Disability and abuse in relation to substance abuse: a descriptive analysis

This analysis reviewed five years of a state's substance abuse treatment admissions and discharges in order to identify specific patterns among persons who had a disability. Using a series of group comparisons, Chi-squares, and logistic regressions, specific patterns of violence and abuse to this population were identified. Results indicate that persons who had a disability and abused substances were more likely to be victimized by physical abuse and domestic violence when compared with their peers without a disability. A person with a disability had about one-half to one-third the odds of receiving long-term residential, short-term residential and intensive outpatient care when compared with persons without a disability.     

The Emerging Problems of Alcohol and Substance Abuse in Late Life

Treatment of substance abuse among older adults will become increasingly important as the number of aged Americans increases. The abuse of psychoactive substances is a major contributor to excess morbidity, mortality, and homelessness among persons of all ages and socioeconomic strata regardless of race or ethnicity. Alcohol and tobacco account for the majority of substance abuse-related death and disability in the United States; the former through cerebrovascular and hepatic disease, accidents and violence, the latter through chronic pulmonary disease and malignancy. Patterns of substance abuse in late life are substantially different from those observed among younger adults. However, treatment may be less challenging. Effective diagnosis and treatment requires a nonpunitive, supportive, but persistent approach. This means the capacity to collect a substance intake history and the ability to formulate a treatment plan or referral strategy to an addiction specialist or residential treatment setting. It is also important for the practitioner to manage negative feelings toward patients who decline treatment or who are chronic abusers.     

The Emerging Problems of Alcohol and Substance Abuse in Late Life

Treatment of substance abuse among older adults will become increasingly important as the number of aged Americans increases. The abuse of psychoactive substances is a major contributor to excess morbidity, mortality, and homelessness among persons of all ages and socioeconomic strata regardless of race or ethnicity. Alcohol and tobacco accountfor the majority of substance abuse-related death and disability in the United States; the former through cerebrovascular and hepatic disease, accidents and violence, the latter through chronic pulmonary disease and malignancy. Patterns of substance abuse in late life are substantially different from those observed among younger adults. However, treatment may be less challenging. Effective diagnosis and treatment requires a nonpunitive, supportive, but persistent approach. This means the capacity to collect a substance intake history and the ability to formulate a treatment plan or referral strategy to an addiction specialist or residential treatment setting. It is also important for the practitioner to manage negative feelings toward patients who decline treatment or who are chronic abusers.     

Russian Perspectives on Elder Abuse: An Exploratory Study

ABSTRACT

The purpose of this exploratory study was to analyze Russian perceptions of elder abuse as reflected in their examples of abusive behavior from an adult child to an aging parent. Also of interest was the possibility of gender differences in the Russian perspectives on elder abuse. The convenience sample consisted of 21 Russian participants (10 males, 10 females, and one without gender identified), who provided examples of extreme, moderate, and mild abuse from an adult child towards an aging parent. Most examples of extreme abuse were forms of physical violence. Typical examples of moderate abuse were instances of psychological aggression–particularly verbal aggression–and neglect. The most common examples of mild abuse were verbal aggression and neglect. One-way analyses of variance revealed statistically significant gender differences in the number of references to psychological aggression in general and to verbal aggression in particular in the examples of moderate abuse, with females giving more examples than males.     

Letter From the Editors

ABSTRACT

In this article we explore older persons’ definitions of and explanations for elder abuse in the Netherlands by means of interviews with older persons. A qualitative study was conducted based on semistructured interviews with 35 older persons who had no experience with abuse. Our findings show that older persons participating in our study define elder abuse foremost as physical violence that is performed intentionally. The study participants explain elder abuse as a result of the dependency and vulnerability of older persons, of changing norms and values, and of changes in the position of older persons in society, which result in disrespect toward older persons and a lack of social control and responsibility. The older persons’ explanations for the occurrence of abuse mainly focus on societal changes; older persons seem to regard elder abuse primarily as a societal problem. This understanding of, and explanation for, elder abuse may influence their detection and reporting behavior, as they may tend to acknowledge only severe cases of intentional physical violence that leave clear and therefore physically detectable evidence.     

