Serena Hall

Currently, elder abuse is a significant issue affecting patients all over the world. The term “elder abuse” is defined as either intentional or unintentional acts by someone in a position of trust that causes harm to an older adult (National Center on Elder Abuse, 2019). To date there is not an exact number of documented people suffering from elder abuse and neglect, but from various studies it can be determined which population sub-groups are most at risk. Some of these populations include those with lower income or poverty level, low social support, dementia, functional impairment, women, adults in their late 50s to 60s, and living with a large number of household members (National Center on Elder Abuse, 2019).

Regarding incidence, one study based in New York found that, “260,000 (1 in 13) older adults were victims of at least one form of elder abuse in the preceding year,” (Lifespan of Greater Rochester Inc., 2011). The most common type of abuse self-reported by New York residents was financial exploitation, but contrastingly, psychological abuse was the most common type according to agencies collecting data. This finding illustrates how difficult it can be to collect and analyze data even in a specific area, because it can be skewed depending on the type of survey distributed (anonymous vs. not anonymous) as well as the chronic illnesses that may plague the population. Within the same study, a healthcare disparity was highlighted for the Caucasian race with a little over half of the population, at 54.9% experiencing some type of elder abuse. Comparatively, only about 18.5% identified as African American, the same percentage identified a Hispanic/Latino, and as little as 3.5% identified as Asian/Pacific Islander (Lifespan of Greater Rochester Inc., 2011). Some reasons for this may be that the Caucasian culture of supporting and allowing parents to live with them as they grow older may be less customary than other cultures. Additionally, Caucasians living in New York may fall into some of the high-risk exposure populations I addressed initially such as low income or living with functional impairment. The Rochester Inc. study also collected data using variables to denote rates of elder abuse in geographical areas. They filtered data by region and by county type. Results depicted that most elder abuse had occurred in the New York City region and in urban areas, which made sense that they aligned (Lifespan of Greater Rochester Inc., 2011). This could be because of understaffed facilities for an area with such a large population. The article also talks about how there is greater visibility of elderlies in urban areas compared to rural areas. An interpretation of this could be that there is more reporting happening because there are more outlets and education provided to patients that compel them to express themselves (Lifespan of Greater Rochester Inc., 2011).

In other parts of the world, such as Korea, researchers have found similar outcomes where, “…9.4% of older adults [where the sample size was 10,674] reported experiencing emotional abuse in the previous year,” (Park, 2018). Within Brazil, over a 6 year span until 2013, about, “14.6 million hospitalizations of individuals aged 60 years or older [were documented]” (Castro, Rissardo, & Carreira, 2018). Therefore, there is evidence that elder abuse is prevalent all over the world with some areas occurring at extensive rates. Lastly, a trend found was that elder abuse and neglect complaints decreased from 7.5 to 5.6 reports per 1000 beds in long-term care (LTC) facilities across the U.S. from 2006 to 2013 (Bloemen, Rosen, Clark, et al., 2015). Although this is positive, it only represents the U.S. and LTC, as well as factoring in that many elderly patients do not self-report abuse. In the next portions of the brief, I will look at some of the causes and effects of elder abuse over time.

Causes of the Problem:

There are several causes that contribute to the issue of elder abuse in long-term care facilities. One of these issues may be resident-to-resident aggression or RRA where nursing home residents, specifically with cognitive impairment, increases the likelihood of elder abuse (Rosen, Lachs, Bharucha, et al., 2008). The journal article discusses the plethora of types of RRA occurring in nursing home environments with screaming or yelling being the most common type, but others such as punching, hitting with an object, inappropriate touching, and others taking place. Some of the triggers behind this happening are feelings of isolation or abandonment, jealousy, impatience, challenges with communal living, or dementia, cognitive impairment, or disinhibition as stated earlier. Although these behaviors and actions are true, some limitations of the study are that all research was conducted at a single LTC facility, therefore not a true representation of all nursing homes. Additionally, some staff may be biased while collecting information on the residents because of shift hours and sometimes being the target of the aggression (Rosen, Lachs, Bharucha, et al., 2008).

Another cause of elder abuse could be the perception of what elder abuse constitutes as amongst various professional staff members/providers at different types of centers. In 2017, a study was conducted across the U.S. and it was discovered that professional staff at community comprehensive support centers viewed elder abuse as, “caregiving stress”, “victim’s personality”, and “dementia of the victims” (Katsumada & Tsukada). On the other hand, domestic violence staff from domestic violence centers and women’s support centers viewed elder abuse as, “abusers’ tendency to control with power,” (Katsumada & Tsukada). This study is importance because it recognizes the variance in perception depending on one’s role and suggests that professional staff from different facilities should work together to develop a standardized protocol of recognizing elder abuse in order to decrease prevalence rates.

A third cause of elder of abuse may be interpersonal factors that affect a family member or nursing home employee’s perspective. Examples of interpersonal factors could be a history of mental illness, alcohol or substance misuse, believing events are outside of one’s control, lacking problem-solving skills, or a life-crisis such a obtaining a chronic illness or a death in the family (Papadopoulos & Fontaine, 2000). Several of these factors could interact with each other and act together in affecting one’s view of humanity (Papadopoulos & Fontaine, 2000).

Effects of the Problem:

Elder abuse is causing many stressors to emerge amongst the population such as psychological distress, depression, as well as frequent hospitalizations due to violence. In India, one study’s goal was to measure the connection between elder abuse and psychological distress amongst older adults. After conducting the study across 7 Indian states, it was found that overall prevalence of psychological distress for adults 60 years or older was 40.6% (Evandrou, Falkingham, Qin, et al., 2017). The discussion area of the article went on to explain how in Indian culture, it is expected of the children to care for their parents during old age, therefore a deviation of this from any kind, ranging from neglect to physical abuse triggers a sense of psychological distress that causes one’s immune system to suppress or deteriorate (Evandrou, Falkingham, Qin, et al., 2017).

Depression was mentioned in the study that took place in Korea, where out of the population that expressed experiencing elder abuse, 44% of them suffered from depression (Park, 2018). In addition to depression, many also stated that they had poor social support and some type of chronic illness. Each of those factors were said to be associated with emotional abuse, which depicts how it is possible to target factors to implement an intervention towards reducing elder abuse. It is also easy to observe how the cause and effect cycle may be cyclical because of chronic illness causing many older adults to utilize LTC facilities, yet they are mistreated because of it. Some older adults have been a victim to abuse so physical they have to be admitted to a hospital. Referring back to the study that took place in Brazil, hospitalizations due to assault were most frequent among males, ages 60 to 69 years old, living in the Southeast region of Brazil, and living in a LTC facility (Castro, Rissardo, & Carreira, 2018). It was suggested that the political structure and financial difficulty of elderly people could be causes of the high violence, but it was not confirmed (Castro, Rissardo, & Carreira, 2018).

From another perspective, an earlier article mentioned that a reason elder abuse may have slightly decreased is because of the Elder Justice Act that was created in 2010 that allowed for elderlies to have access to federal resources to prevent, detect, treat, and intervene with abuse (Bloemen, Rosen, Clark, et al., 2015). Additionally, organizations are realizing the affect of elder abuse on their reputation as a healthcare facility and are utilizing quality methods to assist in avoiding a loss of profit and decrease in reputation (DeHart, 2009). Elderly abuse is an urgent healthcare issue that needs to be placed under more scrutiny in order for prevalence rates to subside permanently.