Elder mistreatment in a rural area in Egypt

Aim: Mistreatment of the elderly is a hidden problem frequently cloaked under the shroud of family secrecy. The aim of the present study was to determine the extent of mistreatment of older people living at their homes in the rural area of Mansoura city, Dakahlia governorate, Egypt. Methods: The present cross‐sectional study was carried out on 1106 respondents, 518 men (mean age 67.6 ± 6.3 years) and 588 women (mean age 68.5 ± 8.4 years), who answered face‐to‐face survey questionnaires. The questionnaires used were; Questionnaire to elicit elder abuse, Actual abuse tool, Elder Assessment Instrument, Risk of abuse tool, Katz index and Geriatric depression scale 15 items. Results: Of the respondents, 43.7% reported mistreatment by family members. The predominant type of reported mistreatment was neglect (42.4%) followed by physical abuse (5.7%), psychological abuse (5.1%) and financial abuse (3.8%). Conclusions: The independent risk factors for overall mistreatment of the elderly were older age, insufficient pension and caregiver other than spouse. Although being dependent, the number of children being three or less and caregiver other than spouse were significant independent attributes for “neglect” as a form of elder mistreatment. Geriatr Gerontol Int 2012; 12: 532–537.     

Screening for Abuse and Neglect of People with Dementia

OBJECTIVE: To investigate characteristics of people with dementia and their caregivers (CGs) that are associated with mistreatment in order to inform clinicians about screening for mistreatment. DESIGN: A convenience sample of CG–care recipient (CR) dyads were assessed for literature‐supported factors associated with mistreatment, and evidence of mistreatment for the prior year was collected. An expert panel considered the evidence and decided on occurrences of psychological abuse, physical abuse, and neglect based on criteria adopted before data collection. SETTING: Participants' homes. PARTICIPANTS: One hundred twenty‐nine persons with dementia and their CGs. MEASUREMENTS: CG and CR characteristics (demographic, health, and psychosocial variables), relationship characteristics, and three elder abuse and neglect detection instruments. RESULTS: Mistreatment was detected in 47.3%. Variables associated with different kinds and combinations of mistreatment types included the CG's anxiety, depressive symptoms, social contacts, perceived burden, emotional status, and role limitations due to emotional problems and the CR's psychological aggression and physical assault behaviors. The combination of CR's physical assault and psychological aggression provided the best sensitivity (75.4%) and specificity (70.6%) for elder mistreatment as defined by the expert panel. This finding has potential to be useful as a clinical screen for detecting mistreatment. CONCLUSIONS: The findings suggest important characteristics of older adults with dementia and their CGs that have potential for use in a clinical screening tool for elder mistreatment. Potential screening questions to be asked of CGs of people with dementia are suggested.     

Risk and protective factors associated with domestic abuse among older Chinese in the People’s Republic of China

Objectives: To identify risk and protective factors associated with elder abuse among older Chinese with cognitive and physical impairment in the People’s Republic of China (PRC).Methods: 1002 dyads of care recipients and family caregivers were interviewed.Results: The mutually reported rates were 9.7%, 0.8%, 33.2%, and 39.7% for psychological abuse, physical abuse, financial exploitation, and caregiver neglect respectively. Caregiver burden, care recipient neuropsychiatric symptoms, and cognitive impairments are prominent risk factors, while protective factors associated with multiple abuse subtypes include caregiver’s use of emotion-focused and solution-focused coping, perception of familism, and premorbid relationship rewards. Distinct factors were observed for respective forms of abuse. Psychological abuse with family poverty; Caregiver neglect with caregiver’s substance use and poor physical health; Financial exploitation with caregiver’s neurotic personality, as well as care recipient’s younger age, absence of chronic illness, and co-residence between the caregiver and care recipient.Discussion: Both similar and distinct factors were observed for different forms of abuse, potentially useful for designing prevention and intervention programs.     

Elder abuse and neglect in long-term care

Patient and caregiver education and other interventions targeted toward risk factors or types of abuse or neglect play an invaluable role in preventing elder abuse and mistreatment.     

Elder abuse.

