Self-determination and elder abuse do we know enough?

This article explores the principle of self-determination as it relates to victims of elder abuse and neglect. Using newspaper accounts and cases from the author's practice and consulting files, various factors influencing the professional's interpretation of this principle are explored. The notion that self-determination allows victims of abuse and neglect to refuse intervention is challenged. The author concludes that the principle of self-determination and the notion of competency are overly simplified in the social work and elder abuse literature and may be misused by allowing abused older victims to choose to remain in often life-threatening situations. Special focus is given to Adult Protection Service worker, but the author asserts that protecting older people, assisting in creative interventions and developing needed services is a shared professional responsibility.     

Self-Neglect and Neglect of Vulnerable Older Adults: Reexamination of Etiology

Using assessment and investigation data from the reported APS cases in Texas, this study examines the types of elder self-neglect and neglect, including medical neglect. It then examines the association between self-neglect and neglect and individual economic resources as well as health care and social service programs for the poor. The findings show that elder self-neglect/neglect is, in large part, attributable to frail older adults' and their families' lack of resources to pay for essential goods and services and the inadequate healthcare and other formal support programs for the older adults and their caregivers. This inadequate public policy coverage, rather than individual and intrafamily risk factors per se, needs to be considered as a significant cause of elder self-neglect/neglect.     

Elderly Victims of Family Abuse,Neglect, and Maltreatment:

Analysis was conducted on 30 cases of elder abuse, neglect, and maltreatment of the elderly seen by attorneys in a legal aid agency in Detroit between 1979 and 1981. The data were collected as part of a larger study of elder abuse cases seen by a variety of agencies in the Detroit area. Analysis revealed that most of the victims suffered from more than one type of abuse or maltreatment. As might be expected, the most common type of abuse seen in the legal aid agency was financial abuse. The study also showed that a legal agency can provide a type of service other agencies cannot provide. These services include: court actions, non-court actions which require the service of a lawyer, and non-legal actions in which an attorney can bring about action through the perceived threat of court action.     

Environmental issues affecting elder abuse victims in their reception of community based services

This study examined the dominant factors that predict the utilization of services by 129 identified elder abuse victims who reside in the community. Utilizing the Andersen Model, services accepted or rejected were analyzed from individual, family and environmental perspectives. Results indicated that service utilization is related to three "need" factors: (1) Victim has cognitive and ADL impairments, (2) Victim has poor health status (self rated), and (3) The abuser is financially dependent on the victim and is also the primary caregiver of the victim. "Enabling" factor (1) Victim lives alone. "Predisposing" factors (1) Abuser is substance abuser and (2) Abuser is female. A great proportion of the elder abuse victims in this study accepted services from an agency that provided a single entry point into the service system and had highly trained personnel utilizing a case management approach.     

Validation Study: The Iranian Version of Caregiver Abuse Screen (CASE) among Family Caregivers of Elderly with Dementia

Since abuse screening is difficult among the elderly with dementia, detection of elder abuse is a serious issue; meanwhile, the number of available tools to assess elder abuse by caregivers is limited. The aim was to evaluate validity and reliability of the Iranian version Caregiver Abuse Screen (CASE) tool. After the translating process of the tool to the Farsi language for 236 dementia participants ≥60 years old and their informal caregivers’ from outpatient’ clinics, in a cross-sectional method then the validity, reliability and factorial structure of the CASE was evaluated. The translated Iranian version CASE reveals a good psychometric property (α = 0.868) with strong internal consistency and reliability. Some variables (depression, burden, dementia intensity, and ADLs) were associated with abuse in dementia elderly. The two-factor structure was obtained in exploratory factor analysis labeled interpersonal abuse and neglect. Generally, the Iranian version of CASE approved with sufficient validity and reliability as a suitable instrument to find the risk of elder abuse among dementia caregivers.     

Psycho-educational support groups for older women victims of family mistreatment: a pilot study

Few programs for domestic violence victims have been evaluated for effectiveness. This gap is even more pronounced for elder abuse service interventions. The study presented here is intended to address this gap by using an experimental research design to evaluate outcomes of an elder mistreatment psycho-social support group pilot for cognitively unimpaired older female victims of mistreatment by family members and significant others for whom they are providing care or support. The support group model used for the study adapts amodel designed by NOVA House, an elder abuse shelter program in Manitoba, Canada. The study was funded by the Hartford Foundation Geriatric Social Work Faculty Scholars Program. While the significance of study findings is limited by the small number of pilot participants, the model intervention and evaluation instrument developed for the study may be utilized for study replication.     

