Elder Abuse in the United States
According to Bonnie and Wallce (2002), "between 1 and 2 million Americans 65 or older have been injured, exploited or otherwise mistreated by someone on whom they depended for care or protection" (p. 9). This abuse ranges from physical abuse and sexual abuse to financial exploitation. If the range of victims seems overly broad — there is a 100% variance between the low and high estimates — it is worth noting that some forms of elder abuse are not reported as elder abuse. This is especially true of sexual abuse of elders (Muehlbauer, 2006, p. 46). Furthermore, according to Cohen, et al (2007),
signs of abuse are often difficult to distinguish from symptoms of illness. Especially problematic is the identification of psychological abuse, which usually shows in psychological outcomes such as apathy, depression, and fearfulness, congruent with the reactions of older people to loss, illness, or cognitive deterioration in old age (p. 1225).
Indeed, it can be said that the very obscurity of elder abuse allows its perpetuation. One study found that "95% of respondents [of a sample of healthcare professionals in Maryland] believe that abuse, neglect and domestic violence among the elderly was not a rare event. However, 49.75% of the providers have not come into contact with a victim of abuse, neglect or domestic violence in the past 12 months" (Rinker 2007, pp. 5-6). There is a fundamental disconnect between our understanding of elder abuse and our ability, as a society and as professionals, to detect elder abuse and put a stop to it when detected.
Elder abuse takes many forms. As Muehlbauer (2006) lists several forms that may elide into the spectrum of "normal" care-giving to such an extent as to be invisible to the layperson or casual observer (which may, unfortunately, include family members visiting an elderly client): "Abuse may include failure to implement a plan of care or provide treatment, unauthorized use of physical or chemical restraints, and the use of medication of isolation for punishment or staff convenience" (p 47). Of course, these forms of abuse may also occur in a home setting, thanks to a home healthcare nurse or a layperson family member who has the responsibility for carrying out healthcare regimes (i.e., administering medication, changing bedding and adult diapers, neglecting proper food, water, and locomotion), though Muehlbauer's comments are directed toward nurses working with an in-patient population. Muehlbauer (2006) also notes, however, that "[n]inety percent of perpetrators in reported elder abuse cases are family members" (p. 48). Unfortunately, this high percentage may simply be due to a bias in reporting — healthcare personnel who abuse their clients or patients may be better at hiding their abuse, or may be simply less likely to face reporting. Elder abuse remains largely hidden, thus the large range of potential victims as described above.
Elder abuse, because it is largely hidden, is a major public health issue. As the population ages — the large "baby boomer" generation is beginning to retire — more strain will be placed on caregivers, and the quality control (background checks, hiring only the highly skilled) for caregivers may tend to suffer, leading to the potential for an epidemic. However, worries for the future is only a part of the problem. Bonnie and Wallace (2002), state that after an extensive review of the extant literature, "a national survey is urgently needed to estimate the prevalence of different types of elder mistreatment in the general population, and in specific regions and subgroups, as well as the co-occurrence of different forms of mistreatment" (p. 24). In the half-decade since that call for a definitive survey, none has been published. Most research continues to involve small, sometimes non-representative samples, in limited regions and in healthcare organizations (e.g., hospitals,...
Cited: Bonnie, R., & Wallace, R. (2002). Elder mistreatment: Abuse, neglect and exploitation in an aging America Washington DC: National Research Council.
Cohen M., Levin, S. H., Gagin, R., Friedman, J. (2007). Elder Abuse: Disparities between older people’s disclosure of abuse, evident signs of abuse, and high risk of abuse. Journal of the American Geriatric Society 55: 1224-1230.
Lachs, M. S., Pillemer, K. (2004). Elder abuse. The Lancet. 364:1263-1272.
Muehlbauer, M. (2006). Elder abuse and neglect. Journal of Psychosocial Nursing 44: 43–48.
Rinker, A. G. (2007). Recognition and perception of elder abuse by prehospital and hospital-based care providers. Archives of Gerontology and Geriatrics 1807: 1-10.
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