The Problem of Elder Abuse
Elder abuse is a complex issue that includes a variety of ways of harming older persons and negatively impacting their lives (McGarry & Simpson, 2009). Estimates vary widely, but some estimates are that between 2% and 5% of elders have experienced abuse (Phelan, 2010). The World Health Organization (WHO) definition of elder abuse is “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 or violates their human or civil rights” (quoted in Phelan, 2010, p. 472).
Elder abuse can fall into any of several categories, including physical abuse, psychological abuse, sexual abuse, financial abuse, and neglect (Phelan, 2010). In the U.S. (but not necessarily in other countries) an additional category of self-abuse is recognized, and is one of the most common reasons for referrals to social services agencies (Phelan, 2010). Barring that category, the most common type of elder abuse is that of neglect or acts of omission (Nazarko, 2011). After neglect, the most common forms of neglect are financial, then physical and psychological (in about equal frequencies), with sexual abuse as the rarest (Nazarko, 2011). Furthermore, the likelihood of care workers being the abuser is quite low (Nazarko, 2011).
Elder abuse is a severely underreported phenomenon, with some estimates indicating that as few as one case in 27 actually being reported to authorities (Mukherjee, 2011). Both abusers and victims tend to deny the abuse happened and attempt to hide it from others (Mukherjee, 2011). Thus, medical professionals often must report only suspected abuse rather than confirmed situations (Mukherjee, 2011). The reporting requirements are also confusing, being mandated by the states rather than the federal government, meaning standards and processes of reporting suspected abuse is highly state-specific (Mukherjee, 2011).
Identification of Elder Abuse Situations
The risk factors of elder abuse were studied by Jackson and Hafemeister (2011). For example, victims of neglect typically have no fear of their abuser and have a history of childhood family violence. They also tend to have difficulty communicating, are dependent on others, may have some level of confusion or dementia but otherwise not have general mental health problems (Jackson & Hafemeister, 2011). Another study noted that the typical abuse victim is a female over 85 years old who is physically dependent on other people and requires high levels of care, and who may have problems communicating or some confusion or dementia (Nazarko, 2011). Communication problems make elders especially vulnerable to abuse (Nazarko, 2011).
Nazarko (2011) noted specific signs of elder abuse that should be noted. Neglect may be accompanied by weight loss, poor hygiene or grooming, pressure ulcers, incontinence, or being left in a wet or soiled bed or other location. Financial abuse is characterized by lacking money to pay bills, food, or basics; a pension that “disappears”; sudden large bank withdrawals; and reluctance of a financial executor to cover bills for necessities like clothing or medical care (Nazarko, 2011). Physical abuse is characterized by unexplained injuries or bruises; signs of being overmedicated; becoming quiet and withdrawn; being overly nervous or eager to please; having poor hygiene or diet; being dehydrated; being isolated; or the loss (or “forgetting”) of aids such as hearing aids, glasses, walkers, canes, etc. (Nazarko, 2011). Sexual abuse is also typified by changes in behavior such as becoming withdrawn or quiet or fearful; greater difficulty in walking or sitting; bloodstained undergarments; painful or itchy genetals; bruised or bleeding in the genital or anal area; unexplained repeated bouts of cystitis; venereal diseases; or sexualized behaviors (Nazarko, 2011).
Jackson, S. L., Hafemeister, T. L. (2011). Risk factors associated with elder abuse: The importance of differentiating by type of elder maltreatment. Violence & Victims, 26 (6), 738-757.
McGarry, J., Simpson, C. (2009). Continuing professional development: Identifying, reporting, and preventing elder abuse in the practice setting. Nursing Older People, 21 (1), 33-38.
Mukherjee, D. (2011). Organizational structures of elder abuse reporting systems. Administration in Social Work, 35 (5), 517-531.
Nazarko, L. (2011). Safeguarding and protection in health and social care. Nursing & Residential Care, 13 (6), 264-268.
Phelan, A. (2010). Elder abuse and the community nurse:Supporting the patient. British Journal of Community Nursing, 15 (10), 472-478.