Elder Mistreatment Identification Instruments:

Elder mistreatment has followed a typical life course as a social problem from naming the problem, to research now to considerable activitiy in identification. This article compares elder mistreatment identification instruments among 15 states which use uniform tools in adult protective services settings. The goal is to distinguish differences in starting points in the areas of the definition, the victim/s, precipitator/s, evaluator/s, and instrument design to find common ground for information-sharing and improvements in the identification process. The results show both similarities and differneces to reconcile differences while preserving them, it is recommended that common ground focus on what rather than who, which, when, why and how - problem-centeredness rather than parties.     

Differentiating self-neglect as a type of elder mistreatment: how do these cases compare to traditional types of elder mistreatment?

Official estimates suggest that self-neglect is the most common type of elder mistreatment. Interestingly, very few researchers have empirically assessed self-neglect as a type of elder mistreatment. In the current study, attention is given to how self-neglect cases handled by adult protective services agencies compare to other types of elder mistreatment. Comparisons are made between the needs of self-neglect clients and other protective services clients as well as the role of stress in the different types of abuse. Findings suggest that self-neglect clients are less likely to need help with certain functional activities. In addition, those who are married and those who have completed fewer years of education are less likely to be labeled as experiencing self-neglect. City differences in rates of self-neglect were also found. Not surprisingly, self-neglect clients were more likely than other protective services clients to refuse services. Implications are provided.     

Elder Mistreatment in U.S. Residential Care Facilities: The Scope of the Problem

Many in the United States believe elder mistreatment in long-term care is serious and widespread, but until recently few studies focused on the problem. This study was designed to describe the scope of mistreatment in assisted living facilities (ALFs) in Arizona during a 3-year period. Findings showed that receiving citations for elder mistreatment was relatively rare. However, analysis of narrative reports from only 7% of facilities showed 598 allegations of mistreatment in complaint investigations, of which 372 (62.2%) were substantiated and given citations for something other than mistreatment. Results show that elder mistreatment in ALFs is seriously underidentified, even by state inspectors.     

Preventing and Combating Elder Mistreatment in Flanders (Belgium): General Overview

In Flanders, the state that comprises the Dutch-speaking part of Belgium, the structural attention given to the problem of elder mistreatment has grown slowly throughout the last decade. Equivalent to the evolution in most other western countries, there is nevertheless still a great lack of scientific research, and several governments (federal, regional, supralocal, and local) are still very reluctant to provide sufficient means in order to prevent and combat elder mistreatment. This article aims to present a general overview of the current state of affairs in the regional state of Flanders to address elder mistreatment. More concretely, it will highlight the history of the Flemish Reporting Point for Elder Abuse, what its aims are, and what definition and typology of elder mistreatment it uses in its daily activities. Because of the importance of well-conducted scientific research and excellent academic support in order for policymakers and social services to deal efficiently with elder mistreatment, the lack of scientific research in Flanders also will be briefly highlighted.     

Analyses of the Concepts of Elder Mistreatment:

The lack of precise and accepted definitions of elder neglect and elder abuse impairs identification of these two distinct but related forms of elder mistreatment and prevents systematic comparison of research findings. As professional attention to elder mistreatment is relatively new, continued progress in various areas is warranted-research, theory development, diagnostic instruments, and prevention and treatment strategies. First, however, some degree of definitional precision and consensus needs to be established. This paper critically examines the current research definitions of elder neglect and abuse and offers suggestions for future progress on this foundational issue.     

Three Case Studies of Elder Mistreatment:

Three case studies involving ethical issues in elder mistreatment are presented. They were created from a variety of actual situations to illustrate the range and complexity of ethical issues that professionals encounter in elder mistreatment and to serve as the basis for discussion of ethical issues by professionals from a variety of disciplines in subsequent chapters of the publication. Problems of physical and mental disability, relational loss, and mistreatment in institutional settings are illustrated. Elements of self neglect as well as neglect and abuse by others are contained in the cases, and intentional and unintentional mistreatment are portrayed. The author highlights some of the ethical dilemmas presented by each of the three cases.     

Ethics and Elder Mistreatment:

This chapter focuses on the meaning of ethics in elder mistreatment. More specifically, ethical issues are distinguished from non-ethical issues and ethical dilemmas. The primary objective is to demystify ethics for elder-serving practitioners and to show how ethics can be a part of the treatment decision-making process. This process details "doing" ethics in the practice setting. It proposes a method for developing ethical practice in the multidisciplinary level. The multidisciplinary level starts with the client and professional ends with the community-based multidisciplinary team. The latter include human services professionals who have the important task of transforming ethical protocols into practice.     

