Understanding of elder abuse and neglect among health care professionals in Malaysia: An exploratory survey

ABSTRACT

Elder abuse and neglect (EAN) is a hidden public health challenge for Malaysia. This cross-sectional survey studied the awareness of EAN among 148 doctors and nurses from two neighboring states in Malaysia using a self-administered questionnaire exploring their knowledge, perceptions, practices, and experience concerning EAN. Both doctors and nurses demonstrated poor understanding of signs of EAN and exhibited misperceptions on reporting requirements. Both groups perceived EAN as a national burden and reporting it as their responsibility; but most felt they had not been trained to diagnose it. Many were unsure of procedures and whether their own intervention could be effective. Only four (nurses) of 41 participants who suspected abuse during the past year reported the cases. Targeted education and uniform protocols are mandatory to ensure best practice with regards to EAN. Further research is crucial to extend this inquiry into the broader health care workforce.     

Street Children in Nairobi and the African Cultural Ideology of Kin-Based Support System. Change and Challenge

Poverty, rapid urbanization, population growth rate, family instability and the declining role of the extended family system are among the key factors responsible for the prevalence of child abuse and neglect in Nairobi. In this state of flux, cases of children who have been battered, abandoned, abused and neglected by their families or displaced as a result of armed conflict in the region have increased at an astounding pace over the past several years. One out of every three children from poor urban families in Kenya is regularly battered or subjected to other forms of maltreatment by a parent or other family members, the public and the authorities. Basically, there are two levels of abuse and neglect. There is abuse and neglect which children experience at home and which drives them onto the streets. There is also abuse and neglect which street children endure while on the streets. This paper discusses some of the ways in which abuse and neglect affect the lives of street children and families. It also highlights the plight of a sample of street children as exemplified by the kinds of difficulties which they endure while on the street. © 1997 John Wiley & Sons, Ltd.     

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.     

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.     

Proper Documentation:

Over the past decade, almost all states in the U.S> have passed legislation related to elder abuse. Most of the legislation mandates that Adult Protective Services (APS) workers assess the validity of reports of alleged elder abuse or neglect. Some states also mandate these workers to plan and manage services aailable to victims. Assessing and serving victims and their families requires that APS workers have knowledge and skills in many areas. One important skill is properly documenting the assessment process. In this paper, a case is made for including proper documentation as an important topic in any APS training prorgam. Then, a systematic method is suggested for training APS workers in how to document their assessments of cases.     

Senator Breaux's Elder Justice Proposal of 2002 Executive Summary

ABSTRACT

The purpose of this exploratory study was to investigate an English sample's perceptions on elder abuse, inflicted by adult children against their aging parents. Fifty participants (14 males, 46 females) provided examples of extreme, moderate, and mild elder abuse. As examples of extreme abuse, most participants mentioned neglect and physical aggression. Various forms of neglect and psychological abuse were their most common examples of moderate and mild abuse. References to physical aggression appeared most often as examples of extreme abuse rather than of moderate or mild abuse. Within these main categories, the specific subtypes most frequently mentioned by the sample included physical neglect, psychological neglect, verbal abuse, and deprivation. More females than males provided examples of financial abuse and physical neglect. Females were also more likely than males to list psychological neglect as an extreme form of abuse and disrespect as a form of mild abuse. At the moderate level, males referred to abuse relating to power more often than females. A positive relationship was found between age and the number of examples of physical neglect given at the moderate level and the number of examples of emotional abuse given at the mild level.     

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.     

Elder Abuse and Neglect Substantiations:

This study set out to measure rates of substantiation of initial abuse and neglect reports and to identify case related factors that are associated with substantiation. Toward this end, analysis was performed on 2,849 cases reported to the Wisconsin Elder Abuse Reporting System in 1988 and 1989. Over 57% of all initial reports were substantiated by the investigating agencies with higher rates for cases of self-neglect only. Among cases involving other abusers, physicial and emotional abuse had the highest substantiation rates. Results also indicate that substantiation rates for all types of abuse and neglect are higher in urban settings. Cases referred by professionals usually have higher substantiation rates than those referred by relatives and neighbors. Higher rates were found for elders living alone and those with several high risk characteristics such as mental illness and Alzheimer's disease. The abusers in substantiated cases were more likely to be spouses, sons, and other relatives. These abusers were also likely to be in one or more risk categories. The amount of services that were offered to and accepted by the victims was associated with substantiation only for alternative placements but not for community based services. Clients in substantiated cases were in fact more likely to refuse services than their peers in unsubstantiated ones.     

