Elder abuse research paper
Elder abuse need not be intentionally inflicted through an action; neglect can also be a form of elder abuse. Caring for an elder can be a stressful responsibility, particularly for familial caregivers who have other responsibilities and may not have either the knowledge or skill necessary to adequately care for their elders. While it is possible to understand the antecedents to abuse and neglect, this does not make them either excusable or acceptable. In addition, there are many programs available to help ease the caregiving burden and give elders the support or care that they ds caregiver; cognitive ability; domestic violence; elder abuse; financial abuse; neglect; physical abuse; psychological abuse; sampling; sandwich generation; self-neglect; sexual abuse; society; socioeconomic status; a society, we often tend to discount the value of older persons and relegate them to positions of lower status. To complicate matters, this loss of status is often accompanied by a concomitant loss of income, giving many elders a lower socioeconomic status than they once had. So, for example, despite elders' capabilities or desires, they may find themselves unable to continue to work due to ageism (i. Discrimination based on age or discrimination against the elderly) in the workplace or find themselves in the advisory role of grandparents rather than the decision-making role of parent, despite the fact that they may have more experience and concomitant insight than the person making the decision. For example, the structural functionalist disengagement theory posits that society and the individual mutually severs many relationships during the aging make matters worse, as cognitive abilities and physical capabilities decline with old age, many elders who are parents find themselves in a situation of role reversal in which their children are now taking care of them. Bathing, dressing, grooming, eating, using the toilet, transferring to or from the bed or chair, getting around the house), the sandwich generation caretaker may soon find that the responsibilities are overwhelming, and tempers may flare or care may become gh it is easy to see why elders are often relegated to lower status positions or even abused or neglected, that does not make such actions either excusable or acceptable. Elder abuse is defined as any form of mistreatment that results in harm or loss inflicted on an older person. Physical abuse includes any physical behavior towards an elder that is violent towards that person (e. Included in physical abuse is domestic violence, or any action by one member of a family that causes physical harm to one or more members of his/her family. However, in cases where the elder is being taken care of by a family member, domestic violence can be perpetrated by the caregiver relative (e. This category of abuse includes verbal or other nonphysical behavior that is violent toward or demeaning or invasive of another person. Psychological abuse is the intentional infliction of mental or emotional anguish through the use of threats, humiliation or shaming, emotional control, withholding of affection or financial support, or other verbal or nonverbal means. In addition to these fairly well-known types of abuse, 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. 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. In passive neglect, the caregiver is unable to meet the needs of the individual due to any number of reasons including the caregiver's stress, ignorance, immaturity, or lack of is difficult to obtain an accurate picture of how widely spread elder abuse is in the united states. 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. In addition, despite the recognition of elder abuse as an important issue, consistent definitions of elder abuse have still not been developed. Despite these problems, however, in recent years, elder abuse has emerged as a significant social problem. According to the national center on elder abuse, as of 2005, best estimates indicate that between one and two million americans aged 65 or older have been injured, exploited, or mistreated by a caregiver. Depending on the methods used for sampling, survey methods, and definitions, estimates of the frequency with which elder abuse occurs vary between 2 percent and 10 percent. However, it is estimated that only one in fourteen cases come to the attention of authorities and only one in twenty-five cases of financial abuse get reported. It has further been estimated that for every case of elder abuse that gets reported, another five are not reported. Of the cases of elder abuse that are reported, approximately 50 percent of the cases involve neglect, 16 percent involve physical abuse, and 12 percent involve financial abuse (andersen & taylor, 2002). In 2010, the american journal of public healthpublished the results of a national study of the prevalence of elder abuse. Percent for potential neglect, all during the previous year, and a current rate of financial abuse by a family member of 5. In 2013, the american psychological association estimated that four million older americans were victims of abuse and neglect of elder of the most common explanations for elder abuse is the additional stress that caring for the elder places on the caregiver. Research has found that elder abusers tend to be middle-aged women, typically the daughter of the victim. In cases of physical abuse, however, the perpetrator tends to be the son or even the husband of the victim. Log in ng a school tative applications in economics & ial markets & breath becomes mistreatment: abuse, neglect, and exploitation in an aging r: 1. The number of cases of elder mistreatment will undoubtedly increase over the next several decades, as the population ages.