Elder Abuse in Residential Settings in Sweden

ABSTRACT

To investigate frequencies and types of elder abuse occurring in residential settings in two municipal areas of Sweden, nursing staff were asked to answer a questionnaire; 499 responded. The findings indicated that elder abuse involving the staff did occur. Eleven percent of the staff knew of situations of elder abuse and two percent admitted that they themselves had been abusive towards an elderly resident. Psychological and physical abuse related to caring activities were most common. In the specific situations reported, the abusers were mostly characterised as hot-tempered, exhausted, and burned out. The abused people were often mentally and/or physically handicapped and generally over 80 years old. Feelings such as powerlessness, anger towards the abuser, and compassion for the abused person were reported. To cope with the situation, they talked to each other or to the manager. They recommended more education and support as the main preventive strategy.     

Intimate Partner Abuse of Older Men: Considerations for the Assessment of Risk

SUMMARY

Intimate partner abuse among older persons, though less common than among the general population, is a significant concern. Drawing from the intimate partner abuse and elder abuse literatures, this paper presents considerations for the assessment of risk for intimate partner abuse perpetrated against older men, with reference to the prevalent gendered view of abuse between intimate partners. Potential victim and perpetrator risk factors specific to this context are discussed and existing risk assessment tools are introduced. Implications and future research directions are discussed with regard to the application of risk assessment technology to this context.     

Cocaine Abusing Women Who Report Sexual Abuse: Implications for Treatment

ABSTRACT

Four hundred seventy-three substance-abusing women were assessed for histories of sexual abuse. The results of bivariate analysis indicated that Sexual Abuse Survivors (SAS) had higher levels of depression, anxiety, and psychological distress. A greater number of SAS reported histories of emotional and physical abuse. They also had greater severity on ASI scales of alcohol, drug, medical, and family/social difficulty. Logistic regression analysis indicated that women who were survivors of sexual abuse were more likely to have histories of emotional and physical abuse, higher levels of addiction severity, and more family members who used drugs. Implications for research and treatment are discussed.     

Statute Definitions of Elder Abuse

ABSTRACT

Older women victims of violence by a partner or family member are more often categorized as victims of elder abuse, not victims of family violence. Their needs are assessed, if at all, by social and health service agencies, often with little knowledge or understanding of domestic violence, while domestic violence policy initiatives, advocacy, and services focus on younger women and children. A survey of domestic violence services in British Columbia and the Yukon found that women over 60 years of age were a very small fraction, generally less than two percent, of women served, and those 50 to 59 years of age were also substantially under-represented. Only four percent of respondents had special services for older women. Comments from respondents confirm that abused older women face enormous difficulties in trying to establish a safe and secure future. It was also evident that better interaction is needed between those providing support and advocacy for abused women, and those who provide health and social services for older persons. A majority of the shelters provided community education to a wide range of agencies. Most have only partial accessibility to women with mobility handicaps.     

Elder Abuse in the United Kingdom

ABSTRACT

In recent years there has been an increased emphasis on violence and abuse within society generally. Following a focus in the United Kingdom (UK) on child abuse in the 1970s and domestic violence in the 1980s, in the 1990s the abuse and neglect of older people began to elicit concern. The initial focus of interest was of situations arising in the domestic setting. More recently, however, much needed attention has shifted to situations involving institutional settings. This paper will discuss abuse and neglect occurring in the UK. It aims to provide a brief overview of the status of current knowledge concerning abuse of older people followed by a discussion of some of the issues relating to the prevention of abuse and neglect from a UK perspective. An exploration of some of the issues involved will contribute to our understanding of abuse and neglect of older people in the UK.     