Elder abuse encompasses physical, psychological, and financial abuse and also includes the violation of an individual's rights, or social abuse. Detection of elder abuse is often obstructed by the denial or shame of the abused older adult and the denial or improper assessment by health care professionals. The ethical struggle professionals face when they suspect abuse may also impede assessment or intervention. Preliminary data on etiologic factors related to elder abuse suggest that misinformation, the caregiver's lack of understanding of the needs of older adults, social isolation, a history of dysfunctional family relationships, and the psychopathologic factors of the caregiver are salient factors for understanding elder abuse. In addition, caregiver burden related to the care of the impaired elder and other external life events is a risk factor for elder abuse. Self-neglect is the type of elder abuse most often reported and the most difficult to handle, because older adults have a right to refuse services. Home care providers often face practical and ethical dilemmas in cases of self-neglect. When making an assessment for elder abuse, it is best to use a multidisciplinary approach. In addition to physical indicators (bruises, malnutrition, fractures), attention must be paid to the social, family, and sexual history of the patient. The psychological history of the patient and caregiver is also important. Reporting laws exist in all states, and health care practitioners must become familiar with the laws in their states. Awareness of elder abuse by professionals working in home care is essential, because the failure to detect abuse can interfere with interventions and in some cases lead to death.     

Changing family structure and elder abuse issues in Japan

Families are now changing; contemporary Japanese women are threatened by loss of their right to care by their family members, and as a result, they are clearly placed in danger of poverty. Elder abuse exhibits different phases, from child abuse or domestic violence, in terms of the power relationship between the abuser and the abused. This leads to incidences of abuse cover-up, creating difficult situations where it cannot be determined who is the abuser and who is the abused. Although the definition of elder abuse by the National Center on Elder Abuse in America (NCEA), namely, physical abuse, emotional/psychological abuse, neglect, financial/material exploitation, sexual abuse, and self-neglect, is used in many parts of the world, a quantitative analysis based on this definition alone does not clarify the relationship between abuse and women in a sexually discriminative society.     

Veterans Experiencing Elder Abuse: Improving Care of a High‐Risk Population About Which Little Is Known

At least 10% of older adults experience abuse, neglect, or exploitation annually in the United States, and this problem is expected to grow as our population ages. Little is known about the prevalence and characteristics of elder abuse of veterans, but it is likely that this population is at high risk based on established elder abuse risk factors. Veterans who receive their care through the Veterans Health Administration (VHA) have a higher prevalence of poor psychological health, poor physical health, functional impairment, cognitive impairment, and social isolation than the general population. As the largest integrated healthcare system in the United States, the VHA has long been a leader in the development of innovative, integrated care programs for older adults. The VHA has another opportunity to lead by promoting research, clinical care, and education on elder abuse, furthering their mission of serving those who served. This article outlines the rationale for developing a research agenda for elder abuse in the VHA, as well as potential first steps toward understanding more about this complex problem affecting veterans.     

Elder abuse and neglect: an overview

The dramatic growth of the American elderly population has great implications for our health care system. The "demographic imperative" that has fueled the awareness of the needs of older adults has a major impact on issues related to social welfare, justice, and economics. There are 45 million people over the age of 60 and 3 million over the age of 85. Those over age 85 represent the fastest growing segment of the elderly population. With this trend comes a segment of the population that is at risk for abuse, neglect, or self-neglect. We are challenged to be aware of the many faces of elder mistreatment and to understand it in the broader context of domestic violence. All health care professionals working with older adults need to become familiar with the recognition, treatment, and prevention of elder abuse and neglect.     

The Abuse Intervention Model: A Pragmatic Approach to Intervention for Elder Mistreatment

Ten percent of older adults experience elder mistreatment, and it is much more common in older adults with dementia. It is associated with higher rates of psychological distress, hospitalization, and death and, in the United States, costs billions of dollars each year. Although elder mistreatment is relatively common and costly, it is estimated that fewer than 10% of instances of elder mistreatment are reported. Given these data, there is a great need for research on interventions to mitigate elder mistreatment and for a practical model or framework to use in approaching such interventions. Although many theories have been proposed, adapted, and applied to understand elder mistreatment, there has not been a simple, coherent framework of known risk factors of the victim, perpetrator, and environment that applies to all types of abuse. This article presents a new model to examine the multidimensional and complex relationships between risk factors. Theories of elder mistreatment, research on risk factors for elder mistreatment, and 10 years of experience of faculty and staff at an Elder Abuse Forensics Center who have investigated more than 1,000 cases of elder mistreatment inform this model. It is hoped that this model, the Abuse Intervention Model, will be used to study and intervene in elder mistreatment.     

Elder abuse and emergency care units

Elder abuse could present with various aspects: physical, psychological, sexual aggression, embezzlement, neglect or self-neglect. According to epidemiological studies, between two and ten percent of the elderly population are concerned, but only few cases are reported, but this rate will likely increase with the growing elderly population. This paper highlights the risk factors for elder abuse. Most of the time, abuse is perpetrated by family members or close relatives, who often are dependent on the victim. It could also be a usual mode of interrelationship in some families, in which careful attention should be paid for the risk of abuse against the younger generation. In emergency care units, physicians infrequently report elder abuse because they fear offending patients or families and believe they do not have appropriate assessment tools. Victims often have low self-esteem, do not want to admit their vulnerability and do not imagine a different way for living with their aggressor. However, assessment and management of elder abuse could be supportive if all members of the team are concerned with this issue and have received appropriate information and education. The best approach is to focus on both the patient and the caregiver and to accept that there are no other tool to reveal abuse than to obtain the confidence of the patient. Every people concerned should remain respectful with each individual and not experience feelings of guilt in this upsetting situation.     

