Older adults affected by polyvictimization: A review of early research

ABSTRACT

In contrast to work within the child-abuse field, polyvictimization of older adults did not become a focus of professional attention until this decade. Despite this lack of formal identification, a search of the research and practice literature revealed that prior research investigating single forms of or other elder abuse issues contained evidence of what was variously termed “multiple,” “multi-faceted,” “co-occurring,” or “hybrid” elder abuse. A wide range of victims (1.4%–89.7%) identified in existing elder abuse studies was found to have experienced what constitutes “polyvictimization.” This late-life polyvictimization evidence, the contexts in which victims are harmed, and information regarding the impact of multifaceted elder abuse are all presented and discussed in this article. Selected published cases illustrate the clinical dynamics operating in late-life polyvictimization situations.     

Cultural and ethical considerations in late-life polyvictimization

ABSTRACT

This article examines the cultural and ethical considerations for professionals working with older adults who experience polyvictimization. Drawing from the Department of Justice training program, Polyvictimization in Later Life (OVC/TTAC, 2017), topics include cultural competencies, ethical standards, personal and professional ethics, and ethical considerations when working in teams. Also described are specific suggestions and recommendations to ensure sensitive and ethical responses when working with cases involving polyvictimization.     

Moving forward: recommendations for advancing late-life polyvictimization practice,policy, and research

ABSTRACT

This article synthesizes what has been learned from the entire polyvictimization in later-life project and offers five categories of recommendations for addressing polyvictimization and its elderly victims through practice, policy, and research. These five recommendations relate to definitions and frameworks, practice, training and education, research and evidence-based interventions, and prevention. Specifically, this article focuses on changes to improve identification, development of policies and practices, and research priorities.     

Polyvictimization in later life: Trauma-informed best practices

ABSTRACT

This article provides a summary of salient trauma findings and conveys the dearth of research pertaining specifically to the trauma of elder abuse. This material, in conjunction with information contained in other articles composing this special issue, lays the foundation for advancing a trauma-informed approach to assisting older adults who have experienced polyvictimization. Informed by the findings presented and their extensive clinical experience with victims of violence, the authors suggest steps for providing a trauma-informed and victim-centered response to older adults who have suffered polyvictimization. These steps are then illustrated with an in-depth late-life polyvictimization case analysis.     

Lethal intimate partner violence in later life: Understanding measurements,strengths, and limitations of research

ABSTRACT

The aim of this article is to conduct a critical analysis of existing family violence literature related to elder abuse homicide, also known as “eldercide.” The focus relates to fatal violence perpetrated by current or former intimates. Men are the most likely victims of homicide but are rarely murdered by partners. Older women are most often killed in the home by a spouse or other family, consistent with the notion of “femicide.” The Federal Bureau of Investigation Supplemental Homicide Reports and the Bureau of Justice Statistics National Crime Victimization Survey are utilized to illustrate trends by sex over time. Intimate partner homicide-suicide is examined via news surveillance. Strengths and limitations of data and methods are addressed. Homicide trends among the members of the baby boom cohort are predicted based on current and future patterns as they age. To facilitate prevention, researchers are encouraged to move beyond simple prevalence estimates toward greater understanding of complex trends, distinctions, and motivations of these violent deaths.     

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.     

Elder Abuse: Feminist and Ageist Perspectives

ABSTRACT

Elder abuse research reports little consensus regarding gender and age. This project examined 99 incidents of elder abuse by an adult child and 86 incidents of elder abuse by a spouse, and compared the groups using the variables: gender, age, and incidents. The results are discussed from a feminist and age perspective. Differences between the groups were found, namely that elder abuse by an adult child is most likely to be financial abuse. Traditional ideas about women and men, as well as ideas about the nature of the old were found to be factors in elder abusive relationships.     

Five-year all-cause mortality rates across five categories of substantiated elder abuse occurring in the community

ABSTRACT

Elder abuse increases the likelihood of early mortality, but little is known regarding which types of abuse may be resulting in the greatest mortality risk. This study included N = 1,670 cases of substantiated elder abuse and estimated the 5-year all-cause mortality for five types of elder abuse (caregiver neglect, physical abuse, emotional abuse, financial exploitation, and polyvictimization). Statistically significant differences in 5-year mortality risks were found between abuse types and across gender. Caregiver neglect and financial exploitation had the lowest survival rates, underscoring the value of considering the long-term consequences associated with different forms of abuse. Likewise, mortality differences between genders and abuse types indicate the need to consider this interaction in elder abuse case investigations and responses. Further mortality studies are needed in this population to better understand these patterns and implications for public health and clinical management of community-dwelling elder abuse victims.     

A new role for imaging in the diagnosis of physical elder abuse: results of a qualitative study with radiologists and frontline providers

Pediatric radiologists play a key role in the detection of child abuse through the identification of characteristic injury patterns. Emergency radiologists have the potential to play an equally important role in the detection of elder physical abuse; however, they currently play little to no part in this effort. We examine the reasons behind this limited role, and potential strategies to expand it, by interviewing attending faculty from Emergency Radiology, Geriatrics, Emergency Medicine, Pediatric Radiology, and Pediatrics. Our interviews revealed that radiologists’ contribution to elder abuse detection is currently limited by gaps in training, gaps in knowledge about imaging correlates, and gaps in inter-team clinical communication. Specifically, radiographic interpretation of elder trauma is severely restricted by lack of communication between frontline providers and radiologists about patients’ injury mechanism and functional status. Improving this communication and re-conceptualizing ED workflow is critical to expanding and optimizing radiologists’ role in elder abuse detection.     

