Elder Abuse Phenomenon Correlating Relationship to Elder Mortality

Elder Abuse Phenomenon Correlating Relationship to Elder Mortality

Elder abuse has received increased scrutiny from the law enforcement and healthcare community in recent years. This increased attention is due in part to the increasing number of elderly in the United States and the passage of various laws designed to improve the reporting of such episodes of abuse as well as the prosecution of those who abuse the elderly. Unfortunately, elder abuse is particularly difficult to detect in some cases and studies have shown time and again that many elderly people are highly reluctant to admit to such abuse for fear of reprisals from the abuser or the possibility of being institutionalized if existing domestic living arrangements are disrupted. The purpose of this study was to critically review the relevant peer-reviewed and scholarly literature concerning elder abuse in general and its contribution to premature death among this population in particular in order to identify opportunities for improving the delivery of support services and describing best practices as they exist today. To this end, a summary of the research, salient findings and recommendations are presented in the concluding chapter.

Chapter 1: Introduction

Statement of the Problem

Purpose of Study

Importance of Study

Scope of Study

Rationale of Study

Overview of Study

Chapter 2: Review of Related Literature

Chapter 3: Methodology

Description of the Study Approach

Data-gathering Method and Database of Study

Chapter 4: Data Analysis

Chapter 5: Summary, Conclusions and Recommendations

Elder Abuse Phenomenon Correlating Relationship to Elder Mortality

Chapter 1:

Introduction

Statement of the Problem

Elder abuse is a growing phenomenon across a wide range of societies and populations today. The research on this social problem has tended to focus on estimates of its prevalence and on characterizations of its perpetrators and victims; however, there remains a paucity of research that have offered explanations for emergence of the phenomenon itself (Litwin & Zoabi, 2004). Estimates of elder abuse in the Western world vary widely, making it difficult to confirm the extent of the problem. In many cases, the phenomenon is underreported due in large part because physical and psychological symptoms of abuse may be denied by victims or misinterpreted by services personnel as simply being the normal consequences of the aging process (Litwin & Zoabi, 2004). In addition, elder abuse is more difficult to detect than others forms of abuse because elders tend to be reluctant to disclose such behaviors, especially when they involve close family members, out of fear of future retribution or their institutionalization if they are removed from the abusive environment.

Moreover, the lack of satisfying treatment alternatives on behalf of abused older people is a disincentive to reporting of risk status (Litwin & Zoabi, 2004). This point is made by Bergeron (2000) who reports that "Elder abuse has been documented to be a social problem of national and international concern" (p. 40). Indeed, the Select Committee on Aging of the U.S. House of Representatives reported that, "Some 5% of the Nation's elderly may be the victims of abuse from moderate to severe... Or more than 1.5 million elderly may be victims of such abuse each year" (Select Committee, 1990, p. xi). A consistent theme that quickly emerges from the research is just how underreported the problem of elder abuse may be in many parts of the country. While all states have laws and services in place to detect domestic elder abuse, only about one in five actual cases is reported and substantiated; therefore, how cases are identified and resolved varies significantly across the nation because laws and regulations vary greatly (Jogerst, 2004).

According to Gellert (1997), there are three settings in which elder abuse generally takes place (a) domestically; institutionally (in nursing homes, hospitals, and long-term care facilities); and through self-neglect and self-abuse. In this regard, Gellert notes that, "Elder abuse tends to occur in a situation in which an elderly person's needs are exceeding, or will soon exceed, the ability of a caregiver to address them adequately. The caregiver experiences increasing frustration and stress as his or her ability to give care diminishes. Elder abuse tends to increase in frequency and severity over time" (Gellert, p. 190). In his book, Handbook of Domestic Violence Intervention Strategies: Policies, Programs, and Legal Remedies, Roberts (2002) reports that:

