An Analysis of the Issue of Elder Abuse in the Families around the United States

Elder Abuse in the Family

The elderly occupy a unique social niche in American society. Many are, and continue to be, active, involved, and independent individuals. However, due to disease processes and normal physiological changes, many elders experience what is euphemistically referred to as a “second childhood.”

Physically, mentally, and/or emotionally, they become dependent upon others for one or many activities of daily living. This dependence, usually in combination with one or more other variables, leaves the elderly vulnerable to abuse.

The abusive situation could be a physical abuse, a sexual abuse, emotional abuse, financial exploitation, neglect, or even a self-neglect. Each year hundreds of thousands of older persons are abused, neglected and exploited by family members and others (AOA, 2003).

Elderly abuse has been accounted for in nearly one-third of the nursing homes in the United States. “Often, the elder abuse violations caused actual harm to residents or placed them in immediate threat of death or serious injury … [and] at least one-half million of our senior citizens were abused or neglected in their own homes.

”(Brayton Purcell, 2003, Para 1) Understanding the major impact on our elderly will set up a direction of intervention to hopefully eliminate or decrease the chances or possibility of elderly abuse in the United States.

There are several avenues of community services available for abusive situations. The first avenue of intervention is for the elderly person to recognize and understand that they are in an abusive situation that is not going to change unless they opt to take the first step.

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Encouragement and education may be the best interventions that a healthcare provider can initiate. Educating the elderly that abuse is not normal and the abuse is not his/her fault may help to encourage the client to take steps to stop the abuse through legal means.

When thinking of Elderly abuse we envision them being mistreated, unkempt, not fed, sexually molested, or spoken to in a negative fashion. Financial fraud is also a manner of abuse for the elderly. If we keep in mind that they experience the same types of abuse that children do, then the interventions become somewhat synonymous with child-abuse interventions. Community services that are available for the abused is as follows: adult protective services, abuse shelters, community support centers, and all day hotlines. Legal advocates are also available to help the elderly focus on what their legal rights are as victims of abuse. Victim assistance, battered treatment centers, and sexual assault programs that are age appropriate can be contacted for assistance as needed.

In Candi’s area there is an organization referred to as CASA: Center for Prevention of Abuse and Violence. “CASA’s mission is to provide quality prevention and treatment programs that reduce the impact of abuse and violence, particularly among women and children, and raise public awareness of abuse and violence while advocating for social change. The agency is currently organized into three operating divisions to accomplish its mission”(CASA, 2003, Para 1). This organization assists anyone at any age. It establishes rapport through therapeutic counseling and provides trauma intervention for victims of abuse or violence. Another possible resource is Adult Protective Service (APS). It’s responsiblity is to investigate abuse, neglect and exploitation of the elderly and those with disabilities.

The mission statement of APS is, “To protect older adults and persons with disabilities from abuse, neglect and exploitation by investigating and providing or arranging for services as necessary to alleviate or prevent further maltreatment”(Texas Homeland Security, 2003, Para 2). Each one of these resources will open many doors of assistance for the victim of the violence and the perpetrators of the crime. Often the right intervention and the willingness to help will encourage the one committing the learn new ways of dealing with anger and frustration rather than physically releasing it on the elderly person.

Once the suspected diagnosis of elderly abuse has been made, the time just following this diagnosis that is most critical and requires careful nursing intervention. The nurse must understand that this is a very delicate situation for both the abused person and the one who is suspected of delivering the abuse. There are specific guidelines that are to be used in the immediate intervention of a suspected elderly abuse case.
The correct approach to abuse, according to the experts on the subject is to give attention to the needs of the aggressor, as well as those of the victim (Abramowitz, 2000). In other words, the perpetuator is as much of a victim poor circumstances as the object of his/her abuse. The abuser is

often under “a great deal of stress, either due to life crisis or the worry and unbending weight of caring for a dependent relative” (Abramowitz, 2000). Professionals must intervene on three levels (Abramowitz, 2000).

The first intervention is in the form of a “crisis intervention”. This intervention is the immediate protection of the abused person. This involves “protective measures, e.g. shelters or protected housing for the elderly at risk” (Abramowitz, 2000). This will involve the immediate removal of the abused from the situation and would be done so with the help of Social Services.

This action is often easier said than done because the victim often feels guilty and shoulders the brunt of the abuse as if their fault. They are not so eager to remove themselves for fear of repercussions. Distance from the situation may provide the opportunity for both to learn how to resolve the problem and restore the relationship. Each will learn new measures of effective communication to keep from any physical abuse. According to Campbell & Landenburger, “families do not always know how to have fun … families may need counseling about the value of recreation and play in reducing tension and appropriately channeling aggressive impulses”(Stanhope & Lancaster, 2000, p. 772).

The second intervention is “counseling for the abuser to help them gain self awareness and learn means of control” (Abramowitz, 2000). It is during this phase that the abuser must accept responsibility for their behavior. Also during this phase the nurse must assess and work with the abuser to determine the reason the person is harming another human. Many professional believe that abuse stems from caregiver stress and resentment due to long-term care of elderly dependents (Rinehart, 2003). Another opinion is that many elderly are abused by a caregiver who is dependent on the elderly person for financial means, such as a place to live or the provision of food. In this situation the abuser is resentful of the elderly person because the abuser is totally dependent on this person for survival. The counseling for the abuser is going to be only as effective as the abuser is willing to accept responsibility for their behavior. In addition to the counseling there will probably be serious legal charges placed against the abuser, depending on the situation.

