Elderly Abuse Strength Based Perspective

In the next 12 years the number of people over the age of 65 years old is projected to double because by year 2030 the millions of baby boomers born between 1946-1964 will become senior citizens ages 66-85. According to statistics and surveys it is said that as many as 2 million Elderly Adults are abused or neglected each year. (NBC News, 2018). Due to the coming onset of elderly adult this is a huge opportunity for current and future social workers to focus on advancing their knowledge in this area. In my paper I will explore what elder abuse is and how we can help using Strength Based Perspective.
Increasingly Elder Abuse is gaining attention of the medical fields, social work field as well as the government. It is the most recent "discovered" type of family abuse. Any act of abuse is uncalled for and wrong especially when it is done to people who are unable to defend themselves. My research has shown me that the awareness of this type of abuse in on the rise and it is important for social workers to gain continuous training in this area to help these people to live out the remainder of their lives free of abuse. The largest issue social workers face with elder abuse is the elder had the right to self-actualization and tends to display great resistance.

On June 14, 2012, World Elder Abuse Awareness day was held in the White House and President Obama proclaimed its importance and the needs to advance the field of elder abuse. (whitehouse.gov, 2018). When reading this proclamation by President Obama I like the way he describes our elders: these people are parents, grandparents, siblings, spouses, aunts, uncles, friends and neighbors. Abuse doesn’t discriminate race, gender, or culture anyone can be victim. These people could be someone that you and I love. It is good to know that the United States government is recognizing the need for awareness for this abuse that has gone on far too long. In my research I could only find articles that state elder abuse has been found an increasing problem in the U.S. since the 1970’s, however, if I had to guess it has probably gone on since the beginning of time. I say that it because elderly people have too much pride to announce their embarrassments, guilts and shame of these horrendous acts done to them usually by someone they love, instead they show great resistance and hide behind an emotional wall.
In a study with 200 physicians whom gave their elderly patients a questionnaire survey to determine barriers and strategies on elder abuse only 65% of the surveys came back and the findings for the reasons why elders do not report were: denial of abuse, resistance to intervention, not knowing where to call for help, lack of protocols to assess and respond to abuse, lack of guidelines about confidentiality, fear of reprisal, and lack of knowledge of the prevalence and definition of elder abuse. (Krueger, Patterson, 2018).

What is Elder Abuse? According to the CDC (Centers for Disease Control and Prevention) elder abuse is defined: "Elder abuse is an intentional act, or failure to act, by a caregiver or another person in a relationship involving an expectation of trust that causes or creates a risk of harm to an older adult. (An older adult is defined as someone age 60 or older.)" (Cdc.gov, 2018) In my own words I would define elder abuse as any act of physical abuse, verbal/emotional abuse, neglect, financial abuse, and sadly it can also be sexual abuse toward any elderly person, especially those whom are no longer mentally capable or able bodied enough to defend themselves. As all of us grow older our bodies become more frail, we lose the energy we once had, our memories get cloudy, our bones get brittle, our overall muscle mass decline and we tend to need to depend on others to do a lot of things for us, that perhaps we once could ourselves. Eventually all of us will become "elder’s". With the exception of a small percentage of extremely healthy elder’s the majority of us are going to need to have helpers in our lives. It is so important that we raise elder abuse awareness and train people to be on the lookout for the signs.

Physical Abuse some physical signs that may trigger suspicions of elder abuse could be: unexplained signs of bruises, scars, open wounds, broken bones, reports of drug overdose, broken glasses, signs of restraint such as rope or tape marks on wrists or ankles, and caregiver refusal to leave anyone alone with the elder. (Helpguide.org, 2018). If we delve deeper into the Physical abuse it can happen from the elder's spouse, children, nurse/caregiver or even friends. Parent abuse is probably the most common type of abuse and typically has addiction attached to it as well as the adult child not having their own financial stability. This may also be the abuse that would have the most resistance from the elder reporting the abuse themselves, what mother or father really wants to report & put their own child in jail? Spousal abuse tends to be something that has most likely occurred on and off the whole relationship. Spousal abuse could also be the result of a lifetime of abuse, the women after suffering abuse for many years may turn on the husband to repay the abuse, she suffered, or spousal abuse could happen in a second marriage. Nurse/caregiver abuse usually happens by a paid staff whom is directly responsible for the elder patient, it is unknow how often this occurs, but it is believed to happen when the caregiver has become stressed out or has burnout on the job, or the elder is difficult and the staff is untrained on how to handle the patient with care. There are also random acts of violence that can occur with elders, mugging can happen on the street, home burglaries elders can be targeted because the attackers see them as an easy target. (Research-paper.essayempire.com, 2018)

Verbal/Emotional Abuse signs would be suspicions or witnessing caregiver behaviors of belittling, threatening, or controlling the elder. Behaviors of the elder would be things like skittish movements, or dementia type behaviors such as rocking, mumbling to themselves and thumb sucking. (Helpguide.org, 2018). Verbal and emotional abuse can scar any person, and while it may not have physical signs doesn’t make it any less important.

Neglect signs would be things like unusual weight loss, malnutrition, dehydration, untreated physical problems, being left dirty or unbathed, soiled clothing or bedding, unsafe living condition (bills not paid/utilities turned off), elder left alone in a public place. (Helpguide.org, 2018). Neglect actually shows up in 2 different forms, neglect from others and self-neglect. Neglect from others including caregivers and family members can be unintentional things like the granddaughter forgot to go by grandma's house to check on her and in it resulted in grandma not eating for 2 days and she stayed in bed in her soiled linens, OR it could be intentional, a caregiver has too much stress, and doesn’t really care about the elderly person and intentionally forgets to do things for them. Self-neglect is when an elder might be lonely after the passing of a spouse, so they stop taking their medications, stop socializing with people, stop eating correctly perhaps in hopes they may die sooner to be with their loved one, this form of neglect is not illegal, but I think it probably occurs often and worthy of mentioning.

