Unit.E.5.4. Senior Abuse/ Neglect

Australia	focus points

Insert forensic focus points here

Canada	focus points

Elder abuse and neglect are important social problems in Canada and have been reviewed elsewhere (1,2). Since the reports of "granny battering" by Baker and Burston in 1975, research has become increasingly systematic in attempting to clarify the nature, extent, and causes of the problem (3,4). (Vida, Monks, & Des Rosiers, 2002). Five broad types of abuse and neglect have been described: physical abuse, psychological abuse or chronic verbal aggression, material abuse or financial exploitation, neglect (intentional or unintentional), and violation of rights. Several references define these terms in detail (1,2,5-10). (Vida, Monks, & Des Rosiers, 2002). "Several community-based studies have estimated the prevalence of elder abuse. In Canada, in a telephone interview random sample of 2000 individuals over age 65 years living in private houses, Podnieks and others reported a 4% prevalence of abuse or neglect, with 2.5% financial abuse, 1.4% chronic verbal aggression, 0.5% physical violence, and 0.4% neglect (9)."(Vida, Monks, & Des Rosiers, 2002).

 

International	focus points

"In Denmark, Finland, and Sweden, Hydle reported a 1% to 8% prevalence of abuse by close relatives (14). In the Netherlands, Comijs and others (15) reported a 1-year abuse prevalence of 5.6% in a random sample of 1797 elderly persons living independently in Amsterdam, with 3.2% verbal aggression, 1.4% financial abuse, 1.2% physical aggression, and 0.2% neglect (15). In Germany, Hirsch and Brendebach (16) reported a 5-year abuse prevalence of 10% in a postal questionnaire sample of elderly living in Bonn, most often psychological and financial abuse" (16). (Vida, Monks, & Des Rosiers, 2002).

 

United Kingdom	focus points

Baker (1975) first wrote about the concept of "granny-bashing" in the British medical journals and described instances where older citizens were abused by family members, caregivers, health care employees, and a host of other individuals.

 

United States	focus points

The earliest discussions of elder abuse arose out of diverse fields: medicine (a "battered old person syndrome" [Baker,1975]), family violence research ("battered parents" [Steinmetz, 1978]), and social work ("abuse of the elderly by informal care providers" [Lau and Kosberg,1978) (Anetzberger, 2000). In the mid- 1970s the concept of "granny-bashing" began to appear in British medical journals and described instances where older citizens were abused by family members, caregivers, health care employees, and a host of other individuals (Baker, 1975; Ogg & Munn-Giddings, 1993). At the same time, predictions were made that the number of elderly citizens living in the United States would increase gradually throughout the 1980s and 1990s. Since then, two things have occurred. First, we have seen increases in longevity and the number of people ages 65 or older. Second, we have witnessed the evolution of the granny-bashing concept into other concepts viewed as more politically correct. These new concepts included battered parent, elder maltreatment, and elder abuse (Crystal, 1987; Katz, 1979; Pillemer, 1986). Although these new concepts have been forthcoming, research into the way elder abuse cases are handled in the legal system is relatively scarce in the literature (Payne, Berg, & James, 2001). Official estimates cited in the elder abuse literature indicate that anywhere from 1 to 2 million adults ages 65 or older are abused annually (Baron & Welty, 1996; Wolf, 1996). Elderly victims often will not report abuse because of a fear of retaliation, shame, or beliefs that the system will do more harm than good. Some fear they will be placed in a nursing home if they report abuse, whereas others see reporting as being nugatory, leading to a cumbersome process placing on their lives time and economic constraints that they would rather avoid (Payne, 2000). In fact, some sources argue that only 1 in 14 cases of elder abuse is reported (Bruce, 1994). Other sources suggest that 1 in 10 older citizens are victims of abuse each year (Heisler, 1991; Wolf, 1996, cited in Wolf, 2000). With an increasing number of elders entering hospital critical care units, the nurse in this setting has a responsibility for detecting signs and symptoms of elder abuse. Elder abuse is manifest in several ways including inflicted physical harm as a result of traumatic injuries or neglect, psychological threats or intimidation, and even financial abuse when the elder's resources have been misappropriated by the caregiver (White, 2000). There are about 34 million people in the United States who are 65 years old (approximately 13% of the population), and 4 million or 1.5 % are 85 years or older.I The United States has an aging population. In 1900, the average life expectancy was 47 years, but thanks to improved diets, sanitation, and antibiotic medications, the life expectancy now for women is 79 years and 72 years for men. The numbers for the oldestold, age 85 or greater, will increase tremendously over the next 10-50 years as the Baby Boomer generation ages.2 By the year 2050, 19 million people or 24% of elders in America will be in this oldest-old category.1 The biggest growth of oldest-old was between 1960 and 1994 with an increase of 274%.2 With this large increase in elderly, a new phenomenon was starting to be described in 1975: "granny battering."' Elder abuse may have been present long before this time, but recognition of the issue did not have the public or the medical community's attention. This article focuses on the issues and concerns of elder abuse and the role of the nurse in identification and management of the problem (White, 2000). The Amendments to the Older Americans Act, 1987, put forth definitions on elder abuse, neglect, and exploitation.2 These definitions provided guidelines only and each state developed its own interpretations and laws from these definitions.4 There are four categories recognized by the Older Americans Act as elder abuse: physical, emotional, financial, and neglect. The National Center on Elder Abuse (NCEA) believes that there should be a total of seven areas, the above four plus self-neglect, sexual abuse, and miscellaneous.3 Elder abuse could be generally described as any intentional action or nonaction that would cause harm to an elderly person. The American Medical Association estimated that one in four older persons have experienced some type of abuse or neglect.6 Although these numbers seem high, the actual number of reported cases can be low. Klienschmidt 3 performed an impromptu survey of emergency physicians in the Dallas, Texas, area (White, 2000). "Researchers have offered various theoretical explanations of why elder abuse occurs: an overburdened caregiver (situational model), a dependent elder or perpetrator (exchange theory), a mentally/emotionally disturbed perpetrator (psychopathology), and a childhood of abuse and neglect (social learning theory). Others have criticized the emphasis on individual traits. They propose that structural forces such as the imbalance of power within relationships (feminist theory) or the marginalization of elders within society (political economic theory) have created conditions that lead to conflict and violence" (Wolf, 2000). "In the US, Gioglio and Blakemore reported a 1% prevalence in a random sample of 342 community-dwelling individuals over age 65 years, with financial abuse being the most frequent form (over 50% of abuse) (11). Pillemer and Finkelhor reported a 3.2% prevalence in a telephone interview random sample of 2020 community-living elderly, with 2% physical abuse, 1.1% verbal aggression, and 0.4% neglect (8). Lachs and others linked an established research cohort of 2812 community-dwelling older adults in New Haven with protective service records (12) and reported a 9-year prevalence of protective service referral for elder abuse of 1.6% (13)." (Vida, Monks, & Des Rosiers, 2002).

