generally fails to acknowledge, or address, violence from children to parents. However, findings from this study suggest that the discourse about family violence needs to be broadened to include child‐to‐mother violence. Implications of this study for practice and research are discussed.     

Self-determination and elder abuse do we know enough?

This article explores the principle of self-determination as it relates to victims of elder abuse and neglect. Using newspaper accounts and cases from the author's practice and consulting files, various factors influencing the professional's interpretation of this principle are explored. The notion that self-determination allows victims of abuse and neglect to refuse intervention is challenged. The author concludes that the principle of self-determination and the notion of competency are overly simplified in the social work and elder abuse literature and may be misused by allowing abused older victims to choose to remain in often life-threatening situations. Special focus is given to Adult Protection Service worker, but the author asserts that protecting older people, assisting in creative interventions and developing needed services is a shared professional responsibility.     

For the Sake of their Health: Older Service Users' Requirements for Social Care to Facilitate Access to Social Networks Following Hospital Discharge

Facilitating older service users’ requirements for accessto or re-engagement in social networks following hospital dischargeis recognized in social care analysis and policy as criticallyimportant. This is because of the associated benefits for restoringphysical health and psychological well-being. However, it tendsto be a neglected dimension of current social care/intermediatecare. Our paper draws on a qualitative study of voluntary sectorhospital aftercare social rehabilitation projects in five UKlocalities, which focused on addressing this issue. Throughexamining older service users’ feedback and experience,our study confirms the health benefits of social care facilitatingaccess to social networks at this crucial juncture. By providingsensitive interpersonal interaction, advocacy and ‘educational’assistance, social care workers supported older service users’re-engagement in a variety of networks. These included friendship,recreational and family groups, health care treatment programmesand locality based contacts and organizations. As a result,material, interpersonal and health care resources were accessed,which contributed to restoring and sustaining physical healthand psychological well-being. The process of such social carealso emerged as critical. This included ensuring that objectivesreflected service users’ priorities; integrating ‘low-level’home care; offering befriending; and challenging the pre-settime frame of intermediate care.     

Trauma and the effects of violence exposure and abuse on children: A review of the literature

A number of studies examining violence exposure in the passeveral years have been successful in linking physical abuse, sexual abuse, domestic violence, and community violence exposure to a wide variety of physiological, emotional, and behavioral problems manifested in short‐term, mid‐term, and long‐term effects. The literature on the effects of physical and sexual abuse is older than the research on children's exposure to domestic violence, which is a decade older than the research on the effects of community violence exposure on children. Despite the differences between the types of violence to which children are exposed, there are significantly similar findings, which point to a link between violence exposure and traumatization.     

A Definitional Discussion of Elder Maltreatment

Currently, there is no one uniform accepted or acceptable definition of elder maltreatment. As an important first step in the continued understanding of elder maltreatment, a differentiation is made between legal and social work definitions and a classification system for defining elder maltreatment from a social work orientation is suggested as a guide for assessment and intervention. Distinctions within each of three major categories of elder maltreatment (elder neglect, elder abuse and violation of the elder's rights) is presented.     

Implementing the Power to Kids programme in home-based (foster) care: Identifying the SAFETY approach

Sexual abuse and dating violence are chronic problems for children and young people in out-of-home care. This study explored the impact of a prevention and response programme Power to Kids, which targets harmful sexual behaviour (HSB), child sexual exploitation (CSE) and dating violence (DV) for children and young people in home-based (foster) care. Twenty-eight case managers, 25 foster carers and 13 children and young people participated in a mixed methods study in Victoria, Australia informed by the research question: How does the Power to Kids programme impact the sexual health and safety of children and young people in home-based (foster) care? The data analysis revealed a SAFETY approach whereby the sexual health and safety knowledge of carers and case managers was enhanced, and carers were given permission to have Brave Conversations with children and young people, who could then apply the new knowledge to their lives. Case managers were upskilled in identifying indicators of sexual abuse and empowered to escalate stalled therapeutic and disruption practice when children and young people were identified as experiencing HSB, CSE or DV.     

Victimization of Juveniles in Out-of-Home Placement: Juvenile Correctional Facilities

The purpose of this study was to draw a picture of the violenceand abuse experienced by youngsters in juvenile correctionalfacilities in Israel. Residents of three types of correctionalfacilities (closed, diagnostic and hostels) for girls and boysindicated whether or not they had personal experiences of eighttypes of victimization by peers and four types of victimizationby staff. The findings showed that all the investigated typesof violence and abuse were present in all three types of correctionalfacilities, though ‘low-level’ acts of violencewere more prevalent than ‘severe’ violence. At thesame time, the findings also pointed to a different pictureof violence and abuse in each type of facility and for eachgender. The findings highlighted the problem of violence andabuse by peers and staff in correctional facilities for juveniles.At the same time, the differential pictures obtained suggestedthat intervention programmes must have both a general componentand a component tailored to the facilities in which they arecarried out.     

Examining the Relationship between Domestic Violence and Depression among Koreans: The Role of Self‐esteem and Social Support as Mediators

Domestic violence is a prevalent social issue in Korea affecting a significant number of people every day. It is thus important to examine how the experience of domestic violence affects their mental health to better address their needs. Using stress‐coping theory as a theoretical framework, this study examines the domestic violence and depression relationship among Korean men and women. Two aspects of self‐esteem and informal and formal social support are examined as potential mediators of this relationship. The data was the first wave of Korean Welfare Panel Study data including 2477 individuals with experiences of abuse. Structural equation modeling procedures were used for analyses. Domestic violence was significantly associated with self‐worth, self‐deprecation, and depression. The experiences of violence eroded self‐worth while reinforcing self‐deprecation and those with more exposure to violence showed a higher level of depression. Self‐deprecation played a significant role in mediating the effect of domestic violence on depression. However, different findings were yielded for social support. While informal social support was significantly associated with domestic violence, formal social support was not associated with domestic violence. Findings suggest for mental health interventions targeting self‐esteem, particularly the diminution of self‐deprecation in working with the victims. Suggestions for future research and implications for social work are also discussed.