It is a sad fact of reality that the elderly in the United States and indeed across the world are or have been abused by those they depend upon for their care. According to the National Center on Elder Abuse (2005), 1 to 2 million Americans who have reached the age of 65 and beyond have been abused in some way.
The problem has increased with the improvement of medical science, which ensures a longer lifespan for Americans and other Western countries. The increase in number of individuals who can be classified as "elderly" in the country has brought about more than simply a longer life. It has also resulted in a number of difficulties for those who are living these lives. In addition to challenges such as the rising costs of living, which can simply not be covered by increasingly meagre pension amounts, the elderly are also suffering social isolation and stigmatization. Furthermore, those who care for the elderly are under increasing pressure not only to provide excellent care, but also to provide such care to an increasing number of individuals. The level of stress often suffered by care givers is then often cited as one of the major factors contributing to the phenomenon of elder abuse.
Elder abuse is nonetheless a complex issue that cannot be reduced to a singular cause. It is a complex problem that needs to be investigated thoroughly in order to find appropriate solutions that will ensure the best outcome for all involved parties.
In order to find solutions for the increasing occurrence of elder abuse, society as a whole needs to involve itself in both the awareness of the problem and its likely solutions. Family members, caregivers, and psychology professionals need to form a network of information in order to not only curb the problem, but also to prevent it in the first place. However, as professionals correctly estimate, it is in no way a simple problem with simple solutions.
THE ROOT of the PROBLEM
The specific reasons for elder abuse, like the issue itself, are many and complex. These relate not only to the rigors of caregiving itself, but also to other factors, including the relationship of the caregiver to the elderly person being cared for, the nature of the care provided, and the personality of the persons involved in the caregiving and care receiving relationship.
Woolf (1998) substantiates the fact that elder abuse is a problem of growing concern in the United States. One main factor in this phenomenon is the lack of public awareness. One of the reasons for this is the sensitive nature of the topic. No person, elderly or otherwise, readily admits to being abused. This is also a common phenomenon in spousal abuse, where the problem often remains hidden for years, and sometimes, tragically, only comes to light once it is too late to provide help. Even worse, those who abuse often feel isolated and unable to obtain help as a result of social as well as professional perception. Hence the problem escalates beyond control, often with tragic or even fatal results. Sadly, this is particularly the case with the elderly.
There are many possible causes for elder abuse, of which one of the most prominent is caregiver stress. Caregiver stress may be the result of a lack of information or necessary skills to care for an adult who is not well or suffering from mental or physical impairment. Nerenberg (2002, p.5) gives an extensive overview of the various factors involved in caregiver stress.
Because finances are usually a constraint upon the nature of the care being provided. Indeed, the author cites studies to suggest that primary care is generally provided by one of the family members, where others serve the role of so-called "secondary caregivers." Nerenberg furthermore states that primary care is generally provided by the spouse, in the absence of which the first choice for care falls to the eldest daughter, or in the absence of a daughter, to the son.
In order to become more aware of the factors involved in elder abuse, it is also necessary to understand the cultural factors involved in caregiving activities. Blacks and Hispanics for example are most likely to engage adult children in caregiving, as the women from these groups are generally more likely to be single than those from Caucasian groups. Hence, adult daughters from minority families are more likely to be engaged in caregiving, as they do not have their own families to care and be responsible for.
Another factor is the progression of the disease. According to Nerenberg (2002, p.6), the progression of diseases that result in dementia demands an increasing level of care. The initial stages of the disease for example would require care only for the higher level functions such as shopping and financial management, whereas an increasingly basic level of care would be required in the future, including dressing and eating.
Particularly in the family context, it must be understood that caregivers have particular needs in terms of the level of care they should provide, and the likelihood that they will continue providing care. Nerenberg (2002, p.6) provides seven markers to indicate the needs and stress trajectories that familial caregivers may be subject to. The first marker is the beginning, when the caregiver first engages in caregiving activities. The second is the self-perception of the person as caregiver. The third marker is reached when the caregiver begins to provide personal care. At the fourth level, the caregiver begins to actively search for formal support. At the fifth level, the familial caregiver begins to consider placing the elder in a nursing home, while acting upon these considerations at the sixth level. Finally, the familial caregiver terminates his or her role as caregiver.
A further factor is the influence of the type or illness or disability in the elderly care receiver. Those who care for elders with cognitive dementing illnesses for example tend to be more prone to depression and other stress-related conditions than those who care for elders with other types of disability (Nerenberg, 2002, p.6). Depression and anxiety for example are found in 43-46% of caregivers whose elders are cognitively disabled as opposed to 35.2% for caregivers whose elders suffer from other types of disability.
Depression and anxiety then also manifest themselves in problems such as lack of sleep, inadequate nutrition, and a lack of exercise. Compounding such problems is the fact that patients with disabilities generally are in need of constant supervision and care. All these factors contribute significantly to familial caregiver stress.
On the other hand, it is also important to acknowledge the growing problem of elder abuse in caregiving institutions such as old age homes, hospitals, and other caregiving facilities. Hence, while their basic lack of expertise and knowledge may result in elder abuse, those with the necessary skills and education could also fall victim to stress that may cause them to become abusive towards their charges. These persons are who Nerenberg (2002, p.1) refers to as "formal" caregivers.
The National Center on Elder Abuse (NCEA, 2005) notes that, while it is difficult to quantify the issues and factors that lead to abuse, certain institutional problems can be isolated in terms of the likelihood of the problem. The risk of abuse is for example higher in an institution where the ratio dementia residents are high, with a low staff ratio. This problem also relates to poor training for aides in charge of residents who have behavioral problem such as hitting or kicking. A low staff ratio would mean long hours for existing staff. The addition of poor training increases the risk of high stress and concomitant abuse.
As mentioned above, a further complicating factor is the fact that abuse is not always readily visible. With a high resident and low personnel ratio, monitoring each caregiving situation is not easy, particularly where abuse is neither suspected nor visible. According to the NCEA (2005), there are three categories of risk factors that should be taken into account when abuse is suspected. The first is facility risk factors, the second resident risk factors, and the third relationship risk factors.
In terms of facility risk factors, poor staffing and training are supplemented by institutional difference in terms of increasing the risk of elder abuse at facilities. Various factors in this regard need attention, including adequate training for staff, monitoring staff stress and burnout, as well as staff ratio and turnover.
Category 2: resident risk factors focus on certain types of residents in nursing homes, who could be more vulnerable to abuse than others. Risk factors in this regard include a high degree of dementia, needs that are not being met, and extreme dependence, which is associated with social isolation.
The third category focuses on relationship risk factors. Such relationships include residents' relationships with their family members and caregivers. If the relationship with family members is distant, for example, residents may be at a higher risk, as nobody from the world beyond…