Financial Abuse signs: large withdrawals taken from the elder's bank account. Sudden changed in their financial situation, personal items or money missing from their home/room, sudden changes in the will, beneficiary changes, power of attorney changes, insurance policy changes. (Helpguide.org, 2018). Typically, financial abuse will occur with someone close to the elder, a child or a relative. Sometimes elders need someone to take care of their finances for them, maybe because their vision has weakened, or they can no longer drive themselves to run errands, and they believe they can trust their loved ones, but all too often the loved ones will take advantage of their new role and steal money from their mom, grandma, grandpa, aunt ect...this abuse again is usually one of the elder's children that may have no financial security and addiction issues, but it really can happen in any kind of relationship. Another rising form of financial abuse is spam telephone calls, people target elderly people, they call them and say they are a relative, trapped in another country and need the elderly person to wire money to them asap, I would like to think the news/media has raises enough awareness of this, but unfortunately there are still many out there who will innocently fall for this scandal
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Sexual Abuse signs would be torn, stained or bloody clothing (especially under garments), unusual private area bleeding, or bruises in or near the genital or breast areas. (Helpguide.org, 2018). According to the National Center on Elder Abuse (2005), elder sexual abuse is "non-consensual sexual contact of any kind with an elderly person" (National Center on Elder Abuse, 2006, p. 1). This type of abuse bothers me to my core, any kind of sexual abuse is horrific, but children and elders are both not able to defend themselves and in the case of an elder they might just be plain to embarrassed or frightened to report it.

Among these basic signs and symptoms of the various types of abuse there are also the deeper signs that people closest to the elder may notice such as depression and anxiety when there has been no known history of these mental illness’ and no recent tragedies in the family that may have caused it.
Resistance in therapy is normal and to be expected. It is when a person/client is trying to avoid change. When a client's daily life patterns (homeostasis) are interrupted, even if the interruption is for the better sometimes it is easier to stay in the life that you know. Some forms of resistance might be: the client denies any abuse, refuses to discuss it, blames themselves, covers for their attacker, changes the subject, fears the attacker might harm them for discussing the abuse. As a therapist/helper is important to avoid being judgmental and to avoid countertransference during this resistance period, once the client gains trust in you they will slowly let down some barriers.

What is Strength Based Perspective in Social Work?
In our practice, the strength-based approach is an alternative to the more common used pathology-oriented approach to helping clients. Instead of placing the focus on the client’s problems, strength-based perspective focuses on the client's strength's, talents, abilities and resources. The helper using this approach will focus on identifying these strengths and assets to assist the client with their problems and goals (Saleeby, 2018).

The strength-based approach places value on the skills, knowledge & potential in the client and their community. This approach highlights the fact that client is the expert of their own life & the helper is there to explain choices and encourage people to make their own decisions. While focusing on the strengths, it does not mean that the helper ignores the client's challenges. It means that the helper collaborates with the client to help them to do things for themselves drawing on their strengths and assets. This practice is goal oriented, & it is important to set attainable goals. During Assessment it is also important to consider all resources that the client has at their disposal to counteract whatever difficult conditions they are facing as well as drawing on the resources in the community and the client's environment (family, peers, coworkers). Strength-based approach aims to create hope for the client. (Iriss, 2018)

Putting Strength-Based perspective into practice: When a client comes in for help, the helper should ask the client to think of some goals for their life. EXAMPLE: a goal for a woman who has been battered by her meth addict son whom lives with her might be: Her immediate goal would be to be safe, another goal might be to stay residing in her own home and for her son to get the help that he needs. The helper can then take these goals and begin to look for resources within the community or the client's environment to assist the client with those goals. The role of the helper is to extend the list of choices, clarify them, and to support the client in becoming confident enough to take the authority to direct the process. (Pdfs.semanticscholar.org, 2018)

Some example questions that could be asked in an interview with elder abuse might be: How have you managed to survive in this situation so far? Who are some people in your life that you can depend on? The last time you can remember your life going well, what was different than it is today? What special hobbies and talents do you have? What are some good things people might say about you? What types of things have you tried in the past that helped this situation? What kind of involvement in the community do you have? If you could have your life any way you wanted it, how would you see your life?
A positive, trusting relationship built between the helper and the client is very important to developing the next process, which is change. A personal and empathetic relationship provides a healing atmosphere. If immediate intervention is needed, the helper is mandated by law to be reported Elder abuse/neglect to APS (Adult Protective Services) Immediately for investigation. Another intervention might be training caregivers to seek self-care avoid compassion burnout. Once a relationship has been established with the client, an assessment has been made and the helper & client have decided on some attainable goals through strength-based perspective, the helper can begin to find resources for the client such as: income support, mental health services, in home supportive services, transportation, housing, as well as medical and legal services. If the victim requests help for their attacker, the helper can also provide referrals for them as well.

In conclusion, with the onset of so many baby boomers about to become elders, it is so very important to continue to raise awareness of Elder Abuse to prevent it. In case work there may be many different approaches to use with this type of client, but the Strength-Based Perspective focuses on the client's strengths and helps provide them hope for their future as well as give the elder client who will be most likely resistant to change the opportunity to create goals for themselves that the helper can help them to carry out. I believe this is a good practice to use with most clients, not just with the elderly and I intend to continue to learn about it.

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