Abuse Of Elderly And Disabled Persons PDF

Abuse of Elderly and Disabled Persons Family Violence University of Belize Outline + Defining Elder Abuse + Types of specific abuses + Prevalence of elder abuse + Consequences of Elder Abuse + Explaining elder abuse + Practice policy and prevention + Abuse of disabled...

Abuse of Elderly and Disabled Persons Family Violence University of Belize Outline + Defining Elder Abuse + Types of specific abuses + Prevalence of elder abuse + Consequences of Elder Abuse + Explaining elder abuse + Practice policy and prevention + Abuse of disabled persons  CASE HISTORY Jenny and Jeff Jr.–Dwindling Assets, Dwindling Devotion + Several years after my husband’s death, my mother-in-law, Jenny, who was 91, became unable to care for herself. She went to live with my brother-inlaw, Jeff Jr., and his wife, Marianne. Although my own aging mother was dying, I took time to visit Jenny, who had always been a loving mother-inlaw. + Over the next year, Jeff Jr. became Jenny’s guardian, and she made out a new will giving one-third of her estate to each of us—myself, Jeff Jr., and Marianne. I didn’t understand this sudden change from the previous division of half for each son, but I said nothing; after all, I was a widowed daughter-in-law. As Jenny continued to deteriorate, I asked Jeff Jr. if he was planning to put Jenny in a retirement home where she would receive around-the-clock care. He said he couldn’t afford to place her in a home and that he and Marianne would care for her at home. I was amazed. Jeff Jr. had sold Jenny’s home for a probable yield of $150,000 in cash. Jeff Jr. and Marianne owned a mini-estate as well as stocks and bonds; they were probably worth $2 million. + I was puzzled by what was going on with Jenny and Jeff Jr., but then I became seriously concerned when I heard a number of rumors from Jenny’s other relatives and friends. They said that Jeff Jr. and Marianne had offered financial advice to several aging relatives. Each had changed his or her will to name Jeff Jr. and Marianne the beneficiaries, and each had died shortly thereafter of neglect and malnutrition. + Over the next few months, I became alarmed when Jenny “refused to come to the phone” to speak to me. Marianne told me that “Jenny couldn’t walk far enough to get to the phone.” After 2 weeks, I drove several hours to visit her. I was appalled when I arrived. There was Jenny, sitting alone in a hot room that smelled like urine. She would not speak to me. She was in the maid’s quarters, with no television and no phone. She was dirty and unkempt. There were no diapers in the room, the small refrigerator held only a piece of moldy bologna, and Jenny had not taken her medications. Later, when I expressed my concern to Jeff Jr., he said that he was going to hire a couple to come in and take care of her. I left feeling some sense of relief that Jenny’s ordeal would soon be over. + A week later, I received a call from the caretaker couple. Frightened by Jenny’s condition when they arrived to care for her, they had called the paramedics, who took Jenny to the hospital, and then they called me. Doctors diagnosed Jenny’s condition as malnutrition, dehydration, and “neglect.” The caretakers said that Jeff Jr. and Marianne had gone on a vacation, leaving no money for food or diapers, no instructions, no telephone numbers or itinerary—not even any information about when they would return. Finally, I felt compelled to call the county adult protective services (APS) agency. Someone there promised to visit the premises and did so. I also called some other relatives, who started making unscheduled visits to see Jenny. + Jeff Jr. and Marianne continue to take unexpected vacations to visit other aging relatives who may “need financial management services in the near future.” I fear that Jeff Jr. and Marianne hope to come home someday to find that Jenny has simply “passed away in her sleep.” I am constantly uneasy about Jenny’s situation. I frequently call APS to see if they can do something more, and I keep “popping in” to check up on Jenny when Jeff Jr. and Marianne are away from home. + Jenny, by all accounts, is doing better now. She is clean and has food in the refrigerator. The caretakers drop in every day briefly and bring in food and diapers on their own. Jenny is still alone most of the time, and she seems too frightened to say much. As Jenny’s life is slowly ending, I feel that my life is “on hold.” I wish I knew for sure  Defining