Elders as Abuse Vulnerable Population - Research Paper Example

 Elders as Abuse Vulnerable Population Introduction Elder abuse first became known in 1980s, with the discovery of a large number of elders subjected to family violence (Pedric-Cornell & Gelles, 1982). The risk of abuse among elders is not limited to physical violence alone. This is a global problem. Elder population is vulnerable to abuse from family members, from caregivers and in institutions such as retirement homes. With the demographic shift towards ageing population, the population of elders vulnerable to abuse is on the rise (Patterson & Malley-Morrison, 2006). This paper aims to look at elderly population as abuse-vulnerable population by reviewing existing literature. Some aspects worthy of attention in this study of elder abuse include its categories, prevalence, risk factors, and effects on the victims. The role of healthcare professionals in managing elder abuse requires elaboration in order to prevent future abuse. Elder abuse and its prevalence Many definitions exist for elder abuse, but there is no similarity among them (McGarry & Simpson, 2008). Action on Elder Abuse of UK defines elder abuse as "A single or repeated act or lack of appropriate action occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person (AEA, 2004, as cited in McGarry & Simpson, 2007). Elder abuse can be categorized as physical abuse, verbal abuse or psychological aggression, financial abuse, and neglect (Patterson & Malley-Morrison, 2006; Comijs, Jonker, van Tilburg, & Smit, 1999). Physical abuse could involve physical or sexual assault, over-medication, or use of restraints (McGarry & Simpson, 2008; Kapp, 1995). Verbal or psychological aggression may involve threats, humiliation, or emotional blackmail (Kapp, 1995; Patterson & Malley-Morrison, 2006). Aged parents in Japan were often blamed for their children's failures (Patterson & Malley-Morrison, 2006). Elders who are financially abused are often targets of their near ones or caregivers (Kapp, 1995). Neglect among elderly may comprise denial of human needs such as food or medical care, psychological neglect, or even abandonment (Patterson & Malley-Morrison, 2006; Kapp, 1995). Table 1 lists some signs and symptoms for each category of abuse, adapted from McGarry and Simpson (2008). Table 1: Categories of abuse: signs and symptoms (Adapted from: McGarry & Simpson, 2008) Category Signs and Symptoms Physical Abuse Bruises, burns, cuts, or fractures inconsistent with explanation Bruises in different stages of healing Unusually shaped bruises Nervousness Clothing that covers bruises Cigarette burn marks Unexplained burns Overmedication symptoms Unauthorized restraints Caregiver's failure to report injuries Psychological abuse Fearfulness, lack of eye contact with caregiver, flinches when caregiver approaches Ambivalent behavior towards the caregiver Deference to caregiver, resignation, and passivity Emotional withdrawal Disturbance in sleep pattern Low self-esteem Defensive behavior Observed verbal aggression by another person Another person's observation or report of humiliation Financial abuse Unusual or inappropriate bank transactions Recent change in property ownership Lack of easily affordable belongings or services Expression of sudden interest or affection from recent acquaintances Caregiver shows more interest towards finances Withholding money Person handling financial affairs is evasive or not cooperative Neglect Inadequate heating/lighting Poor physical condition Poor state of clothing Denial of medical care Malnutrition or weight loss Lack of personal hygiene No privacy No stimulation The data on prevalence and incidence of elderly abuse is not accurate across any population (Patterson & Malley-Morrison, 2006). According to literature, elder abuse is a hidden problem, not mentioned outside the family (McGarry & Simpson, 2008). Embarrassment, concern for privacy, fear of repercussions, physical frailty, and restricted means of communication contribute many cases going unreported (Patterson & Malley-Morrison, 2006; McGarry & Simpson, 2008). Globally, the prevalence of elderly abuse differs among and within nations, depending on the location (urban/rural), ethnicity, and health of the abused (Patterson & Malley-Morrison, 2006). Abuse takes place not only in families, but also at care centers and homes for elders. Elderly women are more likely to be victims of abuse, probably because of their longevity and reticence of men to report abuse (AEA 2004, O'Keefe et al., as cited in McGarry & Simpson, 2008). Research on perpetrators of elder abuse points to men, to people of both sexes working in collusion, and to employed female caregivers (AEA 2004, as cited in McGarry & Simpson, 2008). Risk factors for elder abuse Studies suggest that elder abuse occurs in all populations and that neither victim populations nor perpetrator populations are predictable (Kapp, 1995). However, researchers suggest some risk factors for elder abuse. Older women are targeted often (Pedric-Cornell & Gelles, 1982). Elders at homes or care centers with fewer contacts, cognitive impairment, or social isolation are more likely to be abused (AEA, 2004, cited in McGarry & Simpson, 2008). Abuse is more probable in cases where the caregiver depends on the