The Devil is in the Details: Self-Neglect in Australia

ABSTRACT

Although elder self-neglect is of significant concern to adult protective service (APS) workers in the United States, minimal research has been conducted on this topic in Australia. Using qualitative research methods, this article examines how 24 Australian professionals understand situations of self-neglect. Unlike in the United States, where the term self-neglect is used in a broad and all-encompassing manner, participants in this research differentiated among self-neglect (the neglect of self), squalor (extreme neglect of environment), collecting (the accumulation of certain objects), and hoarding (the inability to throw objects away). It is argued that separating out the various behaviors that are classified under the broad umbrella of neglect can be useful in fostering reflective interventions in these situations.     

Race and Type of Maltreatment in an Elder Abuse System

This paper examines the relationship between race and types of maltreatment experienced by elderly people. In particular, it uses logistic regression analysis to examine whether race of victim is associated with self-neglect, neglect, physical abuse, and material abuse. The findings indicate that race is related to the likelihood of self-neglect and neglect but in opposite directions; whites are more likely to be associated with self-neglect, and blacks with neglect by others. Race was not significantly related to the likelihood of being physically or materially abused. The implications of these findings are discussed.     

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.     

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.     

A Critical Review of the Empirical Literature: Identifying Correlates of Child Neglect

More than half the children in the United States who were victims of maltreatment in 2000 were victims of neglect (USDHHS, 2002). The majority of all child maltreatment related fatalities in 2000 were the result of neglect (USDHHS, 2002), and 27.8% of these fatalities were associated with both physical abuse and neglect (USDHH, 2002). Neglected children are more likely to be younger children (USDHHS, 2000), and the highest rate of child fatality due to maltreatment is between the ages of zero and five (Petit & Curtis, 1997; Gustavsson & Segal, 1994; USDHHS, 1999). The purpose of this article is to present the findings of a systematic review of the research on child neglect from 1990 to 2002. The review critiques method and synthesizes of the current body of knowledge on child neglect.     

Observational Measure of Elder Self-Neglect

The purpose of this study was to improve measurement of elder self-neglect by testing the psychometric properties of the Elder Self-Neglect Assessment (ESNA). Social workers, case managers, and adult protective services providers from 13 Illinois agencies completed a 77-item assessment for 215 clients suffering from self neglect. Analyses used Rasch item response theory and traditional validation approaches to test for dimensionality, model fit, and additional construct validation, resulting in a 62-item assessment. The ESNA met Rasch fit criteria with good internal consistency, item reliability, and construct validity. A 25-item short form also met Rasch criteria. A hierarchy of items associated with severity of abuse was produced by frequency of occurrence. ESNA indicators of self-neglect align into two broad categories: behavioral characteristics and environmental factors, which must be accounted for in a comprehensive evaluation. Theoretical refinements developed using the empirically generated item hierarchy may help to improve assessment and intervention.     

Child abuse and neglect: Perspectives on a national emergency

Hundreds of thousands of children are being abused and neglected in the United States annually. The structures devised to respond to this abuse and neglect have been unsuccessful. The United States government continues to spend billions of dollars on programs to deal with the effects of these unsuccessful responses. Child abuse and neglect in the United States now represent a national emergency. In this article, we will provide a historical, cultural, and contemporary perspective on child abuse and neglect. This perspective throws light on the complexity of the national emergency and provides a context for further exploration of the issue.     

Child Abuse and Neglect: Perspectives on a National Emergency

Hundreds of thousands of children are being abused and neglected in the United States annually. The structures devised to respond to this abuse and neglect have been unsuccessful. The United States government continues to spend billions of dollars on programs to deal with the effects of these unsuccessful responses. Child abuse and neglect in the United States now represent a national emergency. In this article, we will provide a historical, cultural, and contemporary perspective on child abuse and neglect. This perspective throws light on the complexity of the national emergency and provides a context for further exploration of the issue.     

Ensuring an Abuse-Free Environment:

Abuse and neglect of nursing home residents are recognized as a major concern in the United States. The small amount of research conducted to date concerning the extent and correlates of the problem of abuse highlights the need for specialized staff training in abuse prevention. The residents' right to be free from abuse demands that facility staff be equipped with an awareness of the types of abuse, how to recognize the potentially abusive situations, and how to appropriately defuse conflict. This paper describes the development and test implementation of an eight module abuse prevention curriculum designed specifically for nurse aides in long term care facilities.     

A Review of Social Justice and Diversity Content in Diversity Course Syllabi

Given United State's leading position among international social work organizations, it is important that its standards of practice for diversity in social work education are examined. Using a nationwide sample of syllabi (N = 174) in the United States, the purpose of this study is to measure the extent to which various facets of diversity and social justice are incorporated into social work course syllabi. The study further assesses whether social justice content is integrated into diversity courses according to the Council on Social Work Education's 2001 and 2008 Educational Policy and Accreditation Standards (EPAS). The goal is to better understand program adherence to diversity objects designed for social work education curriculum. An examination of course titles, syllabi content, and course objectives revealed a broad array of identified topics; however, terms such as culture/multicultural (79.2%), race (71.7%), diversity (68.2%), ethnicity (63.6%), gender (60.1%), oppression (57.8%), and gay/lesbian (56.1%) were addressed with greater frequency across all syllabi. In an assessment of adherence to 2001 and 2008 EPAS among syllabi, interrater agreement with the use of Kappa revealed modest agreement. Greater transparency in connecting EPAS with diversity course syllabi is an important step in the requirement to improve capability across programs. Implications for future research are discussed.     

