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.     

S 333 IS–108th Congress, 1st Session: To Promote Elder Justice,and for Other Purposes

ABSTRACT

The sample for this exploratory qualitative study of Greek perceptions of elder abuse consisted of 43 Greek participants from urban centers and 28 Greeks from a small island village. Participants were asked to provide examples of extreme, moderate, and mild abuse from an adult child toward his/her aging parent. Half of the examples of extreme abuse were various forms of physical aggression. Predominant examples of moderate abuse were psychological abuse and neglect, and at the mild level neglect was the most highly cited category. The most frequently mentioned specific types of elder mistreatment were verbal abuse, psychological neglect, physical neglect, and hitting. There were no gender differences in the kinds of examples that participants gave or the severity they attributed to their examples. Females were more often presented as victims of abuse than males. A negative correlation was found between age and the number of physical abuse examples given overall, and as types of severe abuse.     

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.     

“I feel like her daughter not her mother”: Ethnographic trans-cultural perspective of the experiences of aging for a group of Southeast Asian refugees in the United States

ObjectiveThis study seeks to understand trans-cultural aging and stressors for aging refugees. It describes the experiences of Cambodian refugee women as they age in the United States.MethodExperiences of 16 Cambodian refugee women (ages 44–60), participants of a Cambodian community health center support group, were examined over a year.ResultsAnalysis revealed complex experiences of aging in the U.S. including these: (a) loss of role as respected elder, (b) fear of living separate from children, (c) feeling devalued by children, and (d) feeling self-blame for intergenerational cultural gap. The women described years of employment interrupted by the exacerbation of post-traumatic symptoms later in life preventing further employment.DiscussionAn ethnographic trans-cultural perspective of the experiences of aging for Southeast Asian refugees. Aging refugees face stressors even 20–30 years after resettlement. Findings show decrease in functioning as survivors of torture age. Recommendations for social service programs and providers are made.     

Adult Day Centers and Mental Health Care

ABSTRACT

This research focused on the mental health issues at adult day centers and used a cluster analysis to profile older persons who received these services. The sample included 280 participants who attended adult day care. The data were collected from intake files using a biopsychosocial framework to guide the selection of variables from January 1, 1999 to December 31, 2000. A cluster analysis revealed two distinct profiles of participants. The first profile was characterized by women, who were single, African-American, had low incomes, relied more on public funding, and had no psychiatric diagnoses. The second profile was differentiated with more men, who were married, relied more on private funding, and had higher incomes and psychiatric diagnoses. Participants clustered in the second profile, including those diagnosed with psychiatric disorders, disenrolled at a faster rate than those in the first profile, including older adults without psychiatric disorders. Both profiles were similar in age, education, caregiving, religious affiliation, household size, and service intensity. They also resembled each other with respect to functional limitations, nutrition risk, and prior nursing home placement. Slight differences were found in frequency of previous hospitalizations and years of education. Recommendations for strengthening the mental health training of social workers employed at adult day centers were made.     

Research Note—Is Social Work Education a Form of Social Work Practice?

ABSTRACT

The inclusion of social work education as a form of practice has been missing from the debates on the need for a unified definition of social work practice. This Research Note reports the findings from interviews with 20 social work educators who were asked whether social work education is a form of social work practice and were encouraged to elaborate on their response. The qualitative data were analyzed using thematic analysis and revealed five themes. The findings contribute to the debate on the need for clarification among social work authorities in shaping the definition of social work practice and the need to provide a clear stance on the extent to which social work education is a form of social work practice.     

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.     

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.     

Service Learning with Rural Older Adults

Abstract

The purpose of this qualitative study was to examine the effects of a service-learning project with rural older adults on social work students' choice of working professionally with older adults upon graduation. Service learning is a course-based community service experience designed to enhance students' understanding of course content while meeting an identified community need at the same time. The service-learning intergenerational project consisted of ten hours of face-to-face interaction between a BSW student and an older adult living in rural South West Virginia and the city of Charleston. Twenty-one undergraduate social work students attending the Micro Practice course participated in the study. Data collection consisted of face-to-face interviews guided by a set of open-ended questions. Data analysis revealed that participation in the intergenerational project did not change a students' choice of major but it increased their desire to explore the field of aging.     

