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.     

Tension and Conflict Factors in Second Marriages as Causes of Abuse Between Elderly Spouses

ABSTRACT

Data for the present research was derived from a pilot study on elder abuse by family members. The pilot study, conducted between 1996–98, is the first of its kind in Israel. From a population of 270 elders, who were identified by welfare and health professionals as victims of abuse by family members, 12 persons who had remarried after the death of a spouse were selected as subjects for an in-depth qualitative study. The research aimed at examining the reasons for abuse through the reports of the victims, comparing their experience to second marriages where spouse abuse was not detected. The findings showed that the decision to establish joint residence, financial arrangements (money management, wills and bequests), issues of power and control, and memories of the deceased spouse are the primary factors for abuse in these second marriages. These factors create situations of tension and conflict between married partners that lead to neglect in care giving, emotional and mental abuse, verbal and physical violence, and financial exploitation.     

Development and Validation of a Tool to Improve Physician Identification of Elder Abuse: The Elder Abuse Suspicion Index (EASI)©

ABSTRACT

This study aimed to develop and validate a brief tool for physician use to improve suspicion about the presence or absence of elder abuse. A literature review on elder abuse, obstacles to its identification, limitations of detection tools, and characteristics of screeners employed by physicians were used to generate elder abuse detection questions for critique by 31 doctors, nurses, and social workers in focus groups. Six resulting questions became the Elder Abuse Suspicion Index (EASI) administered by 104 family doctors to 953 cognitively intact seniors in ambulatory-care settings. Findings were compared to a recognized, detailed elder abuse Social Work Evaluation (SWE) later administered to participants by social workers blinded to the results of the EASI. The EASI had an estimated sensitivity and specificity of 0.47 and 0.75, usually took less than 2 minutes to ask, and 97.2% of doctors felt it would have some or big practice impact. This research is a first phase in the development and validation of a user-friendly tool that might sensitize physicians to elder abuse and promote referrals of possible victims for in-depth assessment by specialized professionals.     

Elder Abuse in a Land of Tradition: The Case of Israel's Arabs

ABSTRACT

This study attempted to assess the scope and nature of elder abuse and neglect in one traditional group currently undergoing change: the Arabs in Israel. One hundred and twenty-eight human service and health professionals in northern Israel were asked to report about all cases of elder abuse and neglect they had encountered for a period of 18 months prior to the study. Findings showed that overall Arab elders in Israel have a 2.5% rate of abuse and neglect (excluding self neglect). This figure is somewhat lower than that reported in the literature for either developed or developing societies. Rates were higher in urban areas, somewhat lower in suburban areas, and lowest in isolated villages. These results lend some support to modernization theories of aging and elder abuse. The profile of the abused elder is not significantly different from that of his Western counterpart. Among alleged perpetrators, however, sons and daughters-in-law rank highest, reflecting cultural patterns in some traditional societies. The article makes some early recommendations in the area of worker training and service enhancement.     

The Application of the Culturagram in Cross-Cultural Practice with Elder Abuse Victims

ABSTRACT

This article discusses the application of the Culturagram, a screening instrument designed to assist practitioners to work more effectively in the assessment and detection of family abuse among immigrant elders. Case studies of selected immigrant groups are presented to illustrate how the Culturagram can be used to promote culturally sensitive practice with immigrant families where elder abuse may be a factor. Assessment, detection, and intervention strategies specific to selected immigrant groups are included in the discussion.     

Decision-Making and Adult Protective Services Workers: Identifying Critical Factors

ABSTRACT

The decision-making process of Adult Protective Service (APS) workers is under-explored in the field of elder abuse. Yet, it is critical in assuring the protection of elders from physical abuse. This article identifies 10 major critical factors used by APS workers in New Hampshire when intervening in substantiated cases of elder physical abuse. The qualitative methodological framework utilized a literature review, two focus groups, 15 individual face-to-face interviews, and a modified Delphi method of analysis. The findings identify the strengths and flaws in the decisional process and suggest considerations for further study.     

