Physical and Sexual Abuse,Battering, and Substance Abuse

Abstract

Women born before 1945 are the older women of today. Many of these women were subjected to childhood physical and sexual abuse and spouse battering at a time where there were no laws to protect them and few people discussed such subjects. Some of these women became substance abusers or lived with substance abusers. While there are retrospective studies on the experiences of adult women who suffered abuse in the family, little is known about the experiences of women over the age of 60 years.

Similarly, there is information on substance abuse among young and middle-aged women, but very little information on or about older womens' experiences with substance abuse. In this study, we review the literature on abuse and substance abuse. We present three clinical cases of older women who have experienced various forms of abuse and who in turn abuse substances. The cases are analyzed. Assessment, treatment, and evaluation methods for social workers are discussed.     

Theorizing Sexuality, Sexual Abuse and Residential Children's Homes: Adding Gender to the Equation

This article is primarily concerned with emphasizing the importanceof gender in relation to understanding and responding to sexualityand sexual abuse/exploitation issues within residential children’shomes. Initially, past research and inquiry reports are analysedand evaluated, not only in relation to their overall conclusionsand recommendations, but also with regard to their consideration,misrepresentation or omission of gender issues. A theoreticalframework is then drawn up which takes into account historicaldebates and contestations around notions of gender. This illustrateshow gender is frequently conflated or merged with understandingsabout sex and sexuality. This theoretical conceptualizationis then extended to consider the effects of the social constructionof childhood and childhood sexuality, and how sex, gender andsexuality may commonly be represented and understood withinorganizational, public-sphere contexts. Important findings froma recent indepth qualitative research project focused on sexualityissues in children’s homes are then presented thematicallyand through narrative excerpts. These findings are also locatedwithin and made comprehensible in relation to the theoreticalframework previously constructed. The conclusion examines theimplications of the findings presented and their theorization,and briefly evaluates the usefulness of recent policy initiativesintended to improve the care and development of ‘lookedafter’ children.     

Cultural Barriers to the Disclosure of Child Sexual Abuse in Asian Communities: Listening to What Women Say

There is apparent under-reporting of child sexual abuse in Britain’sAsian communities and a varied capacity amongst professionalsto respond with cultural competence. Professional approachesoriginate in cultural contexts, which are often different fromthose of most British Asians. If the proportion of childrenand non-abusing carers from Asian communities who access relevantservices is to increase, professionals need to develop betterunderstandings of cultural imperatives which determine behaviourin those communities. Consultations with Asian women in Bradfordreinforce the view that culturally competent practice and respectfuldialogue are essential to the protection of children. They alsohighlight a number of recurring themes. Members of Asian communitiesare aware of child sexual abuse, they recognize that the issueneeds to be addressed by all communities and they report thatmany of those affected within their own communities have foundit difficult to access relevant services. These consultations,like reports of similar work elsewhere, indicate that difficulties,which appear to arise from Asian women’s fears about howagencies will respond, are frequently compounded by the impactof cultural imperatives arising from izzat (honour/respect),haya (modesty) and sharam (shame/embarrassment), which havea considerable influence on how many will behave.     

The Role of Media in Reporting Child Abuse

ABSTRACT

This study looks at the short-term impact that the media coverage of children in need of protection had on the number of cases reported to child protection agencies. The number of reports (N = 11,646) made to these agencies in Canada was tallied each week during a 24-month period. During the same period, a content analysis of print media was conducted regarding child maltreatment and/or child protection services (CPS) to identify and count the number of articles published (N = 1,211) and single out media frenzy events. Results show a statistically significant relationship between media coverage and the number of cases reported to child protection agencies.     

An Exploratory Study of Substance Abuse Among Latino Older Adults

ABSTRACT

Substance abuse among older adults is on the rise. Of particular concern is the increase in alcohol and drug use predicted among Latino elders, expected to result from an upsurge in the Latino population and concurrent growth in the number of older adults. Providing effective treatment for this group will require age-specific, culturally competent interventions. However, few studies have focused on geriatric substance abuse among Latinos. This study aims to lay the groundwork for further research by examining perceptions of the problem among treatment providers and researchers in aging and substance abuse. Implications for social work research and practice are addressed.     

Perceptions of Benzodiazepine Dependence Among Women Age 65 and Older

A phenomenological study explored whether older women who are chronic benzodiazepine users identified themselves as dependent, how dependence was perceived, and how meanings and understandings shaped experiences of benzodiazepine use. Self-reported benzodiazepine dependence was associated with being unable to reduce use or a desire to discontinue use and reliance on benzodiazepines to remain comfortable and able to handle daily life. Themes included: (a) benzodiazepine dependence is similar to dependence to diabetes or blood pressure medications; (b) dependence is distinctive from addiction/abuse; (c) addiction/abuse is perceived as worse than dependence; and (d) concerns of addiction/abuse result in low-dose benzodiazepine use.     

