Infantilization as elder mistreatment:evidence from five adult day centers

To prevent maltreatment, aging services must be age appropriate even as consumers suffer from physical and cognitive disabilities. In this paper, it is argued that exposing older persons to childoriented settings, activities and speech patterns in aging service environments represent a form of psychological mistreatment. Ethnographic evidence from 220 hours of field observations in five "social model" adult day centers revealed infantilization of service users in the form of confinement, baby-talk, nicknames, child-oriented decor, teacher-student learning format, reprimands, use of toys, as well as a loss of privacy regulation, autonomy, choice, and adult status. All centers exhibited some mistreatment, but severe examples were present in two of the five centers studied. Negative influences on behavior, well-being, self-identity, relationship formation, and social interaction were detected, which distinguished mistreatment from poor quality of care. Insider interviews (23) revealed resentment and adaptive strategies employed to distance themselves from infantilization.     

Prevalence and correlates of elder mistreatment in Singapore

The current study attempts to identify the prevalence rate of and risk factors associated with elder mistreatment in Singapore, a multi-ethnic nation in South-East Asia. Information on elder mistreatment was collected from 400 non-randomly selected cognitively intact older adults in a residential area of Singapore. Items on mistreatment were adopted from the Hwalek-Sengstock Elder Abuse Screening Test and the Vulnerability to Abuse Screening Scale. Standardized scales on activities of daily living, loneliness, and items on violence between family members were administered. The prevalence rate of mistreatment was 8.3%. A family environment characterized by psychological and physical abuse between family members and a social environment characterized by loneliness increased the vulnerability of older adults to mistreatment. Older adults who were mistreated reported more depression symptoms than those who were not.     

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.     

Turkey: a pilot study of elder mistreatment in a convenience sample

Attitudes towards elder abuse were explored through a survey on International Perspectives on Family Violence and Abuse in a Turkish convenience sample of 25 females and 14 males, ranging in age from 22 to 58. Participants gave examples of behaviors considered in their culture to be extremely abusive, moderately abusive, and mildly abusive from an adult child toward his or her older parent. Responses were coded into four major categories of abuse, each of which had several subcategories: psychological aggression (including the subcategories of verbal aggression, emotional abuse, disrespect, disobedience, power assertion, blame, and imprisonment), neglect (including physical neglect, psychological neglect, abandonment, and putting the older individual into a nursing home), physical aggression (including beating and hitting), and mistreatment related to goods and services (including economic demands, economic withholding, and labor). The most common examples of extreme abuse were neglect, particulary physical neglect, followed by physical abuse. At the moderate and mild levels, various forms of psychological aggression were most commonly mentioned. The only significant gender difference was that men listed more instances of verbal aggression as examples of extreme abuse than women. A positive correlation was found between age and the number of abandonment examples at the extreme level. Results were interpreted from a cultural perspective.     

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.     

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.     

Practitioners' views on elder mistreatment research priorities: recommendations from a Research-to-Practice Consensus conference

This article presents recommendations from expert practitioners and researchers regarding future directions for research on elder abuse prevention. Using the Research-to-Practice Consensus Workshop model, participants critiqued academic research on the prevention of elder mistreatment and identified practice-based suggestions for a research agenda on this topic. The practitioners' critique resulted in 10 key recommendations for future research that include the following priority areas: defining elder abuse, providing researchers with access to victims and abusers, determining the best approaches in treating abusers, exploiting existing data sets, identifying risk factors, understanding the impact of cultural factors, improving program evaluation, establishing how cognitive impairment affects legal investigations, promoting studies of financial and medical forensics, and improving professional reporting and training. It is hoped that these recommendations will help guide future research in such a way as to make it more applicable to community practice.     

