Elder abuse in nursing homes: an ecological perspective

Population trends suggest that the next 20 years will witness a dramatic increase in the adult population aged 65 and older. Projected increases in the elderly population are expected to significantly increase the stress on family and professional caretakers. Stress, in the context of caregiving relationships, is a risk factor associated with increased prevalence of elder abuse in familial and institutional settings. As increasing numbers of older adults are moved from family caregiving to nursing home care settings, it becomes important to identify the pattern of elder abuse risk factors in nursing home facilities. An ecological model is proposed for better understanding the risk factors associated with elder abuse in nursing homes and the complex interaction of individual/person characteristics and contextual factors in institutional elder abuse. An ecological perspective to institutional elder abuse provides a framework for guiding and informing future research on the risk factors of nursing home abuse and, in turn, for the development of effective interventions and relevant social policies.     

Elder Abuse in Nursing Homes: An Ecological Perspective

Population trends suggest that the next 20 years will witness a dramatic increase in the adult population aged 65 and older. Projected increases in the elderly population are expected to significantly increase the stress on family and professional caretakers. Stress, in the context of caregiving relationships, is a risk factor associated with increased prevalence of elder abuse in familial and institutional settings. As increasing numbers of older adults are moved from family caregiving to nursing home care settings, it becomes important to identify the pattern of elder abuse risk factors in nursing home facilities. An ecological model is proposed for better understanding the risk factors associated with elder abuse in nursing homes and the complex interaction of individual/person characteristics and contextual factors in institutional elder abuse. An ecological perspective to institutional elder abuse provides a framework for guiding and informing future research on the risk factors of nursing home abuse and, in turn, for the development of effective interventions and relevant social policies.     

An Ecological Framework for Contextual Risk Factors in Elder Abuse by Adult Children

ABSTRACT

Future trends suggest both a continued growth of the elderly population, as well as the likelihood of increased demand for family caregiving which may, in turn, be associated with increasing rates of elder abuse. It is important to consider issues related to such caregiving, including potential abuse from an ecological perspective which, in turn, provides a fruitful basis for framing the problem of abuse as a set of contextually-based risk factors. This paper focuses on the contextual risk factors using an applied ecological model, a useful framework for understanding the intergenerational character of elder abuse in families, for developing recommendations for empirically-based action research, and for the development of community-based prevention and intervention strategies.     

Does caregiving increase poverty among women in later life? Evidence from the Health and Retirement survey

Given the rapid aging of the U.S. population and reductions in federal funding, elder care has become a major issue for many families. This paper focuses on a long-term consequence of elder care by asking how caring for elderly parents affects women's subsequent risks of living in poverty. Using longitudinal data from the Health and Retirement Study, we examine whether and how caregiving for parents in 1991 increases women's risks of living in households with incomes less than the poverty threshold, receiving public assistance, and receiving Medicaid in 1999. Our findings illustrate that caregiving in earlier life raises women's poverty risks in later life by intensifying the negative effects of stopping work and declining health on women's economic well-being.     

Husbands and sons in the United States and Japan: Cultural expectations and caregiving experiences

In the United States and Japan, social and demographic changes are placing pressure on men to become involved in elder care. In Japan, 15 percent of caregivers to the elderly are men compared with 28 percent in the United States. This qualitative study uses in-depth interviews with 15 Japanese and 30 American men to compare their daily caregiving experiences and examine the impact of culture on their roles. We identify common elements as well as differences in husbands' and sons' motivations to take on this role, the tasks they perform, the impact on their lives, and societal responses. Culture is a factor in the social shaping of the caregiving experience through different societal expectations about the roles, coupled with different family structure, different caregiving ideals, different views on dependency, and different views on self-expression and on the need to maintain harmonious relationships.     

Elder Abuse and Oppression: Voices of Marginalized Elders

The voices of elderly people from marginalized groups are rarely solicited, and the relationship between elder maltreatment and belonging to an oppressed group has not been adequately investigated. This article reviews the literature on oppression and elder abuse and describes findings from the secondary analysis of data from focus group discussions on elder abuse held with marginalized older adults and (quasi)professionals caring for them in two Canadian cities. Participants identified that increased vulnerability to elder abuse was related to oppression experienced as a consequence of ageism, sexism, ableism/ disability, racism, heterosexism/homophobia, classism, and various intersecting types of oppression.     