After summarizing the social context within which the field has developed, this chapter assesses the present state of knowledge, identifies some of the problems that must be addressed if the field is to move forward, and locates the problem of elder mistreatment in a larger set of challenges confronting an aging aging and vulnerable aging of the population of the united states is a well-recognized demographic fact. The projected growth in the elderly population, long-term care for elderly people with disabilities has become an increasingly urgent policy concern (institute of medicine, 2001; stone, 2000). An increasing number of elderly people reside outside traditional home settings in highly restrictive institutional environments (such as skilled or intermediate nursing facilities) or in less restrictive community-based residential settings, such as assisted living facilities, board and care homes, and adult foster homes. Nursing home population tends to be older and more severely disabled than elders residing elsewhere, with about half of the residents being 85 or older and about half having five adl limitations, in 1996 (stone, 2000); still, four out of five elderly persons with adl or iadl impairments lived in the community setting (alecxih et al. Of those adl-impaired elderly people living in community settings, 37 percent report that they need help but do not receive it or receive less help than is needed (stone, 2000). Long-term care for community-dwelling elders is provided in a traditional home setting, either in an older person’s own home, with or without a spouse, or in the home of a close relative. The 1994 national long term care survey indicated that more than 7 million americans, mainly family members, provided 120 million hours of care to elders with functional disabilities living in the community. These factors increase the pressures on families caring for their elderly relatives and also are likely to increase the demand for institutional trends highlight the growing challenge of ensuring the safety and protecting the other interests of elderly people in the diverse settings in which long-term care is provided. In this respect, protecting older people from mistreatment is an important element of the broad challenge of ensuring quality services in long-term elder mistreatment has attracted sustained efforts from practitioners and some interest from policy makers over the past two decades, it has not received concomitant attention from researchers or from the agencies that provide research funding. For example, fewer than 15 studies on elder mistreatment have been funded by the national institute on aging (nia) since 1990, and support from other agencies has been even less substantial. As a result, elder mistreatment research has thus far been confined to a small community ted citation:"1. Who have produced a modest body of knowledge concerning the phenomenology, magnitude, etiology, and consequences of elder mistreatment. In recognition of these deficiencies, the national institute on aging requested the national research council to commission this study as the first step in an effort to broaden and deepen knowledge about the mistreatment of elders. Support was also provided by the office of behavioral and social science research on women’s health of the national institutes of health and the agency for health care research and quality. This report presents a research agenda for consideration by the national institute on aging and other potential sponsors of research on elder mistreatment—a term we explain more fully in chapter ical and social ch on elder mistreatment is in an early stage, reflecting its relatively recent recognition as a distinct—and important—social problem. The prevailing understanding of the problem, and the social response to it, have gradually emerged over the past half-century, shaped by evolving social responses to child protection and family violence as well as by an intensifying concern about neglect and victimization of vulnerable elderly discord and mistreatment of its vulnerable members were outside the public domain for much of this country’s history. The emergence of the juvenile court in the early part of the 20th century represented a significant assertion of collective responsibility for protecting and “saving” children who had become ungovernable by their parents; over the following decades, the jurisdiction of the juvenile courts gradually reached children who were neglected or abused by their parents (platt, 1969). Legal foundation for modern policies and programs for elder protection was put in place after world war ii, particularly during a burst of national energy geared toward remediation of endemic social problems during the 1970s. Of child current system for protection of elders and other vulnerable adults grew from the child protection system, which itself is only about 40 years old in its modern form. Pediatrician henry kempe, the leader of the group and founder of the international society for prevention of child abuse and neglect, spearheaded a movement to adopt mandated reporting laws. These laws, which were quickly adopted in all 50 states, rested on the premise that the abused child was an aberrant problem (amounting to several hundred egregious cases each year in the united states), and on the belief that the problem could be solved if health professionals brought those cases to the attention of social service authorities. Although initial federal action did not occur until significantly later, with the adoption of the child abuse prevention and treatment act of 1974 (nelson, 1984), that legislation also required states to adopt mandated reporting and investigation as the primary strategy for protecting s of adult g on their parens patriae authority to protect helpless citizens, a few states developed new public welfare programs during the 1940s and 1950s to protect adults who could not manage their own resources or protect themselves from harm. She matched a group of elders receiving protective services with a group from the community who were receiving traditional services, finding that those who were receiving protective services had a higher mortality rate and higher nursing home placement rate than those who were ted citation:"1. As ssbg appropriations declined during the 1980s, however, funding for adult protective services declined; by 1985, it had declined by 42 ght on elder attention was paid to the problem of elder abuse before 1978 except for some intermittent articles published in british and american medical and social services journals. In the late 1970s, the national spotlight was directed for the first time at what was characterized as systematic mistreatment of elderly people. Congressman claude pepper held widely publicized hearings, calling attention to the “hidden problem” of elder abuse in the nation’s families, including what one witness characterized as “granny battering” (wolfe, this volume). As the state response continued to evolve in the early 1980s, many states required reporting of abuse, bringing the problem within the purview of adult protective services. Okar, 1981), he stated that elder abuse was increasing and recommended that congress act immediately to help the states identify and assist elder abuse victims. Finally, in 1989, pepper succeeded in including creation of a national center on elder abuse as an amendment to the older americans act. Although various versions of a national center followed, the current national center on elder abuse was established in retrospect, it appears that elder mistreatment became identified as a national concern when it was conceptualized as an “aging” issue, rather than as an undifferentiated component of adult protection. This also helped to broaden the constituencies interested in research and program development to include gerontologists and the expanding network of service providers and advocates for the elderly. The pepper hearings also cast the problem of elder abuse in a particular light—as a complication of caregiving. The emerging image was that of an impaired victim, usually an elderly parent being cared for by an adult caregiver who wasn’t able to manage the caregiving because of stresses in life, on the job, and in the family. Even though it is only a partial explanation of elder mistreatment, this picture seemed to resonate with congress and the media (wolfe, this volume).
