Abuse of the elderly
Abuse of the elderly
Anatomy or system affected: All systems potentially affected
Definition: A single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person.
Overview
Lack of agreement regarding the definition of elder abuse and its parameters has made the assessment of prevalence and incidence problematic. The definition of “elder” may also vary depending on culture and location across the world. In North America and Europe, the cut off is 65 years; the United Nations uses 60 years or greater to describe “old”; and in some societies “old” is when you become a grandparent. Mysyuk, Westendorp, and Lindenberg studied the history and definitions of elder abuse and found the definition to be related to phrases such as granny battering, elder mistreatment, battered elder syndrome, and old age abuse. See Table 1 for details of each phrase.
Table 1. Definitions of Elder Abuse
| Definitions | Properties | General Developments | ||
| Rational | Forms | Circumstances | ||
| Granny battering (Bakker; Burston) | • “Ill treatment” of older people• Parallel with “baby battering” | Physical assault | • Family crisis• Stresses caring daughter• Vulnerable women• Ageist, negative assumptions | 1975–1977Females and physical abuse |
| Elder abuse (O'Malley et al.) | Physical pain, mental anguish | • Dependence of older person• Intention of harm by caregiver• Deprivation by caretaker of service• Relationship caregiver-caretaker | ||
| Elder mistreatment (Beachler) | 1979–1982 Risk factors and widening of actions | |||
| Battered elder syndrome(Block & Sinnott) | • “Labeling”: syndrome, disease• Powerless and sick older people | Physical, economic, and psychological | ||
| Granny battering (Eastman) | • “Systemic: physical abuse of an elder person by relative” | • Importance of the quality of relationships, females | ||
| Old age abuse (Eastman) | • Applies to older people, not just grannies• A new term “maltreatment”• Narrowing the setting | • Caregiving relative | 1984Widening of victims | |
| Elder mistreatment (Comijis) | • Acts or lack of actions• Personal or professional settings | 1998Widening of perpetrators | ||
| Elder abuse (WHO) | • Excludes random acts of violence or criminal behavior• Reduces specifically but increases the territory covered by the problem | • Focus on trust relationship | 2002–2003 Widening of context | |
| Elder mistreatment (Bonnie & Wallace) | • Excludes cases of self-neglect, and victimization of elders by strangers• Ambiguous terms “harm,” “trust relationships”• Intentional actions | • Vulnerable elder caregiver |
Source: Mysyuk, Westendorp, and Lindenberg, 2013
Introduction
Incidents of elder abuse have been increasing as the general population ages around the world. Elder abuse has not been recognized in the public until recently, and it is still under-recognized and underreported across societies. Abuse of the elderly can have devastating consequences for the victims, including poor quality of life, psychological distress, and loss of property and security. It can occur at all levels of socioeconomic status, all parts of the world, and in multiple settings. People with dementia are especially vulnerable to abuse, with some estimates placing the proportion of dementia patients who have been abused at 50 percent, and elderly women were nearly twice as likely to be abused as elderly men as of 2015.
Types of Abuse
There are five types of elder abuse: physical abuse, psychological/emotional abuse, financial/material abuse, sexual abuse, and neglect. See Table 2 for characteristics and examples of the five types of abuse. Sooryanarayana et al. conducted a review of 1,831 articles on elder abuse from 1990 to 2011, and found that psychological abuse is the most common form of elder abuse, suggesting that abuse may not be identified exclusively by physical examination.