Rural Arab Families Coping with Caregiving

SUMMARY

This research examines the coping patterns of the rural Arab family in caring for a chronically ill elderly relative. The Arab community in Israel is in transition as a result of modernization with changes occurring in the traditional family structure, family norms and living arrangements. This study was conceptualized within the framework of intergenerational solidarity versus ambivalence and utilized a qualitative approach based on the phenomenological paradigm. Data were collected from 10 family units with a chronically ill homebound elder, by means of in-depth interviews. Four people were selected from each unit including the elder, his/her spouse-the primary caregiver-and two other secondary caregivers, usually sons and daughters-in-law. The data indicate the uniqueness of coping patterns among these caregivers in regard to two main components, which are contradictory to findings in the family caregiving literature: differences in the gender of child caregivers and the family readiness to use assistance from formal support systems.     

Elder abuse and oppression: voices of marginalized elders

The voices of elderly people from marginalized groups are rarely solicited, and the relationship between elder maltreatment and belonging to an oppressed group has not been adequately investigated. This article reviews the literature on oppression and elder abuse and describes findings from the secondary analysis of data from focus group discussions on elder abuse held with marginalized older adults and (quasi)professionals caring for them in two Canadian cities. Participants identified that increased vulnerability to elder abuse was related to oppression experienced as a consequence of ageism, sexism, ableism/disability, racism, heterosexism/homophobia, classism, and various intersecting types of oppression.     

Service providers' modes of interacting with frail elders and their families: Understanding the context for caregiving decisions

The purpose of this study was to explore the professional context within which frail elderly individuals and their families operate as they make decisions regarding caregiving. The findings serve to improve our understanding of the nature of the interface between the informal structures of families and the formal structures of the service-provider network. Designed as an exploratory qualitative study, the research process involved one-on-one interviews with providers from 9 areas of service related to elder caregiving. Specifically, analysis of the data revealed 4 provider styles or modes of interacting with elders and their families: Listener, Educator, Encourager, and Advocate. The most frequent mode was Educator, with 7 of the 9 providers referencing it more often than any other mode. The least frequent mode was Listener, with 5 of the service providers referencing it the least often. Implications of these findings for service providers lie in better understanding of how preferences for one style or another may affect their communication with clients. For families, the implications lie in understanding ways to more effectively interact with the formal network of providers in order to have their needs adequately addressed. Further, educators or counselors may be able to use these results in helping families improve their access to resources and services, and in helping providers better serve the needs of clients.     

Making the best of it: Themes of meaning among informal caregivers to the elderly

Interviews with 48 informal caregivers to the elderly indicate that the concept of caregiver meaning can help explain why many caregivers persevere in their roles despite the stress involved. Several general themes of caregiver meaning were found: Gratification and Satisfaction with the caregiving role, a sense of Family Responsibility/Reciprocity, the Friendship and Company which caregiving provided, and a commitment to Doing What Needs to Be Done. Less frequently utilized themes were: having a Caring Personality, and experiencing Personal Growth and an Improved Relationship with the elder. These themes echo the complexity of caregiver meaning reported in the literature to date, and two related interpretations of that complexity are posited: that meaning has both an emotional and a cognitive component, and that there are two different dynamics operating—searching for meaning and finding meaning.     

Mental health and criminal justice issues among perpetrators of elder abuse

ABSTRACT Recent studies on elder abuse suggest that the pathology or impairment of the abuser may be a stronger predictor of elder abuse than characteristics of the victim. To examine the relationship between elder abuse, abuser pathology, and the criminal justice system, the New York City Department for the Aging (DFTA) undertook a survey of older victims of reported domestic abuse seeking assistance from the DFTA Elderly Crime Victims Resource Center. Preliminary findings from the survey indicate that impaired abusers were significantly younger than unimpaired abusers and more likely to live with their elderly victims, to be unemployed, and to have a history of involvement with the criminal justice system.     

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.     