Hearing the Voices of Abused Older Women

Summary

This paper focuses on a qualitative research process that gathered responses from 64 older women aged fifty and older on their experience of violence and abuse. What older women said about abuse in their lives supports the use of a feminist framework as well as the age based analysis of the elder abuse field. Some respondents spoke of abuse from childhood into their later years. Some spoke of partners witnessing or experiencing abuse as children. Some women express concern about possible abuse by their adult children of their own children.

Abused older women like younger women need a safe environment, emotional support, advocacy, information, and peer support. While it is important to consider the perspectives and knowledge of service providers when developing policy and practice on abuse of older women, it is critical to ask the women survivors of abuse or neglect what they believe would benefit them, and others in similar situations.     

Facility Organizational and Facility Resident Characteristics in Nursing Homes Serving Residents With a Mental Health History

ABSTRACT

The prevalence of mental health disorders among nursing home residents has been noted. The purpose of this study was to identify characteristics among nursing homes serving residents with a mental health history. A retrospective, cross-sectional design was conducted using the 2003 national Online Survey, Certification, and Reporting facility data merged with the resident-level Minimum Data Set resulting in 2,499 nursing homes. Across facilities, 22% of the total residents had a diagnosis of a mental disorder not including any form of dementia. Among those with a mental health history, 53% of facility residents had depression and 37% had schizophrenia.     

Part of the Problem or Part of the Solution? The Role of Care Homes in Tackling Delayed Hospital Discharges

As part of current UK policies to reduce the number of delayedhospital discharges, a number of commentators have identifiedan alleged crisis in the care home market as one of key contributingfactors. With local authorities under pressure to cut costs,it is argued, the number of care homes is reducing, and delaysin hospital can often result. Behind this diagnosis is a seriesof assumptions about the role and nature of care home provision,the appropriateness of this form of service for many older people,and the need for more care homes to reduce the number of hospitaldelays. In order to explore and critique these assumptions,this paper reviews the role of care homes in tackling delayeddischarges, and argues the need for fewer and different carehome placements rather than more of this type of provision.     

Impact of Support Groups on Well-Being of Older Women

ABSTRACT

The goal of this study was to determine whether differences in incidence of depression and level of well-being are manifested between older women, aged 60 and older, who attend either (a) a peer-run support group, (b) a staff-run support group, or (c) a comparison group (i.e., who do not attend a support group).

Thirty-six women participating in peer-run and staff-run support groups and 9 women receiving nongroup support were administered the Geriatric Depression Scale and the Philadelphia Geriatric Center Morale Scale. Separate analyses of variance were employed on each scale to determine the significance of differences in scores according to facilitator type (i.e., peer-run vs. staff-run vs. comparison group).

Analysis of scores on the Geriatric Depression Scale indicated significant differences between women in the peer-run groups and women in the comparison group, but no significant differences between women in the peer-run groups and women in the staff-run groups or between women in the staff-run groups and women in the comparison group. Analysis of scores on the Philadelphia Geriatric Center Morale Scale did not indicate any significant differences between women based on facilitator type.

Results of this study have implications for those who run face-to-face support groups for older adults, for those who train peer group facilitators, and for community agencies that desire to initiate a support group system for their clientele.     

Intergenerational Care Perceptions of Older Women and Middle Adolescents in a Resource-Constrained Community in South Africa

ABSTRACT

This study describes intergenerational care perceptions in a resource-challenged community. Ten women (aged 60+) and eight middle adolescents (3 boys and 5 girls) participated in the Mmogo-method®, a visual data-collection method. Textual data were analysed thematically, and visual data by applying Roos and Redelinghuys (2016) proposed steps. Both groups provided physical and instrumental care to the other. Older women cared for adolescents by teaching and disciplining them, while the adolescents cared for them by obtaining an education and by showing respect. Older women felt being cared for when adolescents helped them, obeyed and complied with instructions and discipline, while the youngsters expressed it when their basic needs were addressed and school attendance was enabled. Older women’s expressions of caring about were vague, while the younger people detected, act and elicited reactions from the elders. The adopted care approach informed care perceptions. Joint intergenerational activities are proposed to discover care currencies and contributions of generational members.     

Multilevel Factors Related to Psychosocial Care Outcomes in Washington State Skilled Nursing Facilities

As the primary providers of psychosocial services in skilled nursing facilities, social services professionals report barriers interfering with their ability to meet residents' needs. This study utilizes a 3-category quality assessment framework and a cross-sectional survey design to assess factors impacting the provision of effective psychosocial services in Washington State facilities. Hierarchical linear regression results indicate that the 3-factor model explains 26.4% of the variance in psychosocial outcomes; 4 variables exert the most influence: ownership turnover, practitioner experience, practitioner role identity, and the importance of individualizing care. Findings have implications for developing necessary supports for quality psychosocial care delivery.     