Conceptions of family evolving understanding of elder mistreatment as a social problem has more recently been shaped by another image—the trapped victim of family violence. Spouse abuse and other varieties of intimate partner violence have received increasing professional and political attention since the 1980s, leading to a wide variety of interventions and a substantial investment in research (national research council, 1996; national research council and institute of medicine, 1998). As the consciousness of health professionals has been raised, family violence has been embraced as a public health problem, thereby recruiting researchers and advocates in injury prevention and public health to the field (institute of medicine, 1999). Many of the preventive and protective tools developed in the context of intimate partner violence have now been directed to violence against elders. Bringing elder mistreatment into the domain of family violence widens the angle of the lens and thereby brings new ideas about etiology and prevention into view. Crisis in child ng conceptions of elder mistreatment, and the appropriate social responses to it, will also be shaped, inevitably, by the deep concerns that have emerged over the past decade in the field of child protection. Advisory board on child abuse and neglect issued a highly publicized and rarely disputed declaration of a national emergency in the child protection system. Advisory board on child abuse and neglect (1990) attributed the emergency to the errant design of the child protection system itself: the system has become preoccupied by investigation (rather than prevention and treatment), and community responsibility for ensuring the safety of dependent children has effectively, if unintentionally, been diverted to a small social service agency. Advisory board on child abuse and neglect, 1993) proposed a new national strategy designed to rely on voluntary action to make child protection a part of everyday life (see melton and barry, 1994, melton et al. As wolfe notes in his paper in this volume, several states have attempted to deemphasize investigation in their state child protection statutes, and some major foundations have undertaken initiatives to demonstrate the feasibility of a neighborhood-based, largely voluntary, and largely preventive and supportive child protection system. Similarly, the biggest increase in reporting occurred when sexual abuse was “discovered” early in the 1980s (weisberg, 1984), and criminal prosecution became a common feature in the child protection ition of the frequent linkage between intimate partner violence and child maltreatment (see carter et al. Abuse and severe physical abuse) has not adopted the “perpetrator-victim” model commonly embraced by advocates for battered women (melton and andrews, 2000). It was also speculated that this policy, soon retracted by the legislature, deterred some battered women from seeking protection for themselves and their tensions and policy adaptations in the field of child protection appear to be highly relevant to elder protection at this moment in the evolution of research and public policy in this nascent field. The recent history of child protection offers many lessons for specialists in elder ling conceptions of elder mistreatment draw on a diverse array of images (the forgotten and helpless nursing home resident, the battered granny, the stressed caregiver, the abusing spouse). Yet prevailing policies and practices in these adjacent domains are not fully applicable to elder mistreatment and have been controversial on their own terms. Repeatedly, national research council and institute of medicine panels have called attention to the need for sustained and aggressive research on the phenomenology, magnitude, etiology, and consequences of these problems and on the effects of interventions (national research council, 1993, 1996; national research council and institute of medicine, 1998). Noted that very little is known about the phenomenology, magnitude, etiology, and consequences of elder mistreatment, and that almost nothing is known about the effects of interventions. Although the body of evidence remains sparse, researchers have recently begun to raise doubts about the cost-effectiveness of current interventions (dyer et al. Adult protection is a poorly funded system, and congressman pepper’s single-minded emphasis on the abuse, exploitation, and neglect of vulnerable elderly people has not been sustained by his successors in congress or by a public preoccupied with youthfulness and ill at ease with aging. As a result, elder mistreatment remains hidden, poorly characterized, and largely unaddressed—more than two decades after the pepper hearings first exposed it to public view. It is long past time to move the field forward in a careful and systematic way, drawing on the knowledge already generated in the domains of child maltreatment and intimate partner violence, while remedying the weaknesses that have so far plagued the sses in existing gh there is a sizable body of unpublished reports and commentary on elder mistreatment, fewer than 50 peer-reviewed articles based on empirical research have been published in the field. National research council (1993) and institute of medicine reports (2001; national research council and institute of medicine, 1998) and other authoritative reviews (e. Pillemer, 2001; national institute of justice, 2000) have repeatedly lamented the weakness of the research base for designing programs and informing policy on the wide variety of overlapping problems, ranging from granny battering to neglect by nursing homes, that are grouped under the rubric of elder mistreatment. A systematic program of research is needed to better describe the many facets of the problem and to explore their causes and tanding the nature and scope of the problem is prerequisite to designing and implementing solutions. In the absence of the necessary research, interventions have been designed and implemented in the dark, so to speak. Almost every state has required reporting of suspected cases of elder mistreatment, but little is known about the effects of these requirements (national research council and institute of medicine, 1998). As a field of research, is at about the same embryonic stage of development as child mistreatment was about 30-40 years of the weaknesses of elder mistreatment research are summarized r and inconsistent first major difficulty in analyzing results from previous research on elder abuse and neglect results from the poor definition of the term “elder abuse. To some extent, this problem is a reflection of conceptual confusion: what type of behavior or condition is denoted by the concept of “abuse”? To some extent, it is also traceable to the variations and ambiguities of the state statutes that direct or authorize interventions in cases of elder abuse or neglect. However, researchers have often exacerbated the problem by failing to define or operationalize their terms in a clear and objective way. For example, many researchers refer to the entire range of problems experienced by elders as “abuse,” including lack of proper housing, untreated medical conditions, and lack of social services. Most of the studies are weakened by their undifferentiated treatment of various types of abuse and neglect. That is, all forms of mistreatment are lumped together, despite evidence that the forms of abuse and neglect differ substantially. In some studies, for example, it is difficult to determine whether financial exploitation is included in the research definition.
