Elder Abuse in a Land of Tradition: The Case of Israel's Arabs

ABSTRACT

This study attempted to assess the scope and nature of elder abuse and neglect in one traditional group currently undergoing change: the Arabs in Israel. One hundred and twenty-eight human service and health professionals in northern Israel were asked to report about all cases of elder abuse and neglect they had encountered for a period of 18 months prior to the study. Findings showed that overall Arab elders in Israel have a 2.5% rate of abuse and neglect (excluding self neglect). This figure is somewhat lower than that reported in the literature for either developed or developing societies. Rates were higher in urban areas, somewhat lower in suburban areas, and lowest in isolated villages. These results lend some support to modernization theories of aging and elder abuse. The profile of the abused elder is not significantly different from that of his Western counterpart. Among alleged perpetrators, however, sons and daughters-in-law rank highest, reflecting cultural patterns in some traditional societies. The article makes some early recommendations in the area of worker training and service enhancement.     

Depression and elder abuse and neglect among a community-dwelling Chinese elderly population

Our recent survey of an elderly cohort in mainland China suggests that elder abuse and neglect are common. Unfortunately, there is minimal knowledge about the risk factors for elder abuse and neglect among this population. We aimed to examine depression as a risk factor for elder abuse and neglect among Chinese elderly. A cross-sectional study was performed in a major urban medical center in NanJing, China. Depression was assessed using the Geriatric Depression Scale and direct questions were asked regarding abuse and neglect experienced by the elderly since the age of 60; 412 patients completed the survey. The mean age of the participants was 70 and 34% were female. Depression was found in 12% of the participants and elder abuse and neglect was found in 35% of the participants. After multiple logistical regression, feeling of dissatisfaction with life (OR, 2.92; 95% CI, 1.51-5.68, p < 0.001), often being bored (OR, 2.91; CI, 1.53-5.55, p < 0.001), often feeling helpless (OR, 2.79; CI, 1.35-5.76, p < 0.001), and feeling worthless (OR, 2.16; CI, 1.10-4.22, p < 0.001) were associated with increased risk of elder abuse and neglect. Multiple logistic regression modeling showed that depression is independently associated with elder abuse and neglect (OR, 3.26; CI, 1.49-7.10, p < 0.003). These findings suggest that depression is a significant risk factor associated with elder abuse and neglect among Chinese elderly.     

Depression and Elder Abuse and Neglect Among a Community-Dwelling Chinese Elderly Population

ABSTRACT

Our recent survey of an elderly cohort in mainland China suggests that elder abuse and neglect are common. Unfortunately, there is minimal knowledge about the risk factors for elder abuse and neglect among this population. We aimed to examine depression as a risk factor for elder abuse and neglect among Chinese elderly. A cross-sectional study was performed in a major urban medical center in NanJing, China. Depression was assessed using the Geriatric Depression Scale and direct questions were asked regarding abuse and neglect experienced by the elderly since the age of 60; 412 patients completed the survey. The mean age of the participants was 70 and 34% were female. Depression was found in 12% of the participants and elder abuse and neglect was found in 35% of the participants. After multiple logistical regression, feeling of dissatisfaction with life (OR, 2.92; 95% CI, 1.51–5.68, p < 0.001), often being bored (OR, 2.91; CI, 1.53–5.55, p < 0.001), often feeling helpless (OR, 2.79; CI, 1.35–5.76, p < 0.001), and feeling worthless (OR, 2.16; CI, 1.10–4.22, p < 0.001) were associated with increased risk of elder abuse and neglect. Multiple logistic regression modeling showed that depression is independently associated with elder abuse and neglect (OR, 3.26; CI, 1.49–7.10, p < 0.003). These findings suggest that depression is a significant risk factor associated with elder abuse and neglect among Chinese elderly.     

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.     