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.     

Documenting Inadequate Care in the Nursing Home:

An undercover agent describes his experiences as a nurse's aide gathering evidence that was ultimately used in the prosecution of a corporate entity responsible for the deaths of two Philadelphia nursing home residents.     

Frailty in self-neglecting older adults: A secondary analysis

ABSTRACT

Self-neglect (SN) and frailty in older adults is associated with increased disability and mortality. Despite these commonalities, there have been no studies objectively assessing frailty in older adults who SN. This secondary analysis classified frailty in N = 37 older adults with Adult Protective Services validated SN using the Fried Frailty Phenotype (FFP) of weight loss, weakness, exhaustion, activity level, and walking speed. Overall, 3% were classified as robust, 62% as prefrail, and 35% as frail. Most (72%) were overweight/obese, with clinically significant decreases in activity level (60%) and walking speed (97%). Compared to the original FFP population, older adults who SN exhibit important differences in frailty phenotypes, and finding that the largest percentage of older adults who SN were prefrail may indicate a critical opportunity for intervening in this population to reduce future functional decline and mortality.     

Elderly Prisoners: A Growing and Forgotten Group Within Correctional Systems Vulnerable to Elder Abuse

ABSTRACT

There are over 2.1 million people incarcerated in the nation's jails and prisons. Additionally, close to 600,000 prisoners are released annually into communities across the country. Many prisoners and those released from prisons are elderly. The purpose of this article is to examine the systemic abuse and neglect experienced by elderly prisoners while they are incarcerated and when they are released from prison. Most correctional systems have inadequate resources, processes, and personnel to manage the elderly population inside and outside of prisons. In addition to providing a definition of “elderly prisoner,” two specific problems–prison health care and prisoner re-entry–are examined in the article. The article concludes with recommendations for both policy and research on how best we can further understand and address the multiple needs and concerns faced by elderly prisoners.     

Senator John Breaux: The Elder Justice Proposal of 2002

ABSTRACT

The number of older Americans is steadily rising, and with it will come a concomitant increase in abuse, neglect, and exploitation. The Elder Justice Act will provide federal resources for state and community efforts as well as for research. The major purposes of the Act are to: elevate the issue of elder justice, improve the quality of information about the problem, increase knowledge and promising practices, develop forensic capacity, ensure “safe havens,” increase prosecution, supply needed training to many disciplines, address the issue in underserved populations, review model laws and practices, further security and improve information in long-term care, and encourage greater systemic accountability.     

Elder Abuse Coverage in Newspapers: Regional Differences and its Comparison to Child-Abuse Coverage

ABSTRACT

Dozens of studies have examined how the press portrays crime. Most of these studies focus on some aspect of the criminal or the response to the event. Few have considered the portrayal of victims and even fewer have examined the way the media portrays older victims. To fill this void, this study examines (1) whether elder abuse coverage varies across newspapers and (2) how the extent of elder abuse coverage compares to child-abuse coverage. Results indicate that regional differences appear to exist and child abuse receives far more coverage than elder abuse. Implications are provided.     

Los Angeles County Fiduciary Abuse Specialist Team: A Model for Collaboration

ABSTRACT

The Fiduciary Abuse Specialist Team, sponsored by the County of Los Angeles Area Agencies on Aging, provides expert consultation and training to protective services and other practitioners in cases of elder financial abuse. Collaborative teams efforts facilitate prompt and well coordinated interventions.     

Elder Abuse Detection and Intervention: A Collaborative Approach by B. Brandl,C. B. Dyer,C. J. Heisler,M. J. Otto,L. A. Stiegel,and R. W. Thomas

Mediation has recently been developed in America to help seniors deal with their disputes. Some Long Term Care Ombudsmen and their volunteers have also been trained in mediation for use in institutional conflicts. This paper suggests that elder mediation, through its voluntary, non-coercive process, has the potential for enhancing elder rights, providing an acceptable form of minimal social intervention, and contributing to the prevention of elder abuse at early stages of relational conflicts between elders and their carers.     

Disclosure among victims of elder abuse in healthcare settings: a missing piece in the overall effort toward detection

Elder abuse remains a largely hidden problem in our society and only a small minority of victims are connected to formal support/protective services. Healthcare settings have been identified as a critical milieu to uncover cases of elder abuse; however, under-detection in these settings is a major issue. Victimization disclosure is an important component within the overall detection effort, yet it has received little attention in the elder abuse literature. Drawing on relevant literature from other domains of family/interpersonal violence, this article highlights the disclosure process, as well as disclosure barriers, facilitators, and competencies to consider when working with older adults.     

Mapping Elder Mistreatment Cases: Interactions Between Mistreatment,Dementia, Service Utilization,Access to Services,and Disadvantage

Typical explanations of elder mistreatment have focused on individual-level models. The current study adds to the literature by considering the neighborhood context in which reports of elder mistreatment are made to protective services. Using geographic information system software, the distribution of 751 adult protective services (APS) reports from three cities in southeastern Virginia is analyzed. Results suggest that Alzheimer's cases are distributed differentially across cities and that in one city, reports primarily come from disadvantaged areas. The results also suggest that clients from disadvantaged areas are more likely to refuse services. Implications for policy, theory, and future research are provided.