As discussed below, these terms refer to a category of conditions that has little in common with the conditions that bear on abuse and neglect of elder persons by other chers have also diverged widely in their definitions of the pertinent component terms and have frequently used confusing and unclear definitions. For example, some researchers have used the term “abuse” tautologically; for example, one group of researchers defined elder abuse as “an abusive action inflicted by the abusers on adults 60 years of age or older. Another group called elder neglect and abuse “a generic term that refers to the neglect and/or physical, psychological, or financial abuse of the older person. Furthermore, definitions have differed so widely from study to study that the results of research are almost impossible to compare. While one set of investigators calls “withholding of personal care” physical abuse, a second researcher calls it active neglect; a third subsumes such actions under physical neglect; and yet a fourth considers such behaviors to be “psychological neglect. Lists of injuries to define physical elder abuse, such as cuts, fractures, bruises, and development of better definitions of mistreatment of the elderly should be an extremely high priority for researchers. Researchers must be clear and explicit regarding what is included and excluded from the category of elder abuse in order to conduct any meaningful meta-analyses. This is an equally vexing problem, since the definitions of the varying elements of elder abuse must be operationalized through the design and administration of a research instrument. Many studies have not developed separate research instruments at all; instead, they have simply analyzed the forms used by agencies. These forms are not designed for research and rarely provide data of the type and quality to be of use to researchers. Or studies use as a “measure” of abuse whether a professional has identified an elderly person as “abused”—thereby embracing without further clarification the discretionary judgments of clinicians and caseworkers applying the ambiguous statutory definitions. Even when research instruments have been used, researchers have used highly varying example to illustrate this point may be in order. She then proceeds to define physical abuse as a single incident in which the elder is hit, bit, punched, kicked, threatened with a weapon, or has a weapon used on him or her. Furthermore, he decides that there must be at least two episodes of this behavior for it to be called physical abuse except for those items dealing with weapons, in which case one incident is sufficient. Thus both researchers have included physical abuse in their studies—indeed, it may be the sole focus of each researcher’s study—but the measure of physical abuse differs across the two problem arises for all of the types of elder mistreatment typically investigated, including neglect and financial exploitation. However, even if researchers embraced a common set of definitions for the elements of elder mistreatment and operationalized them the same way, that would still leave the problem of determining whether the instruments actually measure what they purport to measure (validity) and whether they can be reliably administered. At the present time, no measure of elder mistreatment has been validated, nor has any instrument been embraced by the field as a definitive measure of mistreatment, even within a narrow this suggests that researchers, policy makers, and other consumers of research on elder mistreatment must pay careful attention to the definitions and measures of any studies on which they rely. In most cases, the measures will not be leteness of professional the earliest stages of elder abuse research, surveys of professionals have been used to shed light on the prevalence of elder abuse and on risk factors. Investigators typically mail surveys to professionals and paraprofessionals, asking them about contacts with cases of elder abuse or neglect during a given time period. To provide a typical example, in a survey on elder abuse funded by the administration on aging, a sample of professionals, including administrators and direct service workers from 16 types of agencies, was surveyed in each of pennsylvania’s 67 counties. Overall, one-half of the responding agencies reported encountering elder abuse, ranging from over 90 percent of domestic violence agencies, to less than 30 percent for law enforcement, emergency services, medical clinics, and drug/alcohol agencies (fiegener et al. Similarly, a survey of alabama physicians and registered and licensed practical nurses found that 38 percent of the physicians and 53 percent of the nurses had seen cases of elder abuse in the previous year (clark-daniels et al. Best, studies of professional experience provide impressionistic estimates and opinions about the prevalence, correlates, and consequences of elder mistreatment. Although such data may be useful for generating hypotheses for further research, they do not provide a sound basis for designing programs or formulating mistreatment researchers have also relied on samples of cases that have come to the formal attention of a social agency or reporting authority. For example, records of patients at hospitals or social service agencies have been reviewed, and the percentage of elderly persons judged to have been abused is established. The “three model projects on elder abuse,” funded by the administration on aging,Suggested citation:"1. In both types of studies, however, researchers obtained data from professional accounts of mistreatment rather than from interviews with victims is widely recognized that reported cases are highly selective samples, and that there is a large reservoir of unreported and undetected cases of elder mistreatment about which very little is known. Most important, the question of the extent of elder mistreatment cannot be answered by studies of reported cases. In relation to child abuse, for example, see the 1995 gallup poll, finding that far more of america’s children are victims of physical and sexual abuse than officially reported—gallup poll, 1995. In most cases, the research data on elder mistreatment have not come directly from victims, but instead from professionals and outside observers. Such secondhand knowledge may distort the actual dynamics of mistreatment by failing to present the problems and their effects, as the actual participants perceive reports have little value in studying some forms of mistreatment that are rarely reported to adult protective services agencies, such as mistreatment in institutional e elder mistreatment studies have relied so heavily on reports from professionals, crucial data about abuse situations have been missed. Thus, previous research using agency records has rarely been able to obtain detailed information about family history, attitudes, and consequences of mistreatment and other issues. 1997a) have made effective use of these weak datasets by matching cases with higher-quality an effort to generate a national estimate of the occurrence of elder abuse and neglect based on case-identification by professional “sentinels,” the national center of elder abuse, in conjunction with westat, inc. In this study, modeled after recent incidence studies of child abuse, the researchers identified a nationally representative sample of 20 counties in 15 states; for each county sampled, they collected data from the local aps agency as well as approximately 1100 professional “sentinels” having frequent contact with the elderly.