Elder abuse. Using clinical tools to identify clues of mistreatment

Elder abuse occurs most commonly in residential rather than institutional settings, and the most likely perpetrators are known by the victim. Although a defined set of risk factors has not been developed, careful questioning and assessment can help determine whether a patient is at increased risk. The common types of elder maltreatment include caregiver and self-neglect, emotional and psychological abuse, fiduciary exploitation, and physical abuse. Assessment consists of comprehensive physical examination, including scrutiny of the musculoskelatal and genitourinary systems, neurologic and cognitive testing, and detailed social and sexual histories. Clues that cannot be explained medically may signal elder abuse. To properly intervene, clinicians should be familiar with state laws governing reporting procedures and patient privacy.     

Interventions from home-based geriatric assessments of adult protective service clients suffering elder mistreatment

OBJECTIVES: To describe the interventions for adult protective service (APS) clients referred for geriatric assessment. DESIGN: Retrospective cohort study. SETTING: In-home geriatric assessments conducted in two New Jersey counties. PARTICIPANTS: Two hundred eleven APS clients; 74% female; mean age 77. MEASUREMENTS: Cognition, affect, nutrition, prevalence of selected medical diagnoses and functional conditions, and categories of interventions. RESULTS: Home health agency services were initiated for 46% of APS clients suffering from all forms of mistreatment. Institutional placements (36%) and guardianship interventions (36%) were correlated with caregiver neglect, especially in female APS clients and those diagnosed with dementia. Urgent medications (25%) were prescribed across all mistreatment classifications, and acute hospitalization (20%) was correlated with circumstances of physical abuse. CONCLUSION: An in-home geriatric assessment service was able to contribute at least one relevant intervention for 81% of referred APS clients to collaboratively help mitigate elder mistreatment circumstances.     

Elder abuse: disparities between older people's disclosure of abuse, evident signs of abuse, and high risk of abuse

OBJECTIVES: To assess and compare three types of assessment tools for identifying elder abuse: direct questions to elicit disclosure of abuse if it exists, identification of evident signs of abuse, and assessment of high risk for abuse. DESIGN: Cross-sectional. SETTING: Rambam and Hadassah medical centers, Israel. PARTICIPANTS: Seven hundred thirty persons aged 70 and older hospitalized in general hospitals in 2004/05 and their principal caregivers. MEASUREMENTS: Expanded indicator of abuse (E-IOA) tool, questionnaires looking for evident signs of abuse, and direct experience of abusive behavior. RESULTS: Although 5.9% of respondents disclosed experiencing abusive behaviors, 21.4% were identified with evident signs of abuse, and 32.6% were classified as being at high risk for abuse. More than 70% of those who disclosed abuse were identified with evident signs and were at high risk for abuse. Those who disclosed being abused suffered particularly from physical and sexual abuse. According to logistic regression, higher caregiver subjective burden was a predictor of disclosure (odds ratio (OR)=1.81, 95% confidence interval (CI)=1.19-2.74), evident signs of abuse (OR=1.86, 95% CI=1.45-2.35), and high risk of abuse (OR=1.55, 95% CI=1.27-1.88); heavier objective caregiver load was a predictor of evident signs of abuse (OR=1.14, 95% CI=1.05-1.24) and of high risk (OR=1.18, 95% CI=1.06-1.38) only; and respondent functional status was a predictor of evident signs of abuse (OR=1.88, 95% CI=1.70-2.37). CONCLUSION: The use of the three assessment tools is needed for optimal identification of abuse, whereas assessment for high risk proved an efficient method in the absence of respondent disclosure or professional detection of signs of abuse. Hospitalization provides an excellent opportunity for identifying elderly persons at risk of abuse.     