Elder abuse as a form of institutional abuse involves a care-dependent victim and an abusive formal caregiver (e.g., nurse's aide, nurse, home health aide). Institutional abuse can occur in a nursing home, hospital, or the victim's home, with the abuser part of a formal care system. Depending on the severity of the neglect or mistreatment of a care-dependent older adult by a formal caregiver, the abuse or neglect may constitute a criminal offense. Most state laws mandate reporting of any suspected or actual abuse or neglect of a formal caregiver against a care-dependent older adult to the state department of health. Perpetrators may be subject to criminal investigation, prosecution, fines, and loss of license to practice. (p. 488)

While institutional elder abuse has received a great deal of attention, elder abuse by family members has been identified as a growing problem in American society in recent years as well. In fact, since the beginning of the first congressional investigation of elder abuse in 1978 (Olinger, 1991), every state has implemented some form of elder abuse reporting law with an agency designated to accept reports of suspected elder abuse, investigate such allegations, and provide intervention for the elderly victim (Bergeron & Gray, 2003). The American Medical Association (AMA) also issued its first guidelines on elder abuse in 1992, urging physicians and other healthcare providers to be more alert to signs of mistreatment or neglect of older patients by their families or caregivers (Aguilera, 1998). According to this author, "The 42-page guidelines, part of a new AMA campaign against family violence, come amid growing national concern about a long-hidden problem in which as many as 2 million elderly Americans are believed to be victims of abuse or neglect" (Aguilera, p. 112).

According to the National Elder Abuse Incidence Study (National Center on Elder Abuse, 1998) "the best national estimate is that a total of 449,924 elderly people, aged 60 and over, experienced abuse and/or neglect in domestic settings in 1996" (p. 4), and of that number approximately 16% were reported to elder protection agencies. Experts in the field say that elder abuse is grossly underreported for several reasons: the isolation of elderly people, lack of uniform reporting laws, and the general resistance of people, including professionals, to report suspected cases of elder abuse and neglect (Tatara, 1993). The majority of perpetrators of domestic elder abuse are family members (Bergeron & Gray).

According to Baker (2007), the mistreatment of the elderly - even unto death -- represents a widespread and increasingly serious problem in the United States today. "Elders who are mistreated face negative consequences, including higher mortality risk when compared to nonmistreated peers," Baker advises, and adds, "Factors such as childhood physical abuse or neglect, depression, and dependence on others for activity of daily living assistance make elders vulnerable to mistreatment. Geriatric syndromes, such as frailty, may also contribute to elder mistreatment vulnerability, whereas chronic stress may be a mediator in early mortality" (p. 313). Finally, as Ebersole and Hess (1998) emphasize, "In a society becoming increasingly more violent, it is reasonable to assume that abuse of elders and other vulnerable persons will continue to increase" (p. 562).

Purpose of Study

Complex problems require complex solutions and such is the case with elder abuse. According to Thursz, Nusberg and Prather (1995), "The causes of elder abuse are complex, arising from any one of the following: the abuser's personality, the older person's behavior, family dynamics, or environmental pressures" (p. 42). Within this broad range of contributors factors is a constellation of social, cultural and gender issues that make developing effective interventions problematic, and the problem is only going to get worse in the years to come. As Gellert (1997) advises, "A number of factors contribute to elder abuse, including psychological, social, medical, and economic influences. These influences affect an elderly person's interpersonal and family relationships" (p. 191). Therefore, the purpose of this study was to critically review the relevant peer-reviewed and scholarly literature concerning elder abuse in general and its contribution to premature death among this population in particular in order to identify opportunities for improving the delivery of support services and describing best practices as they exist today.

Importance of Study

Since the beginning of the 20th century, average life expectancy in the United States has increased from 47 years to over 75 years (Gardner & Hudson, 1996). According to Johnson (1999), "In 1900, over half of all deaths involved persons 14 years of age or younger. Today only 2% of all deaths occur within this age group. As a corollary, an increase in the relative size of the older population (persons 65 years of age or over) is clearly evident. Elderly persons comprised 4% of the total population in 1900, 12.6% in…