In 1996, according to the projections based on this study, about 450,000 persons age 60 or older experienced abuse or neglect in family settings, about 16 percent of whom were in the aps report files. It is generally acknowledged that these findings detect only the most overt cases and thus significantly underestimate the incidence of elder s of professionals and agency records are justified in those situations in which investigators specifically want to know how professionals view elder mistreatment. But researchers have too often used these professional surveys to estimate the incidence or prevalence of elder mistreatment, or to establish its causes. Future research in this area should go beyond archival data and should rely to a much greater extent on elder persons’ accounts of their experiences and on their perceptions regarding their own of population-based on the extent of elder mistreatment in the general population are sparse. A major advance has been the fielding of major population-based victimization surveys that have helped to establish reliable prevalence estimates of select problems, such as intimate partner violence and child physical and sexual abuse. Similar progress has not occurred in the field of elder the earliest research about two decades ago, studies were generally conducted on small, nonrandom samples, with little generalizabilty to the population. Furthermore, research in the field was conducted independently by investigators from different disciplines, using different methods and without recognizing the problems faced by other investigators. Using a patient-based approach to study elder mistreatment is also fraught with potential for sample bias, in that if an older adult does not have a doctor ted citation:"1. Not come to the emergency department, mistreatment cannot be gh some population surveys have subsequently been fielded, many of them have excluded from the sample potential respondents who may be at high risk for abuse or neglect—e. Older adults with profound dementia, severe hearing or speech impediments, or advanced problems with mobility who are unable to participate in survey research. A two-stage interview process was used: screening to determine if the person was a victim of mistreatment (defined to include physical abuse and psychological abuse and neglect but excluding financial abuse), followed by in-depth interviews by telephone or in person. Despite using different methods, these studies each reported that the prevalence of elder abuse falls in the 3-5 percent range. It should be noted, however, that the scope and content of the definitions used in these studies vary, particularly with regard to financial abuse. Despite attempts to estimate incidence and prevalence in other ways, random sample surveys of the elderly population alone allow for a more accurate assessment of the rate of elder mistreatment. In the united states, a national survey is urgently needed to estimate the prevalence of different types of elder mistreatment in the general population, and in specific regions and subgroups, as well as the co-occurrence of different forms of mistreatment (see chapter 4). Studies of this kind are urgently needed: to date, no prospective study of elder abuse has been conducted. However, in a pioneering study, lachs and colleagues retrospectively linked adult protective services data to a prospective study—the new haven epese study (established population for epidemiologic studies in the elderly) as the basis for this research,Suggested citation:"1. A manual record matching of epese and connecticut ombudsman/elderly protective service records was done to determine if any cohort members had been seen by ombudsmen over an 11-year follow-up period from cohort inception (1982-1992 inclusive). After cohort members who were seen by protective services for the elderly were identified, weighted survival curves from cohort inception were constructed for three subgroups of subjects: (1) those found to have sustained verified elder mistreatment (abuse, neglect, or exploitation) by another party (i. Nonself-neglect), (2) those seen by protective services for corroborated self-neglect, or (3) other members of the cohort who had no contact with elderly protective of control of the data on risk factors and consequences of elder mistreatment are drawn from studies of clinical case samples. For example, some investigators have asserted that the abused elderly tend to be physically or mentally impaired or both. Several studies have attempted to go beyond previous efforts by interviewing the victims themselves and including a control group of nonabused elderly persons (bristowe and collins, 1989; paveza et al. Interestingly, although a number of controlled studies were conducted in the late 1980s and early 1990s, there are virtually no examples of more recent case-control studies of elder of systematic evaluation has been almost no effort to evaluate intervention programs for elder abuse. Little is known about the relative effectiveness of various to such shortcomings, existing studies have not provided adequate data needed to answer three important public policy questions about elder abuse and neglect:Suggested citation:"1. Better data on the true prevalence of elder mistreatment are needed in deciding what action government ought to , what are the characteristics of locations, conditions, situations, and relationships in which the elderly are most vulnerable to mistreatment? To design and implement intervention programs, policy makers and service providers must learn more about the factors that increase or decrease the risk of mistreatment and the conditions that ensure , what interventions prevent elder mistreatment and ameliorate its effects? Extensive evaluation research using scientifically sound research designs is critically ments to elder mistreatment is knowledge about elder mistreatment so underdeveloped? The panel has identified a number of explanatory investigators believe that victims and family members are not suitable respondents for interview studies of elder mistreatment, because they are not reliable respondents, because they are not willing to be interviewed, or because they are incapable of giving the necessary consent. Surveys including such respondents have uncovered serious cases of mistreatment, and a variety of studies have been conducted in which victims have been general, methods that have been used successfully to investigate other forms of family violence have not been applied to research on elder mistreatment. Gerontologists who study elder mistreatment have tended to follow their interests in family caregiving and have seen the problem in this context. However, because much elder mistreatment does not occur in family caregiving situations, this has been a serious limitation. Furthermore, the technology for studying family violence has been developed and refined not by gerontologists, but by child abuse and intimate partner researchers. Elder mistreatment researchers have not been trained in methods of studying other forms of family violence, including sampling methodologies and measurement example of this problem is the lack of studies using the conflict tactics scale (straus, 1978; straus and gelles, 1990, 1992) to study elder mistreatment. It is to some extent the state of the art, but some elder mistreatment researchers do not seem to be aware of is very difficult to obtain access to perpetrators of mistreatment.