Searching for Elder Abuse: A Systematic Review of Database Citations

ABSTRACT

The aim of this review was to describe trends and patterns in elder abuse literature and research. All citations in PUB MED, CINAHL, and PsycINFO databases located using the search term “elder abuse” were retrieved (3,059 citations) and 2,418 unique references were identified. Using manifest content analysis, non-research material (1,986 references) was sorted by type and research references (34 dissertations and 398 research articles) were categorized. Research article references most commonly: (1) investigated prevalence, typology, and definitions of elder abuse; (2) utilized quantitative methodology; (3) had first author affiliations to medicine, nursing, and social sciences; and (4) sampled populations of professionals, personnel, cases, or charts. The USA was most frequently listed of 24 identified countries of origin. Elder abuse research shows lack of diversity, slow increase of qualitative research, limited involvement of older persons and family members as participants, and minimal research from developing countries. This review contributes to knowledge valuable for researchers and experts planning future studies or elder abuse projects.     

Parenting in Females Exposed to Intimate Partner Violence and Childhood Sexual Abuse

Child sexual abuse and intimate partner violence may have a significant impact on parenting. The current study expands on existing research by examining the effects of child sexual abuse and intimate partner violence on parenting styles and parenting self-efficacy. In women from a parenting intervention program (n?=?20), child sexual abuse was related to lower parenting self-efficacy and more permissive parenting. In women at a domestic violence shelter (n?=?45), child sexual abuse was related to current sexual coercion of the partner, and authoritative parenting was related to higher parenting self-efficacy. These results indicate that having a history of child sexual abuse should be taken into consideration when dealing with mothers in violent relationships.     

Visibility Blues: Gender Issues in Elder Abuse in Institutional Settings

ABSTRACT

This article argues that elder abuse in institutional as opposed to domestic settings remains invisible because institutions for elders are mainly all-female spaces where ageism and sexism converge and clients and workers are economically and socially disadvantaged. A general culture of violence that increasingly legitimates the everydayness of abuse and that conforms to dominant gender stereotypes refuses to investigate abuse of women by women. Research is needed into the different kinds of abuse committed in institutional settings by women. Staff and clients need to be enabled to report abuse and effective measures for combating it put in place.     

Healing from Childhood Sexual Abuse: A Theoretical Model

Childhood sexual abuse is a prevalent social and health care problem. The processes by which individuals heal from childhood sexual abuse are not clearly understood. The purpose of this study was to develop a theoretical model to describe how adults heal from childhood sexual abuse. Community recruitment for an ongoing broader project on sexual violence throughout the lifespan, referred to as the Sexual Violence Study, yielded a subsample of 48 women and 47 men who had experienced childhood sexual abuse. During semistructured, open-ended interviews, they were asked to describe their experiences with healing from childhood sexual abuse and other victimization throughout their lives. Constructivist grounded theory methods were used with these data to develop constructs and hypotheses about healing. For the Sexual Violence Study, frameworks were developed to describe the participants' life patterns, parenting experiences, disclosures about sexual violence, spirituality, and altruism. Several analytic techniques were used to synthesize the findings of these frameworks to develop an overarching theoretical model that describes healing from childhood sexual abuse. The model includes four stages of healing, five domains of functioning, and six enabling factors that facilitate movement from one stage to the next. The findings indicate that healing is a complex and dynamic trajectory. The model can be used to alert clinicians to a variety of processes and enabling factors that facilitate healing in several domains and to guide discussions on important issues related to healing from childhood sexual abuse.     

Holocaust Child Survivors and Child Sexual Abuse

ABSTRACT

This study utilized a qualitative analysis of child survivors of the Holocaust who were sexually abused during World War II. The research study aimed to give this specific group of survivors a voice and to explore the impact of multiple extreme traumas, the Holocaust and childhood sexual abuse, on the survivors. Twenty-two child survivors of the Holocaust who were sexually abused during the war completed open-ended interviews. The data was qualitatively analyzed according to Tutty, Rothery, and Grinnell's (1996) guidelines. Three major themes were found: issues relating to the sexual abuse trauma, survivors' perceptions of the abuse, and survivors' general perspectives towards life. The identity of the offenders, Jewish or non-Jewish, determined the survivors' feelings towards themselves, the perpetrators, and about the worth of life.     

