Community-Based System,Reports, and Substantiated Cases of Elder Abuse: Disparities Between Municipalities and Relating Factors in Japan

This study examines (1) the staffing and financial characteristics of systems for elder abuse detection and intervention in the municipal governments of Japan and (2) the relationship among the development of detection and intervention systems, the reporting rates of suspected elder abuse cases, and substantiated abuse rates in 927 municipalities across Japan. Progressive systems for the detection and intervention of elder abuse were significantly associated with a larger number of public officers than in non-progressive systems. Furthermore, greater rates of both suspected and substantiated cases of abuse were associated with progressive systems for elder abuse detection and intervention. Per capita annual expenditures on the comprehensive support project and the community general support center's catchment under the Long-Term Care Insurance (LTCI) program showed no significant association with the development of systems, the rate of suspected cases, or the number of substantiated cases. National social policy makers should examine strategies that would help municipalities assign sufficient staff to elder abuse detection and intervention programs.     

Risk factors associated with elder abuse: the importance of differentiating by type of elder maltreatment

Elder abuse research rarely differentiates by the type of elder maltreatment involved when identifying risk factors. The purpose of this study was to compare risk factors across four predominant types of elder maltreatment (financial exploitation, physical abuse, neglect by others, and hybrid financial exploitation [HFE]). Data were collected from two sources: interviews with victims of substantiated elder abuse, responding adult protective services (APS) caseworkers (N = 71), and third-party informants; and a statewide database that contained all substantiated cases over a corresponding 2-year period (N = 2,142). Using chi-square (interview data) and logistic regressions (Adult Services/Adult Protective Services [ASAPS] data), significant differences across the four types of elder maltreatment were found. These two datasets provide converging evidence for the importance of differentiating by type of maltreatment when identifying risk factors for elder maltreatment and for the importance of considering both the elderly victim and the abusive individual when predicting type of elder maltreatment.     

Combating elder and dependent adult mistreatment: the role of the clinical psychologist

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.     

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.     

Multidisciplinary Team Legislative Language Associated With Elder Abuse Investigations

Professionals from different disciplines providing care and services to persons at risk for or victims of elder abuse have formed various multidisciplinary teams (MDTs). The purpose of the study was to identify the adult protective services–related statutory trends in presence of MDT content and to determine the association of MDT legislation on the rates of reported, investigated, and substantiated domestic elder abuse. Aggregate reports of elder abuse and state statutes for 1999 and 2007 were retrieved from 50 states and the District of Columbia. Statutes of eight states in 2000 and nine in 2008 included text about MDTs. In 2007, investigation rates for those states having MDT text in the statutes were significantly higher than those states without. The incidence of MDTs in the country is unknown. Legislative text is but one factor associated with differences in elder abuse report, investigation, or substantiation rates.     

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.     

Should Elder Abuse Be Decriminalized?

The movement to provide protective services for the elderly has brought about elder abuse legislation that provides criminal sanctions for elder abuse and failure to report suspected cases. This paper addresses the current and potential problems of criminalization of a social service and regulatory issue. It includes a discussion of definition and criminal intent issues as they relate to the problem of elder abuse. The position taken by the author is that the criminalization of the elder abuse problem may hamper efforts of the adult protective services worker.     

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.     

Self-Neglect Among the Elderly

Combinging three years of quantitative data from the Wisconsin Elder Abuse Reporting System with in-depth interviews of a purposeful sample of elder abuse investigators, this study examines differences between substantiated cases of self-neglect and cases of maltreatment by others. Living arrangements were highly associated with the type of maltreatment for which elderly were likely to need service. Mental illness, drug or alcohol problems, and dementia were moderately associated, while being male, white, and older were weakly associated. Referred by a formal support system was also weakly related to receiving services for self-neglect. Qualitative data suggested that family context may also be an important factor. The implications of these findings for policy, programs, and practice aimed at preventing self-neglect are discussed.     

