Neglect of older adults in Michigan nursing homes

Although research on domestic elder abuse and neglect has grown over the past 20 years, there is limited research on elder neglect in nursing homes. The purpose of this study is to estimate the incidence of elder neglect in nursing homes and identify the individual and contextual risks associated with elder neglect. Data came from a 2005 random digit dial survey of individuals in Michigan who had relatives in long term care. Our analytic sample included 414 family members who had a relative aged 65 or older in nursing homes. Results showed that about 21% of nursing home residents were neglected on one or more occasion in the last 12 months. Two nursing home residents' characteristics reported by family members appear to significantly increase the odds of neglect: functional impairments in activities of daily living and previous resident-to-resident victimization. Behavior problems also are associated with higher odds of neglect (p = 0.078). Policy implications of these results are discussed.     

Physical Abuse of Older Adults in Nursing Homes: A Random Sample Survey of Adults With an Elderly Family Member in a Nursing Home

Few empirical studies have focused on elder abuse in nursing home settings. The present study investigated the prevalence and risk factors of staff physical abuse among elderly individuals receiving nursing home care in Michigan. A random sample of 452 adults with elderly relatives, older than 65 years, and in nursing home care completed a telephone survey regarding elder abuse and neglect experienced by this elder family member in the care setting. Some 24.3% of respondents reported at least one incident of physical abuse by nursing home staff. A logistic regression model was used to estimate the importance of various risk factors in nursing home abuse. Limitations in activities of daily living (ADLs), older adult behavioral difficulties, and previous victimization by nonstaff perpetrators were associated with a greater likelihood of physical abuse. Interventions that address these risk factors may be effective in reducing older adult physical abuse in nursing homes. Attention to the contextual or ecological character of nursing home abuse is essential, particularly in light of the findings of this study.     

Physical abuse of older adults in nursing homes: a random sample survey of adults with an elderly family member in a nursing home

Few empirical studies have focused on elder abuse in nursing home settings. The present study investigated the prevalence and risk factors of staff physical abuse among elderly individuals receiving nursing home care in Michigan. A random sample of 452 adults with elderly relatives, older than 65 years, and in nursing home care completed a telephone survey regarding elder abuse and neglect experienced by this elder family member in the care setting. Some 24.3% of respondents reported at least one incident of physical abuse by nursing home staff. A logistic regression model was used to estimate the importance of various risk factors in nursing home abuse. Limitations in activities of daily living (ADLs), older adult behavioral difficulties, and previous victimization by nonstaff perpetrators were associated with a greater likelihood of physical abuse. Interventions that address these risk factors may be effective in reducing older adult physical abuse in nursing homes. Attention to the contextual or ecological character of nursing home abuse is essential, particularly in light of the findings of this study.     

Older adults affected by polyvictimization: A review of early research

ABSTRACT

In contrast to work within the child-abuse field, polyvictimization of older adults did not become a focus of professional attention until this decade. Despite this lack of formal identification, a search of the research and practice literature revealed that prior research investigating single forms of or other elder abuse issues contained evidence of what was variously termed “multiple,” “multi-faceted,” “co-occurring,” or “hybrid” elder abuse. A wide range of victims (1.4%–89.7%) identified in existing elder abuse studies was found to have experienced what constitutes “polyvictimization.” This late-life polyvictimization evidence, the contexts in which victims are harmed, and information regarding the impact of multifaceted elder abuse are all presented and discussed in this article. Selected published cases illustrate the clinical dynamics operating in late-life polyvictimization situations.     

