Elder Mistreatment Abuse, Neglect, and Exploitation in an Aging America (2003) / Chapter Skim
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Pages 261-302
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agency record review, (2) sentinel reports (trained observers in agencies that serve older adults but do not document abuse in official adult protective service LAPS records)
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This is problematic in that researchers attempting to document the extent and rate of elder abuse (irrespective of cognitive status) have adopted methodologies that are better suited for one class or the other of older adults.
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: "much elder abuse does not conform to the child abuse model, and elder abuse victims are not necessarily in a structural relationship to their abusers parallel to that of children.... We argue that it may be useful to start examining elder abuse for more parallels with the spouse abuse situation: legally independent adults, living together out of choice for a variety of emotional and material reasons" (see also Whittaker, 1996)
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Physical health barriers to reporting victimization events include deficits in cognitive functioning, hearing loss, increased susceptibility to fatigue, inability to remain sitting for extended durations (e.g., due to arthritis) , and effects of medication on concentration and memory.
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Moreover, the criteria by which cases are designated substantiated or not and the definitions for particular forms of elder mistreatment vary widely across social service agency, county, and state. The National Center on Elder Abuse (Tatara, 1997)
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Ultimately, it is the judgment of individual caseworkers that determines whether or not a mistreatment event has occurred. A notable strength of agency record review studies such as that conducted by the National Center on Elder Abuse is the highly detailed nature of the data regarding the abuse event.
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Thus, it is very likely that mistreatment rates derived from this study greatly underestimate the true scope of the problem of elder victimization because a great majority of cases go both unreported and undetected by existing formal and informal monitoring agents. Although this approach has been used three times with child abuse, there are several problems with this method when applied to elder abuse.
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Overall, the unresolved issue of mandatory reporting of elder abuse, the relative infancy of elder abuse public education, and the limited conduits of information on elder abuse cases flowing to potential sentinels may severely limit the application of this form of child abuse assessment to elder mistreatment in that the method may lack sensitivity. This lack of sensitivity will be particularly problematic for the population of non-cognitively impaired, relatively independent mistreated older adults who wish to avoid formal service agency involvement in their abuse situations.
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classification of the event by police departments across the country. Overall, these forms of assessment methodology represent preliminary, as opposed to comprehensive, epidemiological data regarding elder mistreatment.
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. These studies, and studies cited below, demonstrate that caregiver assessment may be an acceptable, albeit unidimensional, method of detecting elder abuse in the subset of abusers willing to disclose these behaviors.
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Thus, using risk factors to select perpetrators in order to identify additional risk factors is a tautological methodology, and should be avoided in epidemiological efforts. The Caregiver Abuse Screen (CAS)
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Overall, several indices and interviews exist and have been used successfully with caregivers to measure elder mistreatment. Caregivers can be asked directly about their abusive or neglectful behaviors, or they can be assessed in terms of risk factors.
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Items are scored yes or no, and a score of 3.5 or higher is indicative of abuse. Three domains of elder abuse are assessed: overt symptoms, victim risk characteristics, and victim symptom characteristics (the authors categorize these as violation of personal rights or direct abuse, characteristics of vulnerability, and potentially abusive situation)
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Similarly, Pillemer and Finkelhor (1988) found that 65 percent of elder abuse cases involved spouses as perpetrators.
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Most notably, event-based interviews cannot study neglect and abuse of demented individuals, and of course caregivers or proxies must be assessed in these instances, but this weakness is not inherent in this assessment method, per se. Several other measures have been used to study elder abuse, ranging
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The modified Elder Abuse Attitudes and Behavior Intention Scale-revised (Childs et al., 2000) assesses attitudes toward abuse, intentions to abuse, and actual behaviors of abuse in caregivers.
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Detection and Treatment of Elderly Abuse and Neglect: Protocol for Health Care Professionals, and the Community Based Education Model for Identification and Prevention of Elder Abuse (Weiner, 1991~. Although clinically useful, these tools have little or no psychometric validation, generally use little behavioral description (see "Issues Pertaining to Assessment of Victimization," below)
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Such culturally, generationally, or ethnically charged questions, if not restructured, will produce inaccurate estimates of violence prevalence. In addition to definitional and contextual problems, violent crime, particularly that type of crime associated with interpersonal, psychological, or cultural stigma (e.g., elder abuse)
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Of equal import, preface statements must also provide contextual orientation so that the likelihood of reporting that information sought by the investigator is maximized. For example, if questions regarding elder abuse follow a crime survey in which reported crimes are investigated, and no preface statement is used to specifically direct respondents to disclose all assaults, including those not reported to authorities, then respondents might be biased toward disclosing only those events that have been reported to police (Koss et al., 1993~.
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(Koss et al., 1993) , and a respondent's own victimization history will affect his or her personal definitions of elder abuse (Childs et al., 2000~.
