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.     

A Qualitative Examination of the Similarities and Differences of Elder Abuse Definitions Among Four Groups: Nursing Home Directors,Nursing Home Employees,Police Chiefs and Students

ABSTRACT

A common claim found in the elder abuse literature is that different groups offer varying definitions of elder abuse. Very little research, however, has examined what these differences are and how the differences are manifested in various settings. To fill this void, this research examines the definitions of elder abuse provided by respondents from four groups in the Commonwealth of Virginia: nursing home directors (n = 54), nursing home employees (n = 132), police chiefs (n = 64), and students enrolled in upper-level sociology and criminal justice courses (n = 127). Results of standard thematic content analysis examining the elder abuse definitions show significant differences in several areas. Primarily, nursing home directors are more likely to define elder abuse from an ethical perspective whereas police chiefs and students are more likely to define elder abuse from a legalistic perspective. Implications are provided.     

Chapter Four

Mental health professionals contribute in important ways to both the clinical and ethical issues raised by cases of elder mistreatment. Their clinical competencies contribute to improving quality of life by diminishing psychological suffering and the symptoms of mental illness. They are also used for managing the ethical issues raised by these cases. The ethics of mental health care are based on the values of beneficence, nonmaleficence, autonomy, and justice. The value of autonomy in mental health care gives priority to an individual's long-term ability to act as independently, rationally, and fully in all aspects of life as possible. The concepts of legal and clinical competence also aid in managing the ethical problems represented by cases of elder mistreatment. The ethical protocols of mental health professionals may be distinguished from some other disciplines by the premium given to long-term autonomy and by the aim of insuring treatment for all persons involved in cases of elder mistreatment, rather than limiting treatment responsibilities to the victim.     

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.     

Researching Elder Abuse in Britian

This article explains the lack of British elder abuse research by focusing upon two aspects of the research process; the methadological difficulties of developing indicators of abuse and the ethical problems of using self-disclosure and victimisation surveys when researching a sensitive topic. As an illustration of these difficulties, the experience of using an American research methodology to determine the prevalence of elder abuse in Britain is described.     

Community-Based System,Reports, and Substantiated Cases of Elder Abuse: Disparities Between Municipalities and Relating Factors in Japan

This study examines (1) the staffing and financial characteristics of systems for elder abuse detection and intervention in the municipal governments of Japan and (2) the relationship among the development of detection and intervention systems, the reporting rates of suspected elder abuse cases, and substantiated abuse rates in 927 municipalities across Japan. Progressive systems for the detection and intervention of elder abuse were significantly associated with a larger number of public officers than in non-progressive systems. Furthermore, greater rates of both suspected and substantiated cases of abuse were associated with progressive systems for elder abuse detection and intervention. Per capita annual expenditures on the comprehensive support project and the community general support center's catchment under the Long-Term Care Insurance (LTCI) program showed no significant association with the development of systems, the rate of suspected cases, or the number of substantiated cases. National social policy makers should examine strategies that would help municipalities assign sufficient staff to elder abuse detection and intervention programs.     

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.     

Elder Abuse and Neglect: A Survey of Clergy Awareness,Knowledge, and Intervention Preferences

This article explores the research question: What is the perceived level of elder abuse and neglect awareness and knowledge among Protestant clergy members in Kentucky? Of the 300 clergy contacted, 160 participated, for a response rate of 53.3%. Pearson Chi-Square analyses were used to determine statistical significance, and phi coefficient correlations examined the strength of the associations between variables. Findings indicate that approximately 44% of clergy members in this study report some “awareness” of elder abuse and neglect. However, 56% of clergy respondents do not know that Kentucky is an “any person” mandatory reporting state. Specifically, participating clergy appear poorly informed about legal requirements for reporting elder abuse and neglect and perceive types of abuse differently. Untrained clergy with little formal training indicate a willingness to provide therapy to victims despite reporting that they do not feel qualified to do so.     

Elder Abuse and Neglect:

The study analyzes data from a 1987 survey of 1,137 adult protective service workers in forty states and Washington, D.C. A four-page questionnaire was mailed to obtain information on the perceptions and practices of those practitioners in dealing with cases of elder abuse neglect. Data were collected on the incidence of elder abuse, neglect, self-neglect, and exploitation; the observed frequencies of hypothesized causes of elder abuse and neglect in actual cases; barriers to service; the effectiveness of various methods of intervention; the outcomes of elder abuse and neglect cases; adn the perceived potential of community resources for reducing elder abuse and neglect.     

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.     