Development of a Case Closure Index in Korean Elder Protective Service Agencies

This article describes the development and initial testing of an index to judge appropriateness of closing cases of elder abuse in Korean Elder Protective Service Agencies. An Index to Close Cases of Elder Abuse (ICCEA) was developed with input and feedback from caseworkers and expert reviewers. The ICCEA included client, perpetrator, and family and environmental indicators. A sample of 457 agency records in domestic settings was used to test the validity of the ICCEA. The ICCEA illustrated some validity with three external variables: a global item assessing appropriateness of case closure, case status coded open or closed, and closure reasons. The ICCEA showed potential as an objective guide for deciding whether to close cases of elder abuse and for making follow-up care plans after case closure in Korea.     

Elder Abuse: What Coroners Know and Need to Know

This article presents findings from a survey examining knowledge of elder abuse among Georgia's coroners. More than half of the 116 respondents indicated that they know “almost nothing” or “a little” about distinguishing signs of physical abuse from signs of aging (54%) and mandatory reporting laws and related elder abuse statutes (63%). When asked the frequency with which older adult cases were referred to the medical examiner, 49% indicated “rarely if ever.” Study findings reveal specific opportunities for enhancing training efforts aimed at coroners, who play a critical role in the identification of elder abuse.     

Maybe ignorance is not always bliss: The disparate treatment of Hispanics within the child welfare system

Previous studies indicate that the proportion of culturally diverse children to White children is increasing in public social service agencies. In addition, culturally diverse children are more likely to receive more intensive and punitive services, are more likely to stay within the system for longer periods of time and are reported more often to Child Protective Services. The purpose of the study was to explore how child welfare practices with Hispanic children are different from those applied with White non-Hispanic children. This study was a retrospective, two year, longitudinal, survival analysis of differential child welfare placement outcomes of White non-Hispanic and Hispanic children/families which had substantiated cases of abuse/neglect (n=1001).Findings demonstrate that although cases reported for abuse/neglect are relatively proportionate between Hispanic and White non-Hispanic children, substantiated cases are more likely to occur with Hispanic children. These children are more likely to be placed out of the home more quickly and for longer periods of time than their White non-Hispanic counterparts. The current study demonstrates the need for increased cultural awareness among Child Welfare professionals, especially in terms of assessment and case decision making, and the need for the development of culturally sensitive training modules for CPS and case management personnel.     

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.     

Elder Abuse: Feminist and Ageist Perspectives

ABSTRACT

Elder abuse research reports little consensus regarding gender and age. This project examined 99 incidents of elder abuse by an adult child and 86 incidents of elder abuse by a spouse, and compared the groups using the variables: gender, age, and incidents. The results are discussed from a feminist and age perspective. Differences between the groups were found, namely that elder abuse by an adult child is most likely to be financial abuse. Traditional ideas about women and men, as well as ideas about the nature of the old were found to be factors in elder abusive relationships.     

Elder Abuse and Child Abuse:

Elder abuse has been compared with other forms of intrafamilial violence. Despite obvious age and status differences, elder parents and young children exhibit similarities that make the linking of elder and child abuse compelling. However, difference in the nature of child-to-parent and parent-to-child relations and in the social and legal status of adulthood versus childhood argue against a too facile linking of the two problems. This paper suggests dimensions relevant to a comparison of intergenerational physical abuse of elder parents and young children.     

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.     

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.     

Addressing the measurement challenge in elder abuse interventions: need for a severity framework

ABSTRACT

The field of elder abuse is evolving toward an emphasis on intervention research. However, researchers currently rely on binary approaches to measure elder abuse phenomena, which fail to capture changes in problem status over the course of intervention. This commentary develops a case for severity as a framework to operationalize and measure elder abuse in intervention research and practice. A severity framework provides enhanced elder abuse measurement responsiveness and aligns with the dominant client-centered, harm-reduction clinical approach to intervening with elder abuse cases.     

"No secrets" and beyond: recent elder abuse policy in England

This paper provides an overview of English elder abuse policy including guidelines developed for adult protection by their Department of Health in 2000, a report released from the House of Commons Health Committee in 2004 on elder abuse, related policy changes affecting older adults, the mentally incapacitated, and social care regulations, and the launching of public awareness campaigns. In contrast to the U.S., English policy subsumes elder abuse within the larger category of vulnerable adult protection, steers clear of mandatory reporting, emphasizes abuse by formal caregivers rather than domestic violence, relies on a multi-agency approach to investigation and intervention, and supports more remedial, less punitive regulatory oversight.     

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.