Development of short-form measures to assess four types of elder mistreatment: Findings from an evidence-based study of APS elder abuse substantiation decisions

Improving the standardization and efficiency of adult protective services (APS) investigations is a top priority in APS practice. Using data from the Elder Abuse Decision Support System (EADSS), we developed short-form measures of four types of elder abuse: financial, emotional/psychological, physical, and neglect. The EADSS data set contains 948 elder abuse cases (age 60+) with yes/no abuse substantiation decisions for each abuse type following a 30-day investigation. Item sensitivity/specificity analyses were conducted on long-form items with the substantiation decision for each abuse type as the criterion. Validity was further tested using receiver–operator characteristic (ROC) curve analysis, correlation with long forms and internal consistency. The four resulting short-form measures, containing 36 of the 82 original items, have validity similar to the original long forms. These short forms can be used to standardize and increase efficiency of APS investigations, and may also offer researchers new options for brief elder abuse assessments.     

Understanding "elder abuse and neglect": a critique of assumptions underpinning responses to the mistreatment and neglect of older people

This article provides an overview of the ways in which the mistreatment and neglect of older people have come to be understood as a social problem, one which is underpinned by a variety of substantive and theoretical assumptions. It connects the process of conceptualizing elder abuse and neglect to political-economic and social evolution. The authors draw on a review of the literature, government sources, interest group websites, and their own research to provide a critical commentary illustrating how these understandings have become manifest in legislation, policies, and programs pertaining to "elder abuse and neglect" in Canada. Suggestions are provided for changes in direction for policies, programs, and research.     

Resident-to-resident elder mistreatment (R-REM): a study in residential structures for elderly people (ERI) in Portugal

This study explores patterns of resident-to-resident elder mistreatment (R-REM) in Portuguese Residential Structures for Elderly People (ERI: Estruturas Residenciais para Idosos). Results display a serious situation of R-REM, which occurs in different patterns.     

Ecologically defining the mistreatment of adolescents

Ecologically defined, the problem of adolescent/family conflict for otherwise “normal” families is a reaction to crisis in the life cycle of the family. A family's success in weathering the crisis is indicated by their successful maturation to the next stage of the cycle; we can assume that in such cases the ratio of stress to coping ability was such that the family could integrate that stress. When conflict escalates to abuse and neglect, however, the indication is that stress has outstripped coping ability, and the implication is for stress-reducing intervention quite unlike the standard existing interventions in either the juvenile justice or child welfare systems, which negatively label family members, make them adversaries, fragment their coping capabilities, and even subject them at times to situations worse than those for which they needed help originally. The interventions called for are those that support beleaguered families; that are based on conceptualizations of people as adaptable and capable of solving their own problems if they are given adequate supports.     

The mistreatment of older adults: perpetrator-victim relationships and interventions

ABSTRACT The characteristics of the mistreatment of older adults were investigated in a sample of 128 older adults identified as potential mistreatment cases in three community-based agencies in Quebec. Practitioners completed questionnaires to collect quantitative and qualitative data. The study also examined: (1) difficulties in identifying mistreatment, (2) interventions and outcomes, and (3) reasons for the refusal of services. The major finding (with important implications for practice) was the association between type of treatment and perpetrator relationship to victim. The harm reduction model is suggested as a useful approach to guide interventions.     

Issues of elder care and elder abuse in the Indian context

With 7% of the population of India being elderly, two-thirds of whom live in villages and nearly a half of them in poor conditions, the care of the elderly is a difficult problem to be tackled. The dwindling of the joint family, the rise of dual-career families, a possible shift in filial piety values, the increasing life expectancy with greater chances of a prolonged old age characterized by poverty, degeneration, more empty-nest years, and dependency, have all added to the seriousness of the problem and made the elderly more susceptible than ever to abusive treatment. This paper examines these issues as well as the issue of elder abuse in light of available data and suggests some strategies to meet the problem. Also discussed are the problems, stresses, and strains of caregivers of the elderly. A greater role is envisaged for Non-Governmental Organizations (NGOs) than the state in the care of the elderly, particularly in providing support services to family caregivers.     

