Elder abuse can be defined as any type of neglect or abuse towards an older adult, usually aged 60 or older (Hildreth, Burke, & Glass, 2009). It takes many forms, and anyone can be the perpetrator of it. Typically, elder abuse is perpetrated by a caregiver or someone who has some type of relationship with the elder (Hildreth, Burke, & Glass, 2009). The elder usually trusts the individual who in return threatens his or her safety and health (Hildreth, Burke, & Glass, 2009). In approximately 90% of cases, family members, adult children or spouses are the abusers (Hildreth, Burke, & Glass, 2009).
This is surprising that a family member is typically the abuser in most cases. Elder abuse can also be self-inflicted (Hildreth, Burke, & Golub, 2011). It can be self-inflicted through self-neglect, which will be further discussed throughout this paper. The mistreatment of elders is becoming more recognized as a global concern for public health and social problem (Van Den Bruele, Dimachk, & Crandall, 2019). Elder abuse is largely impacting the older community. Though, the prevalence of elder abuse is difficult to determine because cases are typically underreported. There were about 1 million to 2 million cases of elder abuse in the United States each year according to a 2003 National Research Council report (Hildreth, Burke, & Glass, 2009). This is a significant number of individuals being impacted by abuse. It was then indicated in 2010 that approximately 14.1% of older people who were not institutionalized experienced some form of elder abuse (Mitka, 2011).
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It is shocking that elder abuse is occurring at higher rates for those not institutionalized than those in a nursing home. As of the most recent update about 4.3 million older adults experience at least one form of elder abuse each year (Van Den Bruele, Dimachk, & Crandall, 2019). This is very high and expected to grow. Countries are experiencing rapidly aging populations so the number of people who are impacted by elder abuse is going to expand (Van Den Bruele, Dimachk, & Crandall, 2019). It is predicted that by 2030, over 20% US residents are likely to be over the age 65, which in turn enables a more susceptible population for mistreatment (Van Den Bruele, Dimachk, & Crandall, 2019). Elder abuse is significantly underreported, though it is occurring frequently. The many forms elder abuse can take is physical, emotional, sexual, caregiver neglect, and financial exploitation (Hildreth, Burke, & Glass, 2009). Physical abuse is the obvious type. It involves the cause of pain or injury. This could be by physical or drug-induced restraint (Hildreth, Burke, & Glass, 2009). Physical abuse can cause many problems for an individual.
It can cause injuries such as bruising, sprains, cuts, hair loss, loss of teeth, fractures, burns, etc. (Marshall & Hale, 2018). It is a very serious form of abuse. It can lead to death or serious physical impairments. A study indicated that the United States has the lowest prevalence of physical elder abuse (1.4%) and Nigeria reported the highest rate of physical elder abuse with 14.6% (Pillemer, Burnes, Riffin, & Lachs, 2016). Physical elder abuse is possibly the most obvious predicator for abuse since it is noticeable whether it be bruising, burns, or injuries. Emotional abuse includes the source of any type of mental suffering (Hildreth, Burke, & Glass, 2009). Those who have been emotionally abused can feel humiliated and intimidated. This could occur through threatening, ridicule and yelling. The abuser may try to cause fear and blame them for the abuse they are receiving. They may try to isolate them by withholding social contact. Usually, they are denied basic rights, or the abuser may be overprotective. This can discourage the victim and cause depression and withdrawal. They also may feel indifferent, hopeless, and confused around their abuser (Hildreth, Burke, & Glass, 2009). This can impact the way they think and behave. Being in this state of mind could affect a person’s work or social life. They can experience loss of appetite, agitation, fear, and paranoia (Marshall & Hale, 2018).
The most common risk factor for abuse is social isolation. An example of emotional elder abuse could be forcing them into a nursing home (Van Den Bruele, Dimachk, & Crandall, 2019). The prevalence of emotional elder abuse is somewhat high. It is most prevalence in India (10.8%) and the United States had a low rate with 1.5% (Pillemer, Burnes, Riffin, & Lachs, 2016). Emotional elder abuse although not quite visible, can significantly affect an elder’s life making them extremely vulnerable. Sexual abuse can come in the form of any sexual contact that does receive consent (Hildreth, Burke, & Glass, 2009). Some examples of sexual abuse could include rape or forceful sexual actions (Marshall & Hale, 2018). Sexual abuse can be detrimental to an individual. Those who have been affected by it could deal with trauma to the vagina, breasts, around the rectum, and the mouth (Marshall & Hale, 2018). Sexual abuse can be physical and nonphysical. Physical signs can be the presence of pelvic injuries, anal or genital bleeding, or bruising within the inner thighs (Van Den Bruele, Dimachk, & Crandall, 2019).