In intimate partner studies, a number of researchers have used treatment programs for batterers as sources of research subjects. However, even within the targeted study population (whether community dwelling or residing in institutions), exclusion criteria based on cognitive deficiencies can seriously skew the is some anecdotal evidence that institutional review boards have interpreted the common rule (the governing regulations on research ethics) in an unduly restrictive fashion, impeding potentially valuable research on elder mistreatment (see chapter 8). Reviews of the literature reflect the same small set of names time and again, with few new researchers selecting and remaining in this field. One of the reasons for this situation is that so little funding has been available for research on elder mistreatment. Although the total federal contribution to research on elder mistreatment is uncertain, expenditures by nia, the lead agency for aging research, have totaled $10 million during the last 12 years (1990–2001). Million in 2001; this is a modest sum even in comparison to the underfunded domain of child abuse research, on which federal agencies spend $3. Million each existing body of research is largely descriptive and pragmatic, taking the concepts and definitions used in practice or in statutes as given, rather than deriving the concepts and measures from theoretical premises or hypotheses. The atheoretical nature of the research is reflected in the tendency to lump all forms of mistreatment within a single duals who have attempted to conduct research on elder abuse report that they have sometimes been hindered by a lack of cooperation from agencies responsible for identifying and treating victims of mistreatment. Adult protective services programs and other elder abuse service programs have been characteristically reluctant to assist researchers in research activities, and especially research that involves interviews with victims and their families. Reasons for lack of agency cooperation include a desire to protect their clients’ privacy and to prevent additional disruption in their lives, fear of evaluation research, and a shortage of staff time to devote to ted citation:"1. Every state has enacted a statute authorizing or directing intervention in cases involving vulnerable adults, including the elderly, these statutes vary widely in almost every respect (see appendix b and tables in chapter 2). They specify different ages or circumstance under which a victim is eligible for protective services, often differentiating between in-home and institutional abuse. They also vary in definitions of abuse, classification of abuse as civil or criminal, whether reporting is mandatory or voluntary, and the remedies or resources available when abuse is of the statutes defines conditions or circumstances that warrant intervention. The statutes typically define abuse or mistreatment as a series of broad categories, such as physical abuse, psychological or emotional abuse, sexual abuse or exploitation, and fiduciary abuse or exploitation, as well as neglect. For example, some states do not include psychological abuse within the definition, while others add more specific forms of mistreatment such as “unreasonable confinement” or “abandonment. Moreover, statutes sometimes distinguish between degrees of mistreatment according to the perpetrator’s culpability or state of mind; for example, the law may distinguish among willful infliction of physical abuse, negligently causing physical injury, and failure to prevent addition to variations in the types of mistreatment included in the statutory definition, the statutes also differ substantially in defining the common categories. For example, the definition of emotional abuse in several states includes “ridiculing or demeaning an infirm adult, making derogatory remarks to an infirm adult or cursing or threatening to inflict physical or emotional harm on an infirm adult,” whereas other states require proof of “extreme emotional distress or harm” (see appendix b). When data are reported to some central repository, unless the repository has imposed a specific definition for each of the forms of abuse, the same statutory element will trigger reports in different categories of cases in different states. Interpretation of combined statistics is treacherous, even if the only objective is to compare trends across g in mind the impediments to research identified in this chapter, the panel decided to concentrate its attention on the tasks that are most urgently needed to propel the field forward. Of inconsistencies in definition and measurement that have thus far characterized research on elder mistreatment. Chapter 3 sketches a theoretical framework that may be useful in organizing research on the phenomenology and etiology of elder mistreatment in different settings and contexts. Chapter 4 addresses the challenge of measuring the occurrence of elder mistreatment in the population, highlighting important epidemiological considerations in elder mistreatment research. Chapter 5 summarizes what is now known about risk factors for elder mistreatment and identifies priorities for future research. Chapter 7 reviews policies and programs aiming to prevent or respond to elder mistreatment and identifies priorities for future research. Chapter 8 addresses concerns about protecting human subjects in elder mistreatment research, and chapter 9 identifies some necessary conditions for moving the field forward. 