Combating Elder and Dependent Adult Mistreatment: The Role of the Clinical Psychologist

ABSTRACT

Among the many different professionals who work to address elder and dependent adult mistreatment, the clinical psychologist performs a function that is not well documented. The experiences of a clinical psychologist attached to a medical response team and an elder abuse forensic center provide insight into this complex and multifaceted role. Case examples from an elder abuse forensic center illustrate the breadth of referral questions that a clinical psychologist addresses. This information may be of use to those who would argue that these services be made widely available to elder abuse professionals such as social workers, public guardians, and those in the criminal justice system. The case studies also may be useful for training purposes.     

Risk Indicators of Elder Mistreatment in the Community

ABSTRACT

This study examined risk indicators of chronic verbal aggression, physical aggression, and financial mistreatment in a population-based sample of 1,797 independently living elderly in Amsterdam, The Netherlands. Included were socio-demographic characteristics, physical and psychological health, and functional capacity. The data were collected using standardized interviews that took place in the homes of the respondents. The results showed that chronic verbal aggression was associated with an elder living with a partner or other(s) and in poor or bad health. Physical aggression was associated with an elder living with a partner or other(s) and having depressive symptoms. Finally, financial mistreatment was associated with being male, living alone, being partially dependent in instrumental activities of daily living and having depressive symptoms. The results indicate that the risk indicators of victims of financial mistreatment differ from those of chronic verbal aggression and physical aggression, suggesting that financial mistreatment may occur more often as a single form of abuse whereas verbal and physical aggression may more frequently occur together.     

Gendered Policies and Practices that Increase Older Men's Risk of Elder Mistreatment

SUMMARY

We aim to detail some of the ways that social policy and gendered practices put older men at risk of elder mistreatment. Research on the abuse and neglect that older adults experience has often focused on the characteristics of the victims and the dynamics within families, emphasizing factors such as the likelihood of an intergenerational cycle of violence, substance abuse and dependency, and older men's financial status as key risks in elder abuse. The effect on men from this type of analysis is that elder mistreatment remains an individual or family problem rather than being viewed as a larger societal concern. This article challenges the individualistic focus by outlining the importance of societal forces affecting older men's risk of mistreatment.     

The National Elder Mistreatment Study: An 8-year longitudinal study of outcomes

Objectives: To conduct an 8-year follow-up of the National Elder Mistreatment Study (NEMS) and specify risk ratios for negative outcomes of elder abuse, including DSM-5 defined depression, generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and poor self-reported health.

Methods: Attempts were made to re-contact, via Computer Assisted Telephone Interview, all 752 NEMS participants who reported mistreatment since age 60 at Wave I, as well as a randomly selected sample of non-mistreated NEMS participants

Results: 183 NEMS Wave I elder abuse victims and 591 non-victims provided data. In bivariate analyses, elder mistreatment 8 years earlier increased risk of negative outcomes by 200–700%. However, multivariate analyses revealed that Current (Wave II) social support was highly protective against most negative outcomes (excepting PTSD), and even appeared to nullify effects of mistreatment on GAD and poor self-reported health.

Conclusions: Outcomes of elder mistreatment have not been studied prospectively in a national sample. The NEMS 8-year follow-up findings indicate a strong relationship between elder mistreatment at Wave I and negative emotional and physical health 8 years later. Fortunately, current (Wave II) social support appears to be both consistently and powerfully protective against most negative outcomes.     

Screening Elders in the Emergency Department at Risk for Mistreatment: A Pilot Study

Impaired functional status is associated with risk of elder mistreatment. Screening for functional impairment in elderly patients admitted to emergency departments could be performed to identify patients at risk for elder mistreatment who might benefit from further evaluation. This study utilized a modified Identification of Seniors at Risk (ISAR) screening tool to identify the proportion of elderly at risk for mistreatment due to functional difficulties presenting to two emergency departments in southeastern Virginia, one urban, the other rural. Of a 180-patient cohort (90 per site), 82 screened positive (46%), ISAR > 2 (range 0–6), indicating nearly half of all patients enrolled are at risk for mistreatment. Patients presenting to the urban emergency departments were potentially more at risk than their rural counterparts (p < 0.01). Health care professionals, particularly in urban settings, should consider screening seniors with a simple tool to identify patients at risk of elder mistreatment.     

Elder mistreatment in underserved populations: Opportunities and challenges to developing a contemporary program of research

ABSTRACT

This article provides an overview of the status of research on elder mistreatment among underserved populations in the United States, including gaps in our current knowledge base and scientific and structural barriers to growing research on the exploitation, neglect, and abuse of older people from diverse and disadvantaged ethnic/racial, geographic, sexual identity, and socioeconomic groups. High-priority areas in need of new elder mistreatment research with underserved populations are identified, and suggestions are given for how this research can be facilitated by researchers, university institutional review boards, and funding agencies.     