They often are affected by sexually transmitted infections (Van Den Bruele, Dimachk, & Crandall, 2019). Nonphysical signs are more difficult to point out. They can include new onset of posttraumatic stress disorder, and panic attacks (Van Den Bruele, Dimachk, & Crandall, 2019). These are very serious disorders that can impact one for the rest of their life. Some other signs may include social isolation and/or fear (Van Den Bruele, Dimachk, & Crandall, 2019). Trauma is definitely most common for this type of abuse. A research study found that older adults living in nursing homes who were victims of sexual abuse are usually women and the perpetrators are typically men (Van Den Bruele, Dimachk, & Crandall, 2019). Most of the victims had physical or cognitive impairments which could contribute to the underreporting of elder abuse (Van Den Bruele, Dimachk, & Crandall, 2019). It is horrifying that people would take advantage of an elder. Sexual abuse is typically lower for elders compared to other types. The United States reported the second to the lowest rate of sexual elder abuse (0.5%) with Nigeria being the lowest with 0.04% (Pillemer, Burnes, Riffin, & Lachs, 2016). Sexual elder abuse can affect one physically and emotionally.
It can even end one’s life if the damage from the abuse is severe. Caregiver neglect involves an individual supposed to be taking care of an elder refusing or failing to meet the obligation to give them basic needs (Marshall & Hale, 2018). Examples of neglect can include the failure to get them the medical treatment that they need and basic needs such as food, housing, medical care, clothing, etc. (Marshall & Hale, 2018). A person will have a difficult time surviving without basic needs. Some signs of neglect include dehydration, malnutrition, lack of clothing or grooming, and inadequate hygiene (Marshall & Hale, 2018). For caregiver neglect, Canada had the lowest rate of caregiver neglect (0.4%) and the United States was fairly low with 1.1%. India had the highest rate of caregiver neglect with 4.3% (Pillemer, Burnes, Riffin, & Lachs, 2016). Caregiver neglect is very dangerous, and the prevalence could be highest in India due to cultural values they may be installed. Their culture may think it is acceptable to mistreat their elders and the elders may be afraid to put their family business out there.
Financial exploitation includes a person misusing the resources or funds of an elder (Hildreth, Burke, & Glass, 2009). This can involve a missing material property, a change of will and testament, or being pressured into signing or turning over property, material goods, or funds (Hildreth, Burke, & Glass, 2009). Usually, this is identified when older adults are left with no resources to pay for bills or buy things for basic needs (Marshall & Hale, 2018). This is the fastest growing type of elder abuse with many people taking from the older population. It can be especially devastating since it can take away from all their hard time and sacrifice by a person taking their assets. It was estimated that each year 5.4% of elders are victims of financial fraud (Marshall & Hale, 2018). Financial exploitation can make a person very vulnerable and it is upsetting to have to go through. There is also a type of abuse that an elder can inflict on themselves. This type of abuse is self-neglect. It is defined as an elder being incapable to provide for their own needs. These needs can include food, hygiene, and housing. Self-neglect is usually due to cognitive, physical, or emotional deficiencies (Hildreth, Burke, & Golub, 2011).
This type of abuse is sad since it is one inflicting harm on themselves. This one may also be hard to detect since they may not show how they are feeling or doing to others. There are some risk factors that make individuals more susceptible to elder abuse. Factors that make those more vulnerable has to do with socioeconomic status and sociodemographic characteristics (Marshall & Hale, 2018). Elders who are living in a community are impacted more by abuse. Those who have physical or cognitive impairments are also more susceptible (Marshall & Hale, 2018). They may be more vulnerable to abuse because they are unable to express or be aware of what is going on. Also, they may be more vulnerable because their physical impairments do not allow them to act back or may be weak to specifically physical abuse. It is actually acknowledged that those with Alzheimer’s diseases are 4.8 times more likely to be impacted by elder abuse than individuals who do not (Marshall & Hale, 2018). Individuals who struggle with psychosocial distress also are more likely to be abused (Marshall & Hale, 2018).
Psychosocial distress can affect one’s ability to deal with certain situations, so this will make them less likely to call for help. Additionally, family dynamics can impact the risk of elder abuse (Marshall & Hale, 2018). Elders who have a family who does not get along can lead to abuse, such as a family member (child or grandchild) abusing them. Abuse can even occur at a nursing home and the family does not notice because they are not involved in their care. Also, the stress of caregiving can lead to them abusing the elder (Marshall & Hale, 2018). Cultural factors can even impact the risk of abuse occurring. Some families may have the cultural belief that abuse is acceptable. There may be beliefs that what going on in the home or behind closed doors is a family matter and should be kept private. Cultural beliefs may also include an attitude that elders are insignificant which leads to them being disrespected. These beliefs could lead to the older adult feeling embarrassed. This could make it hard for them to ask for help. They could feel ashamed to reveal their family’s business.
