A Qualitative Examination of the Similarities and Differences of Elder Abuse Definitions Among Four Groups: Nursing Home Directors,Nursing Home Employees,Police Chiefs and Students

ABSTRACT

A common claim found in the elder abuse literature is that different groups offer varying definitions of elder abuse. Very little research, however, has examined what these differences are and how the differences are manifested in various settings. To fill this void, this research examines the definitions of elder abuse provided by respondents from four groups in the Commonwealth of Virginia: nursing home directors (n = 54), nursing home employees (n = 132), police chiefs (n = 64), and students enrolled in upper-level sociology and criminal justice courses (n = 127). Results of standard thematic content analysis examining the elder abuse definitions show significant differences in several areas. Primarily, nursing home directors are more likely to define elder abuse from an ethical perspective whereas police chiefs and students are more likely to define elder abuse from a legalistic perspective. Implications are provided.     

Elder Abuse and Oral Health Care Providers: An Intervention to Increase Knowledge and Self-Perceived Likelihood to Report

The objective of this study was to ascertain whether a symposium on elder abuse raises the level of knowledge and the self-reported likelihood to report elder abuse among licensed oral health care providers. 130 dentists, hygienists, and assistants voluntarily attended a 4-hour training symposium and completed both pre- and postsurveys testing their level of knowledge. Results by statistical analyses, using repeated measurements, Wilcoxon signed-rank test for nonparametric data, showed increases in awareness of reporting process, knowledge/awareness of elder abuse, knowledge of mandated reporter requirements, and comfort levels with recognizing signs and symptoms of elder abuse and neglect. In conclusion, a symposium can increase the self-reported likelihood of reporting elder abuse.     

Elder abuse and oral health care providers: an intervention to increase knowledge and self-perceived likelihood to report

The objective of this study was to ascertain whether a symposium on elder abuse raises the level of knowledge and the self-reported likelihood to report elder abuse among licensed oral health care providers. 130 dentists, hygienists, and assistants voluntarily attended a 4-hour training symposium and completed both pre- and postsurveys testing their level of knowledge. Results by statistical analyses, using repeated measurements, Wilcoxon signed-rank test for nonparametric data, showed increases in awareness of reporting process, knowledge/awareness of elder abuse, knowledge of mandated reporter requirements, and comfort levels with recognizing signs and symptoms of elder abuse and neglect. In conclusion, a symposium can increase the self-reported likelihood of reporting elder abuse.     

Elder Abuse in Chinese Populations: A Global Review

This review focuses on the epidemiology of elder abuse in the global Chinese population with respect to its prevalence, risk factors, and consequences, as well as the perceptions of elder abuse. Evidence revealed that elder abuse and its subtypes are common among the global Chinese population with prevalence ranging from 0.2% to 64%. Younger age, lower income levels, depression, cognitive impairment, and lack of social support were consistently associated with self-reported elder abuse. Caregiver burden was a constant risk factor for the proclivity to elder abuse by caregivers. The adverse health outcomes of elder abuse included suicidal ideation and psychological stress. Some primary research gaps exist: such as, lack of consistency in measurements and recall periods, insufficient studies on the causal relationships between potential risk factors and elder abuse, consequences of elder abuse, and possible interventions. In order to reduce the risk of elder abuse in the global Chinese population, collaboration is encouraged among researchers, health care professionals, social service providers, and policy makers.     

Readability and content of elder abuse instruments

Since elder abuse was first acknowledged as a health care and social problem, incidence and prevalence of mistreatment has been assessed sparingly in the United States and other countries around the world. Standardized instruments for determining the prevalence of elder abuse have not been developed and other instruments measuring a person's function and spousal violence have been adapted for the measurement of elder abuse prevalence. The purposes of this paper are to (1) ascertain the reading grade level of the most frequently used elder abuse prevalence instrument's text and (2) determine the content validity of the instruments with respect to the types of elder abuse included in them. A review of the instruments used to measure elder abuse prevalence was completed and a questionnaire was developed to measure the reading grade level and type of elder abuse content in four instruments. The Fry Readability, Flesch Reading Ease, and McLaughlin Grading formulas were used to determine reading grade level. A questionnaire regarding content validity was sent to 69 faculty and staff in one university department and a 59% return was achieved. The Conflict Tactics Scale and the Hwalek-Sengstock Elder Abuse-Screening Test had the lowest mean score at the 6th grade reading level. Results of content analysis for types of elder abuse demonstrated none of the instruments are comprehensive. Instruments to measure the prevalence are needed which balance readability and content validity.     

