Considering the growing number of elder population in the world, and more specifically in the US, the reality of elder abuse or mistreatment has increasingly become a cause of concern specially for the health sector. Political and social forums have lent a stage for policy debates related to elder abuse. Though statistics show that elder abuse is common in many households and health care facilities, it is still considered as an underreported type of family violence.
The International Network for the Prevention of Elder Abuse and the World Health Organization define elder abuse as “a single or repeated act, or lack of appropriate action occurring within a relationship where there is an expectation of trust which causes harm or distress to an older person” (as cited by Perel-Levin, 2005). Abuse of elderly people occurs in several ways, and often the types of abuse overlap with one another. The five commonly identified categories of elder abuse are physical abuse, psychological or emotional abuse, financial or material abuse, sexual abuse and neglect.
(Bergeron, 2005; Dyer and Rowe, 1999; Kingston & Penhale, 1995; Perel-Levin, 2005). Elder abuse is a violation of human rights Perel-Levin (2005) and it constitutes potentially serious health and social problems (Kingston & Penhale, 1995). Perel-Levin (2005) assert that because of the speed of population ageing worldwide, elder abuse will also increase unless interventions are done to address it. A study made by the National Center for Elder revealed that 1996 saw more than 500,000 victims of elder abuse in America and that the great majority (84%) were not reported.
This implies that there are several millions of elder abuse victims who continue to suffer in silence and without due recourse or help from authorities (NCEA, 1996). In the UK, at least half a million older persons are abused each year, yet it is believed that most such abuse remains unreported because its victims are too frightened, ashamed or embarrassed to come forward (Department of Health, 2007; as cited in Cronin, 2007). Health professionals as well as researchers agree that elder abuse and neglect often take place in the context of illness and caretaking issues (Bergeron, 2005).
It is ironic because these facilities should instead safeguard the welfare and well-being of patients and wards instead of condoning abuse and neglect or turning a blind eye. It is commonly believed that the risk factors for elder abuse are present caretaking facilities that are tasked to safeguard the welfare of the elders. These settings include home health care, mental health clinics, emergency departments, and acute settings, as well as in long-term institutional care (Bergeron, 2005).
These contentions support the critical argument of this paper that the reality of elder abuse and its still blurred status in institutional policy orientations augurs many pejoratives and adverse implications for older adults particularly those residing in nursing facilities. A victim of elder abuse would most likely suffer from worsening health condition which could very well adversely affect his social relationships, mental health and life endeavours. Trends Various sectors of the society have taken the cudgel to win the battle against elder abuse, mistreatment and neglect.
Heading the cry for eradication of the problem is the National Center on Elder Abuse (NCEA) which is under the auspices of the US Administration for Aging. It is working closely with many other advocates. NCEA is composed of a consortium of professionals and experts from various disciplines, most of them being researchers, practitioners and educators (NCEA website). Addressing the elder abuse dilemma has also been pacing up at the World Health Organization and has commissioned researches to gather information about the problem for it to come up with working solutions and interventions on a global scale.
The mandate of the NCEA gives an overview of the efforts of practitioners and advocates to solve the problem on elder abuse and to promote the dignity of elder persons. Elder abuse is studied and dissected in many aspects focusing on 1) causes and risk factors, 2) prevalence and incidence of elder abuse in various contexts (e. g. , the home and health care facilities), 3) clinical screening and abuse identification, 4) evaluation of risk assessment tools and elder abuse instruments, and 5) prevention and treatment protocols with emphasis on evidence-based practice, among others (NCEA website).
In a research partly sponsored by the Commission on Behavioral and Social Sciences and Education and the National Research Council and Institute of Medicine, it is asserted that family violence which includes child abuse, partnership violence and elder mistreatment has become a “major social, health and law enforcement issue” as it continues to impact on policy directions as well as strain the capability of law enforcement agencies, judicial bodies, social service agencies, and health care centers (Chalk & King, 1998).
Elder abuse and neglect issues have been taken in political agenda. In a remarkable eye-opening testimony by Catherine Hawes (Professor and Director of the Southwest Rural Health Research Center at the School of Rural Public Health, Texas A&M University System Health Science Center), she confirmed to the US Senate that indeed elder abuse is a sad reality in residential long-term care settings.
The gist of her testimony contends that patients in such residential facilities are very vulnerable to mistreatment and abuse, that the problem elder abuse and neglect are caused by “low staffing levels and inadequate staff training”, that evidence suggests to the effectiveness of existing guidelines and practices to minimize the problem in residential facilities, and that the elder abuse problem in such settings have not been given the right attention (Hawes, 2002). Elder abuse and neglect has also become a critical issue in the fields of criminology and law enforcement.
The number of elder abuse related studies in the field of criminal justice have escalated. A project conducted by the American Bar Association Commission on Law and Aging, with the assistance of the University of California , Irvine School of Medicine by virtue of a grant made by the National Institute of Justice, highlights several recommendations relating to medical forensic issues on elder abuse were presented and which may be used as a guide in research and policy endeavors of other practitioners.