Readability and content of elder abuse instruments

Since elder abuse was first acknowledged as a health care and social problem, incidence and prevalence of mistreatment has been assessed sparingly in the United States and other countries around the world. Standardized instruments for determining the prevalence of elder abuse have not been developed and other instruments measuring a person's function and spousal violence have been adapted for the measurement of elder abuse prevalence. The purposes of this paper are to (1) ascertain the reading grade level of the most frequently used elder abuse prevalence instrument's text and (2) determine the content validity of the instruments with respect to the types of elder abuse included in them. A review of the instruments used to measure elder abuse prevalence was completed and a questionnaire was developed to measure the reading grade level and type of elder abuse content in four instruments. The Fry Readability, Flesch Reading Ease, and McLaughlin Grading formulas were used to determine reading grade level. A questionnaire regarding content validity was sent to 69 faculty and staff in one university department and a 59% return was achieved. The Conflict Tactics Scale and the Hwalek-Sengstock Elder Abuse-Screening Test had the lowest mean score at the 6th grade reading level. Results of content analysis for types of elder abuse demonstrated none of the instruments are comprehensive. Instruments to measure the prevalence are needed which balance readability and content validity.     

Muted Lives:

Battered older women are a silenced and invisible group. They are silenced by ageist assumptions about them as too resistant and hopeless to change or made invisible by the notion that very frail elders are the only victims of elder abuse. Women over 50, abused by partners or adult children, are not accurately perceived and consequently not adequately helped by current domestic violence or elder abuse intervention systems. A new program serving this group, involving 132 women, shows some important similarities and differences between younger and older battered women. Although barriers can differ across the life cycle, even women of advanced age can be free of abuse or develop coping skills to minimize its damage. This article explores the unique factors affecting older women victimized by domestic abuse. The author concludes with questions and suggestions for helpers interested in better serving older battered women.     

Note From Iran: Self-Reported Elder Abuse in Qazvin, 2012

This brief report provides a first look at self-reported instances of elder abuse by a sample of people 60 years and older living in Qazvin, Iran. Six hundred community-dwelling persons, drawn from the registry files of each health center in Qazin, completed questionnaires during April to October 2012. At least 80% of the participants reported experiencing some form of psychological abuse, financial abuse, and/or neglect at least once during a 2-month period. Physical and sexual abuse were rarely reported. Despite a strong Iranian cultural emphasis on respect for elders, the self-reporting of elder abuse, especially psychological abuse, is greater than our expectation. We recommend that health-related policies and programs begin to identify elder abuse and neglect as a first step in prevention.     

Dependent Adult Children and Elder Abuse

This study investigates quantitatively and qualitatively the characteristics of dependent adult children in substantiated cases of elder abuse. The data come from the Wisconsin elder abuse reporting system in which 204 substantiated cases of abuse by an adult child were reported during an 18 month period. Quantitative analysis indicated that financially dependent adult children were under the age of 40, lived with the elder, and had problems related to alcohol and drugs. The qualitative analysis of 14 case records showed that a second but smaller group of adult children were dependent because of problems related to mental illness. This analysis of case records revealed substantial depression among this population of abused elders. Implications for future research are discussed.     

Exploring gender and elder abuse from the perspective of professionals

We conducted an online survey of professionals working in two Canadian provinces to learn about their knowledge of elder abuse from a gender-based perspective. A total of 169 professionals (90% women) completed a survey in either French or English. Five topic areas emerged from the analysis: the influence of gender on the risk of abuse; types of abuse detected; knowledge gaps; capacity to respond to gender-based abuse; and awareness of resources. To gain further insight into these results, we conducted three focus groups with a total of 24 professionals. Professionals held relatively little recognition of, or knowledge about, gender related to elder abuse. Our results indicate the need to develop educational and awareness raising opportunities for professionals who work with abused older adults in both French and English to identify and respond to the unique needs of older women and men.     

Abuse of elderly male client: efforts and experiences in rural and urban adult protective services

Elder abuse has not been viewed as seriously as child abuse because of the emotional sensibilities attached to child abuse. Although elder abuse is experienced disproportionately by women, men also are in need of protection and engagement. An important factor for understanding the work with elderly men is the social construction of manhood. Both urban and rural settings recognize this as a significant starting point to engage men in services. This paper describes the efforts in both rural and urban Adult Protective Service agencies to identify and work with abused elderly men from a strengths and solution-focused perspective.     