Experience of elder abuse among older Korean immigrants

ABSTRACT

Studies on the scope and nature of Asian American elder abuse conducted with older immigrants are extremely limited. The overall purpose of this study was to examine the extent and type of elder abuse among older Korean immigrants, and to investigate critical predictors of elder abuse in this population. The sample consisted of 200 older Korean immigrants aged 60 to 90 years who resided in Los Angeles County in 2008. One of the key findings indicated that 58.3% of respondents experienced one or more types of elder abuse. Logistic regression indicated that the victims’ health status and educational level were statistically significant predictors of the likelihood of experiencing abuse. The present study, although limited in sample size, measures, sampling methods, and population representation, has contributed to this important area of knowledge. It is recommended that future studies conduct research on elder abuse with more representative national samples that can measure the extent of abuse and neglect more accurately.     

Five-year all-cause mortality rates across five categories of substantiated elder abuse occurring in the community

ABSTRACT

Elder abuse increases the likelihood of early mortality, but little is known regarding which types of abuse may be resulting in the greatest mortality risk. This study included N = 1,670 cases of substantiated elder abuse and estimated the 5-year all-cause mortality for five types of elder abuse (caregiver neglect, physical abuse, emotional abuse, financial exploitation, and polyvictimization). Statistically significant differences in 5-year mortality risks were found between abuse types and across gender. Caregiver neglect and financial exploitation had the lowest survival rates, underscoring the value of considering the long-term consequences associated with different forms of abuse. Likewise, mortality differences between genders and abuse types indicate the need to consider this interaction in elder abuse case investigations and responses. Further mortality studies are needed in this population to better understand these patterns and implications for public health and clinical management of community-dwelling elder abuse victims.     

The prevalence and nature of child sexual abuse: evidence from a female university sample in the UK

It is well established that child sexual abuse is a considerable international problem, yet evidence regarding its prevalence in the United Kingdom is extremely sparse, with the most comprehensive study conducted over a decade ago. The aim of this study is to establish a current estimate of the prevalence and nature of child sexual abuse in the United Kingdom, using a sample of female university students. Of the 213 female undergraduate students who completed questionnaires, 28 were sexually abused, giving a prevalence rate of 13.14%. Information was also obtained regarding the nature of the abuse. These results show that a substantial proportion of female students in the United Kingdom, who appear to be coping with tertiary education, have been sexually abused in childhood. The implications regarding the benefits of prevalence rates to health practitioners are discussed. Copyright © 2001 John Wiley & Sons, Ltd.     

The effect of a family-based intervention with a cognitive-behavioral approach on elder abuse

ABSTRACT

Elder abuse may become a health issue in developing countries, including Iran. The purpose of this investigation was to study the effectiveness of Family-Based Cognitive-Behavioral Social Work (FBCBSW) in reducing elder abuse. In a randomized clinical trial in Iran, 27 elders participated in intervention and control groups. The intervention groups received a five-session FBCBSW intervention and completed the Domestic-Elder-Abuse-Questionnaire (DEAQ), which evaluates elder abuse at baseline and follow-ups. Repeated measures of analysis of variance (ANOVA) and the Wilcoxon test were used to analyze the data. The repeated measures ANOVA revealed that FBCBSW was successful in reducing elder abuse. The Wilcoxon test indicated that emotional neglect, care neglect, financial neglect, curtailment of personal autonomy, psychological abuse, and financial abuse significantly decreased over time, but there was no statistically significant difference in physical abuse before and after the intervention. The findings from this study suggest that FBCBSW is a promising approach to reducing elder abuse and warrants further study with larger samples.     