Emotional harm and neglect: the legal response

This paper reports on a study of the extent to which child protection applications brought to the Melbourne Children's Court in Victoria, Australia, were based on emotional/psychological harm or neglect of a child and what factors were presented as evidence of harm or neglect. The study examined records of 208 court‐ordered pre‐trial conferences heard in the court between February and July 2002. What was found was that, although cases involving emotional abuse have increased in terms of child protection applications, they remain cases that are difficult to decide. While in 1998/9 emotional harm was a ground in 25.7% of child protection matters completed in the Family Division of the Children's Court of Victoria, legal decision‐makers are reluctant to make a finding of child abuse in these cases because there is less accuracy in the determination of emotional harm and negligible legal criteria available to guide decision‐making. Copyright © 2006 John Wiley & Sons, Ltd.     

Five-year all-cause mortality rates across five categories of substantiated elder abuse occurring in the community

ABSTRACT

Elder abuse increases the likelihood of early mortality, but little is known regarding which types of abuse may be resulting in the greatest mortality risk. This study included N = 1,670 cases of substantiated elder abuse and estimated the 5-year all-cause mortality for five types of elder abuse (caregiver neglect, physical abuse, emotional abuse, financial exploitation, and polyvictimization). Statistically significant differences in 5-year mortality risks were found between abuse types and across gender. Caregiver neglect and financial exploitation had the lowest survival rates, underscoring the value of considering the long-term consequences associated with different forms of abuse. Likewise, mortality differences between genders and abuse types indicate the need to consider this interaction in elder abuse case investigations and responses. Further mortality studies are needed in this population to better understand these patterns and implications for public health and clinical management of community-dwelling elder abuse victims.     

Elder Abuse and Neglect in an Urban Chinese Population

ABSTRACT

This study aims to investigate the prevalence of elder abuse and neglect in an urban Chinese population. A cross-sectional study was performed in a major urban medical center in NanJing, China. A total of 412 participants completed the survey and 145 (35%) participants screened positive for elder abuse and neglect. The mean age of the victims was 69 years and 59% were male. Caregiver neglect was the most common form of abuse, followed by financial exploitation, psychological abuse, physical abuse, sexual abuse, and abandonment. Thirty-six percent of the victims suffered multiple forms of abuse and neglect. In the logistical regression analyses of the data, female gender, lower education and lower income were demographic risk factors associated with elder abuse and neglect. A better understanding of these and additional risk factors associated with elder abuse and neglect in older Chinese people is needed.     

English perceptions of elder abuse

The purpose of this exploratory study was to investigate an English sample's perceptions on elder abuse, inflicted by adult children against their aging parents. Fifty participants (14 males, 46 females) provided examples of extreme, moderate, and mild elder abuse. As examples of extreme abuse, most participants mentioned neglect and physical aggression. Various forms of neglect and psychological abuse were their most common examples of moderate and mild abuse. References to physical aggression appeared most often as examples of extreme abuse rather than of moderate or mild abuse. Within these main categories, the specific subtypes most frequently mentioned by the sample included physical neglect, psychological neglect, verbal abuse, and deprivation. More females than males provided examples of financial abuse and physical neglect. Females were also more likely than males to list psychological neglect as an extreme form of abuse and disrespect as a form of mild abuse. At the moderate level, males referred to abuse relating to power more often than females. A positive relationship was found between age and the number of examples of physical neglect given at the moderate level and the number of examples of emotional abuse given at the mild level.     

Disability and Discrimination in Statutory Child Protection Proceedings

Families headed by parents with intellectual disability [1] are among the most vulnerable in the community. Poverty, social isolation and the lack of adequate support services all threaten their well-being. People with intellectual disability who are parents must also contend with out-of-the-ordinary treatment in statutory child protection proceedings. Legal scholars writing mainly in the North American context cite cases in which the children of these parents have been removed despite lack of evidence of abuse or neglect, or when evidence was refuted or, indeed, even when the parent was shown to be providing adequate care. In cases of substantiated abuse and/or neglect, support has not been given to the parent or parents before their children were removed. In this paper, we describe these discriminatory actions and discuss the political, social and institutional conditions that have lead to such extreme consequences for people with intellectual disability who also happen to be parents.     

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.     

Abuse among rural mentally ill.

