The Silent Dilemma: ELDER ABUSE

BY JAMES MILEY

Any type of abuse, whether it be directed at children, a spouse, pet, or elder is unconscionable and must be reported. This particular article is focused on a serious problem in the United States. ELDER ABUSE.

As I was trying to catch-up on some reading related to a story concerning the shutting down of one of the largest in-home care companies in Minnesota, I noticed a few ‘related’ stories concerning elder abuse. I’ve heard of elder abuse in certain situations, but it’s not a topic of conversation brought up on a regular basis, such as the other forms of abuse that are more broadly discussed like child abuse, domestic abuse, or even alcohol and drug abuse.

As I started to research the series of articles and reports about elder abuse, I was surprised by the lack of information on the subject. But as I read through data it became evident as to why there is so little to study about elder abuse.

One statistic that was prominent in all of the studies was the fact that reporting of elder abuse is very low.
One report that caught my eye was the National Elder Abuse Incidence Study of 1998, conducted by National Center of Elder Abuse at The American Public Services Association. The study seemed to me to be outdated, written in 1998, using information from 1996. But as I read it and the other related studies, I found that the percentages haven’t changed dramatically since the study was released.

How severe is the problem?

The most alarming statistic to me, was the fact that; The best national estimate is that a total of 551,011 elderly persons, aged 60 and over, experienced abuse, neglect, and/or self-neglect in domestic settings. Of this total 115,110 or (21%) were reported to and substantiated, the remaining 435,901 (79%) were not reported. One can conclude from these figures that almost four times as many new incidents of elder abuse, neglect, and/or self-neglect went unreported.

Of the 115,110 reports, 61.6 percent (70,942) were reports of abuse in which elders were maltreated by other people. While 38.4 percent were incidents of self-neglect. The sheer magnitude of incidents is staggering. The most common types of abuse were: neglect – 34,525 (48.7%), emotional/psychological abuse – 25,142 (35.5%), financial/material exploitation 21,427 (30.2%), and physical abuse 18,144 (25.6%).

The report went on to breakdown who was reporting the abuse. The most frequent reports were family members, who were responsible for 20 percent of all reports, followed by hospitals, 17.3 percent, police/sheriffs 11.3 percent. In-home service providers, friends/neighbors, and physicians/nurses/clinics each reported between 8 and 10 percent of the total reported incidents. The remaining were made by out-of-home service providers, banks, public health departments, and other reporters.

The study went to point out that as you go deeper into old age, your chances of abuse increase dramatically. The oldest elders (those 80 years of age) who made up 19 percent of the U.S. elderly population at the time the study was conducted were far more likely to be victims of all categories of abuse with the exception being only abandonment. This age group accounted for more than 51 percent of neglect reported incidents, 48 percent of financial/ material abuse, 43 percent physical abuse, and 41 percent emotional/psychological abuse. In all types of abuse and neglect, elderly victims ranging in age from 60-64 and 65-69 years accounted for the smallest percentages.

Female elders are far more likely to be the victims of abuse. At the time the study was created, nationally, women made up 58 percent of our elderly population. However, they were victims of 76.3 percent of all emotional/psychological abuse reported incidence, 71 percent of physical abuse incidents, 63 percent of financial/material exploitation, and 60 percent of neglect, which is reported as the most frequent type of maltreatment.

If the aforementioned statistics are bad enough, here is a few more eye-openers.

Approximately half of the substantiated incidents of elder abuse involved elderly persons who were not able to care for themselves (48 percent), 29 percent were somewhat able to do so, while 23 percent able to care for themselves.

Characteristics of the Perpetrators

The information concerning at whose hands the abuse is delivered, is disturbing! Read on:

Overall, men were perpetrators of abuse and neglect 52.5 percent of the time. Of the substantiated cases of abuse males were the most frequent perpetrators for abandonment (83.4 percent), physical abuse (62.6 percent), emotional abuse (60.1 percent), and financial exploitation (59 percent). Only in the cases of neglect were women slightly more frequent (52.4 percent) perpetrators than men.

The age category with the perpetrators was the 41 to 59 age group (38.4 percent), followed by those in the 40 years or less group who were perpetrators in more than one quarter of reports (27.4 percent). About one-third of perpetrators (34.3 percent) were elderly persons themselves (60 and over). Perpetrators of financial/material exploitation were particularly younger compared to other types of abuse, with 45.1 percent being 40 or younger and another 39.5 percent being 41-59 years old. Eighty-five percent of the perpetrators of financial/material exploitation were under age 60.

