Self-Neglect: Implications for Prosecutors

ABSTRACT

Historically, the view of elder mistreatment in the United States has been similar to that of child abuse and has been detrimental to the understanding of elder mistreatment. Until recently, there was little understanding of the complexity of elder mistreatment and the legal system lacked appropriate laws with which to handle this growing problem. Over the last two decades, legislation, laws, and criminal codes of conduct have been developed to tackle the problem of elder mistreatment. However, little knowledge or understanding of the public health problems and legal implications related to the most common form of elder mistreatment referred to Adult Protective Services (APS), elder self-neglect, is available. The growth of this national problem has expanded the role of the legal system and pushed the development of interdisciplinary research with the intent of defining and understanding the problem of self-neglect and with the ultimate goal of expanding intervention strategies. The Consortium for Research in Elder Self-Neglect of Texas (CREST) is the leader in this field and the pilot study suggests numerous medical and legal implications for both intervention and future research.     

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.     

A social capital approach to the prevention of elder mistreatment

The current demographic landscape features an increasing number of elderly individuals in the care of some trusted other. Being cared for by a trusted other raises the potential for mistreatment of the elder by that trusted other. The goal of this paper is to explore the possibility of preventing elder mistreatment by increasing the bridging and bonding social capital available to caretakers. Attending to social capital lets researchers expand their focus toward areas rarely examined through current stress-outcome models (e.g., interpersonal interactions). First, elder mistreatment and social capital are defined and discussed. Then, a model is forwarded that details how social capital might mitigate the effects of caretaker stress and decrease the probability that caretakers will engage in elder mistreatment in both home and long-term care institutional settings. Finally, implications for future research and practical intervention are discussed.     

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.     

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.     

Tolerance of Elder Abuse and Attitudes Toward Third-Party Intervention Among African American,Korean American,and White Elderly

SUMMARY

Studies have found that professionals and the lay public differ consistently from one another in the ways in which they perceive elder abuse. A potential variable that may explain this observed difference is cultural norms among ethnic groups. Using 18 statements, this study examined similarities and differences among elderly from three ethnic groups in their tolerance for potential elder abuse, perceptions regarding perpetrators and the causes of elder abuse, and attitudes toward third-party intervention and reporting of elder abuse to the authorities. Results suggest that while African American and White elderly are remarkably similar in their responses to most statements, Korean American elderly differed significantly from the other two groups in their tolerance for medical mistreatment, financial exploitation and neglect, perceptions of causes, and attitudes toward reporting elder abuse. These findings have implications for understanding potential barriers to preventive outreach efforts, investigation, and intervention in cases of elder abuse in a culturally diverse community.     

Chapter Eight

Even experiences practitioners in the field of elder abuse and neglect have had limited experience with the American civil system. This chapter explains the overall goals of the criminal and civil systems, the rules governing them, their processes, and the ways in which they can prevent and combat elder mistreatment in an ethical context. Practical application of goals, rules, and process of each system is described inn the sections on the three cases. This chapter represents one of the first attempts to view the criminal and civil legal systems conjointly and to advocate for the cooperation of the two systems in individual cases of elder mistreatment. It also describes the role of the two legal systems in relation to practitioners in the health and social services context and advocates for a multidisciplinary approach to elder 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.     

The devil is in the details: self-neglect in Australia

Although elder self-neglect is of significant concern to adult protective service (APS) workers in the United States, minimal research has been conducted on this topic in Australia. Using qualitative research methods, this article examines how 24 Australian professionals understand situations of self-neglect. Unlike in the United States, where the term self-neglect is used in a broad and all-encompassing manner, participants in this research differentiated among self-neglect (the neglect of self), squalor (extreme neglect of environment), collecting (the accumulation of certain objects), and hoarding (the inability to throw objects away). It is argued that separating out the various behaviors that are classified under the broad umbrella of neglect can be useful in fostering reflective interventions in these situations.     

