Understanding the Causes of Elder Abuse, Research Paper Example

Abstract:

Scenarios and Circumstances: Seeking an Understanding of the Causes of Elder Abuse

A startling incidence rate of abuse in America’s nursing and long-term-care facilities places the nation’s rapidly increasing elderly population in a vulnerable position.  The National Center on Elder Abuse reports that as many as 1.8 million elderly Americans are victims of abuse annually from caregivers, non-caregivers and family members.  Incidents of abuse are chronically under-reported, due to fear of reprisals, uncertainty as to what constitutes abuse and many other factors.  There is a decided lack of understanding and preparedness among mandatory reporters, those individuals charged with reporting abuse cases to state authorities.  Studies have found that there is a generally perceived need for training and for other forms of support in order to mitigate the frustration and anger that often manifests itself in physical or verbal/psychological patient abuse.

Scenarios and Circumstances: Seeking an Understanding of the Causes of Elder Abuse

Introduction:

AsAmerica’s elderly near the end of the life cycle, many find themselves in an unaccustomed position – dependency.  It’s an existence that most are completely unfamiliar with  and, as such, many are placed in harm’s way.  “They are particularly vulnerable because most suffer from several chronic diseases that lead to limitations in physical and cognitive functioning and are dependent on others” (Hawes, 2009:446).

These are individuals who have spent their lives raising families and caring for others.  As they slip into old age, it is reasonable to expect that these peoplewill receive the same care and consideration most of them have provided for their families for decades.  Unfortunately, this expectation falls tragically short.  Far too many who suffer various forms of physical and psychological abuse from caregivers.

The Centers for Disease Control (CDC) estimate that there are approximately 1.5 million people living in nursing homes at any one time.  This places a significant portion of our population at risk for abuse.  And the number is growing.  The census bureau projects a 147 percent population increase between 2000 and 2050.  By comparison, the overall population is only expected to increase by about 49 percent.  As the baby boomer generation continues to age, the numbers of those requiring long-term care in nursing or other care facilities will swell nursing home patient levels.

Thesis:

Nearly overwhelming growth, coupled with regulatory,clinical and logistical neglect, has created an environment in which elder abuse flourishes.  It is a situation that reflects predictable and preventable conditions.

Review of Relevant Literature

It is difficult to compile truly accurate statistics in the reporting of elder abuse.  A 1996 study by the National Center on Elder Abuse (NCEA), which was based on state-by-state reporting data,indicated that there were “between 820,000 and 1,860,000 abused elders in the country” (Tatara and Kuzmeskus 1997).

In “Multidisciplinary Reports of Nursing Home Mistreatment” (McCool, Jogerst, Daly, and Xu 2009), a survey of two representative nursing homes in Iowa indicated that there was strong suspicion of an unacceptable level of elder abuse prevalent in those facilities.  It also showed that the level of reporting of abuse was dramatically lower than the suspected incident rate.  Fifty-three percent of respondents admitted suspicions of abuse, while only 35 percent actually reported abuse, a disturbing trend that may suggest the actual rate of abuse occurs at much higher levels than previously thought.  When asked why they did not report suspected abuse, respondents’ answers reflected another worrisome trend.

Those surveyed indicated that reasons for under-reporting suspected abuse may include feelings that “they are not qualified to judge an abusive situation, or fear of retaliation following in the wake of filing a report.  Staff expressed theneed for better training and better, more clear- cut definitions of abuse, which is quite interesting considering that Iowa is the only state that requires training for its mandatory reporters” (McCool, Jogerst, Daly, and Xu 2009).

The Iowa study provides an interesting benchmark, particularly when its survey results are coupled with national statistics.  In 2007, with 1.5 million people living in nursing facilities, there was an average of 20 cases of abuse reported per nursing home.  If the Iowa survey offers a representative view of the reporting of abuse relative to its actual occurrence, we are seeing a potentially staggering degree of prevalence nationwide, one that has truly attained epidemic proportions.

Abusecan take multiple forms.  In long-term care settings, physical abuse includes examples of “hitting, slapping, pushing, or striking with objects.  In nursing homes, other types of actions have been included, such as improper use of physical or chemical restraints.  Physical abuse also typically includes sexual abuse or nonconsensual involvement of any kind, from rape to unwanted touching or indecent exposure” (Hawes, 2009:448).

The parameters for verbal or psychological abuse are less clearly defined.  In general, this form of abuse is considered to include “intentional infliction of anguish, pain, or distress through verbal or non-verbal acts…,” as well as incidents of humiliation, intimidation and harassment (Clarke and Pierson, 1999:632).

One study of nursing facility staff revealed that 36 percent had witnessed an incident of physical abuse, while 81 percent had seen or heard examples of verbal abuse.  Respondents reported that physical abuse included an “excessive use of restraints as well as multiple types ofphysical aggression,” while psychological abuse took the form of isolating, insulting, swearing, shouting and threatening (Gibbs and Mosequeda, 2004:31).

Applications

The patient’s condition and physical incapacity may play a part in the incidence of abuse.  A nine-year study showed that cognitive impairment was a particularly prevalent risk factor in

the mistreatment of elders.  More specifically, elders suffering from dementiaappear to be at especially high risk for abuse.  A detailed study showed that 12 percent of respondent caregivers had abused a dementia patient in their care (Gibbs and Mosqueda, 2004:31).

Causation comprises a wide range of factors.  These include general motivators, such as generally negative or hostile perceptions of the elderly.  More specific reasons have to do with environmental reasons.  Caregiver stress, low levels of job satisfaction, and employee “burnout” appear to be widespread causes of various kinds of abuse.  It is difficult to determine what kind of employee is most likely to be affected by these phenomena, though prior behavioral histories are supposed to be factored into the hiring equation.