Elder Abuse in Turkey and Associated Risk Factors

Abstract

Elder abuse is one of the most important problems encountered by the elderly. Health, economical and psychological dimensions of the experience of aging also pose risk for elder abuse. This study aims to determine the abuse to which elder people are exposed based upon their own evaluations and to investigate the risk factors associated with elder abuse. This is a cross-sectional study among quantitative designs. Population of the study comprises 309 outpatient elders over the age of 65 referring to Ayd?n Do?an Geriatrics Clinic of Ankara University, Turkey. Collected data were analyzed by chi-square test and logistic regression. In total, 70.9% of the elderly participating in this study experienced abuse more than once. Majority of the participants were victims of emotional abuse (64.1%), followed by neglect and abandonment (26.9%) and economic abuse (12.6%). There was significant relation between sex, marital status, health status of the elderly and being abused (p?p?相似文献   

Going It Alone: Post-9/11 Veteran Nonuse of Healthcare and Social Service Programs During Their Early Transition to Civilian Life

Transitioning from military to civilian life is challenging for a substantial number of veterans. Successful transitions require veterans to function well in various well-being domains including employment, education, financial, health, and social relationships. There are many programs and services designed to assist veterans transition to civilian life. However, veterans rarely avail themselves of supportive resources. This study examined veteran nonuse of programs and services within the first three months of their transition to civilian life. Results revealed that male veterans often reported that they did not need programs. Female veterans and veterans from the lowest enlisted ranks were more likely to report that they did not know if they were eligible for support programs. A small percentage of veterans indicated they had not found the right program or did not know where to go to get help. Veterans need clear information about available programs, eligibility requirements, where to locate them, and how to identify which programs will benefit them. Future research should focus on what predicts veteran use of programs and services, how use changes over time, and how programs and services should be advertised/marketed to different veteran populations, particularly those at risk for poor transition outcomes.     

Communities respond to elder abuse

This article traces the development of services to prevent and treat elder abuse over a twenty-year time span. It begins by describing the various forms of elder abuse and the challenges they pose to service providers and program developers. Also described are abuse reporting statutes, the roles of various agencies involved in abuse investigations and responses, services commonly needed by victims, funding sources, and common impediments to service delivery.     

The Relative Contributions of Occupation Groups in the Discovery and Treatment of Elder Abuse and Neglect

The study analyzes data from a national survey of direct practice workers in Area Agencies on Aging. Rank orders of the ratings of the helpfulness of 14 occupational groups for abuse and neglect, respectively, are compiled at both the discovery and treatment stages of intervention. T-tests are used to compare the performances of each occupational group in cases of abuse to performances in cases of neglect. Discussion focuses on factors which might facilitate or inhibit cooperation across occupational lines in discovering and treating elder abuse and neglect.     

A Definitional Discussion of Elder Maltreatment

Currently, there is no one uniform accepted or acceptable definition of elder maltreatment. As an important first step in the continued understanding of elder maltreatment, a differentiation is made between legal and social work definitions and a classification system for defining elder maltreatment from a social work orientation is suggested as a guide for assessment and intervention. Distinctions within each of three major categories of elder maltreatment (elder neglect, elder abuse and violation of the elder's rights) is presented.     

Vital Conversations with Family in the Nursing Home: Preparation for End-Stage Dementia Care

Family members of persons with advanced dementia may be asked to make complex treatment decisions without having adequate knowledge regarding the risks and benefits. This 6-month, prospective, randomized trial tested the effect of an intervention consisting of a face-to-face, structured conversation about end-of-life care options with family members of nursing home residents with advanced dementia. A comparison group received only social contact via telephone. Structured conversations between a palliative care team and intervention group family members included goals of care and how best to achieve those goals, and provision of psychosocial support. Psychosocial support was also provided via telephone at three 2-month intervals. Family members participated in three telephone interviews: baseline, 3, and 6 months. Specific advance directives for persons with dementia were extracted from medical records. Results showed that intervention families had higher satisfaction with care than comparison families at the 6-month time point, and they were more likely to have decided on medical options listed in residents' advance directives (Do Not Resuscitate, Intubate, Hospitalize) over time. Study findings reinforce the need for increased education and support for families around issues of end-of-life care decisions for advanced dementia.     

Use of a single page elder abuse assessment and management tool: a practical clinician's approach to identifying elder mistreatment

Elder abuse is a growing, alarming public health issue. As health care professionals, our challenge is to balance our duty to protect the safety of the vulnerable elder with the elder's right to self-determination. Clinicians in busy practice settings across the continuum of care as well as community-based social workers, emergency medical system, police, and banking personnel are collaborative partners needing tools that focus on early recognition, assessment, intervention, and management of elder abuse. A simple one-page tool that provides principles of assessment and management, best practice guidelines and screening questions will hopefully serve to raise awareness of this important public health issue and maintain a high index of suspicion for elder abuse, neglect and financial exploitation.     