The Changing Valuation of Dogs1

In recent decades, the United States has witnessed profound changes in the sociocultural valuation of dogs, variously described as humanization, sentimentalization, or sacralization. A broad look at this “sacralization” of dogs in the United States reveals that this changing valuation has altered dogs’ place within economic processes. In particular, these changes parallel Viviana Zelizer’s work on the changing valuation of children a century ago. In this article, we further specify Zelizer’s insights by arguing that these accompanying economic transformations are best understood as shifting of a dogs’ place within budgetary units: from objects for human consumption to fellow actors humans consume with and around.     

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 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.     

Making devices

Between 2003 and 2007 photographer Ellen Garvens made a series of photographs in prosthetics and orthotics laboratories and clinics in the United States, Cambodia, Laos and Thailand. The photographs explore the materials and processes of prosthetic making, and the environment within which this work takes place; a space too of encounter between patients and their new prosthetic limbs. Although made during quiet moments when these spaces were devoid of human activity, the viewer is nevertheless aware of the indexical relationship between the objects and spaces and the situations of violence and conflict or human misfortune that give them their purpose.     

Severe self-neglect: an epidemiological and historical perspective

Older adults with severe self-neglect have multiple deficits in various social, functional and physical domains, and often live insqualor. These individuals often present with poor personal hygiene, domestic squalor and hoarding which results in a threat to their own health as well as personal and public safety. Severe self-neglect occurs along a continuum with older adults often having cognitive and affective disorders compared with younger individuals presenting with psychiatric illnesses. In cases of severe self-neglect with hoarding, evidence has shown this behavior occurs in diverse social strata and not among the wealthy and professionals alone as believed earlier. Due to the multiple conditions associated with severe self-neglect, this population will require an interdisciplinary, multidimensional approach to reduce morbidity and mortality rates including nursing home placement. Research on this group has been limited and is rarely described in the medical and nursing literature. Future research is needed to provide practitioners with effective screening instruments and interventions on cases of severe self-neglect.     

Elder abuse in the United Kingdom

In recent years there has been an increased emphasis on violence and abuse within society generally. Following a focus in the United Kingdom (UK) on child abuse in the 1970s and domestic violence in the 1980s, in the 1990s the abuse and neglect of older people began to elicit concern. The initial focus of interest was of situations arising in the domestic setting. More recently, however, much needed attention has shifted to situations involving institutional settings. This paper will discuss abuse and neglect occurring in the UK. It aims to provide a brief overview of the status of current knowledge concerning abuse of older people followed by a discussion of some of the issues relating to the prevention of abuse and neglect from a UK perspective. An exploration of some of the issues involved will contribute to our understanding of abuse and neglect of older people in the UK.     

What Explains the Decline in First Marriage in the United States? Evidence from the Panel Study of Income Dynamics, 1969 to 2013

Rates of entry into first marriage have declined sharply in the United States during the past half century, and there is evidence of broad gaps in marriage entry by race and education. Although a large literature explores the influences on marriage for single cohorts, there is little research that tests explanations for this decline across multiple cohorts. The authors use individual and contextual measures of employment and incarceration to predict transitions to first marriage in the Panel Study of Income Dynamics (1969–2013). They test two prominent theories of why marriage rates have declined: the decreased availability of “marriageable” men and the increased economic standing of women. They find that men's reduced economic prospects and increased risk of incarceration contributed to the decline in first marriage rates during the past 45 years in the United States, although these basic measures of economic and carceral conditions cannot explain the entire decline.     

Long‐Term Heterosexual Cohabiters and Attitudes toward Marriage

Limited research has specifically examined long‐term heterosexual cohabiters (LTHCs), whose lengthy unions challenge the notion that cohabitation is a life stage. Drawing upon in‐depth interviews with 48 LTHCs, this article identifies six themes that LTHCs use to talk about their attitudes toward marriage. Three of these themes highlight ways in which heterosexuals are trying to construct anti‐oppressive heterosexual identities. These six themes are especially structured by social class, elucidating a broader class‐based bifurcation of family life in the United States. These findings challenge existing paradigms about cohabitation and illuminate the diversity of reasons people choose to cohabitate. Implications for broader shifts in intimate life are discussed.     

How are drugs approved? Part 2: ethical foundations of clinical research

In the United States, the U.S. Food and Drug Administration (FDA) evaluates and approves drugs through a process that includes clinical research. The purpose of clinical research is to diminish uncertainty by acquiring knowledge. For drug development, the goal is to approve drugs that are safe and effective. Because of the uncertainty, however, participation in clinical research entails some degree of risk. Ethical principles provide the framework on which studies can be designed and conducted and which appropriately balance benefits and risks for research participants. As part of a broad overview of the drug development process, this article reviews the ethical foundations of clinical research.