CH.4 Family Violence - Elder Violence

ELDER ABUSE

Definition of Elder Abuse

  • Definition Origin: Coined in the late 1970s by the House Select Committee on Aging chaired by Claude Pepper.

  • Classification of Elder Abuse: (Wolf, Pillemer, and Godkin, 1989)

    • Physical Abuse: Infliction of physical pain or injury.

    • Psychological Abuse

    • Material Abuse

    • Active Neglect

    • Passive Neglect

  • Legal Question: Should passive neglect be treated the same way legally as intentional abuse?

  • CDC Definition: An intentional act or failure to act by a caregiver or another person in a trust relationship causing or creating a risk of harm to an older adult.

  • Elder Definition (Elder Justice Act): An individual age 60 or older.

Challenges in Addressing Elder Abuse

  • Ensuring a consistent definition of "elder abuse"

  • Accurately measuring the prevalence of abuse

  • Lack of a standardized national reporting system

Elder Abuse Prevention and Prosecution Act (EAPPA) Data (2017)

  • NAMRS: National Adult Mistreatment Reporting System collects state-level adult protective services data

  • NIBRS: National Incident-Based Reporting System collects state-level law enforcement data

Extent of Elder Abuse

WHO (World Health Organization) Report (2022)

  • Increased rates of abuse of older people during the COVID-19 pandemic

  • Serious physical injuries and long-term psychological consequences associated with abuse

  • Prediction: Abuse of older people will increase with rapidly ageing populations in many countries

Aging Population Data

  • Demographic shifts from 1960 to 2060:

    • Projected population dynamics between ages 60+ and children under 18.

  • 2021 Population Projection: For the first time, older adults are projected to outnumber children by 2034.

Statistical Data Examples

  • Projected total of older adults (2016-2060): 94.7 million by 2060, accounting for 22.8% of the population.

  • Data Sources: U.S. Census Bureau, National Population Projections

CDC (Centers for Disease Control) Report (2021)

  • Elder abuse is common: approximately 1 in 10 individuals aged 60+ living at home

  • From 2002 to 2016: 643,000+ older adults treated in emergency departments for nonfatal assaults and over 19,000 associated homicides.

  • Vulnerability groups: Non-Hispanic Black, American Indian/Alaskan Natives, and Hispanic adolescents have higher rates of homicide compared to Non-Hispanic Whites.

Maltreatment Types

Reports from the National Adult Maltreatment Reporting System (2021)

  • Maltreatment Types: Statistics show the following number of victims

    • Suspicious Death: 75

    • Abandonment: 814

    • Other Exploitation: 1,440

    • Sexual Abuse: 1,635

    • Other: 4,071

    • Financial Exploitation: 37,644

    • Emotional Abuse: 27,399

    • Neglect: 38,000

    • Self-Neglect: 176,047

Gender Identity and Maltreatment Reports (2021)

Gender Breakdown by Year

  • Analysis of clients and victims by gender identity from 2016 to 2021 indicated a predominance of female victims.

  • 58% female clients vs. 42.6% male clients reported.

Clients and Victims by Race (2021)

  • Representation of clients and victims by race:

    • White: 58.6% clients, 59.9% victims

    • Black or African American: 12.3% clients, 12.7% victims

    • American Indian or Alaska Native: 1.0% clients, 0.9% victims

    • Asian: 1.8% clients, 0.7% victims

    • Native Hawaiian or Other Pacific Islander: 0.2% clients, 0.3% victims

    • Other: 5.4% clients, 0.4% victims

Risk Factors for Elder Abuse

Victim Risk Factors (National Center on Elder Abuse)

  • Includes chronic medical conditions, financial dependence, cognitive deficits, social isolation, prior trauma exposure, etc.

  • Mental health problems and high levels of stress are significant contributors.

Dementia vs. Alzheimer’s Disease

  • Dementia: A group of symptoms affecting memory, thinking, and social abilities.

  • Alzheimer’s Disease: A severe brain disorder eroding cognitive functions, leading to complete dependence.

Risk Factors for Perpetration (CDC, 2020)

  • Individual Level: Mental illness, substance abuse, and lack of caregiving training.

  • Relationship Level: High financial and emotional dependence on the elder.

  • Community Level: Limited services for elder care.

  • Societal Level: Acceptance of aggressive behavior towards older adults.

Offender Characteristics

  • Average Age: 45 years old.

  • Race: 77% identified as Caucasian.

  • Education: 38% did not graduate high school, with 44% receiving a high school diploma.