Land of the Free,Home of the Brave: Voting Accommodations for Older Adults

Voting is a fundamental right for all United States citizens, one that usually continues for elderly people as long as they are alive. As adults age, certain issues regarding voting warrant deeper consideration than in previous years, especially those presenting as a result of impaired sight, hearing difficulty, dementia, or other special needs. What will happen to millions of men and women who have taken the right to vote for granted, but who gradually become immobile or physically impaired? What are states doing to help secure the enfranchisement of an increasing number of older adult voters? The purpose of this article is to address these issues by focusing on the following questions: What has been the historical nature of polling place accommodations for elderly people? What are states doing in terms of accommodating older voters at the polls while ensuring the integrity of the voting process? What effect has recent Help America Vote Act legislation had with regard to polling place accommodations? Our results indicate that accommodations for older voters are being made but are not yet at a level required to serve a rapidly aging population.     

Elder abuse in nursing homes: an ecological perspective

Population trends suggest that the next 20 years will witness a dramatic increase in the adult population aged 65 and older. Projected increases in the elderly population are expected to significantly increase the stress on family and professional caretakers. Stress, in the context of caregiving relationships, is a risk factor associated with increased prevalence of elder abuse in familial and institutional settings. As increasing numbers of older adults are moved from family caregiving to nursing home care settings, it becomes important to identify the pattern of elder abuse risk factors in nursing home facilities. An ecological model is proposed for better understanding the risk factors associated with elder abuse in nursing homes and the complex interaction of individual/person characteristics and contextual factors in institutional elder abuse. An ecological perspective to institutional elder abuse provides a framework for guiding and informing future research on the risk factors of nursing home abuse and, in turn, for the development of effective interventions and relevant social policies.     

Elder Abuse in Nursing Homes: An Ecological Perspective

Population trends suggest that the next 20 years will witness a dramatic increase in the adult population aged 65 and older. Projected increases in the elderly population are expected to significantly increase the stress on family and professional caretakers. Stress, in the context of caregiving relationships, is a risk factor associated with increased prevalence of elder abuse in familial and institutional settings. As increasing numbers of older adults are moved from family caregiving to nursing home care settings, it becomes important to identify the pattern of elder abuse risk factors in nursing home facilities. An ecological model is proposed for better understanding the risk factors associated with elder abuse in nursing homes and the complex interaction of individual/person characteristics and contextual factors in institutional elder abuse. An ecological perspective to institutional elder abuse provides a framework for guiding and informing future research on the risk factors of nursing home abuse and, in turn, for the development of effective interventions and relevant social policies.     

Gay,Lesbian, Bisexual,and Transgender (GLBT) Elders

Abstract

Current gay, lesbian, bisexual, and transgender (GLBT) individuals age 65 years and older grew up before the Gay Rights movement. They have learned over many years to hide their identities in order to avoid discrimination and ridicule. Unfortunately, this secrecy has led to the near invisibility of the elder GLBT population and to poor health and service access. This paper reviews what we know about GLBT elders, describes some of the unique strengths they bring to the aging process, and outlines some of the challenges they face. Micro, mezzo, and macro practice implications are suggested.     

A Telephone Counseling Program for Elder Abuse in Japan

ABSTRACT

In the 21st century, one-fourth of the Japanese population will be 65 years and older. Not only is the duty to report elder abuse not defined by the law but there is no special organization with clinical facilities to respond to incidents of elder abuse. A report in 1994 by the Society for the Study of Elder Abuse (SSEA) showed the need for definitive social measures to prevent elder abuse. Based on that research, SSEA organized the Japan Elder Abuse Prevention Center and initiated a volunteer telephone counseling service “Help Line” that was available for several hours on Mondays. Within an 18 month period, 209 cases were handled of which 150 concerned abuse, neglect, and financial exploitation. Callers were more often the elder or the daughter than other relatives or outsiders. Sons were the more prevalent perpetrators, and financial abuse the most common type of mistreatment reported. Recommendations include new laws and social welfare policies that adapt to the changes in an aging society.     