Table 2. Types of Abuse
| Types of Elder Abuse | Characteristics | Examples |
| Physical Abuse | The infliction of pain or injury | Slapping, hitting, kicking, force-feeding, restraining, striking with objects |
| Psychological/Emotional Abuse | Infliction of mental anguish | Verbal aggression or threat, threats of institutionalization, social isolation, humiliating statements |
| Financial/Material Abuse | Illegal or improper exploitation and/or use of funds or resources | Theft of money, coercion to deprive the older person of his or her assets, such as forcible transfer of property |
| Sexual Abuse | Nonconsensual contact of any kind with an older person | Suggestive talk, forced sexual activity, touching, fondling with a nonconsenting competent or incompetent person |
| Neglect | Intention or unintentional refusal or failure of designated caregiver to meet needs required for older person's well-being | Failure to provide adequate food, clothing, shelter, medical care, hygiene, or social stimulation |
Source: Perel-Levin, 2008
Screening
Several tools have been created, almost exclusively for North America, but few are accepted for wide application because they are regarded as not accurate, specific, or sensitive enough to be reliable. Tools include the Hwalek-Sengstock Elder Abuse Screening Test (HSEAST), the Brief Abuse Screen for the Elderly (BASE), the Caregiver Abuse Screen (CASE), the Indicators of Abuse Screen (IOA), and the Elder Abuse Suspicion Index (EASI). Screening for elder abuse should be considered in the context of cultural norms. For example, some rituals that take place in one culture may be offensive and considered abuse in another. The general approach for detecting elder abuse is through identifying high risk factors including: social isolation, frailty of the victim including functional disability and cognitive impairment, pathology of the abuser (such as alcohol or other substance abuse, cognitive impairment or mental health problems), caregiver stress/anger, dependence of abuser on victim (specifically in financial abuse), and also the degree of reliance of the victim on the abuser. Once abuse is identified, the clinician must play an important role to keep the patient safe and provide patient advocacy.
Reporting
According to a 2010 nationwide study in the United States published in the American Journal of Public Health, 11.4 percent of respondents aged sixty or older reported experiencing at least one incident of neglect or physical or emotional abuse in the preceding year. A 2017 study looking at twenty-eight countries estimated that 15.7 percent of people aged sixty or older had experienced some form of abuse. However, elder abuse is widely under-reported, and it is thus difficult to know with certainty how widespread the problem is. A 2014 estimate by the US Department of Health and Human Services suggested that as few as one in twenty-four cases are reported to the authorities. As stated by the World Health Organization, “Although the extent of elder mistreatment is unknown, its social and moral significance is obvious; therefore, it demands a global multifaceted response, one which focuses on protecting the rights of older persons.” People who are concerned or suspicious that elder abuse is occurring close to them should call 1-800-677-1116 (for United States only), and a trained operator will give instructions for reaching a nearby agency. More information is available through the Department of Health and Human Services: National Center on Elder Abuse (http://www.ncea.aoa.gov/index.aspx).
Bibliography
Acierno, Ron, et al. "Prevalence and Correlates of Emotional, Physical, Sexual, and Financial Abuse and Potential Neglect in the United States: The National Elder Mistreatment Study." American Journal of Public Health 100.2 (2010): 292–97. Print.
"Crimes against Older Adults." Office for Victims of Crime, US Department of Justice, 2018, https://ovc.ncjrs.gov/ncvrw2018/info‗flyers/fact‗sheets/2018NCVRW‗OlderAdults‗508‗QC.pdf. Accessed 5 Mar. 2019.
Department of Health and Human Services. National Center on Elder Abuse: Administration on Aging. Retrieved October 8, 2013, from http://www.ncea.aoa.gov/index.aspx.
"Elder Abuse." World Health Organization, 8 June 2018, www.who.int/news-room/fact-sheets/detail/elder-abuse. Accessed 5 Mar. 2019.
Mysyuk, Yuliya, Rudi G. J. Westendorp, and Jolanda Lindenberg. “Added Value of Elder Abuse Definitions: A Review.” Ageing Research Reviews 12.1 (2013): 50–57. Print.
Perel-Levin, Silvia. "Discussing Screening for Elder Abuse at Primary Health Care Level." World Health Organization. WHO, 2008. Web. 18 Mar. 2015.
Sooryanarayana, Rajini, Wan-Yuen Choo, and Noran N. Hairi. “A Review on the Prevalence and Measurement of Elder Abuse in the Community.” Trauma, Violence and Abuse 14.4 (2013): 316–25. Print.