Korean American Elderly's Knowledge and Perceptions of Elder Abuse

ABSTRACT

“This study examines Korean American elders” perceptions of elder abuse and its perpetrators and explores cultural, as well as non-cultural influences on such perceptions. Face-to-face interviews were conducted with 100 elderly Korean Americans, 60 years of age or older, residing in Los Angeles County. Respondents reported 46 abuse cases, categorized into the following six types: financial abuse (36%), psychological abuse (24%), culturally specific abuse (17%), neglect (15%), physical abuse (4%), and other (4%). Most respondents identified elder abuse in terms of abrogation of filial piety, suggesting the centrality of “children” in Korean American elders⁵ lives and well-being. Findings demonstrate that employing a uniform definition of elder abuse across all cultures and ethnic groups without attending to the cultural and subjective aspects of a given situation may result in missing problems and needs identified as important by the elderly themselves. Implications for social work practice and program development are discussed.     

Brief Report: Attitudes About Responding to Survey Questions Concerning Childhood Sexual Abuse by Hispanic Female College Students

In no studies have research participants been asked how they feel about answering questions concerning childhood sexual abuse. We have performed searches from two different search engines again and have found nothing published which specifically addresses this question in the way we have. A questionnaire about childhood sexual abuse was administered to a sample of Mexican-American female college students. Over 32% reported positive histories of childhood sexual abuse before age 18. These subjects were more uncomfortable (37%) than those who did not experience childhood sexual abuse when answering questions about childhood sexual abuse (12%; p < 0.00001), but they were not more uncomfortable in answering questions about alcohol or drug use. Women who were sexually abused in childhood also readily disclosed childhood sexual abuse histories despite revealing discomfort about being asked questions concerning childhood sexual abuse. Our findings support concerns by researchers that childhood sexual abuse is neglected because researchers have an unwarranted perception about how fragile sexually abused subjects are as subjects.     

Elderly Korean immigrants' socially and culturally constructed definitions of elder neglect

Little research has been conducted among the elderly on the topic of neglect. Not only is there a paucity of research, but also there is the problem of widely varying definitions of neglect. These two challenges led to a study of how neglect is understood by elderly Korean immigrants as it pertains to behaviors of adult children and family members. Interviews with 124 elderly Korean immigrants were conducted to assess conceptualizations of elder neglect. Data were analyzed using a grounded theory approach. Results revealed five interrelated themes with strong connections to dimensions of health and mental health: (a) culture-specific definitions of elder neglect, (b) contexts in which elder neglect occurs, (c) impact of neglect on elders, (d) expectations from adult children, and (e) strategies for dealing with elder neglect. Implications for culturally competent, family-centered service delivery to elderly Korean immigrants are discussed, specifically focusing on service provision of health and mental health care.     

The Diagnostic Utility of the Child Sexual Behavior Inventory for Sexual Abuse: A Systematic Review

Children with alleged child sexual abuse (CSA) need to be assessed systematically. The use of validated instruments during the assessment, like the Child Sexual Behavior Inventory (CSBI), could add diagnostic value. We aim to assess the diagnostic utility of the CSBI to differentiate between sexually abused and non-abused children. We conducted a systematic review. We searched the electronic databases MEDLINE and PsychInfo for studies comparing CSBI scores in sexually abused children and non-abused children (2–12 years old). Two independent reviewers extracted data and assessed the methodological quality. We included 7 (out of 1048) articles. The CSBI total scores were significantly higher in CSA-victims compared with non-abused children (in case–control settings). However, in children with suspected CSA, the results were ambiguous. One study reported significant differences. Another study reported weak diagnostic ability for the CSBI-3 in children with suspected CSA (a sensitivity and specificity of 0.50, with a positive predictive value of 0.28, and a negative predictive value of 0.72). Research on the diagnostic utility of the CSBI for suspected CSA is limited and shows disappointing results. Until more research is done, the CSBI should not be used on its own to differentiate between sexually abused and non-abused children.     

The effect of a family-based intervention with a cognitive-behavioral approach on elder abuse

ABSTRACT

Elder abuse may become a health issue in developing countries, including Iran. The purpose of this investigation was to study the effectiveness of Family-Based Cognitive-Behavioral Social Work (FBCBSW) in reducing elder abuse. In a randomized clinical trial in Iran, 27 elders participated in intervention and control groups. The intervention groups received a five-session FBCBSW intervention and completed the Domestic-Elder-Abuse-Questionnaire (DEAQ), which evaluates elder abuse at baseline and follow-ups. Repeated measures of analysis of variance (ANOVA) and the Wilcoxon test were used to analyze the data. The repeated measures ANOVA revealed that FBCBSW was successful in reducing elder abuse. The Wilcoxon test indicated that emotional neglect, care neglect, financial neglect, curtailment of personal autonomy, psychological abuse, and financial abuse significantly decreased over time, but there was no statistically significant difference in physical abuse before and after the intervention. The findings from this study suggest that FBCBSW is a promising approach to reducing elder abuse and warrants further study with larger samples.     