Mental Health and Criminal Justice Issues Among Perpetrators of Elder Abuse

ABSTRACT

Recent studies on elder abuse suggest that the pathology or impairment of the abuser may be a stronger predictor of elder abuse than characteristics of the victim. To examine the relationship between elder abuse, abuser pathology, and the criminal justice system, the New York City Department for the Aging (DFTA) undertook a survey of older victims of reported domestic abuse seeking assistance from the DFTA Elderly Crime Victims Resource Center. Preliminary findings from the survey indicate that impaired abusers were significantly younger than unimpaired abusers and more likely to live with their elderly victims, to be unemployed, and to have a history of involvement with the criminal justice system.     

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.     

Reaching the Breaking Point:

This study was designed to examine the phenomenon of mistreatment associated with mood disturbance of the caregiver in elder caregiving situations. The data were obtained from 110 caregivers aged 55 and over caring for a physically or mentally ill elder at home. A causal model was developed to examine the effects of personal and situational variables on mistreatment by abuse or neglect. Results indicated there were seven predictors of potential to mistreat: total mood disturbance, an external locus of control orientation, a low level of social support, income inadequacy, poor physical health, and two emotional coping strategies. These variables accounted for 46% of the variance.     

Emotional Correlates of Caregiving

This study examined correlational patterns among psychological measures administered to caregivers who participated in a training program to prevent elder abuse. Seventy caregivers of persons aged 50 years or older were administered the Cost of Care Index, Anger Inventory, Brief Symptom Inventory, and the Rosenberg Self-Esteem Scale. Results suggest that perceptions of caregiving burden are related to psychological distress and self-esteem but not to anger. Implications of these findings for caregiver training and elder abuse prevention are discussed.     

The Vulnerability for Elder Abuse Among a Sample of Custodial Grandfathers: An Exploratory Study

ABSTRACT

Older adults have been known to make sacrifices in their caregiving roles. Gerontology literature on custodial grandparents has primarily focused on grandmothers and the challenges they face when they assume primary care for grandchildren. Little is known about the risks that older men face when they become custodial grandparents. This article highlights types and warning signs of abuse, exploitation and neglect. Exploratory study was undertaken with a racially diverse group of custodial grandfathers to fill a gap in the literature about the vulnerability for elder abuse, exploitation and neglect as expressed by older Black, Latino and White custodial grandfathers. To provide a more inclusive understanding of elder abuse, areas of vulnerability were identified for consideration by practitioners, educators and researchers. The implications of this research point to the need to rethink elder abuse assessment, prevention and intervention strategies with older men.     

The vulnerablility for elder abuse among a sample of custodial grandfathers: an exploratory study

Older adults have been known to make sacrifices in their caregiving roles. Gerontology literature on custodial grandparents has primarily focused on grandmothers and the challenges they face when they assume primary care for grandchildren. Little is known about the risks that older men face when they become custodial grandparents. This article highlights types and warning signs of abuse, exploitation and neglect. Exploratory study was undertaken with a racially diverse group of custodial grandfathers to fill a gap in the literature about the vulnerability for elder abuse, exploitation and neglect as expressed by older Black, Latino and White custodial grandfathers. To provide a more inclusive understanding of elder abuse, areas of vulnerability were identified for consideration by practitioners, educators and researchers. The implications of this research point to the need to rethink elder abuse assessment, prevention and intervention strategies with older men.     

The Impact of Relationship Dynamics on the Detection and Reporting of Elder Abuse Occurring in Domestic Settings

There is a keen desire to increase the detection and reporting of elder abuse. The purpose of this study was to describe the circumstances under which abuse is detected and reported and to identify the relationship dynamics that might be impacting detection and reporting decisions. Interviews were conducted with 71 Adult Protective Services (APS) caseworkers, 55 of their elderly clients, and 32 third-party adults. Detection and reporting are distinct but related acts. The temporal relationship between detection and reporting generally differed depending on the nature and quality of the relationship between (a) the victim and offender and (b) the victim and reporter. Efforts to increase reporting may benefit from taking into consideration these relationship dynamics. A range of individuals detected and reported elder abuse, including victims, under a range of circumstances, reinforcing the value of public efforts to increase awareness of elder abuse.