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For those who indicate that a specific form of violence has occurred, additional questions regarding relationship to the perpetrator, whether or not the event was one in a series, the first and most recent times the event occurred, etc., can be asked. Combining highly specific behaviorbased questions with computer-assisted skip out patterns achieves the same brevity of interviews found in gateway surveys, without a loss in sensitivity.
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Finally, in-person interviews can be conducted in households that do not have telephones. (However, the advantage of in-person interviews over telephone interviews insofar as telephone availability is concerned may be illusory.
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Thus, the integrity of the interview and subsequent collected data are more thoroughly preserved by the telephone interviewing methodology. Moreover, telephone interviews are far less expensive than in-person interviews and generally require significantly less time to complete.
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First, the physical and emotional effects of such events, particularly elder abuse and nonfamilial physical and sexual assault, are often very similar, or at least share a number of similarities (Acierno et al., 1997~. Second, both forms of violence appear to have several risk factors in common (e.g., poverty, limited resources, previous victimization)
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This methodology also has the significant advantage of assessing a variety of categories of elder mistreatment simultaneously, compared to record review or FBI UCRs, in which types of mistreatment are largely limited to specific crime types that may or may not be in line with elder abuse definitions (e.g., verbal assault and emotional abuse)
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. , l servlce-provl~ log protesslonais are educated about this compulsion to report instances of elder abuse and neglect that is, until elder abuse is treated similarly to child abuse for cognitively disabled elders estimates derived by agency records and sentinel systems will lack sensitivity.
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. In-person Interview: victims In-person interview: family/caretakers + TABLE 10-2 Assessment of Seniors with Significant Cognitive Impairment Feasibility Sensitivity Cost Record review Sentinel reports C
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Radika, and J.A. Reinberg 2000 Young and middle-aged adults' perceptions of elder abuse.
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Pillemer 1988 Elder abuse: Its relationship to other forms of domestic violence. In Family Abuse and Its Consequences: New Directions in Research, G
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Kosberg, J.I. 1988 Preventing elder abuse: Identification of high risk factors prior to placement decisions.
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Gans 2000 Elder abuse by adult children: An applied ecological framework for understanding contextual risk factors and the intergenerational character of quality of life. International Journal of Aging and Human Development 50:329-359.
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Journal of American Geriatrics Society 36:758-762. 1992 Victimization of the elderly: Elder abuse and neglect.
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EPIDEMIOLOGICAL ASSESSMENT METHODOLOGY APPENDIX ASSESSMENT TOOLS From Hwalek and Sengstock (1986~. Elder Abuse Screening Test 293 1.
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Clothing good ELDER MISTREATMENT Elder Assessment Tool _Home Family _Alert Female _Medicare Private Pay Other Nursing Home Other Friend Alone Confused _Unresponsive Orthopedic Changed Mental Status yes no good fair poor fair poor USUAL LIFESTYLE 13. Maintenance of hygiene self assist 14.
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Outcome Referral to Elder Abuse team Referral to Clinical Advisor 35. Summary Statement Too busy to fill out No abuse/neglect suspected present absent present absent
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296 From Reis and Nahmiash (1998~. ELDER MISTREATMENT INDICATORS OF ABUSE Indicators of abuse are listed below, numbered in order of importance.4 After two- to three-hour home assessment (or other intensive assessment)
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EPIDEMIOLOGICAL ASSESSMENT METHODOLOGY From Reis and Namiash (1995~. Caregiver Abuse Screen Please answer the following as a helper or caregiver 1.
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Aclult Chilct/Caregiver Risk Dynamics 3.1 Was abused or battered as a chilci 3.2 Poor self-image 3.3 Limited capacity to express own needs ELDER MISTREATMENT HALF Assessment Almost Some of Always the Time Never
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Attitudes Toward Aging 5.1 Aged adult views self negatively due to aging process 5.2 Adult child views aged adult negatively due to aging process 5.3 Negative attitude toward aging 5.4 Adult child has unrealistic expectations of self or the aged adult 6. Living Arrangements 6.1 Aged insists on maintaining old patterns of independent functioning that interfere with the child's needs or endanger aged adult 299 Almost Some of Always the Time Never
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ELDER MISTREATMENT Almost Some of Always the Time Never PLEASE COMPLETE IF YOU HAVE HAD A ROMANTIC PARTNER IN THE PAST YEAR. No matter how well a couple gets along, there are times when they disagree on major decisions, get annoyed about something the other person does, or just have spats or fights because they are in a bad mood or tired or for some other reason.
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EPIDEMIOLOGICAL ASSESSMENT METHODOLOGY Never Once Twice A Have you discussed the issue calmly B
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A Have you hit or tried to hit your ELDER MISTREATMENT Never Once Twice 0 0 0 0 More Than 6-10 11-20 20 en- en- en.
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