Practitioners' views on elder mistreatment research priorities: recommendations from a Research-to-Practice Consensus conference

This article presents recommendations from expert practitioners and researchers regarding future directions for research on elder abuse prevention. Using the Research-to-Practice Consensus Workshop model, participants critiqued academic research on the prevention of elder mistreatment and identified practice-based suggestions for a research agenda on this topic. The practitioners' critique resulted in 10 key recommendations for future research that include the following priority areas: defining elder abuse, providing researchers with access to victims and abusers, determining the best approaches in treating abusers, exploiting existing data sets, identifying risk factors, understanding the impact of cultural factors, improving program evaluation, establishing how cognitive impairment affects legal investigations, promoting studies of financial and medical forensics, and improving professional reporting and training. It is hoped that these recommendations will help guide future research in such a way as to make it more applicable to community practice.     

The changing career of "elder abuse and neglect" as a social problem in Canada: learning from feminist frameworks?

ABSTRACT "Elder Abuse and Neglect" was constructed as a social problem by experts and has largely been a product of "expert" knowledge building and intervention. The idea of woman abuse as a social problem, on the other hand, originated with women themselves. The paper examines the changing social context in which some older people are currently seeking ownership of responses to mistreatment. It explores emerging criticisms of present constructions of "elder abuse and neglect" and the needs they imply, and links these to feminist frameworks. It then considers the appeal and utility of these frameworks for older women active in the fight against mistreatment.     

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.     

Self-Neglect Among the Elderly

Combinging three years of quantitative data from the Wisconsin Elder Abuse Reporting System with in-depth interviews of a purposeful sample of elder abuse investigators, this study examines differences between substantiated cases of self-neglect and cases of maltreatment by others. Living arrangements were highly associated with the type of maltreatment for which elderly were likely to need service. Mental illness, drug or alcohol problems, and dementia were moderately associated, while being male, white, and older were weakly associated. Referred by a formal support system was also weakly related to receiving services for self-neglect. Qualitative data suggested that family context may also be an important factor. The implications of these findings for policy, programs, and practice aimed at preventing self-neglect are discussed.     

The conceptualization of mistreatment by older American Indians

The problem of how to conceptualize elder mistreatment goes back several decades, and is especially important for ethnic minority populations, who may have perspectives that differ from the dominant society. This community-based participatory research study, which examined perceptions of mistreatment by family among 100 urban and rural older American Indians, permits a rare glimpse into how Native elders themselves understand this issue. Here, good treatment was conceptualized in terms of being taken care of, having one’s needs met, and being respected. We found relatively high standards for how elders should be treated—such as the belief that an elder’s needs should be anticipated and met without the elder needing to ask—in the face of widespread accounts of the mistreatment of elders within the community, largely through various acts of financial exploitation and neglect. Substance abuse and culture loss were blamed formuch of the elder mistreatment occurring in contemporary Native communities.     

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.     

The Devil is in the Details: Self-Neglect in Australia

ABSTRACT

Although elder self-neglect is of significant concern to adult protective service (APS) workers in the United States, minimal research has been conducted on this topic in Australia. Using qualitative research methods, this article examines how 24 Australian professionals understand situations of self-neglect. Unlike in the United States, where the term self-neglect is used in a broad and all-encompassing manner, participants in this research differentiated among self-neglect (the neglect of self), squalor (extreme neglect of environment), collecting (the accumulation of certain objects), and hoarding (the inability to throw objects away). It is argued that separating out the various behaviors that are classified under the broad umbrella of neglect can be useful in fostering reflective interventions in these situations.     

Gendered policies and practices that increase older men's risk of elder mistreatment

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 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.     

Assessment of older adults’ satisfaction with adult protective services investigation and assistance

This study examined elder self-neglect client satisfaction with services provided by an Adult Protective Services (APS) program. A total of 77 community-dwelling older adults with APS-substantiated self-neglect responded to the standardized and widely used 8-item Client Satisfaction Questionnaire. Approximately 75% of the participants reported being satisfied with the overall services. They felt that the services provided were responsive to their need(s) and helped them deal with their problem(s). Greater than 80% responded that they would refer a friend, would utilize APS in the future if necessary, and were at least satisfied with the amount of help received. The extent to which their needs were met received the lowest satisfaction scores. Future studies are needed to examine elder self-neglect client satisfaction in relation to specific services.     

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.