Financial Exploitation of Elders: Analysis of Risk Factors Based on County Adult Protective Services Data

ABSTRACT

While all types of elder abuse and neglect are serious problems affecting thousands of vulnerable elders, financial exploitation has especially serious implications for the victims’ economic well-being and quality of life, because it may deprive the victims of their life savings and assets and thus their economic foundation for independence. In this study, data from the case files of a county adult protective services program were analyzed to identify risk factors associated with financial exploitation of and mismanagement by elders. The elders who were financially exploited were, on average, in their late seventies and tended to be cognitively impaired. We also found that owner-occupant elders were especially vulnerable to exploitation and that financial mismanagement and exploitation often occurred together. Approximately 60% of the perpetrators were relatives of the elderly victims, mostly their adult children, and the rest of the perpetrators were not related to the victims. Implications for interventions include case management for frail, cognitively impaired elders; preventive educational programs; and ongoing collaboration among adult protective services, financial institutions, and law enforcement agencies.     

Decision-Making and Adult Protective Services Workers: Identifying Critical Factors

ABSTRACT

The decision-making process of Adult Protective Service (APS) workers is under-explored in the field of elder abuse. Yet, it is critical in assuring the protection of elders from physical abuse. This article identifies 10 major critical factors used by APS workers in New Hampshire when intervening in substantiated cases of elder physical abuse. The qualitative methodological framework utilized a literature review, two focus groups, 15 individual face-to-face interviews, and a modified Delphi method of analysis. The findings identify the strengths and flaws in the decisional process and suggest considerations for further study.     

Screening for elder abuse in hospitalized older adults with dementia

When older adults with dementia are hospitalized for psychiatric treatment, which elder abuse screen to use is questionable. This article reviews screens to identify desirable characteristics. For clinician completion, the Elder Assessment Instrument and the Brief Abuse Screens for the Elderly are recommended. For the older adult, the brief Hwalek-Sengstock Elder Abuse Screening Test is suitable. The Modified Conflict Tactics Scale, which can be used by both the older adult and the nonprofessional caregiver, has many of the recommended characteristics. Research is necessary in the application of these screens within hospitals to detect elder abuse within this specialized population.     

Screening for Elder Abuse in Hospitalized Older Adults With Dementia

When older adults with dementia are hospitalized for psychiatric treatment, which elder abuse screen to use is questionable. This article reviews screens to identify desirable characteristics. For clinician completion, the Elder Assessment Instrument and the Brief Abuse Screens for the Elderly are recommended. For the older adult, the brief Hwalek-Sengstock Elder Abuse Screening Test is suitable. The Modified Conflict Tactics Scale, which can be used by both the older adult and the nonprofessional caregiver, has many of the recommended characteristics. Research is necessary in the application of these screens within hospitals to detect elder abuse within this specialized population.     

The Legal Response to Elder Abuse and Neglect

ABSTRACT

The United States legal system, both civil and criminal, has been underutilised in dealing with elder abuse and neglect. Social service and health practitioners have been unfamiliar with the language and procedures in legal settings. Legal remedies have been obscure or inadequate to address the problems. When elder abuse and neglect were first “discovered” in the late 1970s, efforts focused on safeguarding the victim through civil justice remedies, i.e., guardianships, mandatory reporting laws, adult protective services. The criminal justice system also became involved in order to hold the alleged wrongdoer accountable. Specialised units have developed in police departments and prosecutor offices to deal with the criminal behavior. New laws are providing more flexibility for the legal system, both civil and criminal. A multidisciplinary approach to elder abuse and neglect is needed because abused or neglected elders are frequently involved with many agencies. Attention to the legal aspects of the issue are apparent in the Summit Conference held by the National Center on Elder Abuse in 2001 and the development of the Elder Justice Act which was introduced into the U.S. Senate in 2003.