The final level of intervention is to coordinate with other resources and agencies for involvement in the care of the elderly. Empowerment of the victim will enhance and eliminate further opportunities of abuse. “Further violence, degradation and exploitation of family members will not be tolerated, but that all family members are respected, valued human beings … and safety of every family member is the first priority”(Stanhope & Lancaster, p. 772). Creating this inner strength is a major step towards rehabilitation and recovery from what could have been a devastating ending if no intervention was implemented. The victim will realize by the end of the therapy that their responses to the actions were perfectly normal and the strides accomplished have made them a more confident individual. With continued support for their positive reactions and additional nursing interventions towards recovery will guarantee their health and safety.

As stated earlier, elder abuse is an umbrella term to describe one or more different abusive situations. The abusive situation could be a physical, sexual, or emotional abuse, financial exploitation, neglect, or even a self-neglect. According to the Administration on Aging, annually hundreds of thousands of the elderly are injured or killed by an abusive caregiver. In general, all health care practitioners are responsible for reporting elder abuse to Adult Protective Services, or similar agencies, who will investigate potential cases of abuse (Rinehart, 2003). Physicians especially must be aware of state reporting laws and policies that are applicable to them as physicians. In many states there is a documented law that any person who knowingly fails to make a report is committing a Class A misdemeanor.

The requirement to report elder abuse is not only state mandated but is also mandated by the American Medical Association. In 1992, the AMA’s House of Delegates adopted the Council on Ethical and Judicial Affairs’ report on abuse (AMA, 1992], (Rinehart, 2003). This report made it clear to physicians that a physicians’ moral and ethical obligation to notify authorities of abuse goes beyond merely treating the bodily manifestations. This council believes that treating just the injuries does not address the family violence and that is what is at the root of these victims of elderly abuse. When Physicians do not diagnose abuse, it is most likely to continue and will often escalate (Rinehart, 2003).

The determination that an elderly person is the victim of abuse is going to be diagnosed by a medical team approach. However, in order to comply with state laws, avoid a misdemeanor charge, and more importantly to prevent any further abuse to the elderly person it is advisable to report any suspected abuse situation. It is much better to err in the form of caution as to not err and an elderly person continues to suffer abuse.

The nurse’s initiation of these first three interventions is not all that is needed to resolve the abuse issue. The most important intervention involves the abused person and it is perhaps the most difficult intervention that the nurse will face. Upon recognition of abuse as intentional and voluntary, the recourse of the victim; is to facilitate his/her own means of healing (Elder Abuse, 2003). The abused must allow themselves to become empowered in order to take control of the abuse situation and to begin to resolve the issues surrounding the abuse. This is the intervention that will require an active participation from the abused person.

In addition to the interventions described above there are several goals the nurse should establish in order to provide adequate continued intervention in elderly abuse cases. Communication with all persons involved in the situation with accurate feedback, especially addressing those who are resistant to change. The nurse must always be aware that his/her plan of intervention must be revised during this time of dealing with the abused and abuser. “If obstinacy to change is found, a face-toface encounter with family” is necessary and always encouraging empathy (Elder Abuse, 2003).

In conclusion, the elderly are a unique group in today’s society. Typically, they are independent contributing members of society, but age and disease changes the situation for many. The ravages of age and disease cause many of the elderly to become as dependent as children. This “second childhood” put the elderly at risk to be abused as much as children are. Legal and ethical issues arise when the healthcare provider suspects abuse. Legally the suspected abuse must be reported to the authorities. Ethically, removing the elderly victim from harm is imperative. Also it is important for the nurse to remember that, “addressing abuse can always result in criminal prosecution. An environment of trust, support, and confidentiality should be established” (Elder Abuse, 2003).

References

1. Abramowitz, L. (2000). Abuse of the Elderly. Retrieved December 15, 2003 from http://www.wholefamily.com/about60plus/abuse/elderabuse1.html
   Brayton Purcell. (n.d.).
2. Elder Abuse Information: Ways to combat elder abuse and nursing home abuse. Retrieved December 8, 2003, from http://www.elder-abuse-information.com/index_ptr.htm
3. CASA. (n.d.). CASA; Center for Prevention of Abuse & Violence. Retrieved December 19,2003, from http://CASACares.org/miss.vis.htm/
   Elderly Rights & Resources. (2003).
4. Administration on Aging. Retrieved December 15,2003 from http://www.aoa.gov/eldfam/Elder_Rights/Elder_Abuse/Elder_Abuse.asp
5. Elder Abuse in Nursing Homes: Concerns for the Nurse Practitioner. (2003) Retrieved December 15, 2003 from http://www.csudh.edu/dearhabermas/ibekwe01.htm
6. Rinehart, B. (2003). Trauma in the Elderly: Is it Abuse?. Retrieved December 15, 2003 from http://www.medicineandbehavior.com/mb981229.html
   Stanhope, M., & Lancaster, J. (2000).
7. Violence and human abuse. In Sally Schrefere (Ed.),