  • Employment: 1/3 to 2/3 unemployed at the time of the incident.

  • Marital Status: 70% unmarried at the time of the offense.

  • Criminal Record: Between 25% and 46% had a criminal record.

  • Mental Health: Reported mental illness in 25% to 35% of cases.

  • Family History: Nearly 50% reported history of early childhood violence.

Types of Elder Abuse

  1. Physical Abuse: Intentional use of physical force leading to injury, distress, or death.

    • Signs: Untreated injuries, pain from touch, dehydration, malnutrition.

  2. Psychological Abuse: Verbal or nonverbal behavior inflicting distress by someone in a trust relationship.

    • Signs include: Depression, anxiety, confusion.

  3. Material Abuse/Financial Abuse: Unauthorized use of an elder’s resources for someone else’s benefit.

    • Signs include: Missing personal items, unpaid bills, sudden changes in financial situations.

  4. Neglect: Failure to meet an elder's basic needs, resulting in health or safety risks.

    • **Self-Ne: The elder fails to care for themselves, leading to malnutrition or unclean appearance.

  5. Sexual Abuse: Non-consensual sexual contact with an older adult.

    • Signs: Bruising around sensitive areas, anxiety, sleep disturbances.

Theories of Elder Abuse

  • Intergenerational Transmission of Violence: Family relationships do not always predict elder abuse severity.

  • Psychopathology Theory: Mental disorders in abusers lead to violence; more valid for elder abuse than for spousal abuse.

  • Social Exchange Theory: Dependency contributes to abusive dynamics.

  • Family Stress Theory: Caregiving stress leading to conflict and abuse.

  • Neutralization Theory: Techniques abusers use to rationalize their behavior.

    • Five Techniques:

      • Denial of responsibility

      • Denial of injury

      • Denial of victim

      • Condemnation of the condemners

      • Appeal to higher loyalty

Federal Statutes Related to Elder Abuse

  1. Older American Act (OAA) of 1965: Focused on poverty reduction and nutrition programs.

  2. Elder Justice Act (EJA) of 2010: First comprehensive federal law addressing elder abuse, focusing on preventing and responding to abuse, neglect, and exploitation.

  3. Elder Abuse Prevention and Prosecution Act (2017): Strengthened the federal response and emphasized the need for national data.

  4. Omnibus Budget Reconciliation Act of 1987 (OBRA ‘87): Set minimum standards for nursing homes and rights of residents addressing neglect.

Reporting Elder Abuse

  • Reporting Laws: Mandated for certain professionals like medical personnel to report suspected elder abuse.

  • Challenges in Reporting: Limited knowledge of requirements, fear of repercussions, victim denial.

Adult Protective Services Reporting Example (New York)

  • Any individual can report when there is a belief an adult may need protective services.

    • Reporting Process: Contact local services or agencies for action.

    • Resources: New York Office of Children and Family Services Helpline.

Reasons for Underreporting of Elder Abuse (RAINN, 2023)

  • Victims' physical or mental limitations may hinder reporting.

  • Dependency on the abuser for care can prevent disclosure.

  • Fear of retaliation or negative outcomes from reporting.

Prevention of Elder Abuse (CDC, 2022)

  • Establish a support system for older adults and caregivers.

  • Report suspected abuse proactively.

  • Educate community on identifying signs of elder abuse.

  • Regularly check on socially isolated older adults.

  • Provide caregiver support and resources.

Community Initiatives: TRIAD

  • Definition: A national community policing initiative combining law enforcement, seniors, and community groups

  • Goals of TRIAD:

    • Increase awareness and education about crimes against seniors

    • Enhance communication between seniors and law enforcement.

Guardians and Conservators

  • Conservator: Manages the estate of a person who cannot manage affairs.

  • Guardian: Cares for individuals unable to care for themselves due to age or incapacity.

Other Intervention Strategies

Addressing Elder Abuse in LGBT Partnerships

  • LGBT elders are at higher risk due to factors such as social isolation and internalized prejudices.

  • Inclusive practices and reducing social isolation are key strategies for intervention.

  • Culturally competent services and legal protections are essential for LGBT older adults experiencing abuse.

Intervention Strategies for LGBTQ+ Older Adults

  1. Culturally Competent Services: Training for APS, healthcare, and long-term care staff.

  2. Reducing Social Isolation: Peer support groups, outreach, and case management.

  3. Legal and Financial Protections: Advanced directives, power of attorney planning, and safeguards against exploitation.

  4. Affirming Long-Term Care Policies: Include protections for visitation rights and gender-affirming practices in care.