Each American adult has the right to make individual decisions. These decisions include preferences in lifestyle, occupation, diet, housing, health-care treatment, and allocations of financial resources. The right to autonomous decision making is not limited to young or middle-aged adults, nor is it limited to those occasions during which the individual has the capacity to personally participate in the decisions (US Congress, 1987). The right also applies to elderly, incapacitated, mentally ill, or dependent adults. Because of this autonomy, no individual must suffer physical, psychological, or financial coercion. Based on these rights, all 50 states have enacted statutes to protect dependent adults and to authorize government intervention in cases of suspected adult abuse (Hunzeker, 1990). Iowa is one of the states that has enacted dependent adult abuse legislation, and in 1988, health-care practitioners in Iowa became mandatory reporters of adult abuse (Iowa Code, 1992). As mandatory reporters, all nurses who treat, counsel, examine, or attend dependent adults must observe the physical status and interpersonal relationships of their clients and significant others to identify potential conflict or injury. Categories of abuse recognized by the Iowa law include physical, sexual, and financial abuse, neglect by self, and neglect by another (Figure).     

Dilemmas in planning for the protection of children and youths in residential facilities

Protection of children and youths after placement must be given increased emphasis because deinstitutionalized care is itself not harm-free and also because the needs of many children for care, control, and treatment are likely to be met in residential facilities for the foreseeable future. However, the diverse and often incompatible views of advocates and providers of child care about the issues affecting the protection of residents in institutions loom as obstacles to planning for the protection of children and youths after placement. Both of the extreme views of institutional abuse and neglect issues deny the need for child protection after placement. The first holds that since the child or youth is being protected and/or treated, no ongoing child protection is necessary. The other view holds that any child protection effort short of closing residential facilities is futile and therefore without merit. Underreporting of abuse or neglect is widespread; accountability of facilities for the protection of residents is, as a result, unevenly established. These conditions are attributable in part to the inadequate statutory base for protecting children in institutions. At the same time, because of the lack of a planned approach to protection within facilities, and between facilities and child protection agencies, residential facilities are likely to suffer negative public exposure when moderate or serious incidents of maltreatment become public. The absence of procedures for facilities themselves to recognize abuse and neglect invites exposure of incidents by staff and residents. The ad hoc manner in which incidents are managed by external agencies often inflicts unwarranted costs on the reputations of residential facilities that in many cases may have only one or two serious incidents a year. Finally, the use of "last resort" placements may be putting some children and youths into situations of unacceptable risk. Despite the existence of differing views in the residential care field, we have identified areas of agreement between the child protection agencies and residential facilities upon which public policy might build. The problem may not be so much that these attitudes exist, as that the states have not responded in a planned and credible way to the problem of institutional abuse and neglect. Nevertheless, development of a planned and credible approach must deal with these areas of difference if protection of children after placement is to be improved.     

The impact of childhood abuse and neglect on adult mental health: a prospective study

This paper examines the impact of three types of victimization in childhood--sexual abuse, physical abuse, and neglect--on lifetime measures of mental health among adults. In contrast to research that relies on retrospective recall of childhood victimization, this work uses a prospective sample gathered from records of documented court cases of childhood abuse and neglect in a midwestern city around 1970. These subjects were interviewed about twenty years later. In addition, this research compares outcomes of the 641 members of the abuse and neglect group with a matched control group of 510 persons who did not have documented cases of abuse or neglect. The results indicate that men who were abused and neglected as children have more dysthymia and antisocial personality disorder as adults than matched controls, but they did not have more alcohol problems. Abused and neglected women report more symptoms of dysthymia, antisocial personality disorder, and alcohol problems than controls. After controlling for stressful life events, however, childhood victimization had little direct impact on any lifetime mental health outcome. This research indicates the importance of adopting an approach that places childhood victimization in the context of other life stressors and of prospective changes over the life course.     

Australian Service Providers' Responses to Elder Abuse

This article presents the findings of a survey of 175 service providers in Sydney, Australia, the majority of whom were doctors in general practice. Thirty-two percent of respondents had encountered cases of physical, psychological, or financial abuse or caregiver neglect of people 65 years old and over. Community nurses and social/welfare workers were particularly likely to have encountered cases of abuse. The findings suggest that coordination between health, welfare, and criminal justice agencies in Australia needs improvement. Policies to address elder abuse and neglect in Australia are in their infancy. As a priority governments should work towards effective training of professionals and appropriate intervention guidelines for services.