The effectiveness of selected interventions for previous maltreatment: enhancing the well-being of children who live at home

The authors critically assessed reviews of the literature published between 1984 and 2002 to describe the state‐of‐knowledge about the effectiveness of interventions aimed at protecting or improving the welfare of child victims of maltreatment and who remain in the family home. The interventions studied target children, parents or families. They chiefly involve cases of sexual abuse, physical abuse or neglect; very few concern psychological abuse or exposure to violence. For the most part, the intervention effectiveness indicators measure changes in parents’ and children's knowledge (e.g. better knowledge of child development), attitude (e.g. gains in enthusiasm), emotion (e.g. decreased anxiety) and behaviour (e.g. decreased rates of aversive behaviours). Few assessments follow up on participants to determine whether the changes are lasting. The small number of evaluative studies, methodological limitations and disparities in the content and the carrying out of interventions make it difficult to draw sound conclusions about the effectiveness of interventions, even for interventions most often and most favourably assessed, such as behavioural and cognitive‐behavioural interventions with maltreating parents. Implications for practice, research and policy are underlined.     

Ombudsman program characteristics related to nursing home abuse reporting

The purpose of this research is to determine if there is an association between ombudsman report rates of abuse, gross neglect, and exploitation from 1997 through 2002 and ombudsmen's public and staff education, investigative process, program expenditures, and census demographics. Data were obtained from the National Ombudsman Reporting System. Ombudsman annual reports of nursing home abuse, neglect, and exploitation are representative of that state's individual program. These reports should not be construed to represent all abuse in nursing homes. Physical abuse and resident-to-resident abuse were the highest rates of abuse reported. Census demographics and ombudsman program characteristics were associated with rates of abuse.     

Consumer fraud and the elderly: a review of Canadian challenges and initiatives

Financial abuse is the most common type of elder abuse. Consumer fraud, a form of financial abuse perpetrated by criminals who do not know the victim, is not well studied. Seniors represent a disproportionate percentage of the victims of consumer fraud. This article reviews the data on the prevalence of consumer fraud (primarily telemarketing scams) in Canada. It examines the reasons why Canadian seniors are targets of fraud. It also describes many unique initiatives developed at the local, provincial and national level in Canada to educate seniors and those who care for them about the types of scams and the risks of fraud.     

Nursing home social services directors and elder abuse staff training

In a nationally representative study of 1,071 nursing home social services directors 80% of social services departments provided resident rights training and 60-70% were involved in abuse training. Departments headed by recent grads and in chain nursing homes or in the northeast were more likely to be involved in training. Seventy-two percent of social services directors were able to provide one-on-one training about reporting suspected abuse; education and licensure were related to ability to train.     

Nursing Home Social Services Directors and Elder Abuse Staff Training

In a nationally representative study of 1,071 nursing home social services directors 80% of social services departments provided resident rights training and 60–70% were involved in abuse training. Departments headed by recent grads and in chain nursing homes or in the northeast were more likely to be involved in training. Seventy-two percent of social services directors were able to provide one-on-one training about reporting suspected abuse; education and licensure were related to ability to train.     

'School was just a nightmare': childhood abuse and neglect and school experiences

Children who have experienced abuse display significant difficulties in dealing with all aspects of the school environment. This paper examines the experiences at school of a group of respondents who had been subject to abuse and neglect during their childhood and adolescence. A qualitative research approach, utilizing in-depth interviews, was used to explore their perspectives and insights in relation to their experiences. The findings of this study show how the various forms of abuse and neglect experienced in their families had consequences for them in the school setting. A further important finding was a lack of professional student welfare support for the interviewees at school. Implications for prevention and intervention approaches in relation to both policy and service delivery are outlined.     

Social services provided for physically abused children in Sweden: background factors and interventions

This study aims at describing and analysing what kinds of social services are provided for physically abused children in Sweden. The social services files were examined for 113 children under 15 years of age (67 boys and 46 girls) who had been reported to the police as having been physically abused by a parent or equivalent caretaker in a particular police district. The children's social services files indicated an increased risk of a parental abusive behaviour prior to the abuse incident. There had been former interventions in 81 per cent of the families and previous reports on neglect or abuse in 44 per cent of the 113 families. After the abuse incident, investiga-tions were opened in 80 per cent of the cases. The three most common interventions were placement in foster care, referrals to Child and Adolescent Psychiatric Service and Social Services support contacts. The study shows that there was a tendency towards more proactive work with injured children, children of immigrant parents and children of mentally ill parents.