Elder Abuse +American Psychological Association definition + “Elder abuse is the infliction of physical, emotional, or psychological harm on an older adult. Elder abuse can take the form of financial exploitation or intentional or unintentional neglect of an older adult by the caregiver”  Examples of Specific Abuses +Emotional/psychological abuses. + Examples include verbal assaults, insults, threats, intimidation, humiliation, and harassment. + Other examples are treating an elder person like an infant; isolating the person from his or her family, friends, or regular activities; giving the person the silent treatment; and enforced social isolation (National Center on Elder Abuse, 2007). + It should be noted that emotional abuse is not illegal.  +Physical abuses. +Some examples of physical abuses are striking a Examples of person with or without an object, hitting, beating, Specific Abuses pushing, shoving, shaking, slapping, kicking, pinching, and burning. +Other examples include inappropriate use of drugs, physical restraints, force- feeding, and physical punishment  Examples of Specific Abuses +Financial abuse. + Financial abuse of elders consists of a number of behaviors: + (a) abuse of a durable power of attorney, bank account, or guardianship; + (b) failing to compensate transfers of real estate; + (c) charging excessive amounts for goods and services delivered to an elder; + (d) using undue influence to gain control of an elder’s money or property; + (e) confiscating pension or Social Security checks; + (f) denying medical care to avoid paying the cost of care; and + (g) refusing to repay loans Examples of Specific Abuses +Sexual abuse. + Direct forms of sexual abuse of elders encompass intercourse, molestation, sexualized kissing, oral/genital contact, and digital penetration. + Indirect forms of sexual abuse include unwanted sexual discussions, exhibitionism, and exposed masturbation (Ramsey-Klawsnik et al., 2007). + Experts typify rape as a crime of violence rather than a crime of sexual passion.  Examples of Specific Abuses + Internet pornography. + A surprising newer type of sexual abuse has come to light in the form of pornographic websites that display older victims. + These sites offer still photographs of elderly women posed in every conceivable sexual activity. + Viewers can also play short video clips of elderly women engaged in sexual activities. + These media materials are classified as pornography, but laws regarding the use of older women hinge on the adults’ ability to consent. + Police officers who are specially trained in child and elder sexual abuse investigate these cases  Examples of Specific Abuses + Neglect. + Examples of neglect include failure to provide an elderly person with food, water, clothing, shelter, personal hygiene, medicine, comfort, and personal safety (National Center on Elder Abuse, 2007). + Self-Neglect. + Examples of self-neglect include failure of an elder to provide food, water, clothing, shelter, personal hygiene, and medication for himself. + Self-neglect can also be defined as behavior of an elderly person that threatens his life or safety. + Self-neglect behaviors exclude those of a mentally competent adult who understands the consequences of his actions  Examples of Specific Abuses + Abandonment. + Examples of abandonment include putting an elder demented person on a bus to another state or dropping an elder off at the hospital with no identification (i.e., granny dumping). + Hospitals concerned with expenses have dumped persons who are seriously mentally ill, elderly and homeless, veterans with PTSD, and the disabled onto the streets  Examples of Specific Abuses Violation of human rights. Examples When a caregiver withholds an elder victim’s mail. Removing all the doors from the elder’s room to deprive her of privacy Interfering with the elder’s religious observances. Ignoring the elder person’s preferences in his selection of friends  Examples of Specific Abuses +Scams by strangers. + Although not a form of family violence, caregivers of the elderly may have to respond to a scam of an elder by a stranger. + Some scams by strangers include + (a) valueless winnings that elder must pay to collect; + (b) fraudulent investment schemes; + (c) requiring cash deposits for repairs; + (d) predatory lending; and + (e) lottery scams  Attitudes Toward Abuse of Elderly Persons Negative attitudes toward elders involve the concept of postmaturity, the idea that elders are living too long. Ageism – prejudice or discrimination on the grounds of a person's age age biases cast elders in the role of second-class citizens. three types of ageism: (a) personal - (one’s own beliefs) (b) institutional (e.g., mandatory retirement age) (c) unintentional (unaware practices).  