The Increasing Incidence of Domestic Abuse of the Elderly
Ann Kriebel-Gasparro*
Assistant professor, Department of Nursing, Pennsylvania, US
Submission: July 07, 2019; Published: August 06, 2019
*Corresponding author: Ann Kriebel-Gasparro, Assistant professor, Department of Nursing, Pennsylvania, 1001 City Avenue EE126, Wynnewood, PA 19096, US
How to cite this article: A Kriebel-G. The Increasing Incidence of Domestic Abuse of the Elderly. JOJ Nurse Health Care. 2019; 10(5): 555800. DOI: 10.19080/JOJNHC.2019.10.555800.
Abstract
Every year, approximately 4 million older Americans are victims of physical, psychological or other forms of abuse and neglect. Approximately fifty percent of older adults with dementia are mistreated or abused. Elder abuse, or domestic violence of the elderly, is a serious human rights violation and consists of various forms of abuse - physical, verbal, psychological, financial, and sexual resulting in distress and sometimes death. Abuse of the elderly is not limited to economic, cultural, or racial criteria – it occurs across all socioeconomic levels but affects those with dementia most terribly. Recent research has shown that the perpetrators of elder abuse may have certain characteristics such as dependency on the elder, a history of mental health issues or substance abuse. Bruising patterns can be hallmarks of abuse and the provider suspicious that an elder is being abused should interview the elder in private by asking key questions. Reporting suspicion of abuse is paramount to ending the increasing incidence of elder abuse. .
Keywords: Domestic Abuse; Elderly Abuse
Introduction
Elder abuse, or domestic violence of the elderly, is a serious human rights violation and consists of various forms of abuse - physical, verbal, psychological, financial, and sexual resulting in distress and sometimes death Center for Disease Control, [1]. Approximately fifty percent of older adults with dementia are mistreated or abused MetLife Mature Market Institute [2]. In addition, an estimated 13.5% of older adults have suffered emotional abuse since the age of 60 Acierno et al. [3].
A Famous Case of Elder Abuse: Wealth Is No Shield
In the case of Brooke Aster, a wealthy socialite from a prominent family in New York who was a generous philanthropist – her wealth did not shield her from financial abuse from her only son. Her son, with the help of her lawyers, defrauded her of millions by having her sign papers when she was confused. In addition, her lawyers forged her signature signing over several estates to her son. Eventually, her grandson filed for a guardianship and multiple convictions were brought against her son and one lawyer for a scheme to defraud, grand larceny, offering false instruments for filing, forgery, possession of stolen property and conspiracy Rosenberg [4].
Physical Signs of Abuse: Where the Bruise Is Matters
The location of bruising when assessing an older person for abuse is important. Mosqueda and colleagues Mosqueda, Burnight, & Liao [5] studied bruising in 101 persons 65 and older. Their results indicate that contrary to bruising in a younger person, the elderly may have bruises begin as a yellow spot on the first day–suggesting that aging of bruises by color is not accurate in the elderly. They also found that the majority of elders without dementia remember bruises sustained on their trunk as this is an uncommon area for an accidental bruise; but often do not remember bruises on their extremities because bumping into things is common. Mosqueda and colleagues found that ninety percent of bruises were on the extremities (lower legs and arms) and not a single accidental bruise occurred on the neck, ears, genitals buttocks, or the soles of the feet. Mosqueda L, Burnight K, & Liao S [5]. Bruising in the geriatric population. Research report submitted to the US Department of Justice.
The Department of Justice Elder Justice Initiative educational video indicates that bruises on the face, neck, torso, and lateral arms can be an indicator of physical abuse. In addition, fractures, scalding, ligature marks, or injuries that match a hand, fingerprints, or an object should cause suspicious of abuse Elder Justice Initiative, [6]. A study by Wiglesworth and colleagues found that inflicted bruises are larger, with a mean size of 5 cm or larger, and those less than 1 cm are usually not associated with physical abuse Wiglesworth et al. [7].
Dementia Can Be A Trigger for Abuse
Older persons with dementia experience irreversible deterioration in their ability to perform activities of daily living and require intensive support from a caregiver. Research indicates that caring for persons with dementia increases the risk of caregiver burnout Fang & Yan [8] potentially leading to abuse Downes, Fealy, Phelan, Donnelly, & Lafferty [9]. Therefore, older persons with dementia are at increased risks of abuse; and this abuse usually goes unnoticed because of their lack of cognitive capacity to detect and report abuse Tronetti [10]. Adult children caregivers who were abusive were often dependent on parents for housing, financial assistance, and emotional support Jackson & Hafemeister [11]. Abusive situations were enhanced due to the caregiver’s addiction to alcohol, pain medications, or recreational drugs Jogerst, Brady, Dyer, & Arias [12] mental illness Acierno et al. [1].