Development and psychometric properties of the Geriatric Mistreatment Scale

Aim: Elder mistreatment is a phenomenon that has increased proportionally to the increase in the number of older adults in different populations of the world. So far, in Mexico there is no instrument measuring and assessing this phenomenon. The objective of the present study was to develop and to know some psychometric properties of the Geriatric Mistreatment Scale (GMS). Methods: A documentary and qualitative investigation was undertaken to contextualize the mistreatment phenomenon in Mexico. Each item was included in the preliminary version if it obtained 80% or greater agreement by experts (content validity). The preliminary scale (49‐item) was applied to 626 older adults using a probabilistic sample representative of the older adults living in Mexico City. Then a statistical process was carried out to reduce the number of items, prove their internal consistency and associations with other measurements. The 22‐item final version of the GMS that assesses physical, psychological, neglect, economic mistreatment and sexual abuse is reported herein. Results: The mean age of participants was 71.94 ± 8 years. The internal consistency (Cronbach's alpha = 0.83) was appropriate. Subject memory complaint, depression, functional dependence and other measurements were associated with overall mistreatment. Regarding prevalence, 10.28% reported having experienced at least one type of mistreatment. Conclusion: The 22‐item GMS had an acceptable internal consistency; the relationship with other measurements was significant according to the hypotheses. Therefore, the GMS is recommended for the screening of the five different types of elder mistreatment. Geriatr Gerontol Int 2013; 13: 466–474 .     

Community approaches to elder abuse

Collaboration of professionals from diverse disciplines is required to address the multiple, complex issues and needs of community-dwelling elders who are abused or neglected. Reporting suspected elder abuse or neglect cases to Adult Protective Service (APS) agencies provides access to services that address the social, medical, and legal needs of elderly persons. A geriatric interdisciplinary team can provide a comprehensive medical, functional, and social assessment. Based on the findings from the assessment and in collaboration with the APS team, the intervention plan can be formulated. Some cases of elder abuse or neglect may require intervention from the criminal justice or the civil justice system for serious legal issues such as sexual assault, financial exploitation, or guardianship. Other resources, such as Area Agencies on Aging, local women's shelters, and The National Center for Elder Abuse, are available to help manage elder abuse and neglect cases in the community.     

Elder Abuse

SUMMARY

The various forms of elder abuse and neglect affect large numbers of older adults in the United States. Physicians have an ethical and, in most states, legal role in recognition and intervention where elder mistreatment is suspected. A number of risk factors have been identified, usually focusing on patient vulnerability, as well as caregiver and financial factors. Additional complicating elements include caregiver stress and burden, the patient's cognitive abilities and decisional capacity, and pre-existing psychosocial concerns aggravated by health and financial issues. The three cases discussed in this paper represent a range of these concerns. They present serious challenges to physicians and other health care providers. Awareness of legal and ethical concerns, attention to communication, and principles of geriatric care can enhance the physician's ability to address these situations.     

The prevalence of undiagnosed geriatric health conditions among adult protective service clients

PURPOSE: We sought to determine the prevalence of remediable health conditions from in-home geriatric assessments of referred adult protective service (APS) clients suffering elder mistreatment. DESIGN AND METHODS: We used a retrospective cohort study of 211 APS clients (74% female; age, M = 77 years) in two central New Jersey counties. RESULTS: Dementia was the most frequent diagnosis (62% prevalence) and was positively correlated with occurrences of financial exploitation (R =.199; p =.01) and caregiver neglect (R =.174; p =.03) among female APS clients. Depression (37% prevalence), hypertension (36%), involuntary weight loss (34%), pain (32%), and falling (26%) all appeared equally distributed, though urinary incontinence (23% prevalence) was strongly correlated with circumstances of caregiver neglect (R =.31; p =.003). IMPLICATIONS: This new effort to link APS workers with geriatric clinicians conducting in-home health assessments proved effective for identifying a high prevalence of remediable health conditions among APS clients suffering various manifestations of elder mistreatment.     

Abuse and Neglect in Older Men

Abstract

Elder abuse and mistreatment is a growing national concern. While victims and perpetrators are both men and women, much of the focus has been on women. Reports of the gender distribution of elder mistreatment conflict with some studies citing a greater prevalence in males and others showing a female predominance. The article summarizes the research on elder mistreatment, emphasizing the gender distribution. Older men are more likely to be victims of neglect, particularly abandonment. We use case vignettes to illustrate these major research findings. We also present data from a series of focus group interviews that included older men. The comments of the men about elder mistreatment were analyzed and are presented in this article. Through these findings we show that more research is needed to understand the similarities and differences between male and female victims of elder abuse and mistreatment.     

Elder abuse, neglect, and exploitation: policy issues

Elder abuse remains a rapidly growing but largely invisible national policy issue. As the number of elderly persons increases, so will elder abuse, neglect, and financial exploitation. This has implications not only for the victims and the programs struggling to protect them but also for publicly funded programs such as Medicare and Medicaid. The urgent problem is to address elder abuse on a national level in a comprehensive and informed way to prevent the untold suffering of hundreds of thousands of older persons who deserve to live their final years with dignity and security.