Elder Abuse in the United States

Aging is a normal process of human life. According to Merriam-Webster online dictionary, to age means "to become old, to show the effects or the characteristics of increasing age" (Merriam-Webster, n.d.). The process of aging affects every person and nobody can escape it. In our society the number of elderly persons in our country is growing rapidly. According to Population Reference Bureau report "Fact Sheet: Aging in the United States" , "the number of Americans ages 65 and older is projected to more than double from 46 million today to over 98 million by 2060, and the 65-and-older age group’s share of the total population will rise to nearly 24 percent from 15 percent" (Mather, 2016). When people aged they wish to be independent, secure and participate in all activities as they were younger, but many of them are struggle from chronic diseases (diabetes, arthritis and heart disease) that affect their physical activity level. Also, they suffer from falls, behavioral and oral health problems that affect their quality of life, too (NCOA, 2018). Eighty percent of the elderly population has at least one chronic condition, sixty eight percent have two or more (NCOA, 2017). Heart disease, cancer, stroke, Alzheimer’s disease, and diabetes are the leading causes of death among elderly in the United States (Older Americans, 2016).

The elderly people are the most vulnerable population in our society due to physical and mental impairments, isolation, and dependence on others with all their activities. When elders became physically frail and begin to depend on others to meet their basic needs, they often seen as a helpless burden on their families and the community; they grow to be vulnerable to abuse and neglect from people who take care of them. According to World Health Organization (2018), the definition of elder abuse is defined as "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." Elder abuse is an increasing and is a very serious problem in our society that can happen to any older adult in a variety of settings. "Approximately 1 in 10 Americans aged 60+ have experienced some form of elder abuse. Some estimates range as high as 5 million elders who are abused each year. One study estimated that only 1 in 14 cases of abuse are reported to authorities" (NCOA, 2018). " In Massachusetts, the Executive Office of Elder Affairs reported 9,800 confirmed abuse and neglect cases in the state in 2017, a nearly 40 percent increase over 2015" (Paul Singer, 2018). It is difficult to obtain an accurate picture of how widely spread elder abuse is in the United States, because many elders are reluctant to report their abusers for fear of losing the help that they need to take care of themselves or of being further abused.

Elder abuse may come in emotional, physical, financial or sexual means, and also it can be a neglect of the elders (CDC, 2016). Physical elder abuse is non-accidental use of force against an elderly person that results in physical injury: hitting, inappropriate use of drugs and restraints, placing a person under inappropriate confinement situations (Stark, 2012). Emotional elder abuse happens when people speak to elderly persons in ways that cause emotional pain or distress (Stark, 2012). Humiliation and ridicule is one common form of verbal emotional abuse (Stark, 2012). Isolating an elderly person from friends, family, and activities that they are used to participating in, is a common form of nonverbal psychological elder abuse (Stark, 2012). Sexual abuse is another type of elder abuse; it happens when a person has contact with an elderly person without their consent (Stark, 2012). Also, an elder can also be the victim of financial abuse. This type of abuse includes any behavior that financially harms another person such as the illegal or improper use of an older person's funds, property, or other resources (CDC, 2016). Elder abuse can also take the form of neglect, in which a caregiver fails to meet the basic needs of the elder in his/her care; it is involves not maintaining proper hygiene to the elders, not allowing the elders to participate family and other social ceremonies, not taking them for medical treatment when they are sick and poor maintenance of the elder’s house of residence (CDC, 2016). According to Acierno et al., "emotional and sexual abuses are most frequently committed by partner, spouse or well known person; neglect by child or grandchild; and physical maltreatment by partner or spouse" (2010). Financial abuse is the most prevalent type of elder mistreatment and estimated $2.9 billion a year (Adams & Robertson, 2018).

Many elderly people are abused in their homes, their relatives’ homes, and even in facilities that are responsible for their care. According to Earlam et al., "about 90 % of elder abuse is committed by a family member in the home, with the other 10 % by hired caretakers, intimate partners, or health care workers in long-term care facility" (2018). Elder women are abused more than man and about 40 % of these woman are over the age of 80 (Richards, 2011).