The elder may be afraid to lose where they live and being unable to be financially and emotionally stable on their own (Marshall & Hale, 2018). This definitely can contribute to why elder abuse is often underreported. Gender can also be a factor that impacts one’s likelihood of being abused. It was shown that female gender is a potential risk factor for abuse. For various populations that are abused, women are often the victim. In a study, it was indicated that women were 17% more likely to be abused than men with 10.9% (Van Den Bruele, Dimachk, & Crandall, 2019). It was assumed that women are more susceptible to abuse because they live longer (Van Den Bruele, Dimachk, & Crandall, 2019). They are usually affected by a loss of independence in daily routines and deal with cognitive impairments (Van Den Bruele, Dimachk, & Crandall, 2019).
Going back to cultural factors, certain cultures have the mindset that women are socially trained to be abused (Van Den Bruele, Dimachk, & Crandall, 2019). It was found that when it comes to financial and emotional elder abuse, women are more likely to be impacted by it (Van Den Bruele, Dimachk, & Crandall, 2019). Being an elder who is female is possibly affecting a person’s likelihood of being abused. Elder abuse has many negative health outcomes. It can lead to an individual dying. The morbidity and the premature mortality rate have increased due to elder abuse (Van Den Bruele, Dimachk, & Crandall, 2019). Older victims of elder abuse experience various adverse health effects. They may not be seen right away and occur long before the abuse has ended. Some of the long-term effects that are amongst those who were abused include new or worsening health problems, being institutionalized earlier than planned, and premature death (Van Den Bruele, Dimachk, & Crandall, 2019).
Not only can abuse affect elder’s physically, but also psychologically. The effects may include anxiety and depression (Lachs & Pillemer, 2015). If a person’s health is impaired, it can then impact their welfare. They will be less likely to be happy and often feel uncomfortable talking to others about it (Lachs & Pillemer, 2015). The psychological abuse elders may face can make them less likely to report the abuse. Preventing elder abuse is complex. Many sectors of society need to be involved. Educating health care professionals and the public about elder abuse is definitely important (Daly & Butcher, 2018). There are no many specific interventions for the prevention of elder abuse. Elder abuse interventions have rarely been studied. To appropriately intervene, there would need to be legislation and education (Daly & Butcher, 2018). There would need to be corporation from caregivers as well as social support. Batterer interventions and money management programs are important for elder abuse (Daly & Butcher, 2018).
They are important since many of the times elders are being abused physically and financially. The help from multidisciplinary teams and a circle of friends during interventions is helpful (Daly & Butcher, 2018). Research has indicated that interprofessional teams working together is the best practical approach to helping victims (Lachs & Pillemer, 2015). These teams involve physicians, social workers, attorneys, law-enforcement personnel, and other community participants (Lachs & Pillemer, 2015). They meet together often to discuss cases in the local community and organize a response that is effective (Lachs & Pillemer, 2015). There are not many programs for intervention, but one is APS (Lachs & Pillemer, 2015). It is a federal program that receives reports of suspected abuse and they are usually at the middle of case investigations (Lachs & Pillemer, 2015).
Those who take care of elders are especially important in the prevention of elder abuse. Home healthcare clinicians are responsible for assessing and identifying risk factors of abuse while doing routine visits (Marshall & Hale, 2018). Mandatory reporting for healthcare professionals for suspicion of abuse is usually required in most states (Marshall & Hale, 2018). Detecting elder abuse can lead to intervention which can then prevent elder abuse. This can happen through having support services and managing underlying problems and stressors (Marshall & Hale, 2018). They are also responsible for taking steps to educate caregiver, parents, and families about elder abuse and providing support for them (Marshall & Hale, 2018). Caregivers showing signs of distress should be referred to counseling to avoid potential abuse and get their stress down (Marshall & Hale, 2018).
Physicians play a large role also since the prevalence of cognitive impairment from dementia is high. They need to see whether or not the elder is able to make decisions and is able to accept or reject intervention. This typically requires a psychiatrist or geriatrician (Lachs & Pillemer, 2015). Those who reject intervention and lack decision-making need someone present with them such as a guardian (Lachs & Pillemer, 2015). All healthcare providers are responsible for knowing the signs of elder abuse and reporting it especially home health clinicians and physicians since they are usually working closely with elders. To conclude, elder abuse is occurring frequently and is expected to increase with the older population growing. Elder abuse is not being recognized quite often due to the lack of research on it and the fact that many elders are cognitively impaired or have certain cultural beliefs.
There are many forms of elder abuse, though financial exploitation is the fastest growing type and emotional abuse is occurring at the highest rates, especially in India. Gender, cultural beliefs, physical or cognitive impairments, and family dynamics can impact the risk of elder abuse. Elder abuse can largely impact one’s life since it can lead to death and psychological disorders such as anxiety and depression. It can affect one’s overall well-being. To prevent elder abuse, more needs to be done. But, what seems to be the best approach is for healthcare providers to work together to help those dealing with elder abuse. It is important to detect elder abuse before it takes a turn for the worst. Elder abuse is a very complex issue and takes a team to prevent it.
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