1-1 conclusions and recommendations regarding elder mistreatment sion or ts, definitions, and guidelines for measurement: chapter research on the phenomenology of elder mistreatment is a critical early step in the further development of the development of widely accepted operational definitions and validated and standardized measurement methods for the elements of elder mistreatment is urgently needed to move the field forward. Theoretical model of elder mistreatment: chapter panel recommends systematic, theory-driven longitudinal research, both qualitative and quantitative, exploring the changing dynamics of elder people’s relationships and the risk of mistreatment, as they are affected by changing health status, social embeddedness, and caregiving and living arrangements, in both domestic and institutional occurrence of elder mistreatment: chapter tion-based surveys of elder mistreatment occurrence are feasible and should be given a high priority by funding agencies. Preparatory funding should be provided to develop and test measures for identifying elder g agencies should give priority to the design and fielding of national prevalence and incidence studies of elder mistreatment. These studies should include both a large-scale, independent study of prevalence and modular add-ons to other surveys of aging addition to improved household and geographically referent sampling techniques, new methods of sampling and identifying elder mistreatment victims in the community should be developed in order to improve the validity and comprehensiveness of elder mistreatment occurrence mental modules pertaining to elder mistreatment should be included in existing comprehensive geographic health and social surveys, including ongoing longitudinal studies of aging the measurement issues have been satisfactorily addressed, a comprehensive national prevalence study of elder mistreatment should be ted citation:"1. The occurrence of elder mistreatment in institutional settings, including hospitals, long-term care and assisted living situations, is all but uncharacterized and needs new study sampling and detection factors for elder mistreatment: chapter s examining risk indicators and risk and protective factors for different types of elder mistreatment are urgently needed. Research on risk and protective factors should take into consideration the clinical course of elder mistreatment. Advances in measurement in risk and protective factor research are ing and case identification in clinical settings: chapter ntial research is needed to improve and develop new methods of screening for possible elder mistreatment in a range of clinical ch is needed on the process of designating cases as incidents of mistreatment in order to improve criteria, investigative methods, decision-making processes, and decision ch assessing the capacity of older persons with cognitive impairments to provide accurate testimony is needed for improving the accuracy of case identification, not only in clinical settings, but also in legal settings, including prosecutorial decision making and formal ch is needed to help illuminate the characteristics of common injuries, such as their etiology, natural course, distribution, and severity so that the process of identifying cases of elder mistreatment can become more accurate and ting interventions: chapter ch on the effects of elder mistreatment interventions is urgently needed. Existing interventions to prevent or ameliorate elder mistreatment should be evaluated, and agencies funding new intervention programs should require and fund a scientifically adequate evaluation as a component of each ted citation:"1. Or panel strongly recommends systematic studies of reporting practices and the effects of reporting, taking maximum advantage of the opportunity for comparisons of practices and outcomes in states with and without mandated ch is needed on the effectiveness of adult protective services interventions, ideally in study designs that compare outcomes in cases in which services were provided with those in which eligible recipients declined offered services or other cases in which mistreatment of an equivalent nature has been utorial response to elder mistreatment is an understudied area that should receive heightened attention by the national institute of justice and other funders of criminal justice ch about the use of civil justice interventions and their effectiveness in preventing exploitation and other harm to elders should be jointly sponsored by the national institute of justice and the administration on panel strongly encourages government agencies and private sponsors of elder mistreatment programs to give priority to interventions that emphasize specialized professional training and interdisciplinary collaboration.