The Centers for Medicaid and Medicare Services prohibit nursing homes from hiring individuals with a past history of abuse in a nursing facility.  Criminal background checks are not required in every state.  As well, non-caregiver employees aren’t subject to the same level of scrutiny as those directly involved in patient care.  In summation, standards are not uniform and, in many states, are simply inadequate to provide sufficient protection against the hiring of individuals with a predilection for abusive behavior.

In-home abuse of elderly individuals requiring care is an even more insidious problem.  Many of these incidents are not reported, remaining hidden under the veneer of family shame, secrecy and cover-up.  It’s difficult to determine how many elders suffer from in-home abuse.

Some experts believe that as few as one of every 14 cases of domestic elder abuse is reported.

Neglect is the most common type of elder abuse.  It has increased dramatically over the last six years, from 47 percent of reported cases in 1990 to 55 percent in 1996.  One of the most disturbing trends in this form of elder abuse is that the majority of perpetrators are adult children of the victims.  It’s a trend on the increase: from 1990 to 1996, the number of child abusers increased from 30.1 percent to 36.7 percent (Tatara and Kuzmeskus 1996).

The NCEA also reported that the majority of victims were female, though the gap between female and male victims has narrowed slightly.  Abuse incidence by sex changed more radically:  in 1990, males were abusers 54.7 percent of abusers were male, but by 1996 statistics showed that there was no significant gap between males and females when it came to committing abusive acts (Tatara and Kuzmeskus 1996).

In the Iowa nursing home study, respondents were asked why incidents of abuse were not reported more frequently and in a timely manner.  Most of the reasons given hinted at an atmosphere of intimidation and fear of repercussions.

“Half of the participants discussed how issues like frustration from dealing with difficult residents and fatigue from being overworked might lead to situations of ‘rough handling’and verbal abuse. Eight employees mentioned that they see people get frustrated when dealing with difficult residents, especially residents with dementia” (McCool, Jogerst, Daly, and Xu 2009).

Others indicated that they were uncertain of what constituted an “incident.”  Several expressed concern that perpetrators seemed to be young people with little experience and no formal training, and that they could stand to benefit from taking, or being required to take, a periodic “time out” to avoid allowing feelings of frustration to gain control of them.

There were also concerns that incidents of abuse, even if reported, would not be acted on promptly.  Some worried that some kind of internal investigation would ensue in order to determine in what context the alleged incident occurred, which tended to discourage the reporting from taking place.

Summary and Conclusions:

One common thread running through the problem of elder abuse is lack of training among professionals at the patient service and prosecutorial levels. Adult protective service caseworkers have focused largely on protecting frail or mentally incompetent elders, and have traditionally ascribedfeelings of being overwhelmed and caregiver frustration as reasons for abuse (Uekert 2002).

Misconceptions about elder abuse and the overall lack of initiative seen in the reporting of cases should be addressed through more extensive training for primary and secondarycaregivers.  A 2001 study by the National Adult Protective Services Association found that adult protective service administrators in 42 states felt that there was inadequate funding for training (Uekert 2002).

At the facility level, there appears to be a credibility problem with mandatory reporters who are not well educated and not trained in methods for identifying and responding to mistreatment of the elderly.  Many caregivers seem to feel that there is reason to fear backlash from state reporting agencies if they file a report with a facility’s mandatory reporter who isn’t adequately trainedto understand and respond to elder abuse issues.

In addition to training for providers, there is also a need for support group interventions among nursing home caregivers and non-caregivers.  Support groups could help impart coping skills to professional and non-professional caregivers alike.  A greater emphasis on training and support holds significant potential for reversing the growing trend of elder abuse in nursing facilities and in the home.

In general, “research findings indicate the need to hold periodical structured regular training for the staff, particularly practical nurses and nursing assistants, unrelated to their professional seniority, concerning difficulties that might arise while caring for demented residents, difficulties in coping with heavy workloads, views about the elderly, and managing their feelings towards residents. In addition, it is advisable to hold support groups for staff in which they can share their difficulties in coping with demented residents and their personalinability to handle stressful situations that lead them to abuse residents and in which they can learn from the experience of other staff members how to cope with these difficulties” (Ben-Natan 2009).

References

Ben-Natan, Merav. “Psychosocial factors affecting elders’ maltreatment in long-term care facilities.”International Nursing Review 57.1 (March 2010): 113-120. Wiley-Blackwell Full Collection. Web. 25 September 2010

Clarke M.E. and Pierson W. “Management of elder abuse in the emergency department.” Emergency Medicine Clinics of North America 17:631-644, 1999

Gibbs, Lisa M. and Mosqueda, Laura.  “Confronting Elder Mistreatmentin Long-Term Care.” Annals of Long Term Care.12.4 (April 2004): 30-35.  23 November 2010

Hawes, Catherine. Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. National Academies Press: 2003.

McCool, Jessica J., Jogerst, Gerald J., Daly, Jeanette M., & Xu, Yinghui. “Multidisciplinary Reports of Nursing Home Mistreatment.” Journal of the American Medical Directors Association 10.3 (March 2009). Science Direct. Web. 29 September 2010.

Tatara, Toshio and Kuzmeskus, Lisa.  “Summaries of Statistical Data on Elder Abuse in Domestic Settings for FY 95 and FY 96.” Washington, DC: National Center on Elder Abuse, 1997.

Uekert, Brenda. “Elder Abuse and Neglect.” National Association of Prosecuting Attorneys newsletter.  2002.