In 1975 physicians began to take notice of their elderly patient’s injury patterns which they referred to as granny battering. (1) Elder abuse developed a definition, which was later adopted by the World Health Organization, as elder abuse is either a single or a repeated act or a lack of appropriate action occurring within any form of relationship where there is an expectation of trust, which causes harm or distress to an Elderly person physically and or mentally.
Elder domestic abuse is a silent crime against those who are 65 and older. Elder abuse is when someone of trust harms the wellbeing of an elder person. Elderly domestic abuse can come in many forms such as physical, financial and mental abuse. Most of the elder abuse goes unreported because of isolation or shame. It may occur when a vulnerable adult lives alone or with a relative, it may also occur within nursing, residential or daycare settings, in hospitals, custodial situations, support services into people’s own homes, and other places previously assumed safe, or in public places (Department of Health 2000, paragraph 2.14) However, no clear data exist on the number of deaths that result from elder abuse or neglect. The potential contribution of abuse and neglect to the death of an elder is rarely investigated, as natural deaths are expected with advancing age. Elders are often reliant on others for care making them a vulnerable population. Although the deaths of other vulnerable populations, including children, are routinely investigated, no protocols for elder death investigation have been enacted. There have been several proposals to implement investigation tools to assess elderly adults and residence for indicators of abuse or neglect. Investigations may assist in differentiating self-neglect and caretaker neglect. Elderly adult observations include evidence of injuries, personal hygiene, malnutrition and/or dehydration, decubitus ulcers, evidence of restraint, unexplained vaginal or anal bleeding, and previous reports with Adult Protective Services. To differentiate between self-neglect and caretaker neglect, an assessment of the level of dependence on others for activities of daily living and the level of involvement of the caretaker are determined. The decedent’s living condition assessment includes evidence of forced isolation; lack of food, water or utilities; soiled clothing and/or bedding; filthy or unsafe living conditions; and inappropriate administration of medications. With proper training, medical examiners can easily implement these protocols. Such information is extremely valuable for determining whether further investigation and examination of the decedent are warranted.
How prevalent is domestic violence among this group? Domestic abuse in later life can be detrimental. From both the physical and mental aspect of the injuries, any elderly victims die before the incident are reported. Therefore, it appears that the vulnerability and poor mental health of an older person may influence a person’s perception of elder abuse. It is thought that the more frail and vulnerable an older person is deemed to be, the more likely they are to be subjected to abuse and in circumstances where an older person’s mental health deteriorates, and abusive behaviors may be perceived as more acceptable. Elderly abusers come in the form of family, care providers and sometimes nursing home staff.
What are some unique aspects of the dynamics of domestic violence in this group? According to National Center on Elder Abuse (NCEA) many elderly adults dependent upon family members, guardians and health care professionals to interpret and communicate their needs, and in many cases to provide personal care, social support, and ongoing supervision. Because individuals suffering from dementia often experience poor judgment and impaired communication skills, they may be more vulnerable to abuse and neglect. It is often a hard topic, particularly for older people as they frequently depend on relatives for care and support as they age, making them even more vulnerable (Daskalopoulos et al. 2006a). Underreporting by older people, families, and the public also occurs because of a lack of awareness and understanding of abusive behaviors.
Abuse and neglect are frequently socially defined; therefore, due to cultural diversity, the meaning and understanding of abusive behaviors must be understood within the social context in which they occur (even where values and customs have been firmly embedded in the social structure). Much of the literature has been culturally sensitive determining public perceptions of elder abuse within that culture and examining the differences in what is considered abusive or non-abusive behavior (Malley-Morrison et al. 2006).
Significant differences between various ethnic groups have been found in what is considered elder abuse. Furthermore, greater tolerance has been shown for certain forms of elder abuse in certain cultures (Moon & Williams 1993). Much of the existing literature reports on surveys which have examined elder abuse in terms of cultural differences. Although surveys conducted about sensitive issues can be taxing, they are a means of eliciting the public’s views about such private matters (Ryan et al. 2001).
Public perceptions of elder abuse may affect judgment on what is considered acceptable behavior towards and treatment of older people. Thus, these perceptions can also have implications for the prevention and identification of elder abuse. Increased knowledge, understanding, and awareness of abusive incidents towards older people could enable people to recognize abusive situations and to react more appropriately and promptly (Werner et al. 2005).
This review will provide an insight into how elder abuse is defined and perceived by the public.
Some cultures have deeply held societal values about the family where there is a widely held understanding that domestic affairs should never become public knowledge (Daskalopoulos et al. 2006b). Family matters are kept private, as any family discord made public is considered shameful (Soeda & Araki 1999). This is also reflective of Irish culture where, in small communities, in particular, family matters and disputes tend to be kept within the family circle. This may impact on estimates of the prevalence of elder abuse as people are reluctant to disclose such information and may wish to continue maintaining a good public face and a sense of normality. Such a protective stance creates challenges for research in this area as people are reluctant to disclose familial circumstances and familial problems. As cultural values and beliefs play a significant role in how elder abuse is perceived, defined and interpreted, this review will pay particular attention to the cultural norms and beliefs of the country where the studies cited were done.
Penhale (2008) pointed out that, despite the fact that there are inconsistencies with the definition of elder abuse, there is in fact general consensus in relation to the types of elder abuse that occur. These mainly include physical abuse, sexual abuse, neglect, financial abuse, psychological abuse and emotional abuse (Penhale 2008). When interpreting findings, it is important to note that respondents may know what constitutes elder abuse without having heard the term itself (Tsukada et al. 2001). Legally, it makes it challenging to prosecute an abuser because they have a hard time establishing if the signs of abuse are from aging or actual abuse.
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