Attitudes Toward Abuse of Elderly Persons Media stereotyping. The media show great bias in depicting elderly people. Entertainment media includes relatively few depictions of elders who lead rewarding lives They portray supportive character to children and grandchildren. Alternatively, media may portray them as cranky and laughable  Attitudes Toward Abuse of Elderly Persons +Criminalization of elder abuse. + In the United States, adult children are not legally required to help elderly parents in need + it is difficult to know whom society should hold accountable for elder care (or neglect)  PREVALENCE OF ELDER/ADULT ABUSE The incidence of physical abuse declines with age Problems in obtaining accurate prevalence estimates of elder abuse Definitional ambiguity hinders assessment the mutuality of abuse complicates definitions and hence counting it is not always clear who is the victim and who is the perpetrator e.g. Elders may strike out at their caregivers when prevented from going outside alone the cognitive decline of many elders may prevent them from reporting their abuse or prevent others from believing them PREVALENCE OF Disclosure reluctance Elders are often unaware they are being abused as legally ELDER/ADULT defined Elder abuse victims are notoriously unwilling to disclose their abuse ABUSE Failure-to-disclose rates may be as high as 50%. Disclosure rates are so low that obtained data must represent underreporting Elements of reluctance to report  Types of Injuries and Estimates Primary injuries : PREVALENCE 1st contusion/abrasion 2nd laceration OF 3rd fracture Primary sources of injury were assaults as ELDER/ADULT follows: ABUSE 1st by body part (hit or kicked, etc) 2nd blunt object 3rd pushed 4th undetermined Perpetrators were most likely to be family members or acquaintances.  Significantly more chronic pain, depression, and high blood pressure than non-abused persons. Duties in a suspected case of elder abuse (Elder protective services) CONSEQUENCES OF ELDER ABUSE Determine whether the information available is sufficient to warrant an investigation Substantiate whether abuse/neglect actually occurred Assess the elder’s decision-making capacity about his or her care Evaluate what services are needed to sustain the elder Characteristics of Abused Elders Age An elder is defined as person 60 or 65 years of age or older Elders 80 years or older are targets of abuse and neglect significantly more often than others. Gender Crimes reported by victim or gender  Characteristics of Abused Elders +Characteristics of Elder Abusers +Age: under the age of 60 +Gender: Most abusers of elders 60+ years were female +Relationship to victim: + family members are the primary perpetrators of elder abuse + Type of Abuse by Perpetrators’ Relationship to Victim State survey Victim self reports EXPLAINING ABUSE OF ELDERLY PERSONS +Correlates of elder abuse  EXPLAINING ABUSE OF ELDERLY PERSONS +Social Learning Theory +Children exposed to violence are likely to grow up to adopt proabuse norms that eventually contribute to their abusing their own parents or grandparents +The learning connection may be a retaliatory response for past abuse—You hurt me then; now I’ll hurt you  EXPLAINING ABUSE OF ELDERLY PERSONS +Social Exchange Theory + Assumes that “social interactions involve the exchange of rewards and punishments between people and that people seek to maximize rewards and minimize punishments in these exchanges” + elders have little to offer in the way of rewards, so interacting with them is costly and rarely “pays off.” + The high costs of assuming responsibility for elder care, in combination with the few tangible rewards, can result in abuse. EXPLAINING ABUSE OF ELDERLY PERSONS + Stress and Dependency Theories + The burden of caregiving + Correlational link between some burdensome caregiver tasks and measures of caregiver stress + Sandwich generation” - the burden of middle-aged adults who must care for their own children while concurrently caring for aging parents + Strain on the adult sibling designated as the caretaker by other siblings. + Elder caregiving becomes the individual responsibility of one child, not the whole family + Dependency of abused