Addressing the measurement challenge in elder abuse interventions: need for a severity framework

ABSTRACT

The field of elder abuse is evolving toward an emphasis on intervention research. However, researchers currently rely on binary approaches to measure elder abuse phenomena, which fail to capture changes in problem status over the course of intervention. This commentary develops a case for severity as a framework to operationalize and measure elder abuse in intervention research and practice. A severity framework provides enhanced elder abuse measurement responsiveness and aligns with the dominant client-centered, harm-reduction clinical approach to intervening with elder abuse cases.     

An Overview of Elder Abuse and Neglect in Australia

ABSTRACT

Only relatively recently has the issue of elder abuse come to prominence in Australia. Until the late 1980s it was a hidden problem with little knowledge of its presence. Attention was drawn to elder abuse after the publication of a number of reports and research projects, allowing the development of responses at national and state levels. This paper gives an overview of the development of elder abuse as a social, legal and medical issue in Australia, and describes the diverse range of responses from the national, state and territory governments.     

Developing Strategies for the Prevention,Detection and Management of Elder Abuse: The Irish Experience

ABSTRACT

It is only within the past two decades that elder abuse has received governmental attention in Ireland. There had been little awareness, and no structures in place to tackle this problem prior to this. Media highlighting of particular cases, and an exploratory study undertaken in 1998, prompted the setting up of a governmental working group on elder abuse. Unique to this group was the trialling of a proposed system in two pilot sites. This allowed for recommendations based on actual practice, and has lead to the adoption of a network of elder abuse caseworkers, among other recommendations.     

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.     

Financial exploitation of older persons in adult care settings: comparisons to physical abuse and the justice system's response

The current study uses a sample of 242 elder financial abuse cases and 314 elder physical abuse cases handled by fraud control units to shed some light on the dynamics of elder financial exploitation and the way the justice system processes these cases. Attention also is given to the way that the processing of elder financial exploitation cases can be distinguished from the processing of elder physical abuse cases. Results show that a wide range of elder financial exploitations cases are committed, and these cases should be broadly defined. Implications are provided.     

Elder Abuse and Child Abuse:

Elder abuse has been compared with other forms of intrafamilial violence. Despite obvious age and status differences, elder parents and young children exhibit similarities that make the linking of elder and child abuse compelling. However, difference in the nature of child-to-parent and parent-to-child relations and in the social and legal status of adulthood versus childhood argue against a too facile linking of the two problems. This paper suggests dimensions relevant to a comparison of intergenerational physical abuse of elder parents and young children.     

An overview of elder abuse and neglect in Australia

Only relatively recently has the issue of elder abuse come to prominence in Australia. Until the late 1980s it was a hidden problem with little knowledge of its presence. Attention was drawn to elder abuse after the publication of a number of reports and research projects, allowing the development of responses at national and state levels. This paper gives an overview of the development of elder abuse as a social, legal and medical issue in Australia, and describes the diverse range of responses from the national, state and territory governments.     

Ethical and legal challenges of mandated child abuse reporters

Background

Mandated reporters inconsistently report child abuse cases. Ethical dilemmas and legal challenges to reporting arise creating barriers to assist abused children and their families.

Purpose

The purpose of this study was to describe professionals' ethical dilemmas and legal challenges to reporting child abuse.

Method

A qualitative study was conducted to explore the ethical and legal challenges of mandated reporters when reporting child abuse. Individual interviews between 60 and 100 min were conducted with a purposive sample of 18 mandated reporters including physicians, nurses, social workers, and teachers. Grounded theory methodology was used to develop categorical themes that reflected mandated reporters' experiences and challenges.

Result

Three themes emerged from the data: conflicts, time, and law as refuge. Professionals described challenges in balancing autonomy, beneficence, nonmaleficence, and justice. There was no best solution to do no harm. The associated stigma and pressure of cultural and secular norms of child abuse inhibit professionals' action based on legal and ethical requirements. The theme of time included limited time and an uncertain future. The law provides security and refuge for professionals to find a solution to the challenges of reporting child abuse.

Conclusion

The ethical and legal challenges of reporting child abuse create complex dilemmas for mandated reporters. Ethical principles are in constant opposition when negotiating rights of children and rights of parents. Supportive structures and education are needed to assist professionals in meeting their reporting obligation and solving their dilemmas.     

Improving medicolegal death investigative gaps of fatal elder abuse

The purpose of this brief is to present several case vignettes that illustrate omissions in the investigation of elder deaths. These vignettes demonstrate the need for a standardized approach in the conduct of medicolegal investigations of fatal elder abuse. For each of the described oversights, a recommendation is offered to address the gap in investigation processes, which in turn could improve the determination of cause and manner of elder death. Inherent limitations of resources and practical realities of death investigation are discussed and recommendations are made for future research. Viewed broadly, deficiencies in elder death investigations can lead to the underreporting of elder abuse and the reduction of legal options for victims, which may reflect a systemic pattern of social injustice.     

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.