Elder Abuse Research: A Systematic Review

The purpose of this research was to provide a systematic review of, and assign an evidence grade to, the research articles on elder abuse. Sixteen health care and criminal justice literature databases were searched. Publications were reviewed by at least two independent readers who graded each from A (evidence of well-designed meta-analysis) to D (evidence from expert opinion or multiple case reports) on the quality of the evidence gained from the research. Of 6,676 titles identified in the search, 1,700 publications met inclusion criteria; omitting duplicates, 590 publications were annotated and graded.     

Elder Abuse and Neglect—“Old Phenomenon”: New Directions for Research,Legislation, and Service Developments

This article poses the question: Is elder abuse and neglect a social problem, showing that it is. Elder abuse, though, is still the most hidden form of mistreatment and a key to governmental responses to an ageing population. It is an important facet as a family violence problem, an intergenerational concern, as well as a health, justice and human rights issue. Because the phenomenon of elder abuse and neglect is so complex and multi-dimensional, it has to be addressed by multi-professional and inter-disciplinary approaches. Raising awareness is a fundamental prevention strategy and an important step in causing changes in attitudes and behaviors. This has been accomplished by INPEA and the article was developed from the lecture given by the author on receiving the International Rosalie Wolf Award from INPEA. The discussion focuses on elder abuse as a product of global ageing, stemming from population ageing, which is consistent with an increased prevalence of abuse of all vulnerable groups, older people among them. It is pointed out that baseline and trend data on the nature and prevalence of senior abuse are crucial to policy responses and the development of appropriate programs and services. Difficulties in assessing the scope of the phenomenon, though, are due to: problems in definitions and methodology, which create difficulties in comparing data from various countries; lack of social and familial awareness; isolation of some elders, especially migrants; elder abuse as a ‘hidden issue’ that usually occurs in the privacy of the home and is viewed as a family affair; limited access to institutional settings. Difficulties also exist in constructing a unifying research framework in order to study the phenomenon due to a lack of comparison groups, a lack of representative national surveys and difficulties in measurement. There is currently, however, an increase in prevalence and incidence studies from both sides of the Atlantic and especially from Europe. But while prevalence studies provide base-data on numbers, little is known about key conceptual issues for policy, practice and the understanding of different forms of abuse and neglect. Theoretical under-development hampers the collection of systematic cumulative knowledge which is based on universally agreed upon and standardized tools, and reduces the ability to discover unifying themes and their relationship to local idiosyncrasies existing in the field. Additionally, there has been no attempt to develop theoretical knowledge grounded in data from the study of elder abuse itself. The following vehicles for action are, thus, suggested: Developing international, national and regional research agendas and data bases; developing policy and legislation; developing services and interventions and developing educational programs.     

Prevention of Elder Mistreatment in Nursing Homes: Competencies for Direct-Care Staff

Existing training on elder mistreatment in nursing homes focuses on detection and reporting of abuse, with little training specifically targeted toward prevention of mistreatment before it occurs. We used qualitative interviews with nursing home staff, policy makers, and related professionals to identify training needs. Based on participant accounts, we drafted a number of competencies essential for caregiver training to prevent mistreatment in nursing homes. Competencies include those dealing with definitions and policies, risks for mistreatment, communication and respect in relationships with residents, and development of a cooperative work environment. Competencies are discussed along with illustrative examples, and implications for practice and policy are addressed.     

Family Members' Reports of Non-Staff Abuse in Michigan Nursing Homes

Recent research showed that mistreatment of nursing home residents by other residents may be highly prevalent. The present study examined the issue from family members' perspectives. The data came from the 2005 and 2007 random-digit dial telephone surveys of Michigan households with a family member in long-term care. Based on family members' reports, about 10% of nursing home residents aged 60 and over were abused by non-staff in nursing homes (e.g., other residents and visitors) during the past 12 months. Family members were more likely to report non-staff abuse when the nursing home residents were younger, were female, had behavior problems, and had greater level of physical functioning. Family members who reported staff abuse were four times more likely to also report non-staff abuse.     

The Critical-Ecological Framework: Advancing Knowledge,Practice, and Policy on Older Adult Abuse

The abuse of older adults in our society is a recognized yet understudied issue compared to other forms of family violence. Within this article, research, theory, and practice in family violence and older adult abuse are compared; elements that can be transferred to the field are analyzed; and gaps are identified. An extensive literature review, two focus groups with local stakeholders, and interviews with six key informants recognized as national subject experts formed the basis of this analysis. The results informed the development of a critical-ecological model designed to address the gaps and advance the field.     