elders + Elder dependency is a strong predisposing factor for abuse + Alzheimer’s-impaired elders were at greater risk for abuse than elders without the disease + Caregiver stress is a risk factor for emotional and financial mistreatment + This model is not well supported because it blames victims for the abusive behavior of others  EXPLAINING ABUSE OF ELDERLY PERSONS Abuse by the Severely Mentally Ill (SMI) Most abusers are not mentally ill The total amount of violence perpetrated by those who are SMI is actually very small media attention has led to a common but false belief that the frequency of such cases is very high Criminality of elder abusers. Elder abusers have high rates of criminality Adult children who are abusive can be considered predatory offspring. Because of their children’s criminality, drug/alcohol problems, personality disorders, or mental illness, elders sometimes report their victimization with the hope of getting services for their children  PRACTICE, POLICY, AND PREVENTION ISSUES Practitioners working with elderly people are often unable to detect abuse and neglect Practitioner training: Service providers said they would like more training Elder abuse investigator training: Failing to validate cases of real abuse leaves victims vulnerable to ongoing or even escalating abuse. Guardianship dilemmas. Geriatric social workers need knowledge about guardianship statutes specifically a basic understanding of the decision-making process undertaken to determine the need for a guardianship appointment. PRACTICE, POLICY, AND PREVENTION ISSUES +Risk factors for elder abuse +Practitioners need greater understanding of the precursors of elder abuse to protect potential victims more readily. +Victim and Perpetrator Risk Factor PRACTICE, POLICY, AND PREVENTION ISSUES Treatment of Enrolling elder abusers in batterer counseling groups has been ineffective The counseling needs of elder abusers seem not to parallel those of elder abusers younger batterers. (a) an order of protection to remove the abuser from the residence Legal needs (b) guardianship of the elder and/or his or her estate; (c) a representative payeeship to safeguard certain types of the elder’s of elders. income, such as social security; (d) protection against involuntary commitment to a mental health care facility PRACTICE, POLICY, AND PREVENTION ISSUES + Standard of care owed to a principal by an agent in a power of attorney arrangement: + (a) to act in the best interests of the principal + (b) to keep the principal’s property separate from the property of the agent + (c) to keep records of the agent’s transactions on behalf of the principal + (d) to make records and a copy of the power of attorney available upon the request of key individuals, + (e) to avoid conflicts of interest  PRACTICE, POLICY, AND PREVENTION ISSUES Legal Issues Some topics under discussion include denying sex offenders residency and sex offender employment in nursing homes and placing undercover patients in homes to identify abuse Experts have added new types of abuse or new definitions (a) abduction—removing a vulnerable adult from the state or preventing his return to the state (b) abandonment—a caregiver’s desertion at a time when a reasonable person would continue providing care, (c) isolation—false imprisonment or preventing the elder from communicating with the outside world PRACTICE, POLICY, AND PREVENTION ISSUES Medical Responses The responsibility of responding to elder mistreatment has fallen heavily upon healthcare professionals because elderly individuals are very likely to visit healthcare facilities Medical screening: medical experts in nearly every field should participate in screening elders suspected of being victims of elder abuse.  PRACTICE, POLICY, AND PREVENTION ISSUES Documenting abuse. In addition to using screening questions, nurses can check an elder’s body for physical signs of abuse or inadequate care and conduct a psychological assessment. Nurses and other medical personnel should photograph and document any evidence of elder abuse PRACTICE, POLICY, AND PREVENTION ISSUES +Possible physical signs of abuse. +“red flags” ABUSE OF DISABLED PERSONS  ABUSE OF DISABLED PERSONS Forms of disability include developmental disability (e.g., cerebral palsy) traumatic brain injury major mental disorders degenerative brain diseases (e.g., Parkinson’s) and organic brain damage (e.g. dementia) Stigmatization render handicapped people invisible  Disability is defined