Advance Care Planning in the Delivery of Adult Protective Services

ABSTRACT

In ensuring the safety and protection of older adults from abuse and exploitation, adult protective services (APS) workers face a variety of situations involving serious illness and end-of-life conditions. Many older adults encountered in APS will present with one or more chronic conditions that may warrant discussion of advance care planning with clients and their families. This study surveyed APS workers (n = 508) in 21 states regarding encounters with end-of-life situations and the practice of future care planning. Results revealed that three-fourths of APS workers encounter clients with serious illnesses and about two-thirds do discuss planning in advance for care. More than one-half of the respondents indicated client incapacity and refusal to address future care needs as barriers to discussing planning in advance for care. Recommendations to enhance advance care planning among APS workers are discussed.     

Comparing Perceived Quality of Life in Nursing Homes and Assisted Living Facilities

Abstract

Residents 65 years old and older living in nursing homes (NH) and assisted living facilities (ALFs) were matched on a scale of functional ability: The Sickness Impact Profile for Nursing Homes (SIP-NH). Of the 97 NH and 100 ALF residents who were evaluated using the SIP-NH, 43 pairs, matched by level of disability, were formed. Each member of the 43 pairs was administered two quality of life instruments: the Ferrans and Powers Quality of Life Index (QLI), as well as a single direct question regarding quality of life. Matched pair t-tests revealed no differences in quality of life scores, contrary to the hypothesis that the matched residents in nursing homes would have perceptions of a lower quality of life than residents of assisted living facilities.     

The Effect of Housing on Perceptions of Quality of Life of Older Adults Participating in a Medicaid Long-Term Care Demonstration Project

Summary

As the nation struggles with the great increase in the numbers of older adults, many questions arise about how to provide housing and long-term care options that will ensure the quality of life of older adults. This study demonstrates that older adults and their families perceive quality of life more positively once moved from a nursing home to an assisted living facility using Medicaid funds. Results of this exploratory study are promising and suggest that having housing options available across the continuum of care with individualized case management offers older     

Care of Older Adults in Iceland: Policy Objectives and Reality

ABSTRACT

We examine the implementation of the Icelandic government's policy on formal care of older adults in Iceland. The policy as expressed in legislation and other policy documents is to ensure access of older adults to the appropriate level of health and social care services. How does the actual level of formal care compare with the policy objectives? Does there exist an implementation deficit, and if so, why? We address the question by analyzing Icelandic and international statistical databases. The findings reveal a gap between the aims of the current policy and its delivery. As elsewhere in the Nordic region, the policy allows for the emphasis to be on home-care services in which the individual's needs are assessed comprehensively. Administrative problems and insufficient resources to better understand and explain the problem are identified. Current steps to address the problem include the necessity of a comprehensive evaluation of the level and quality of elder-care services in Iceland, which would help compensate for the shortcomings of the existing public statistical databases. In future research, it is necessary to analyze how services can be coordinated while increasing responsiveness to the voices of older adults and their relatives on the care of older people.     

Assessment of a Brief CES-D Measure for Depression in Homebound Medically Ill Older Adults

Black elderly individuals represent one of the most disadvantaged groups in the United States in terms of income levels, health problems, and access to supportive services. This paper describes four major factors to be considered by social service providers to focus their programs toward needs of the black elderly population in their local communities. A research project designed to examine the social service needs and service utilization of the black elderly in a Midwestern community indicated that the following factons hould be considered if effective service programs are to be implemented: (1) Negotiation Initiative, (2) Responsible Research, (3) Symbolism, (4) Modeling.     

Older Latina Women and HIV/AIDS: An Examination of Sexuality and Culture as they Relate to Risk and Protective Factors

Older Latina women are one of the least studied American demographic groups with regard to social, health, or sexual behavior. This could leave social workers and other geriatric professionals unprepared for dealing with HIV/AIDS in this population. Currently, older Latina women are one of the fastest growing groups of new AIDS cases. Twenty percent of all women ever diagnosed with the disease are Latina and 5.5% of Latinas infected with the virus are older. The number of diagnosed infections is increasing in older women, including Latinas, in spite of recent declines in infection rates with younger populations. There are also a potentially large number of cases that go misdiagnosed or undiagnosed.

This article also addresses risk and protective factors related to gender roles, traditional Latino family values, religion, socioeconomic factors, health, and health care, with special attention to the triple jeopardy faced by this population by virtue of being female, seniors, and minorities. The article concludes with recommendations for the development of culturally competent practices with older Latinas and the development of a research agenda to better understand their risk-related and health-seeking behavior.