Elder abuse coverage in newspapers: regional differences and its comparison to child-abuse coverage

Dozens of studies have examined how the press portrays crime. Most of these studies focus on some aspect of the criminal or the response to the event. Few have considered the portrayal of victims and even fewer have examined the way the media portrays older victims. To fill this void, this study examines (1) whether elder abuse coverage varies across newspapers and (2) how the extent of elder abuse coverage compares to child-abuse coverage. Results indicate that regional differences appear to exist and child abuse receives far more coverage than elder abuse. Implications are provided.     

A comment on Wong and Waite, “Elder mistreatment predicts later physical and psychological health: Results from a national longitudinal study,” JEAN Issue 29(1), pp. 15–42

Wong and Waite present a longitudinal study of elder abuse and its effects. However, they contend that their data do not support the protective effects of social support, a finding in contrast with virtually all existing research on the topic. Closer inspection of their variables indicates that they misclassify elder abuse insofar as their results are actually in terms of only one type of elder abuse, psychological abuse, ignoring physical and sexual abuse. They also define “elder abuse” using only one question: “Is there anyone who insults you or puts you down?” Finally, they measure social support with the single item: “if they generally feel they can open up to, and rely on, these significant others.” It is not, therefore, surprising that they observed that social support was not protective considering health outcomes.     

Elder Abuse Coverage in Newspapers: Regional Differences and its Comparison to Child-Abuse Coverage

ABSTRACT

Dozens of studies have examined how the press portrays crime. Most of these studies focus on some aspect of the criminal or the response to the event. Few have considered the portrayal of victims and even fewer have examined the way the media portrays older victims. To fill this void, this study examines (1) whether elder abuse coverage varies across newspapers and (2) how the extent of elder abuse coverage compares to child-abuse coverage. Results indicate that regional differences appear to exist and child abuse receives far more coverage than elder abuse. Implications are provided.     

Material Abuse of the Elderly:

During the last decade, the area of elder abuse has received increasing attention from researchers, providers, advocates, and policy makers. Although studies on elder abuse indicate that misappropriation of assets is not uncommon, material abuse represents an area that has not been addressed. Using a case study approach, this article analyzes two material abuse situations. Issues raised in the case studies are used to develop criteria for appraising potential material abuse situations and offering guidelines for assessing the appropriateness of guardianship as a means of protecting victims of material abuse.     

Elder Abuse in Portugal: Findings From the First National Prevalence Study

In this study, we present findings of the Portuguese national prevalence study, “Aging and Violence,” the purpose of which was to estimate the prevalence of abuse and neglect of older people in family settings over a 12-month period and examine the relationship between abuse and sociodemographic and health characteristics. Through a telephone survey of a representative probability sample (N = 1,123), we evaluated 12 abusive behaviors and demographic data. Overall, 12.3% of older adults experienced elder abuse in family settings. The prevalence rates of specific types were as follows: psychological, 6.3%; financial, 6.3%; physical, 2.3%; neglect, 0.4%; and sexual, 0.2%. Logistic regression was employed to determine the relationship between abuse and covariates. The study suggests that education level, age, and functional status are significantly associated with abuse. Accurate estimates of the prevalence of elder abuse and understanding of victim and perpetrator characteristics are fundamental to designing effective strategies for prevention and intervention.     

Elderly in America: A Descriptive Study of Elder Abuse Examining National Incident-Based Reporting System (NIBRS) Data, 2000–2005

Elder abuse is the newest form of intrafamilial violence to garner the attention of the public, policy makers, health officials, researchers, and the criminal justice system. Despite evidence that elder abuse is a growing problem, there is little known about the phenomenon because of persistent limitations in the extant empirical work. The present study examined a large cross-national sample of reported incidents (n = 87,422) collected as part of the National Incident-Based Reporting System (NIBRS), 2000–2005. Addressing limitations in prior works, this research employed a criminal justice oriented definition of elder abuse examining victim, offender, and incident characteristics using chi-square tests and logistic regression to establish baseline findings from a more comprehensive sample of data than previously existed. Results render a baseline profile of victims and abusers and suggest that gender differences prevail throughout elder abuse. This work both corroborates and contrasts past findings of elder abuse research, providing new insights and much needed baseline data.     