as sensory, physical, mental, or emotional conditions, lasting six months or more, that make it difficult to perform activities of daily living, such as walking, climbing stairs, dressing, bathing, learning, or remembering. Defining Types of abuse against the disabled Disability terrorizing behaviors, severe rejection, isolation, ignoring behaviors, and use of physical and medical restraints withholding services that the disabled person cannot perform unaided, such as toileting, bathing, and feeding. withhold food and water. unplug an assistive device or place a walker just out of reach utilization of targeted behaviors like moving furniture around in the house so that a blind person will stumble and fall.  Attitudes toward disabled women reflect negative stereotyping: Attitudes Disabled mothers cannot perform satisfactorily as mothers. Toward Disabled women are either asexual or promiscuous. Disabled Disabled women cannot discuss serious matters. Persons Placing disabled women in the position of deprivation allows others to have control over them Estimates of Abuse of Disabled Persons + Cases are underreported even though disabled people are more likely to be abused than nondisabled people because + the nature of this population’s handicaps (e.g., deafness, speech impairments) + Failure of a large proportion of disabled persons to recognize abuse + abuse has been such a routine aspect of their living condition that it seems normal.  Estimates of Abuse of Disabled Persons Research findings Estimates of abuse of disabled. Disabled women suffer more abuse than nondisabled Adults who are both mentally ill and have a substance women and disabled men. abuse disorder are more likely to be victimized by physical abuse and IPV than those without a disability Nondisabled women experience abuse almost exclusively from their male partners. Homeless and seriously mentally ill women experience a victimization rate of 97% Disabled women who experience multiple forms of abuse are older than nondisabled women. Studies of male IPV against women with severe psychiatric disorders (e.g., schizophrenia) have rates varying from 21% to 75%. Disabled abused women are less educated, less employed, and less likely to be in a relationship than Disabled women suffer an average of 3.9 years of nondisabled women. physical and sexual abuse before escaping compared with 2.5 years for nondisabled women Disabled women suffering multiple forms of abuse are less employed than disabled men.  The handicapped individuals’ constitutionally guaranteed sexual rights by curtailing their sexual activities is often overlooked. Sexual Assault Sexual assault/sexual coercion are very common in this population of Disabled Persons Abusers frequently use deception to gain sexual access to disabled women Perpetrators of Abuse of Disabled Persons +Offenders of disabled persons are relatively extensive because of additional caregivers +Relationships between Abuser of Disabled Persons and Their Abusers  Characteristics of Disabled Victims and Their Abusers Women who are disabled suffer from a multitude of disabilities The male partners of abused women often use alcohol or drugs at the time of the abuse Police do not respond to calls from disabled women as often as non-disabled women Sexually assaulted women do not as readily turn to rape crisis centers after an assault as nondisabled women do. There is a strong sense of isolation among deaf sexual assault victims due to impediments of deafness  Practice, Policy, and Prevention + Interventions and policy initiatives to improve the quality of life of persons with disabilities + Psychologists and other professionals need to be aware of their own prejudices against disabled people (Behnke, 2009). + Provide electronic memory aids that can be programmed for disabled persons (e.g., doctor’s appointments) (Cohen-Mansfield et al., 2005). + Develop learning DVDs with input from disabled persons (Boyden, Esscopri, Ogi, Brennan, & Kalsy-Lillico, 2009). + Be aware that 32.3% of family-based disabled adults need financial support; 40% of these live in a household where the primary income earner is 60+ years of age (Fujiura, 2010). + Provide transitional services for young disabled persons going to college (Kirkendall, Doueck, & Saladino, 2009). + Foster independence through health-promoting activities in readiness for the Special Olympics (Mackey, Lynnes, Nichols, & Temple, 2009). References +Family Violence Across the Lifespan – Chapter 12