Searching for Elder Abuse: A Systematic Review of Database Citations

ABSTRACT

The aim of this review was to describe trends and patterns in elder abuse literature and research. All citations in PUB MED, CINAHL, and PsycINFO databases located using the search term “elder abuse” were retrieved (3,059 citations) and 2,418 unique references were identified. Using manifest content analysis, non-research material (1,986 references) was sorted by type and research references (34 dissertations and 398 research articles) were categorized. Research article references most commonly: (1) investigated prevalence, typology, and definitions of elder abuse; (2) utilized quantitative methodology; (3) had first author affiliations to medicine, nursing, and social sciences; and (4) sampled populations of professionals, personnel, cases, or charts. The USA was most frequently listed of 24 identified countries of origin. Elder abuse research shows lack of diversity, slow increase of qualitative research, limited involvement of older persons and family members as participants, and minimal research from developing countries. This review contributes to knowledge valuable for researchers and experts planning future studies or elder abuse projects.     

Perceptions of Adult Protective Services Workers of the Support Provided by Criminal Justice Professionals in a Case of Elder Abuse

ABSTRACT

This paper summarizes results of a 1997 survey of adult protective services workers in 43 states. The survey yielded ratings of police and victim assistants in detecting and treating elder abuse and estimates of the likelihood that criminal justice professionals would provide ten forms of assistance in a case of elder abuse. Respondents also reported the most helpful services supplied by criminal justice professionals, the services that were most difficult to obtain, and overall ratings of criminal justice professionals in cases of elder abuse. Findings provide insights about relationships between adult protective services workers and criminal justice professionals.     

Combating Elder and Dependent Adult Mistreatment: The Role of the Clinical Psychologist

ABSTRACT

Among the many different professionals who work to address elder and dependent adult mistreatment, the clinical psychologist performs a function that is not well documented. The experiences of a clinical psychologist attached to a medical response team and an elder abuse forensic center provide insight into this complex and multifaceted role. Case examples from an elder abuse forensic center illustrate the breadth of referral questions that a clinical psychologist addresses. This information may be of use to those who would argue that these services be made widely available to elder abuse professionals such as social workers, public guardians, and those in the criminal justice system. The case studies also may be useful for training purposes.     

Visibility Blues: Gender Issues in Elder Abuse in Institutional Settings

ABSTRACT

This article argues that elder abuse in institutional as opposed to domestic settings remains invisible because institutions for elders are mainly all-female spaces where ageism and sexism converge and clients and workers are economically and socially disadvantaged. A general culture of violence that increasingly legitimates the everydayness of abuse and that conforms to dominant gender stereotypes refuses to investigate abuse of women by women. Research is needed into the different kinds of abuse committed in institutional settings by women. Staff and clients need to be enabled to report abuse and effective measures for combating it put in place.     

The effect of a family-based intervention with a cognitive-behavioral approach on elder abuse

ABSTRACT

Elder abuse may become a health issue in developing countries, including Iran. The purpose of this investigation was to study the effectiveness of Family-Based Cognitive-Behavioral Social Work (FBCBSW) in reducing elder abuse. In a randomized clinical trial in Iran, 27 elders participated in intervention and control groups. The intervention groups received a five-session FBCBSW intervention and completed the Domestic-Elder-Abuse-Questionnaire (DEAQ), which evaluates elder abuse at baseline and follow-ups. Repeated measures of analysis of variance (ANOVA) and the Wilcoxon test were used to analyze the data. The repeated measures ANOVA revealed that FBCBSW was successful in reducing elder abuse. The Wilcoxon test indicated that emotional neglect, care neglect, financial neglect, curtailment of personal autonomy, psychological abuse, and financial abuse significantly decreased over time, but there was no statistically significant difference in physical abuse before and after the intervention. The findings from this study suggest that FBCBSW is a promising approach to reducing elder abuse and warrants further study with larger samples.     

