Elder Mistreatment Abuse, Neglect, and Exploitation in an Aging America (2003) / Chapter Skim
Currently Skimming:
1. Introduction
1. Introduction
Pages 9-33
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 9... ...
The number of cases of elder mistreatment will undoubtedly increase over the next several decades, as the population ages. Yet little is known about its characteristics, causes, or consequences or about effective means of prevention or management.
|
From page 10... ...
or in less restrictive community-based residential settings, such as assisted living facilities, board and care homes, and adult foster homes. Among the 34 million persons over age 65 in 1995, 5 percent were nursing home residents, and 12 percent lived in the community setting with ADL or IADL limitations.
|
From page 11... ...
The 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., 1997~. Approximately 17 percent of these community-dwelling older persons are considered severely disabled, with limitations in three or more ADLs.
|
From page 12... ...
The 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. Although the threads of child protection, adult protection, and family violence were intertwined in the history of that period, they are summarized separately below.
|
From page 13... ...
Origins of Adult Protection Drawing on their parens Patrice 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. New adult protective services units were established not only to provide social services, but also to provide legal services, such as guardianship.
|
From page 14... ...
Until this time, most SSBG funds had been used exclusively for child protective services. This new federal program directed the states to provide protective services to adults who, "as a result of physical or mental limitations, are unable to act in their own behalf: are seriously limited in the management of their affairs; are neglected or exploited; or are living in unsafe or hazardous conditions." A number of states then codified this federal mandate and, by 1978,20 states had legislation establishing adult protection units as part of their social services agencies.
|
From page 15... ...
Although various versions of a national center followed, the current National Center on Elder Abuse was established in 1998. 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.
|
From page 16... ...
, and criminal prosecution became a common feature in the child protection system. Recognition of the frequent linkage between intimate partner violence and child maltreatment (see Carter et al., 1999)
|
From page 17... ...
For example, a legislative determination in Minnesota that exposure of children to intimate partner violence is per se evidence of child neglect led to an immediate doubling of referrals to child protective services, a huge increase in expenditures, and increased stress and loss of confidentiality for women and their families living in shelters (Edleson, 2000~. It was also speculated that this policy, soon retracted by the legislature, deterred some battered women from seeking protection for themselves and their children.
|
From page 18... ...
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 field.
|
From page 19... ...
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." Similarly, some researchers define physical abuse in terms of actions: hitting, pushing, choking, etc.
|
From page 20... ...
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. Researcher B also includes physical abuse in his definition of elder abuse.
|
From page 21... ...
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, onehalf 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., 1989~.
|
From page 22... ...
· Case reports have little value in studying some forms of mistreatment that are rarely reported to adult protective services agencies, such as .
|
From page 23... ...
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 mistreatment.
|
From page 24... ...
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,
|
From page 25... ...
Lack of Systematic Evaluation Studies There has been almost no effort to evaluate intervention programs for elder abuse. Certainly, no study has as yet attempted a randomized control group design in this area.
|
From page 26... ...
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 techniques.
|
From page 27... ...
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 research.
|
From page 28... ...
They specify different ages or circumstance under which a victim is eligible for protective services, often differentiating between inhome 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 documented.
|
From page 29... ...
Chapter 8 addresses concerns about protecting human subjects in elder mistreatment research, and Chapter 9 identifies some necessary conditions for moving the field forward. The panel's conclusions and recommendations are presented in Table 1-1.
|
From page 30... ...
Supplemental modules pertaining to elder mistreatment should be included in existing comprehensive geographic health and social including ongoing longitudinal studies of aging populations. Once the measurement issues have been satisfactorily addressed, a comprehensive national prevalence study of elder mistreatment should be undertaken.
|
From page 31... ...
Risk Factors for Elder Mistreatment: Chapter 5 Studies examining risk indicators and risk and protective factors for different types of elder mistreatment are urgently needed. A particularly critical need exists for such studies in institutional settings.
|
From page 32... ...
Whenever 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)
|
From page 33... ...
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 danger. Moving Forward: Chapter 9 An 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 field.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.