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.     

Meeting Life Challenges

SUMMARY

Mental health and social service providers need to understand the contextual experience of diverse aging populations and the types of life challenges they have encountered. This research examined the life challenges specified by a purposive sample of 75 urban community-dwelling low-income older adults from four high-rise housing facilities. Thirty-four study participants were Jewish American and 41 were African American. Results indicate that many participants of both groups identified personal events such as bereavement and health as stressors, but only the Jewish Americans identified societal events such as World War II. Both groups found social resources moderately valuable in meeting life challenges, but religious resources were frequently identified by African American older adults and personal resources were highly endorsed by Jewish Americans, resulting in a hierarchy of coping styles for each group. Results suggest that mental health and social service providers can create interventions to reinforce and strengthen natural client resources that may vary according to ethnic and racial differences     

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%.     

“This will help your children”: Service providers’ experiences with military families during cycles of deployment

ABSTRACT

Military families face not only the same challenges as other families, but also unique issues due to their military involvement. Parenting programs for civilian families can be helpful, but they do not generally cover the specific issues faced by military families. The purpose of this qualitative study was to gather information from a focus group of eight service providers about the types of issues that affect military families, such that content and delivery of workshops at a social service agency could be formed to specifically cater to military families. This study utilized a phenomenological approach, and analyses revealed areas for social service involvement around the cycle of deployment. Specifically, social services could be helpful by using psychoeducational and normalization techniques around the five major themes that resulted from this study: (1) the issues of servicemembers psychologically withdrawing before deployment, (2) family cohesion and connectedness during and after deployment, (3) family stability during reintegration of the service member, (4) military families experience many of the same challenges that nonmilitary families do (such as domestic violence and financial issues), and (5) utilizing a military culture framework for all military family programs.     

Mapping the Elder Mistreatment Iceberg: U.S. Hospitalizations With Elder Abuse and Neglect Diagnoses

Purpose: This study describes U.S. hospitalizations with diagnostic codes indicating elder mistreatment (EM). Method: Using the 2003 Nationwide Inpatient Sample (NIS) of the Healthcare Costs and Utilization Project (HCUP), inpatient stays coded with diagnoses of adult abuse and/or neglect are compared with stays of other hospitalized adults age 60 and older. Results: Few hospitalizations (< 0.02%) were coded with EM diagnoses in 2003. Compared to other hospitalizations of older adults, patients with EM codes were twice as likely to be women (OR = 2.12, 95% CI = 1.63–2.75), significantly more likely to be emergency department admissions (78.0% vs. 56.8%, p < .0001), and, on average, more likely to have longer stays (7.0 vs. 5.6 days, p = 0.01). Patients with EM codes were also three to four times more likely to be discharged to a facility such as a nursing home rather than “routinely” discharged (i.e., to home or self-care) (OR = 3.66, 95% CI = 2.92–4.59). Elder mistreatment–coded hospitalizations compared to all other hospitalizations had on average lower total charges ($21,479 vs. $25,127, p < .001), with neglect cases having the highest charges in 2003 ($29,389). Implications: Knowledge about EM is often likened to the “tip of the iceberg.” Our study contributes to “mapping the EM iceberg”; however, findings based on diagnostic codes are limited and should not be used to minimize the problem of EM. With the so-called graying of America, training is needed in recognizing EM along with research to improve our nation's response to the mistreatment of our elderly population.     