One of the major risk factors for elder abuse is shared living environment (Lachs et al., 2015). Most elder abusers depend on the elder for financial assistant; they therefore abuse them so that they can benefit financially at the elder expenses (Lachs et al., 2015). Most elders’ abusers are stressed in life and they abuse the elders out of stress and problems upon them, because they see the elders as burden on top of their problems (Stark, 2012). Also, some of elder abusers are mentally ill; this makes them not to care about the elders and can mistreat them carelessly (Stark, 2012). Cognitive impairment creates the need for more assistance with activities of daily living and this put the elders at more risk for abuse. Wiglesworth et al. (2010), state "almost 50% individuals with Dementia are abused or neglected by their caregivers." When elderly people lost their friends and family members it put them at risk for abuse due to social isolation (WHO, 2018).

Formal regulations and responses to elder abuse are found at federal and state level. "Elder Justice Act, the first comprehensive federal legislation to address elder abuse, was signed into law by President Obama in March, 2010 as part of the health care reform act (The Elder Justice Act, 2010)". National Center on Elder Abuse (NCEA) is a national resources center that provides statistics, information, assistance and training for health care professionals and people who want to get information on elder abuse: how it can be prevented, reported and treated (Falk et al., 2012). On a state level the first agency to respond to a report of elder abuse is Adult Protective Services (Watson, 2013). This agency investigates, regulates and provides help for the victims of abuse. Long-Term Care Ombudsman Program is a program that addresses elder abuse complaints in the long-term care system (Falk et al., 2012). Area Agencies on Aging provides services to assist elders and their families with care they needed (Falk et al., 2012).

All health care providers and members of the community should be aware of common signs of elder abuse: unexplained bruises, bedsores, large bank withdrawals, sudden changes in behaviors, and appearing frightened around particular people (Stark, 2012). No matter how minor or severe the abuse, health care providers have a duty to assess elderly patients according to recommended protocols and report suspected abuse to designated authorities (Falk et al., 2012). Elder abuse may be a minor issue that can be easily resolved or it can result in severe and life-threatening health problems that can cause to disabilities and even death (CDC, 2016).

The most important step for preventing elder abuse is understands that no one should be the subjected to any type of abuse. Health care providers need to educate patients and caregivers on elder abuse. The effectiveness of educational programs for elderly, professionals who work in community settings and institutional settings and for perpetrators was examined by Moore and Browne (2016). The authors stated the benefits of these programs, especially for professionals in community settings: "increase awareness of the reporting process, knowledge/awareness of elder abuse, knowledge of mandated reporter requirements, and increased comfort levels with recognizing signs and symptoms of abuse and neglect" (Moore& Browne, 2016, p. 388). Hotlines are one of the emerging practices to prevent and treat elder abuse, because when elderly people utilize hotlines they get more access to mental and behavioral services and get help and advices that they needed (Moore& Browne, 2016, p. 393).

Community based approaches to prevent elder abuse are education and providing the community resources for support caregivers and members to decrease stress and isolation (Moore& Browne, 2016, p. 388). Caregivers and family members who demonstrate signs of distress should referred to social services for counseling to help decrease stress level and prevent the abuse. Some approaches for preventing abuse for the elderly who lives in their homes are training older people to serve as visitors for other people who are isolated, creating support group for victims of elder abuse, setting up community programs for social interaction among the elderly. The development of effective care plans, staff training, programs to address stress among staff and policies and programs to improve the social and physical environment of the long-term care facilities will prevent the elder abuse in institutional settings. Services for the treatment of mental health problems and substance abuse, education and jobs available for people who abuse the elderly are some measures that can prevent the abuse of the elders.

Conclusion

Elder abuse is a significant problem in the United States and often goes unreported and unrecognized. Everyone has the right to be protected in any means of abuse. Abuse of the elders will be considered as one of the worst. Elders’ people are so vulnerable from such abuse causing them to feel distrustful and alone. In our days the number of elderly people in our country is growing rapidly and more attention is needed to the geriatric population to help these people age successfully and be protected from any abuse. It’s our responsibility to create an environment for the elderly people in which ageing is accepted as a natural part of the life cycle. Elderly should have the opportunities to participate fully in all activities, get help that they need and have the right to live in dignity (free of abuse and exploitation). Health care professionals should not only educate the people on elder abuse, but should advocate on behalf of elders to protect them.

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