Experience of elder abuse among older Korean immigrants

ABSTRACT

Studies on the scope and nature of Asian American elder abuse conducted with older immigrants are extremely limited. The overall purpose of this study was to examine the extent and type of elder abuse among older Korean immigrants, and to investigate critical predictors of elder abuse in this population. The sample consisted of 200 older Korean immigrants aged 60 to 90 years who resided in Los Angeles County in 2008. One of the key findings indicated that 58.3% of respondents experienced one or more types of elder abuse. Logistic regression indicated that the victims’ health status and educational level were statistically significant predictors of the likelihood of experiencing abuse. The present study, although limited in sample size, measures, sampling methods, and population representation, has contributed to this important area of knowledge. It is recommended that future studies conduct research on elder abuse with more representative national samples that can measure the extent of abuse and neglect more accurately.     

Bruises on the soul: older women,domestic violence and elder abuse

This article presents an overview on the status of current knowledge concerning elder abuse and neglect, and to move to a consideration of factors from the field of domestic violence. For many years, attempts to understand the phenomenon of elder abuse remained a problem because of its complexity. This paper, however, discusses abuse and neglect at three levels--macro, mezzo, and micro: macro abuse refers to issues at a societal level; mezzo abuse refers to behaviors, attitudes, and policies inflicted on older people at the community level; micro abuse refers to issues in the domestic setting. All definitions of elderly abuse generally include physical, psychological and financial abuses and neglect. Added to these categories of abuse are sexual and social abuses. Attempts were also made to understand the dynamics of elderly abuse. Majority of the cases of abuse among elderly people happens among the females and is mostly inflicted by their spouses. Deteriorating health, thwarted hopes, expectations and plans; a diminution in capacities to function and manage; an increase in vulnerability and dependence all contribute to the development or continuation of abusive situations within intimate relationships in old age. Although gender played a major role in elderly abuse, attempts to consider it in relation to this issue remained limited. Based on the discussions presented, it was made clear that elderly abuse is comparable to domestic violence, although it is different from other forms of family violence.     

Identification and treatment of older persons with sarcopenia

Abstract

In the last decades, sarcopenia in older persons has been operationalized by the assessment of lean body mass, muscle strength and/or physical performance. Several definitions of sarcopenia, using different parameters and cut-offs, have been proposed. However, which is the best definition to describe and to assess this condition is still matter of debate. Hand grip strength has been suggested as better predictor of incident mobility impairment and mortality, than skeletal muscle mass. In the light of the current knowledge, we sought to propose an operative approach for identifying and treating sarcopenic older persons according to main categories of sarcopenia: the age-related or primary sarcopenia and disease-related or secondary sarcopenia. We suggest that a quantitative assessment of grip strength alone might be sufficient to identify patients with primary sarcopenia. When chronic diseases accompany the ageing process, the combined assessment of muscle strength plus a balance test could be more appropriate. The identification of tests and pathological relevant cut-offs that facilitates the entry of sarcopenia into the clinical practice, could step forward researchers and physicians. This could be important for planning multidisciplinary models to maximize the maintenance of locomotive abilities especially in older persons affected by chronic diseases such as Parkinson’s disease.     

Poverty,undernutrition, and child mortality: Some inter-regional puzzles and their implicationsfor research and policy

This paper examines the relationship between measures of income poverty, undernourishment, childhood undernutrition, and child mortality in developing countries. While there is, as expected, a close aggregate correlation between these measures of deprivation, the measures generate some inter-regional paradoxes. Income poverty and child mortality is highest in Sub Saharan Africa, but childhood undernutrition is by far the highest in South Asia, while the share of people with insufficient calories (undernourishment) is highest in the Caribbean. The paper finds that standard explanations cannot account for these inter-regional paradoxes, particularly the ones related to undernourishment and childhood undernutrition. The paper suggests that measurement issues related to the way undernourishment and childhood undernutrition are measured might play a significant role in affecting these inter-regional puzzles, and points to implications for research and policy. An erratum to this article can be found at     

Feasibility and Acceptability of Smartphone Assessment in Older Adults with Cognitive and Emotional Difficulties