The Use of Chemical Restraints for Older Long-Term Hospital Patients: A Case Report from Finland

The purpose of this study was to describe the use and concomitant use of psychotropics and other drugs as chemical restraints in the aged in long-term hospital care. The study consisted of 154 patients (42 men, 112 women) hospitalized in five long-term care wards in Pori City Hospital, Finland. Three or more psychotropics were regularly given to 33% of the patients and regularly or irregularly to 53% of the patients. Two or more benzodiazepine derivatives or related drugs were regularly given to 24% of the patients and regularly or irregularly to 46% of the patients. The very poor cognitive and functional abilities of the patients, the common concomitant use of psychotropic drugs, the use of psychotropics to control the behavior of the patients, and the lack of documentation of the effects and side effects of the drugs give rise to the conclusion that psychotropics were used as chemical restraints in these long-term care wards.     

Assessing Capacity Within a Context of Abuse or Neglect

In 2000, with the implementation of Part III of the Adult Guardianship Act: Support and Assistance for Abused and Neglected Adults, British Columbia formally recognized the need to examine issues of decisional capacity of older adults within a context of abuse or neglect. Interestingly, however, although the test of capacity was clearly laid out under this piece of legislation, the potential influence that living in a situation of abuse or neglect may have on how the person makes decisions is not explicitly addressed. Similarly, this is a missing link throughout the literature discussing decisional capacity in older adults. This gap exists despite the fact that determining the “protection” needs of someone who is being abused and/or neglected often hinges directly on that person's decisional capacity. The purpose of this article is to examine the unique aspects associated with assessing and determining capacity for older adults who are living in a situation of abuse or neglect. The specific objectives are to: (a) examine how living in a situation of abuse or neglect may influence the determination of capacity and (b) explore the implications of conducting an assessment within a potentially abusive context. The legal notion of undue influence and the psychological concept of relational connection are introduced as potentially important for considering decision making within this context.     

Elder Abuse and Neglect in Institutional Settings: The Resident's Perspective

This article strives to share research findings concerning the rights and empowerment of the elderly living in various long-term care (LTC) or residential care facilities (public and private sectors) in Quebec, Canada. Inspired by the theories of constructivism, the research aims to understand the residents’ perception of abuse, as well as the strategies they are developing to exercise their rights and liberties. Data from semistructured interviews with 20 residents, mostly very old women aged 80 to 98, are presented. Results show that residents’ perception of abuse: (1) is conditioned by sensationalistic media coverage; (2) is limited to physical mistreatment; and (3) tends to legitimize day-to-day infringements of their rights, as these “minor” violations seem inoffensive when compared to the “real” acts of violence reported in the media. Tensions that can build up among residents, sometimes resulting in intimidation or even bullying, were addressed.     

Feasibility of Integrating Mental Health Screening and Services Into Routine Elder Abuse Practice to Improve Client Outcomes

This study examined law enforcement and prosecution involvement in 71 cases of elder abuse where pure financial exploitation (PFE), physical abuse (PA), neglect (Neglect), or hybrid financial exploitation (HFE) (financial exploitation co-occurring with physical abuse and/or neglect) occurred in a domestic setting. Victims of elder abuse and assigned Adult Protective Services (APS) caseworkers were systematically interviewed. Law enforcement officials were involved in 54% of the cases, and 18% of the cases were prosecuted. PA was significantly more likely to trigger a law enforcement response and to be prosecuted than Neglect or PFE. HFE involved prosecution for assault rather than financial exploitation. Generally, the victims of elder abuse were not receptive to criminal justice involvement, which appears to have a significant impact upon the level of this involvement. The reasons for this reluctance are discussed, as well as the challenges and limitations of criminal justice system involvement and related implications for policy and practice.     

Perceptions of Institutional Elder Neglect in Civil Court

Perception of institutional elder neglect (IEN) in civil court was investigated. Experiment 1 participants (N = 162) read an IEN trial summary in which alleged victim testimony was presented or not. Victim testimony increased the likelihood of ruling for the plaintiff, partially mediated by credibility of witnesses for each side. Experiment 2 (N = 68) included a condition with testimony from the victim's floor-mate. Likelihood of ruling for the victim: victim = floor-mate > no testimony, was mediated by perceived credibility of the plaintiff's case. Results are discussed in terms of the importance of alleged victim testimony in IEN cases.