In another research, Blake & Dolon (2006) gives a comprehensive and methodical approach to the abuse and neglect issue that will be of great use to the criminal justice system and the social services sector, among others. Practical examples and situations are given to illustrate their concepts and to describe proposed interventions in the legal context (e. g. , establishment of guardianship), for the health sector (e. g. , diagnosis and treatment), and in the social services sector (e. g. , home care or counselling). Forensic studies also provide guidance in conducting research-based forensic interviews.
One such study is that Cooper and King (2006), which set up clear interview guidelines in aid of forensic investigation of an offender who committed sexual assault against an elderly. An evaluation of the criminal justice response to elder abuse in nursing homes was conducted by Payne & Gainey (2006). Analyzing 801 cases of elder abuse in nursing homes revealed that physical assault is the most common form of abuse and that work stress contributes to elder abuse incidence. The researchers suggest that preventative measures should be implemented forthwith in nursing homes. Implications
The health and medical sciences as well as occupational science are linked together because they focus on the health and well-being of human beings. Implications of elder abuse to the health sector come from different perspectives, but the essence of occupational science and justice are mostly integrated in these perspectives. For health care providers, they are not only in an ideal position to engage in early identification, support and referral of persons experiencing elder abuse but should also recognize and accept it as their responsibility to address the risks of elder abuse (Kingston & Penhale, 1995).
However, Fulmer, et al (2004) say that the health care sector experience difficulty fulfilling these roles. Citing several studies, it was asserted that elder abuse treatment attitudes among nurses with older patients tend to be negative (McLafferty & Morrison, 2004) and that ignorance in hospitals of the problem of elder abuse is characteristic of the situation in general (Cohen, et al, 2006). Richardson, et al; (2002) found that at baseline, staff often do not recognize, record and report abuse.
Still, Nahmiash and Reis (2000) found in their study that the most accepted and successful strategies for abused older adults are concrete: nursing and other medical care and homemaking assistance, thus health professionals, especially nurses, are likely to be among those accepted by abused adults. Accident and emergency departments are often the first point of contact for an abused older person (Dyer & Rowe, 1999).
Notwithstanding the problems in recognising abuse and the complexities of dealing with older people, emergency nurses need not prove or disprove it is present; it is their responsibility though to act if they suspect it (Cronin, 2007) and they should not be afraid to seek help if they are suspicious of abuse, lest they fall short of their responsibility. (Dyer and Rowe, 1999). For the occupational therapist, an acute understanding of elder abuse and its symptoms could help him screen and identify elder abuse, refer incidence to authorities or to enhance therapeutic protocols to restore health and well-being of an abused elder.
Knowledge of the experiences of an elderly patient will give the practitioner valuable insights on the patient’s physical state and mental condition and which will help the patient-therapist partnership in designing and implementing therapeutic programs. Conclusion The sad reality of elder abuse stares us into the face and we can’t help but stare back in terror and fear. The face of an old person with beaten black and blue or a disposition that showed the heartbreaking misery of being attacked or robbed by one’s own family are indeed not only poignant pictures but terrifying as well.
Imagine millions of faces like these. It would be a terrible world to live in. As already underscored earlier, elder abuse is underreported. Even as statistics show that millions of abuse cases have been reported, there are millions more who are hidden and kept secret. The reported statistics is just the tip of the iceberg. As also discussed, elder abuse is committed in residential facilities by no less than the health professionals who are supposed to be the protectors of their health and well-being. This is a cause of panic. This is an issue that should not escape the judicious eyes and ears of law and government.
Occupational science could contribute so much in policy-making as well as designing protocols to prevent or treat elder abuse. References Bergeron, L. R. (2005). Elder abuse: Clinical assessment and obligation to report. In K. A. Kendall-Tackett (Ed. ), Health consequences of abuse in the family: A clinical guide for evidence based practice.. Washington DC: American Psychological Association. pp. 109-128. Blakely, B. & Dolon, R. (2006). Elder mistreatment (from Crisis Intervention in Criminal Justice/Social Service). Springfield, IL: Charles C. Thomas Publisher Ltd. Chalk, R. and King, PA, eds. (1998).
Violence in families: Assessing prevention and treatment programs.. Washington, DC: National Academy Press. Cohen, M. , et al. (2006). Risk of abuse by their caregivers: development of a screening tool for identifying elderly people at risk of abuse by their caregivers. The Journal of Aging and Health. Retrieved Sept 25 2008 from ttp://jah. sagepub. com/cgi/content/abstract/18/5/660 Cronin, G. (2007). Elder abuse: the same old story? Emergency Nurse. Vol 15, No 3 June 2007. Dyer, C. & Rowe, J. 1999. Elder abuse. Trauma 1999; 1: 163-169 Arnold Publishers Fulmer, T. (2004). Progress in elder abuse screening and assessment instruments.
Journal of the American Geriatrics Society. Vol 52, No 2. Retrieved January 10, 2009 from http://www. hartfordign. org/publications/trythis/issue15. pdf. Fulmer, T. , Paveza, G. , Abraham, I. , & Fairchild, S. (2000). Elder neglect assessment in the emergency department. Journal of Emergency Nursing, 26, 436-443. Hawes, Catherine. (2002). Elder abuse in residential long-term care facilities: What is known about prevalence, causes, and prevention. Testimony before the U. S. Senate Committee on Finance, June 18, 2002. Retrieved April 13, 2009 from http://finance. senate. gov/hearings/testimony/061802chtest. pdf.
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