Lessons on social and health disparities from older lesbians with alcoholism and the role of interventions to promote culturally competent services

ABSTRACT

Older adults who are lesbian, gay, bisexual, or transgender (LGBT) face greater health risks and possibly more costly care because of their reluctance to seek out health and long-term care services because of limited cultural sensitivity of service providers. This is particularly evident in older lesbians who face substantial risk of health problems associated with alcoholism and are less likely to be open with health care providers because of stigma combined with feelings of alienation, stress, and depression. An estimated 4.4 million older adults are predicted to have problems with alcohol by 2020, and the rates of alcohol-related hospitalizations are similar to those for heart attacks, creating exorbitant medical costs. More culturally competent health and long-term care may reduce health care costs by effectively addressing the dynamics of alcoholism, aging, and lesbian culture. Training initiatives such as those developed by the National Resource Center on LGBT Aging have begun to address the need of a more culturally competent aging services network. This article provides exemplars from empirical data on older lesbians with alcoholism to highlight some of the health, economic, and social disparities experienced in the aging LGBT community. Current interventions in the form of cultural competence training for service providers are presented as a potential step toward addressing health disparities among LGBT older adults.     

Assessing Impact of Service-Learning Project on Older,Isolated Adults in Rural America

ABSTRACT

With help from a grant from the Corporation for National Service, service learning was infused into four classes of a graduate gerontology course, Aging Well. Thirty-one students were paired with 31 older adults for a period of up to twenty hours. The impact on the emotional and social wellness of the older adults was assessed through student journals, electronic e-mail reflection, and the administration of a survey to older adults. A quantitative assessment of the older adults was attempted using the Life Satisfaction in the Elderly Scale and the Geriatric Depression Scale. Analysis indicated that the service provided to the older adult had a positive impact on their emotional and social wellness.     

Definitions of Elder Abuse in an Italian Sample

ABSTRACT

The purpose of this exploratory qualitative study was to analyze definitions of elder abuse in an Italian convenience sample. Fifty-three Italian participants (15 males, 38 females) provided examples of mild, moderate, and extreme mistreatment of older individuals by their adult children. Analyses were conducted to identify frequently mentioned types of abuse and to determine how severe they were judged to be. Also examined was the extent to which gender and age contributed to response patterns. Most examples of extreme elder abuse made reference to physical abuse and neglect, while references to psychological aggression and neglect predominated as examples of moderate and mild abuse. Examples of neglect appeared with equal frequency at all levels of severity, but physical aggression was mentioned primarily as a form of extreme abuse, and psychological aggression was mentioned more frequently in examples of moderate and mild abuse. The most frequently identified types of specific abuse were abandonment, verbal abuse, emotional abuse, and psychological neglect. When giving examples of extreme abuse, females mentioned more instances of financial exploitation than males. They also gave more examples of verbal aggression and lack of respect as instances of moderate abuse and behaviors reflecting power or control as examples of mild abuse. A statistically significant negative relationship was found between age and the number of examples given of particular types of mistreatment at each of the levels of severity of abuse.     

Coverage of Veterans of the Wars in Iraq and Afghanistan in the U.S. Media

To evaluate how the media frames veterans of the wars in Iraq and Afghanistan, this study systematically assesses the discourse on Iraq and Afghanistan veterans in the New York Times and Washington Post from 2003 to 2011. Our analysis of a stratified sample of 151 articles featuring veterans from either the wars in Iraq or Afghanistan finds that the media frames veterans as damaged by their service but deserving of government benefits and social assistance. When the media frames veterans as actively engaging in society, their social engagement is often because of or despite their injuries or mistreatment. We find interplay between victimization and deservingness such that depictions of the cohort as physically and mentally damaged complement and justify arguments for a sustained high level of benefits to accommodate the needs of veterans. We thus argue that generous benefits for veterans partly stem from their depiction as having suffered from their service.     

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.     

Cultural Change and Chinese Immigrants' Distress and Help-Seeking in Hong Kong

Abstract

The study examined, within a stress-coping paradigm, the contribution of acculturation, enculturation, and acculturative stress to distress and help-seeking among Mainland Chinese immigrants in Hong Kong. One hundred and thirty-one female immigrants were recruited from community service centers. Hierarchical regression results showed that general stress and acculturative stress were linked to distress. Social support did not play a buffering role on distress. Whereas length of residence and social support were strongly related to informal helpseeking, acculturation, along with age and social support, were related to professional help-seeking. Given the differential effects of various cultural change variables, the importance of independently assessing their influence on immigrant mental health and help-seeking is warranted.