elder socially and financially or where the elder depends on the caregivers (AEA 2004, cited in McGarry & Simpson, 2008). Caregivers with chemical or alcohol dependence, with mental health problems, who were victims of transgenerational violence, and who are completely dependent on the elders for financial support are more likely to become perpetrators of abuse (Kapp, 1995; McGarry & Simpson, 2008). Long-term caring for a dependent elder could lead to stress that could trigger abuse (Bennett & Kingston 1993, cited in McGarry & Simpson, 2008). A long-term relationship with the elderly person, especially where the elder formerly dominated the relationship, may cause the caregiver to retaliate through abuse (BGS, 2003, cited in McGarry & Simpson, 2008). In families where the elders are under legal guardianship of another member, the risk of financial abuse is more (Levesque, 2002, as cited in Patterson & Malley-Morrison, 2006). Changing cultural values, immigration, and shift to urban areas increase cases of neglect and abuse of elders (Patterson & Malley-Morrison, 2006). Other risk factors for elder abuse include severe mental or physical illness or financial constraints (Kapp, 1995). Coping mechanisms in abused elder population Chronic exposure to abuse among elders will affect their physical and psychological health. Comijs et al. (1999) studied the personality traits and coping capacities of abused elders and noted: Victims of verbal abuse showed less control over problem situations. They were aggressive when angered or frustrated. Physically abused elders use a passive or avoidant problem-solving approach. Financially abused elders showed negative belief in their self-efficacy and tendency to harm themselves. Very few victims use an active problem-solving approach towards the abusers. Withdrawing from the situation, breaking contact with the perpetrator, or inaction were the most common approaches. Comijs et al. (1999) suggested that peoples' problem-solving approach affects their vulnerability to elder abuse. Role of medical professionals and nurses Healthcare professionals including doctors and nurses are most likely to observe and recognize symptoms of elder abuse (Kapp, 1995). Earlier, healthcare professionals who observed symptoms of elder abuse in their patients could not take action out of concerns of client confidentiality. However, legislations today mandate reporting of elder abuse. Healthcare professionals are encouraged to identify, intervene, and report elder abuse and to preserve and provide evidence for future intervention (Kapp, 1995). There is a need to educate healthcare professionals on identifying, reporting, and managing elder abuse (McGarry & Simpson, 2007). In the UK, nurses are given guidelines to identify, prevent, and manage elder abuse (McGarry & Simpson, 2008). Training nurses in managing elder abuse could help in detecting elder abuse in early stages and in preventing future elder abuse, say McGarry and Simpson (2007), who have developed an education program for nurses. Conclusions Elders are a vulnerable to abuse across all populations. Abuse in elders is categorized as physical abuse, verbal abuse, financial abuse, and neglect. The exact prevalence and incidence of abuse is unknown as many cases go unreported. Many risk factors make elders vulnerable to abuse. Abused elders show different coping mechanisms. Their approach to tackling problems influences their vulnerability. Healthcare professionals can help in managing and preventing elder abuse by identifying, intervening, and reporting such cases. Training healthcare professionals, especially nurses, in managing elder abuse can help detect abuse in early stages and prevent future abuse. Reference List Action on Elder Abuse. (2004). Hidden Voices: Older People’s Experience of Abuse. London: AEA. Bennett, G., & Kingston, P. (1993) Elder Abuse: Concepts, Theories and Interventions. London: Chapman and Hall. British Geriatrics Society. (2003). Written Evidence Submitted for House of Commons Health Select Committee Inquiry into Elder Abuse. (Evidence 177). London: BGS. Comijs, H.C., Jonker, C., van Tilburg, W, & Smit, J.H. (1999). Hostility and coping capacity as risk factors of elder mistreatment. Soc Psychiatry Psychiatr Epidemiol, 34, 48–52. Kapp, M.B. (1995). Elder mistreatment: Legal interventions and policy uncertainties. Behavioral Sciences and the Law, 13, 365–380. Levesque, R. J. R. (2002). Culture and Family Violence: Fostering Change Through Human Rights Law. Washington, DC: American Psychological Association. McGarry, J., & Simpson, C. (2007). Nursing students and elder abuse: Developing a learning resource. Nursing Older People, 19(2). McGarry, J., & Simpson, C. (2008). Identifying, reporting and preventing elder abuse in the practice setting. Nursing Standard, 22(46), 49–55. O’Keeffe, M., Hills, A., Doyle, M, et al. (2007). UK Study of Abuse and Neglect of Older People. Prevalence Survey Report. London: National Centre for Social Research. Patterson, M., & Malley-Morrison, K. (2006). A cognitive-ecological approach to elder abuse in five cultures: Human rights and education. Educational Gerontology, 32, 73–82. Pedrick-Cornell, C. , & Gelles, R.J. (1982). Elder abuse: The status of current knowledge. Family Relations, 31, 457–465. Read More