All new initiatives should include sufficient funding for ch ethics: chapter igators and institutional review boards (irbs) need clearer guidance (without rigid rules) concerning two issues that tend to recur in elder mistreatment research: conditions under which research can properly go forward with participants whose decisional capacity is impaired, and the proper responses to evidence of mistreatment elicited during the course of the study. The panel recommends that the national institute of aging, in collaboration with the office of human research protections and other sponsors of elder mistreatment research, undertake a consensus project to develop ethical guidelines and provide necessary er feasible, investigators should consult representative members of the populations being studied (elder persons and caregivers, nursing home residents and staff, etc. To ascertain their perspectives and preferences regarding the proper responses to evidence of mistreatment (and the related ethical issues raised by the proposed research), and should take this information into account in developing the ted citation:"1. Or mistreatment reporting statutes should be amended to exempt researchers from their mandatory should issue certificates of confidentiality designed to insulate elder mistreatment researchers from any legal obligation to disclose possible cases of mistreatment that otherwise may arise under state law, including tort “duty to protect” obligations as well as reporting statutes. Issuance of these certificates should be predicated on the assumption that irbs will carefully scrutinize the protocols to ensure that participants are protected from harm and that, under appropriate circumstances, irbs will permit investigators to take voluntary steps to protect subjects in forward: chapter adequate long-term funding commitment to research on elder mistreatment must be made by relevant federal, state, and private agencies to support research careers and to develop the next generation of investigators in the ted citation:"1. Mistreatment: abuse, neglect, and exploitation in an aging hardback | $ members save 10% or register to save! The late 1970s when congressman claude pepper held widely publicized hearings on the mistreatment of the elderly, policy makers and practitioners have sought ways to protect older americans from physical, psychological, and financial abuse. Yet, during the last 20 years fewer than 50 articles have addressed the shameful problem that abusers—and sometimes the abused themselves—want to mistreatment in an aging america takes a giant step toward broadening our understanding of the mistreatment of the elderly and recommends specific research and funding strategies that can be used to deepen it. The book includes a discussion of the conceptual, methodological, and logistical issues needed to create a solid research base as well as the ethical concerns that must be considered when working with older subjects. It also looks at problems in determination of a report’s reliability and the role of physicians, emts, and others who are among the first to recognize situations of mistreatment in an aging america will be of interest to anyone concerned about the elderly and ways to intervene when abuse is suspected, including family members, caregivers, and advocates for the elderly. It will also be of interest to researchers, research sponsors, and policy makers who need to know how to advance our knowledge of this 're looking at openbook, 's online reading room since 1999. Author manuscript; available in pmc 2016 feb hed in final edited form as:j elder abuse negl. Daly, department of family medicine, carver college of medicine, university of iowa;contributor ponding author: 01290-f pfp, 200 hawkins drive, iowa city, iowa 52242, @ylad-ettenaejauthor information ► copyright and license information ►copyright notice and disclaimersee other articles in pmc that cite the published cta systematic review of elder abuse research has not been conducted across disciplines. The purpose of this research was to provide a systematic review of and assign an evidence grade to the research articles on elder abuse. The literature review was of english-language publications reporting research on abuse of people aged 55 years and older, from any country. Titles, abstracts, and publications were retrieved from 16 databases and were reviewed by at least 2 independent readers who graded each from a (evidence of well-designed meta-analysis) to d (evidence from expert opinion or multiple case reports) on the quality of the evidence gained from the research. Financial support for elder abuse research is needed along with more rigorous research ds: elder abuse, elder mistreatment, abuse, neglect, exploitation, researchelder mistreatment “refers to (a) intentional actions that cause harm or create a serious risk of harm (whether or not harm is intended) to a vulnerable elder by a caregiver or other person who stands in a trust relationship to the elder or (b) failure by a caregiver to satisfy the elder’s basic needs or to protect the elder from harm” (national research council, 2003, p. The world health organization defines abuse 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” (2009, p. Types of elder mistreatment include abandonment, emotional abuse, financial or material exploitation, neglect, physical abuse and sexual abuse (daly & jogerst, 2001). For the purpose of this study, the term elder abuse will be used as the all-inclusive term, as it is the main term listed in all states’ and the district of columbia’s adult protective services-related statutes. Elder abuse is also the term used as the medical subject heading for literature searches by the national library of medicine (nlm). The nlm defines elder abuse as emotional, nutritional, or physical maltreatment of the older person generally by family members or by institutional recent 2003 national research council’s report on elder abuse research stated, “no efforts have yet been made to develop, implement, and evaluate interventions based on scientifically grounded hypotheses about the causes of elder mistreatment, and no systematic research has been conducted to measure and evaluate the effects of existing interventions” (national research council, 2003, p. The purpose of this study was to provide a systematic review of and assign an evidence grade to the research articles on elder sto determine the current status and quality of elder abuse research, a comprehensive review of the health sciences literature was performed, and each publication was graded. Elder abuse research publication inclusion criteria were: english-language articles reporting completed research on abuse of people aged 55 years and older, from any country. The databases were searched using combinations of the following keywords: abuse, aged, elder, elder abuse, neglect, and exploitation. In addition, two other mechanisms were used to retrieve the elder abuse research: a manual search of the reference list of publications dated prior to 1990 and a reference search of elder abuse reviews or the 16 database searches, 6,676 citations and were retrieved (see table 1). If an abstract was not available and the title indicated it could be research, the publication was viewed online or retrieved from a library. All selected articles were published in peer-reviewed journals and contained original data on elder abuse. Single case reports were omitted from the 1literature databases searched, number of citations and research publications search for elder abuse reviews or annotations resulted in seven publications in which the reference lists were reviewed (cloke, 1983; giordano & giordano, 1984; johnson, o’brien, & hudson, 1985; national clearinghouse on family violence, 1983; moore & thompson, 1987; schlesinger & schlesinger, 1988; spencer, ashfield, vanderbijl, & bischof, 1996). The reference list of those citations were reviewed to determine if there were additional elder abuse research articles available, not already found in the database citation review. Most of these reviews were of books, book chapters, conference proceedings, internet sites, non-research articles, research articles and reports. The reference lists showed no new research articles beyond those found in the research study was critically reviewed, annotated, and assigned an evidence grade based upon the type and strength of evidence from the research. Different kinds of research vary in terms of methodological validity, how results are presented and how they are understood by individuals. The grading schema used to make recommendations for the elder abuse research publications were based on the level of evidence and grade for recommendations by the centre for evidence based medicine at the university of oxford and adapted for this project (centre for evidence based medicine, 2009).