This feasibility study assessed perceived acceptability, adherence rates, and reasons for nonadherence to smartphone-based ecological momentary assessment (EMA). At two sites, participants (n = 103) ages 65 years or older with diagnosed anxiety or depressive disorder and cognitive concerns responded three times daily to smartphone-based EMA questions assessing clinical outcomes for two 10-day periods. Quantitative and qualitative measures followed both 10-day EMA periods. Overall, 76% of participants completed surveys on ≥ 10 of the 20 assessment days, and 70% of participants completed at least 30% of the total surveys. Reasons for nonadherence included technical, logistical, physiological, and cognitive issues. Smartphone-based EMA is feasible in older adults with cognitive and emotional difficulties. EMA tools should be responsive to the needs and preferences of participants to ensure adequate acceptability and adherence in this population. Our findings can inform the design, development, and implementation of mobile technologies in older adults in research and clinical contexts.     

Note From Iran: Self-Reported Elder Abuse in Qazvin, 2012

This brief report provides a first look at self-reported instances of elder abuse by a sample of people 60 years and older living in Qazvin, Iran. Six hundred community-dwelling persons, drawn from the registry files of each health center in Qazin, completed questionnaires during April to October 2012. At least 80% of the participants reported experiencing some form of psychological abuse, financial abuse, and/or neglect at least once during a 2-month period. Physical and sexual abuse were rarely reported. Despite a strong Iranian cultural emphasis on respect for elders, the self-reporting of elder abuse, especially psychological abuse, is greater than our expectation. We recommend that health-related policies and programs begin to identify elder abuse and neglect as a first step in prevention.     

Recruitment,enrollment & data collection with victims of elder abuse and neglect identified from police incident reports

ABSTRACT

This study evaluated the success of researcher-generated recruitment, enrollment, data collection, and safety protocols for field research with victims of elder abuse and neglect (EAN) identified from police incident reports in terms of their success including cost-effectiveness, ability to generate a representative sample, and safety. After reviewing 492 police incident reports involving victims age 65 years or older to identify cases of EAN 62 victims were identified. Mail, phone, and in-person recruitment strategies were used. After 259 recruitment attempts, 52 (84%) eligible victims were contacted, of which 24 (46%) consented to participate. Phone calls were the least expensive mechanism to produce a successfully enrolled participant. Findings from a regression show completion of a research interview could not be predicted by victim, suspect, or offense characteristics, indicating that the recruited victims likely represent the population they were drawn from. No safety or adverse events occurred.     

Emotional Correlates of Caregiving

This study examined correlational patterns among psychological measures administered to caregivers who participated in a training program to prevent elder abuse. Seventy caregivers of persons aged 50 years or older were administered the Cost of Care Index, Anger Inventory, Brief Symptom Inventory, and the Rosenberg Self-Esteem Scale. Results suggest that perceptions of caregiving burden are related to psychological distress and self-esteem but not to anger. Implications of these findings for caregiver training and elder abuse prevention are discussed.     

Comparisons of sexual assault among older and younger women

This study examined the nature and extent of coercion, violence, and physical injury among older victims of sexual assaults (55 years and older) and compared these with the sexual assault victims of mid-age (31-54 years) and younger women (15-30 years). The results of this investigation reveal that older victims of sexual assault are more likely to be living alone at the time of the attack. In addition, older victims of sexual assault tended to report higher rates of vulnerabilities such as psychiatric and cognitive disabilities than did younger female victims. In contrast to younger victims, elder sexual assault victims are also more likely to be assaulted in their own home and one-quarter of older victims require ambulance involvement. Although the use of weapons was most likely in the sexual assaults of younger women, the use of physical violence and restraint was common and equally likely among all three groups. Similarly, vaginal penetration and the presence of physical trauma were just as likely in elder victims as in younger victims of sexual assault. These results reveal new information about the nature and extent of violence and coercion in elder female sexual assaults. The vulnerability of the older victims illustrated in this investigation raises a number of research questions about these women's prior history of victimization and future safety.     

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.