About three-fourths (77.4 percent) of domestic elder abuse perpetrators at the time of the study were white, and less than one-fifth (17.9 percent) were black. Other minority groups accounted for only 2 percent of the perpetrators, while the race of 2.7 percent of the perpetrators was unknown.
Data show that family members were the perpetrators in nine out of ten (89.7 percent) substantiated incidents of domestic elder abuse and neglect. Adult children of elder abuse victims were the most likely perpetrators of substantiated maltreatment (47.3 percent) Spouses represented the second largest group of perpetrators (19.3 percent). In addition, other relatives and grandchildren, at 8.8 percent and 8.6 percent respectively, were the next largest group of perpetrators. Non-family perpetrators included friends/neighbors (6.2 percent), in-home service providers (2.8 percent), and out-of-home services providers (1.4 percent).

The study went on to state that the; results of the National Elder Abuse Incidence Study strongly confirm the validity of the “iceberg” theory of elder abuse that has been accepted in the aging research community for more than 20 years. The fact that only 21 percent of abuse cases are reported, 79 percent going unreported is the most frightening statistic of the entire report. The main reason for non-reporting: the fact that the elderly fear retribution from their caregiver as a result of reporting the abuse.

As I’m sure anyone reading this piece can imagine, the victims of elder abuse are stuck in a rather precarious position. They either accept the abusive treatment at the hands of their caregivers, or face the often unaffordable option of moving into an assisted-living facility. Depending on their current condition, they may look to in-home care assistance. But anyone who has any experience with caregiving understands the elderly’s health/mental/emotional condition can change rapidly and without notice.

Elder abuse is a social problem that can be curbed greatly. Everyone who has a parent, spouse or friend that is in need of caregiver assistance must be diligent when observing the type, quality and level of assistance being delivered. We must ask the tough questions when suspicions of abuse or maltreatment arise. We can make the last chapter of our loved ones lives better by taking the time to listen, observe, and report when warranted. Our elders face daily challenges most of us are unaware of. Elder abuse shouldn’t be added to their list! Our goal should be to make sure all seniors live in safe, comfortable, familiar surroundings, which enable them a dignified end of life existence.

Below are the Center for Disease Control and Prevention definitions of elder abuse.

Elder abuse is any abuse and neglect of persons 60 and older by a caregiver or other person in a relationship involving an expectation of trust.

Physical Abuse occurs when an elder is injured (e.g., scratched, bitten, slapped, pushed, hit, burned, etc.), assaulted or threatened with a weapon (e.g., knife, gun, or other object), or inappropriately restrained.

•Sexual Abuse or Abusive Sexual Contact is any sexual contact against an elder’s will. This includes acts in which the elder is unable to understand the act or is unable to communicate. Abusive sexual contact is defined as intentional touching (either directly or through the clothing), of the genitalia, anus, groin, breast, mouth, inner thigh, or buttocks.

•Psychological or Emotional Abuse occurs when an elder experiences trauma after exposure to threatening acts or coercive tactics. Examples include humiliation or embarrassment; controlling behavior (e.g., prohibiting or limiting access to transportation, telephone, money or other resources); social isolation; disregarding or trivializing needs; or damaging or destroying property.

•Neglect is the failure or refusal of a caregiver or other responsible person to provide for an elder’s basic physical, emotional, or social needs, or failure to protect them from harm. Examples include not providing adequate nutrition, hygiene, clothing, shelter, or access to necessary health care; or failure to prevent exposure to unsafe activities and environments.

•Abandonment is the willful desertion of an elderly person by caregiver or other responsible person.

•Financial Abuse or Exploitation is the unauthorized or improper use of the resources of an elder for monetary or personal benefit, profit, or gain. Examples include forgery, misuse or theft of money or possessions; use of coercion or deception to surrender finances or property; or improper use of guardianship or power of attorney.

Why is a Consistent Definition Important?

A consistent definition is needed to monitor the incidence of elder abuse and examine trends over time. Consistency helps to determine the magnitude of elder abuse and enables comparisons of the problem across locations. This ultimately informs prevention and intervention efforts.

Unfortunately, elder abuse has been 1) poorly or imprecisely defined, 2) defined specifically to reflect the unique statutes or conditions present in specific locations (e.g., states, counties, or cities), or 3) defined specifically for research purposes. As a result, a set of universally accepted definitions does not exist.