Domestic Violence and Intergenerational Rates of Child Sexual Abuse: A Case Record Analysis

Using case review at a shelter for battered women and their children, this exploratory study investigated the association between physical abuse, exposure to domestic violence and intergenerational occurrence of child sexual abuse. The charts of 570 children were reviewed in an attempt to explore the relationship between the children's experiences with sexual abuse and their nonoffending parent's own history of having been sexually abused. Results indicated that a significant percentage of nonoffending parents who reported a history of child sexual abuse also had children who were sexually abused. Additionally, we found that most (93%) of the children studied had been exposed to domestic violence, and while the base rate of sexual abuse was relatively low (11%), the rate of physical abuse of the children was substantial (41%). Logistic regression results indicated that children of sexually abused nonoffending parents may be at heightened risk for sexual abuse. Implications for treatment and intervention are discussed.     

Factors Related to Prosecution of Child Sexual Abuse Cases

ABSTRACT

This study explored how various factors regarding the victim, offender, abuse situation, and case evidence were related to prosecution decisions in child sexual abuse cases. Data were collected from records of 200 closed child sexual abuse cases served at a southwestern United States agency during 1989–1990. Results indicated that cases involving recently reported abuse and offenders who were charged with abusing multiple child victims were significantly more likely to be prosecuted than cases involving less recently reported abuse and offenders charged with abusing only one victim, respectively. In terms of the victim-offender relationship, prosecution was most likely for cases with offenders who were strangers, next most likely for acquaintances and step and extended family members, and least likely for biological nuclear family members. Also, cases with medical evidence of abuse were more likely to be prosecuted than cases without medical evidence only when serious abuse was involved. In addition, prosecution was significantly less likely for cases with younger victims than for cases with older victims. Seriousness of abuse, the presence of medical evidence, and recency of abuse did not account for this victim age-prosecution status relationship. Furthermore, no cases involving possible custody disputes were prosecuted. Implications are discussed concerning the need for focused and integrated efforts in responding to allegations of child sexual abuse.     

Elder Abuse: Risk Factors and Use of Case Data to Improve Policy and Practice

ABSTRACT

Countering the generally reactive community approach to prevention and treatment of elder abuse, this study employs analysis of local elder abuse case data to estimate the incidence of elder abuse, neglect, and exploitation and to measure the risk factors, including co-location of other forms of abuse, that predict elder abuse in Miami-Dade County, Florida. The authors also compare the model of intervention used in Florida and elsewhere to best practice models that incorporate elements of domestic violence treatment models. They present a series of specific recommendations for improving local abuse data-collection, analysis, and training so that local policy makers, planners, and practitioners can make proactive, community-specific, culturally-sensitive preventive efforts effective. The findings and recommendations have direct relevance for policy and practice in any community in the United States.     

Psychological Abuse in Family Studies

Abstract

One of the first documented psychoeducational programs to educate college students about the perils of psychological abuse is described. The intervention was designed to help students examine their personal experiences of psychological abuse and consider how the information could be used in their careers. The process of creating the intervention and publicizing it to the campus community is discussed. The content of the intervention, participants, implementation, and evaluation processes are described. Operational definitions and dramatic skits of psychological abuse are described along with historical context and current research findings. Ways of working through psychological abuse, and services available to recover from it, are presented. Evaluation data, immediately after workshop completion and one week later, indicated that participants positively evaluated this intervention and reported both positive attitudinal and behavioral outcomes. Limitations and implications of this psychoeducational program for the prevention of interpersonal violence are discussed.     

Elder Abuse in Residential Settings in Israel—Myth or Reality?

ABSTRACT

The article tries to answer the question: Is elder abuse in residential care in Israel a myth or a reality? A broad definition of abuse was used, including the ‘classical’ forms presented in the literature, and also violation of rights and any act that infringes on quality of life of residents. As no data exist which directly explored this issue, the analysis was based on: recent laws mandating the report of abuse, governmental surveillance data, court cases, media clippings, and data from quality of life studies. Findings reveal that abuse in its ‘classical’ form exists only in a limited number of small private unlicensed facilities. However, when using the broader definition, abuse is a reality in many settings, exercised mainly by nurses' aides.