Older Adult Abuse and Neglect
Elderly abuse and neglect is a growing social problem. Increasing awareness about the risk factors for elderly abuse is paramount in our efforts against this social evil. Health institutions that are responsible for providing direct care and rehabilitation services for the elderly people should be specially trained to provide quality care that fulfils the physical, emotional and mental needs of the elderly patient. A coordinated effort that includes family physician, emergency care providers, family members, 'Adult protective services', and the public is necessary to protect our elderly population from abuse and neglect.
The issue of elder abuse assumes great significance as the life expectancy of Americans is on the rise and as an aging nation more and more people are getting older. Statistics suggest that around 2.1 million elderly American people are victims of physical or psychological abuse. But this figure does not represent the full scale of the problem as authorities state that for every reported case of elderly abuse there are at least five cases that go unnoticed. [APA, 2011] While it is the general opinion that elder abuse happens in old age homes or nursing care centers, the shocking truth is that most cases of elder adult abuse happens in the family settings and by close family members . Though physicians are required to report suspected case of adult abuse, less than 2% of reports to 'Adult Protective Services' are filed by them, clearly suggesting the need for more awareness among medical personnel caring for elderly people. [Taylor et.al (2006)] At the critical point of their lives elderly people need all care and support to overcome this growing social evil of abuse and neglect. A brief overview of adult abuse would provide us a better picture of the problem, increase our awareness and help in intervention efforts.
Elder Abuse and Neglect
Elderly abuse is a serious problem with the number of adults above 65 years of age slated to increase to almost 20% of the national population by 2020. [Hardin & Hudson, (2005)] Studies have highlighted that the abusers are mostly family members or caretakers. Since in majority of the cases elderly abuse takes place in a family setting it is difficult to identify. Furthermore, the number of reported incidents is much lower compared to child abuse or spouse abuse as the victims are in most cases physically impaired, dependent and isolated. Elderly abuse can be classified into four types namely a) Physical abuse, b) Psychological abuse c) sexual abuse and d) financial abuse. [APA, 2011]
Physical and Psychological Abuse
Physical abuse refers to inflicting pain and discomfort on the elderly person by treating them roughly. Acts such as shoving, beating, slapping, pinching, or even the use of excessive force when assisting them in their daily care routines, can be categorized as being physically abusive to the person. Over medicating, rationing food or even letting the elderly person get exposed to extremes of temperature are clear instances of physical abuse. Sometimes physical abuse takes the form of unnecessary restraint by locking the elderly person or the total neglect of elderly person by the family members. Emotional abuse includes a range of activities that are intimidating, threatening or insulting to the elderly person. These include verbal abuse by calling them names, talking to them in a disrespectful manner, inducing fear in them by talking in a threatening manner, etc. Sometimes disabled elders are totally isolated from the usual family activities making them feel lonely and uncared for. [APA, (2011)]
Sexual and Financial Abuse
Sexual abuse of the elderly is one of the most under reported cases of elderly abuse. As a recent report from the national institute of Justice indicates, the more aged a person is the more unlikely that a case of sexual abuse would be investigated as elder abuse victims are not evaluated routinely for sexual abuse. [NIJ, (nov 2007)] Sexual abuse of physically impaired and disabled elderly people is an act that takes away their dignity and should not be left unnoticed. Health care workers should be trained to be more aware of the possibility of sexual abuse of the elderly. Financial exploitation of elderly simply means using the financial savings of the elderly person for self needs by way of extortion or forgery. Buying expensive goods using the elderly person's savings, impersonating and signing cheques, misuse of power of attorney and embezzlement are various forms of financial abuse of elderly people. One recent study in British Columbia indicated that 1 out of 12 elderly people are financially abused for an average of $20,000. [APOAN]
Abuse in the rehabilitation centers
The despicable but sad truth is that elderly abuse is prevalent in extended care centers. Several cases of abuse in rehabilitation centers including beating, withholding of food, and sexual abuse have been recorded in these extended health care settings. Since financial gains appear to be the main motto of these extended caretaker facilities, the management in most cases lend a deaf ear to the reports of abuse. Also in many cases, elderly people are admitted in these care settings and are not frequently visited by their family members, which leave them at the mercy of the nurses and other care givers at these centers. Several such cases where the abuse in these rehabilitation centers had worsened the condition of the patient to a critical level necessitating emergency room admission have been reported. [Hardin & Hudson, 2005]
Elderly Abuse (Prevention Interventions)
Elderly abuse is a problem that needs to be rightfully tackled. Spreading awareness and educating the healthcare workers and the public about the risk of abuse is at the heart of the interventions. In particular, healthcare workers in the emergency care should be trained to notice signs of elderly abuse and immediately report these to concerned authorities. There should be a thorough checkup for any cuts, bruises or other marks that are signs of physical abuse. Studies have revealed that in most instances physicians do not report suspected cases of elderly abuse due to fear of litigation. Development of appropriate protocols for reporting these abuses would facilitate physicians in actively countering elderly abuse. [Hardin & Hudson, 2005]Since most cases of elderly abuse happens in the family settings, social awareness of the problem would help in improved detection of abuse. If there is any forceful social isolation of an elderly person it is a good sign of possible abuse. If there is any strong suspicion of possible abuse, the public can be proactive by bringing the matter to the attention of appropriate state health service authorities. For instance, the National Center on Elder Abuse (NCEA) could be contacted for reporting cases of abuse.
Community health care providers should also encourage social contacts as a means to relieve stress in the care givers. Respite care providers should be actively utilized so that caregivers are not overwhelmed with the responsibilities of care provision for the elderly. Once an incidence of abuse is detected by adult protective services, they could focus on any underlying behavioral problems in the caregivers. Providing counseling services for such behavioral problems would go a long way in preventing elderly abuse in the family settings. [APA, 2011]
Elderly abuse and neglect is a growing social problem. The aging American population and increasing life expectancy place increased demands on healthcare and related elder care services. Health institutions that are responsible for providing direct care and rehabilitation services for the elderly people should therefore be specially trained to provide quality care that fulfils the physical, emotional and mental needs of the elderly patient. Increasing awareness about the risk factors for elderly abuse and the types of abuse is paramount in our efforts against this social evil that is unfortunately a growing concern in our society. Emergency care physicians and nurses can be major players in identifying and reporting abuse of elderly patients. Health institutions and rehabilitation centers should have strict protocols to report and manage instances of elderly abuse. From the family members perspective, improving social contacts, utilizing respite care services and counseling programs for behavioral issues would go a long way in helping reduce the stress involved in care giving and ease their burden. Living in the country which is leading the world in technology and quality of healthcare services it is indeed embarrassing that we let this indignation happen to our elderly citizens. A coordinated effort that includes family physician, emergency care providers, family members, 'Adult protective services', and the public is necessary to protect our elderly population from abuse and neglect.
1) APA, (2011), 'Elder Abuse and Neglect: Search for Solutions', retrieved Apr 3rd 2011 from, http://www.apa.org/pi/aging/resources/guides/elder-abuse.aspx
2) D. Kay Taylor, Ghassan Bachuwa & Joyvina Evans et.al (Mar 2006), 'Assessing Barriers to the identification of elder abuse and neglect: A community wide survey of primary care physicians' Journal of the National Medical Association, Vol 98, No 3, available online at, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2576103/pdf/jnma00190-0095.pdf
3) Eugene Hardin, MD, FACEP, (2005), 'Elder Abuse -- Society's Dilemma', J Natl Med Assoc, 97(1),…