Financial exploitation of older persons in adult care settings: comparisons to physical abuse and the justice system's response

The current study uses a sample of 242 elder financial abuse cases and 314 elder physical abuse cases handled by fraud control units to shed some light on the dynamics of elder financial exploitation and the way the justice system processes these cases. Attention also is given to the way that the processing of elder financial exploitation cases can be distinguished from the processing of elder physical abuse cases. Results show that a wide range of elder financial exploitations cases are committed, and these cases should be broadly defined. Implications are provided.     

The Hospital Elder Assessment Team:

Elder abuse literature shows that health care professionals are aware of elder abuse/neglect laws but do not understand the requirements nor have the skills to diagnose the problem (Clark-Daniels & Daniels, 1990). Many victims of elder abuse appear in hospital emergency rooms for medical evaluation. Although 42 of the 50 states now have mandatory elder abuse/neglect reporting laws, few hospitals have responded with interdisciplinary elder protective teams in contrast to the situation with child abuse reporting laws. One exception has been the establishment of a multidisciplinary elder assessment team at Beth Israel Hospital, Boston, MA, to address the complex issues of recognition and assesssment of elders seen in the hospital who are suspected victims of abuse. Included in the mission of the team are consultation, support, and education to hospital staff about elder abuse and neglect.     

Tolerance of Elder Abuse and Attitudes Toward Third-Party Intervention Among African American,Korean American,and White Elderly

SUMMARY

Studies have found that professionals and the lay public differ consistently from one another in the ways in which they perceive elder abuse. A potential variable that may explain this observed difference is cultural norms among ethnic groups. Using 18 statements, this study examined similarities and differences among elderly from three ethnic groups in their tolerance for potential elder abuse, perceptions regarding perpetrators and the causes of elder abuse, and attitudes toward third-party intervention and reporting of elder abuse to the authorities. Results suggest that while African American and White elderly are remarkably similar in their responses to most statements, Korean American elderly differed significantly from the other two groups in their tolerance for medical mistreatment, financial exploitation and neglect, perceptions of causes, and attitudes toward reporting elder abuse. These findings have implications for understanding potential barriers to preventive outreach efforts, investigation, and intervention in cases of elder abuse in a culturally diverse community.     

Elder abuse: factors related to perceptions of severity and likelihood of reporting

This study examined factors that affect assessments of abuse as depicted in scenarios in which a caregiving daughter abuses her elderly mother through over-medication. College students (N = 239) read scenarios that varied in terms of the past quality of the caregiver/elder relationship and whether or not the elder adult was depicted as suffering from dementia. The role of the participants' own family caregiving experiences also was explored. Results from a factorial ANOVA showed that individuals who perceived the relationship as difficult and whose parents had served as caregivers rated the behavior in the scenario as more abusive and were more willing to notify authorities than participants in other conditions. Results are discussed with a focus on educating families and those working with elderly populations.     

Letter From the Editors

ABSTRACT

In this article we explore older persons’ definitions of and explanations for elder abuse in the Netherlands by means of interviews with older persons. A qualitative study was conducted based on semistructured interviews with 35 older persons who had no experience with abuse. Our findings show that older persons participating in our study define elder abuse foremost as physical violence that is performed intentionally. The study participants explain elder abuse as a result of the dependency and vulnerability of older persons, of changing norms and values, and of changes in the position of older persons in society, which result in disrespect toward older persons and a lack of social control and responsibility. The older persons’ explanations for the occurrence of abuse mainly focus on societal changes; older persons seem to regard elder abuse primarily as a societal problem. This understanding of, and explanation for, elder abuse may influence their detection and reporting behavior, as they may tend to acknowledge only severe cases of intentional physical violence that leave clear and therefore physically detectable evidence.