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.     

Further Validation of the QUALCARE Scale

The main goal of the study was to conduct a further validation of the QUALCARE Scale by documenting its criterion validity. More precisely, the study was designed to test the usefulness of the scale in identifying family-mediated elder mistreatment. Because the study used a French version of the scale, its inter-observer reliability, internal consistency, and construct validity were reexamined. Forty elder/caregiver dyads participated in the study. The elders were referred by professionals involved in their home care. The opinion of these professionals regarding the possible existence of a mistreatment situation within the family was used as the criterion against which the QUALCARE score was compared. The results suggest that a measure of quality of care is a valid indicator of the risk of mistreatment. However, the reproducibility of the scale proved to be insufficient. Its future use should therefore be preceded by more extensive training than that given in the present study.     

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.     

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.     

Gendered Policies and Practices that Increase Older Men's Risk of Elder Mistreatment

SUMMARY

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.     

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.     

Risk Indicators of Elder Mistreatment in the Community

ABSTRACT

This study examined risk indicators of chronic verbal aggression, physical aggression, and financial mistreatment in a population-based sample of 1,797 independently living elderly in Amsterdam, The Netherlands. Included were socio-demographic characteristics, physical and psychological health, and functional capacity. The data were collected using standardized interviews that took place in the homes of the respondents. The results showed that chronic verbal aggression was associated with an elder living with a partner or other(s) and in poor or bad health. Physical aggression was associated with an elder living with a partner or other(s) and having depressive symptoms. Finally, financial mistreatment was associated with being male, living alone, being partially dependent in instrumental activities of daily living and having depressive symptoms. The results indicate that the risk indicators of victims of financial mistreatment differ from those of chronic verbal aggression and physical aggression, suggesting that financial mistreatment may occur more often as a single form of abuse whereas verbal and physical aggression may more frequently occur together.     

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.     

Screening Elders in the Emergency Department at Risk for Mistreatment: A Pilot Study

Impaired functional status is associated with risk of elder mistreatment. Screening for functional impairment in elderly patients admitted to emergency departments could be performed to identify patients at risk for elder mistreatment who might benefit from further evaluation. This study utilized a modified Identification of Seniors at Risk (ISAR) screening tool to identify the proportion of elderly at risk for mistreatment due to functional difficulties presenting to two emergency departments in southeastern Virginia, one urban, the other rural. Of a 180-patient cohort (90 per site), 82 screened positive (46%), ISAR > 2 (range 0–6), indicating nearly half of all patients enrolled are at risk for mistreatment. Patients presenting to the urban emergency departments were potentially more at risk than their rural counterparts (p < 0.01). Health care professionals, particularly in urban settings, should consider screening seniors with a simple tool to identify patients at risk of 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.     

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.     

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.     

Elder Mistreatment

SUMMARY

New information on elder mistreatment and conflict management among certain ethnic groups has necessitated changes in the practice arena. Clinical approaches depend on the victims' ability to identify themselves as victims, their degree of collective self, preferred conflict management techniques, and ability to identify their own power resources. Practice considerations and modifications include looking for subtle behaviors indicative of psychological abuse and neglect, using words that are culturally familiar and acceptable, and educating elders and their families about how other families relate and solve problems. Other interventions involve the use of the third party for cathartic displacement, and based on a temporal model of the exchange process, creating a power balance by maximizing the victims' potential power while minimizing the perpetrators' potential power.     

Lesbian,Gay Male,Bisexual and Transgendered Elders: Elder Abuse and Neglect Issues

ABSTRACT

Unfortunately, due In large measure to our society's still-pervasive social prejudice against and ignorance about sexual orientation and gender minorities, there have been few studies of this population of elders, and virtually no one has examined how this population's culture affects its experience with elder abuse. Based on the author's knowledge of this community and discussions with social workers and domestic violence specialists who serve it, these clients are likely to be more resistant than other clients to accepting services. Greater awareness of the existence and circumstances of lesbian, gay male, and transgendered elders should help protective services staff in building rapport with these clients and in getting them the services and assistance that they need.     

Response to Acierno’s comments on Wong and Waite, “Elder mistreatment predicts later physical and psychological health: Results from a national longitudinal study”

We respond to Dr. Acierno’s concerns about the measurement of elder mistreatment and social support in the National Social Life, Health, and Aging Project. We made our analytic decisions carefully and conducted systematic robustness checks and believe our findings are theoretically important.     

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: Implications for prosecutors

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.     

The neglected elder: a family systems approach.

Abuse and neglect of older adults is largely an invisible problem. Those who are vulnerable are often hidden from the public eye. Troubled families characteristically maintain an isolated existence and, therefore, the mistreatment of elders can occur without the knowledge of neighbors or interested community members. Factors that operate to keep the problem hidden include society's emphasis on family privacy, the victim's unwillingness or inability to report the problem, stereotypes about the aged, and denial (Quinn, 1986). Although the problem of abuse and neglect of elders is not as prevalent as child maltreatment, it is a significant societal problem in need of increased public awareness. This article will focus on the treatment of elder neglect within the context of the family.     

Elder mistreatment in underserved populations: Opportunities and challenges to developing a contemporary program of research

ABSTRACT

This article provides an overview of the status of research on elder mistreatment among underserved populations in the United States, including gaps in our current knowledge base and scientific and structural barriers to growing research on the exploitation, neglect, and abuse of older people from diverse and disadvantaged ethnic/racial, geographic, sexual identity, and socioeconomic groups. High-priority areas in need of new elder mistreatment research with underserved populations are identified, and suggestions are given for how this research can be facilitated by researchers, university institutional review boards, and funding agencies.     

Elder Abuse in Costa Rica

ABSTRACT

This paper describes how the problem of domestic elder abuse in Costa Rica is being perceived and acted upon by direct service providers and other professionals in the field of aging. Costa Rica is a small Central American democracy in which the family is the central institution and the sense of filial obligation is strong. In this cultural context elder abuse often takes the form of overprotection by family members who deprive elders of their autonomy. Although they suffer from this loss, elders frequently do not define it as abuse, making it difficult for professionals to intervene. A more serious concern was abandonment of elders by families (with or without intent to harm) since there are few facilities or resources to accommodate such elders. Overall we found a mixture, sometimes in the same person, of resignation in the face of a phenomenon that may come inevitably with modernization and committed activism. We illustrate the latter by describing the efforts of two Costa Rican organizations to prevent elder abuse.