The National Elder Mistreatment Study: Race and Ethnicity Findings

The prevalence of elder mistreatment with respect to race and ethnicity was examined in an unweighted sample of 5,777 participants (5,776 participants in weighted sample). Random Digit Dialing methodology was used to select a representative sample of community-dwelling older adults, and the survey was available in English and Spanish. Mistreatment types included emotional, physical, and sexual abuse. Race- and ethnicity-based differences were largely absent, and the only observed increase was for physical mistreatment among non-White older adults; however, this association was not sustained in multivariate analyses controlling for income, health status, and social support. Findings are in contrast to prior reports of increased risk of mistreatment in minority populations and point to correlated and modifiable factors of social support and poor health as targets for preventive intervention.     

Prevention of Elder Mistreatment in Nursing Homes: Competencies for Direct-Care Staff

Existing training on elder mistreatment in nursing homes focuses on detection and reporting of abuse, with little training specifically targeted toward prevention of mistreatment before it occurs. We used qualitative interviews with nursing home staff, policy makers, and related professionals to identify training needs. Based on participant accounts, we drafted a number of competencies essential for caregiver training to prevent mistreatment in nursing homes. Competencies include those dealing with definitions and policies, risks for mistreatment, communication and respect in relationships with residents, and development of a cooperative work environment. Competencies are discussed along with illustrative examples, and implications for practice and policy are addressed.     

Mistreatment of Vietnamese Elderly by Their Families in the United States

ABSTRACT

Generally, research on elder abuse has focused on the elders in mainstream America so that little is known about the nature and scope of elder abuse occurring in the Vietnamese community. This study presents the results of a research project on the relationship of Vietnamese elders residing in Santa Clara County, California and their families. It also explores cultural factors that may be associated with elder mistreatment such as issues of dependency and personal indebtedness. The implications for intervention and prevention are discussed, along with proposed changes in human service programs that could enhance the well-being of Vietnamese elders.     

Definitions and indicators of elder abuse: a delphi survey of APS caseworkers

Instruments designed to measure specific types of elder mistreatment are not available, but they may be warranted after an initial screen indicates abuse or risk for abuse. The purpose of this study was to evaluate definitions for different types of elder mistreatment and validate the indicators as perceived by adult protective services (APS) caseworkers' opinions. Through 351 APS research network participants, a Delphi survey was completed. A 45% return rate was achieved for round one and 40% for round two with 70 same respondents from both rounds. These types of abuse, emotional abuse, exploitation of finances and/or property, neglect, physical abuse, and sexual abuse, have some similar and some extremely different indicators that singly and together expand their definition. Instruments to measure five different types of abuse are offered for caseworker or prevalence study use.     

Elder Mistreatment

SUMMARY

New information on elder mistreatment and conflict management among certain ethnic groups has necessitated changes in the practice arena. Clinical approaches depend on the victims' ability to identify themselves as victims, their degree of collective self, preferred conflict management techniques, and ability to identify their own power resources. Practice considerations and modifications include looking for subtle behaviors indicative of psychological abuse and neglect, using words that are culturally familiar and acceptable, and educating elders and their families about how other families relate and solve problems. Other interventions involve the use of the third party for cathartic displacement, and based on a temporal model of the exchange process, creating a power balance by maximizing the victims' potential power while minimizing the perpetrators' potential power.     

Measuring Perceived Mistreatment: Potential Problems in Asking About “Discrimination”

Many studies have used survey data on perceived everyday mistreatment to assess the extent and health impact of racial discrimination and of discrimination based on weight, sexual orientation, and other reasons. Some surveys use the word “discrimination” in the initial question put to respondents, while other surveys do not use this word. This research note argues that including “discrimination” in the initial question may depress reports of perceived mistreatment, particularly among whites. It tests this possibility with data from the 1995–1996 National Survey of Midlife Development in the United States, which used “discrimination” in the initial question, and the 2001–2003 National Survey of American Life, which did not use this word. Findings suggest that using “discrimination” in the initial question considerably depresses whites’ reports of everyday mistreatment.     

Preventing and combating elder mistreatment in flanders (belgium): general overview

In Flanders, the state that comprises the Dutch-speaking part of Belgium, the structural attention given to the problem of elder mistreatment has grown slowly throughout the last decade. Equivalent to the evolution in most other western countries, there is nevertheless still a great lack of scientific research, and several governments (federal, regional, supralocal, and local) are still very reluctant to provide sufficient means in order to prevent and combat elder mistreatment. This article aims to present a general overview of the current state of affairs in the regional state of Flanders to address elder mistreatment. More concretely, it will highlight the history of the Flemish Reporting Point for Elder Abuse, what its aims are, and what definition and typology of elder mistreatment it uses in its daily activities. Because of the importance of well-conducted scientific research and excellent academic support in order for policymakers and social services to deal efficiently with elder mistreatment, the lack of scientific research in Flanders also will be briefly highlighted.