 

Focus Points Reference

Anetzberger, G. J. (2000). Caregiving: Primary cause of

elder abuse? Generations, 24(2), 46-51. Retrieved December 26, 2002, from Academic Search Premier Database: http://search.epnet.com/direct.asp?an=3539867&db=aph

Heisler, C. J. (2000). Elder Abuse and the Criminal

Justice System: New Awareness, New Responses. Generations, 24(2), 52-58. Retrieved December 26, 2002, from Academic Search Premier Database: http://search.epnet.com/direct.asp?an=3539868&db=aph

Payne, B. K., Berg, B. L., & James, L. D. F. (2001).

Attitudes about sanctioning elder abuse offenders among police chiefs, nursing home employees, and students. International Journal of Offender Therapy and Comparative Criminology, 45(3), 363-382. Retrieved September 22, 2002 from the Proquest database.

Vida, S., Monks, R. C., & Des Rosiers, P. (2002).

Prevalence and correlates of elder abuse and neglect in a geriatric psychiatry service. Canadian Journal of Psychiatry, 47(5), 459- 467. Retrieved December 26, 2002, from Academic Search Premier Database: http://search.epnet.com/direct.asp?an=6854005&db=aph

White, S. (2000). Elder abuse: Critical care nurse role

in detection. Critical Care Nursing Quarterly; 23(2), 20-25. Retrieved December 26, 2002, from Academic Search Premier Database: http://search.epnet.com/direct.asp?an=6777999&db=aph

Wolf, R. S. (2000). The nature and scope of elder

abuse. Generations, 24(2), 6-12. Retrieved December 26, 2002, from Academic Search Premier Database: http://search.epnet.com/direct.asp?an=3539244&db=aph

 

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From 'forensic presentations' in the forensic sourcebooks the following presentations have been selected for this unit:

Unit.E.5.4. Senior Abuse/ Neglect

Forensic Medicine/Forensic History/Historical Firsts and Facts

Australia	Presentation(s)

Insert power point presentation here

Canada	Presentation(s)

Elder Abuse

International	Presentation(s)

Insert power point presentation here

United Kingdom	Presentation(s)

Insert power point presentation here

United States	Presentation(s)

Insert power point presentation here

 

This section will continually be added to with guest presentations from forensic experts locally, nationally and internationally and with student presentations.