Korean American Elderly's Knowledge and Perceptions of Elder Abuse

ABSTRACT

“This study examines Korean American elders” perceptions of elder abuse and its perpetrators and explores cultural, as well as non-cultural influences on such perceptions. Face-to-face interviews were conducted with 100 elderly Korean Americans, 60 years of age or older, residing in Los Angeles County. Respondents reported 46 abuse cases, categorized into the following six types: financial abuse (36%), psychological abuse (24%), culturally specific abuse (17%), neglect (15%), physical abuse (4%), and other (4%). Most respondents identified elder abuse in terms of abrogation of filial piety, suggesting the centrality of “children” in Korean American elders⁵ lives and well-being. Findings demonstrate that employing a uniform definition of elder abuse across all cultures and ethnic groups without attending to the cultural and subjective aspects of a given situation may result in missing problems and needs identified as important by the elderly themselves. Implications for social work practice and program development are discussed.     

Financial Abuse of Elders and Dependent Adults: The FAST (Financial Abuse Specialist Team) Approach

ABSTRACT

The Financial Abuse Specialist Team, a partnership of professionals from diverse disciplines, volunteer their time to review cases of financial elder abuse and facilitate comprehensive service delivery. The team also advocates for legislative reform, educates the community about the problem, and trains professionals in how to recognize, prevent, and resolve financial elder abuse.     

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.     

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.     

The Hospital Elder Assessment Team:

Elder abuse literature shows that health care professionals are aware of elder abuse/neglect laws but do not understand the requirements nor have the skills to diagnose the problem (Clark-Daniels & Daniels, 1990). Many victims of elder abuse appear in hospital emergency rooms for medical evaluation. Although 42 of the 50 states now have mandatory elder abuse/neglect reporting laws, few hospitals have responded with interdisciplinary elder protective teams in contrast to the situation with child abuse reporting laws. One exception has been the establishment of a multidisciplinary elder assessment team at Beth Israel Hospital, Boston, MA, to address the complex issues of recognition and assesssment of elders seen in the hospital who are suspected victims of abuse. Included in the mission of the team are consultation, support, and education to hospital staff about 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.     

Financial Exploitation of Elders: Analysis of Risk Factors Based on County Adult Protective Services Data

ABSTRACT

While all types of elder abuse and neglect are serious problems affecting thousands of vulnerable elders, financial exploitation has especially serious implications for the victims’ economic well-being and quality of life, because it may deprive the victims of their life savings and assets and thus their economic foundation for independence. In this study, data from the case files of a county adult protective services program were analyzed to identify risk factors associated with financial exploitation of and mismanagement by elders. The elders who were financially exploited were, on average, in their late seventies and tended to be cognitively impaired. We also found that owner-occupant elders were especially vulnerable to exploitation and that financial mismanagement and exploitation often occurred together. Approximately 60% of the perpetrators were relatives of the elderly victims, mostly their adult children, and the rest of the perpetrators were not related to the victims. Implications for interventions include case management for frail, cognitively impaired elders; preventive educational programs; and ongoing collaboration among adult protective services, financial institutions, and law enforcement agencies.     

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.     

Detection and Prevalence of Abuse of Older Males: Perspectives from Family Practice

SUMMARY

Family doctors' frequent contact with seniors put them in reasonable positions to detect elder abuse and initiate referral to adult protective services. Since doctor reporting is low, however, this paper explores whether the gender of patient and/or doctor impacts on identification of elder mistreatment, or creates differential detection of one gender over the other. Use of the validated Elder Abuse Suspicion Index (EASI), and a structured social work evaluation, is described to provide some gender-based data from Canadian family practice. Specifically, while the prevalence of elder abuse is estimated to range from 12.0% to 13.3%, the specific prevalence was found for females to be 13.6% to 15.2% and for males 9.1% to 9.7%.