Addressing elder abuse: the Waterloo restorative justice approach to elder abuse project

The Community Care Access Centre (CCAC) of Waterloo Region, in partnership with a number of other social service agencies, designed and implemented a restorative justice model applicable to older adults who have been abused by an individual in a position of trust. The project was very successful in building partnerships, as many community agencies came together to deal with the problem of elder abuse. The program also raised the profile of elder abuse in the community. However, despite intensive efforts, referrals to the restorative justice program were quite low. Because of this, the program moved to a new organizational model, the Elder Abuse Response Team (EART), which has retained the guiding philosophy of restorative justice but has broadened the mandate. The team has evolved into a conflict management system that has multiple points of entry for cases and multiple options for dealing with elder abuse. The team has developed a broad range of community partners who can facilitate referrals to the EART and also can help to provide an individualized response to each case. The transition to the EART has been successful, and the number of referrals has increased significantly.     

Exchange,role modeling and the intergenerational transmission of elder support attitudes: Evidence from three generations of Mexican-Americans

Social exchange theory and role modeling are alternative theories of how the willingness to provide intergenerational assistance is transmitted from one generation to the next. Distinguishing between these theories is difficult because they apparently lead to identical predictions. In this paper we propose a test that can distinguish between the two theories. We find a data set containing the variables necessary to implement the test and use it to estimate models of young adults’ elder support attitudes. The results provide at best weak evidence of exchange, but are consistent with a role model explanation of the transmission of intergenerational assistance attitudes, particularly for young men.     

Using clinical signs of neglect to identify elder neglect cases

Elder neglect is the one of the most pervasive forms of mistreatment, and often the only place outside of the individual’s residence to identify and assist neglected individuals is in a medical setting. However, elder neglect cases treated in hospitals do not present with a single diagnosis or clinical sign, but rather involve a complex constellation of clinical signs. Currently, there is a lack of comprehensive guidelines on which clinical signs to use in screening tools for neglect among patients treated in hospitals. Using the DELPHI method, a group of experts developed and tested a scale to be used as a pre-screener that conceptually could be integrated into electronic health record systems so that it could identify potential neglect cases in an automated manner. By applying the scale as a pre-screener for neglect, the tool would reduce the pool of at-risk patients who would benefit from in-depth screening for elder neglect by 95%.     

Willingness and availability: Explaining new attitudes toward institutional elder care among Chinese elderly parents and their adult children

This paper studies the attitudes of Chinese elderly parents and their family members toward institutional elder care. Based on a sample survey of 265 elderly residents in 67 elder home institutions and 114 family members, this study finds that elders and family members generally had high evaluations of institutions' quality in terms of facility, medical, and direct care conditions. Elders who reported improved health and emotional well-being after entering institutions gave higher ratings to those institutions' quality. Among adult children, those who had more siblings tended to rate institutions higher than those who had fewer siblings. Factors that influenced elders' willingness to stay in an institution included marital status and financial ability. Widowed elders were more willing to stay in institutions compared with married counterparts. Elders who rated service charge very high preferred to stay at home due to the high cost of institutional care. In the family relatives' sample, gender was found to be related to willingness to place elderly parents in an institution; female children were less willing to place elderly parents in the institution.     

Risk factors associated with elder abuse: the importance of differentiating by type of elder maltreatment

Elder abuse research rarely differentiates by the type of elder maltreatment involved when identifying risk factors. The purpose of this study was to compare risk factors across four predominant types of elder maltreatment (financial exploitation, physical abuse, neglect by others, and hybrid financial exploitation [HFE]). Data were collected from two sources: interviews with victims of substantiated elder abuse, responding adult protective services (APS) caseworkers (N = 71), and third-party informants; and a statewide database that contained all substantiated cases over a corresponding 2-year period (N = 2,142). Using chi-square (interview data) and logistic regressions (Adult Services/Adult Protective Services [ASAPS] data), significant differences across the four types of elder maltreatment were found. These two datasets provide converging evidence for the importance of differentiating by type of maltreatment when identifying risk factors for elder maltreatment and for the importance of considering both the elderly victim and the abusive individual when predicting type of elder maltreatment.