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From 'forensic cases' in the forensic sourcebooks the following case studies have been selected for this unit

Unit.E.5.4. Senior Abuse/ Neglect

Forensic Medicine/Forensic History/Historical Firsts and Facts

Australia	case study

Insert case study here

Canada	case study

Insert case study here

International	case study

Insert case study here

United Kingdom	case study

Insert case study here

United States	case study

Heisler, C. J. (2000). Elder Abuse and the Criminal

Justice System: New Awareness, New Responses. Generations, 24(2), 52-58. Retrieved December 26, 2002, from Academic Search Premier Database: http://search.epnet.com/direct.asp?an=3539868&db=aph Note: The cases of elder abuse in the Heisler (2000) article '' The financial arena is a common area of abuse. In one case, an elderly woman, the owner of several valuable pieces of real estate, was befriended by a long-time tenant who isolated her, convinced her that her "enemies" intended to harm her, and took over her assets. He invested in high-risk investment schemes, redecorated the mansion he occupied, and bought a French chateau. He employed his own friends to provide personal care to the woman and drill her to pass a mental health assessment indicating that she was competent to make decisions about her financial affairs. He hired a friend of his who was a certified accountant to give her investment advice, and when he feared loss of control over her assets, he married her'' (Heisler, 2000). ''In another case, a lonely, confused, and socially isolated older man met a new acquaintance at a neighborhood restaurant in San Francisco. In short order, she professed great affection and love for him, and he quickly married her He bought her a home in another community, which the two never shared, added her as a joint tenant to his bank accounts and other assets, and made a will in her favor. The new wife was the mother of children by her longterm common-law, or putative, husband'' (Heisler, 2000). ''Sometimes offenders target neighborhoods where older people live, working alone or in bands. They use a variety of scams, representing themselves as home repair contractors, utility department employees, or workers from a governmental agency They gain the older person's trust and quickly collect money for services that are never performed or steal valuables from the elder's home" (Sklar,1999, cited in Heisler, 2000). ''Home healthcare workers have also exploited vulnerable older people. For example, in one San Francisco case, a nurse caring for a disabled older woman stole her money and other valuables. The nurse was prosecuted and placed on probation. She then befriended an elderly man, married him, and began looting his assets. She was prosecuted for another series of thefts and burglaries from friends and associates. These new crimes and the acts against her husband became the basis for revoking her probation and sending her to prison '' (Heisler, 2000). ''Examples of physical abuse and neglect are of course the most sensational. In South Carolina, a 91-year-old woman who was cared for by her children in their home was neglected for so long that she developed a decubitus ulcer that exposed her spine. Bobby pins used to hold pads in place had become embedded in her skin. Bodily waste was in the ulcer, and the smell was overwhelming. She died of sepsis'' (Heisler, 2000). ''In southern California, two brothers allowed their father to "rot" to death in bed until he died from neglect, malnutrition, dehydration, and septic shock from bedsores. The 68-year-old victim was paralyzed, bedridden, and unable to control his bodily functions. His sons lived in his rented home and used his pension checks to pay the bills. One son was responsible for managing the income; the other was responsible for providing personal care. The father was not fed, given water, taken to the bathroom, or cleaned. The family knew that he needed medical care but did not provide it (Wright, 1991, Heisler, 2000). ''In San Francisco, an 84-year-old woman with dementia was admitted to a hospital with breathing difficulties and covered with bruises, described by one expert as similar to those sustained by airplane crash victims. The attack was committed by her son'' (Heisler, 2000). ''Criminal justice professionals see domestic violence cases involving elderly spouses. Some occur in long-term marriages, with abuse having lasting over decades, and others occur in new marriages. Some incidents even occur after the battering spouse has died or become incapacitated and the adult son steps into his father's shoes and attacks his mother. In each of these forms, the abuse is usually perpetrated to accomplish power and control over the victim'' (Heisler, 2000).

 

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From 'forensic experts' in the forensic sourcebooks the following panel of experts has been selected for this unit:

Unit.E.5.4. Senior Abuse/ Neglect

	forensic panels of experts

Insert forensic panel here…………

Australia	authors/experts

Insert specific author/expert name(s) here

Canada	authors/experts

Insert specific author/expert name(s) here

International	authors/experts

Insert specific author/expert name(s) here

United Kingdom	authors/experts

Insert specific author/expert name(s) here

United States	authors/experts

Insert specific author/expert name(s) here

 

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