Perpetrators of Abuse: Other Qualities
Perpetrators of abuse are often unemployed at the time of the abuse, may be using drugs or other substances, and are usually socially isolated and may be living with one or both parents, but often with the mother. Many abusers have had problems with the law, mental health illness, and prior run-ins with law enforcement. Caregivers who abuse often have mental health treatment Amstadter et al. [13] and dependency issues – the child (often son) may be dependent on a mother for housing or financial support. This situation becomes volatile when the son depends on the parent for support, and the parent can no longer be a source of support due to frailty for dementia Fang & Yan [8].
Reporting Domestic Abuse
The most common referral is to Adult Protective Services Dyer et al. [12] and there is an office in each state. Abuse can be a risk factor for premature death Lachs & Pillemer [14] and may cooccur with other forms of elder abuse (Pavlik, Hyman, Festa and Dyer, 2001). Adults have a right to make their own decisions (even bad ones) until a court finds evidence to the contrary. Determining if an elderly person who self-neglects has the mental capacity to make decisions for themselves—including decisions which may endanger their health or safety, can be difficult. Capacity can fluctuate and be difficult to assess (e.g., psychologists who work with the elderly) can be challenging. Nurse Practitioners who see these patients in their practice can administer the Mini Mental State Exam (MMSE) to determine mental capacity. To begin a guardianship a court order is often needed Stiegel [15].
Who are the Perpetrators of abuse?
Those with access to older adults, such as spouses, partners, family members, fiduciaries, paid or unpaid care or community service providers, and resident(s) or service recipients in care settings are the people who have the easiest access to the older person. The majority of perpetrators have an ongoing relationship with the elderly victims before mistreatment occurs Jackson & Hafemeister [11], Krienert, Walsh, & Turner [16]. Many perpetrators who cultivate relationships with an elder person are often seen as “good people” and primary sources of friendship or support for older adults, making identification and reporting of abuse difficult. Therefore, it is key to look at the known person as vs. a stranger if abuse suspected. Research shows males are more commonly perpetrators of abuse; however, other studies indicate that females can be perpetrators as well Ramsey-Klawsnik, Teaster, Mendiondo, Marcum, & Abne [17]. Adult Protective Services (APS) found about half of the abusers are men Teaster et al. [18] and Krienert et al. [16] found that about 71% of abusers were men. Males are commonly offenders of sexual abuse of older family members in communities and older residents in care facilities; the age of the offender can be anywhere from 16 to 90. The abuser can be charming, attentive and persuasive and outright manipulative Ibrahim [19].
How to Interview the Suspected Victim of abuse
Talk to the elder alone, if family is in the room, they will be reluctant to talk to you. There are reasons an elderly person will fear talking of abuse: fear of retaliation, especially if the person is their caregiver, or has control over their finances or transportation and meals, fear of being placed in a facility, or fear of loss of love. Listen to older adults and others who may tell you about suspicions of abuse, do not discount claims of abuse simply because of cognitive impairment. Questions to ask the elder in private may include: Do you feel safe? Is anyone hurting you or scaring you? Has anyone taken things that belong to you without asking or without your approval? Do you rely on anyone else for help? What kind of help? - Does that person ever fail to help you meet your needs? Are you concerned about your finances? Are you afraid of anyone in your life? Cohen [2]. The Elder Abuse Suspicion Index (EASI) was developed by a physician to screen for suspicion of elder abuse Yaffe, Wolfson, Lithwick, & Weiss [20] (Figure 1).
Why Veterans are at Higher Risk for Abuse as They Age
Veterans can be at higher risk of abuse as they age because of their higher incidence of PTSD and depression, and often poor mental and physical health which increases their vulnerability to abuse as elders. These issues often lead to marital problems as they age, and many veterans are divorced and living alone. More than half of older vets report some difficulties in physical function; the Veterans Administration estimated that 18-28% of vets age 80 and older had some type of dementia in 2014 and this is expected to increase as more veterans age and return from wars Villa, Harada, Washington, & Damron-Rodriguez [21].
What to Do If You Suspect Abuse
Elder abuse is seriously under reported for many reasons. You do not need to prove abuse is occurring – just that you suspect it. Not reporting can be more serious – if it is later found that there was a duty to report and it was not—there can be serious repercussions. To report suspected abuse in the community, contact your local Adult Protective Services agency (APS) For state reporting numbers: http://www.napsa-now.org/get-help/ help-in-your-area/
Resources for Patients and Families:
Understand Decisional Capacity
Financial capacity and financial judgment often decline before other functions. For help contact Eldercare Locator at https://eldercare.acl. gov/Public/Index.aspx Help with Financial Power of Attorney (POA), Living Wills, Trusts, guardianships, incapacity, and estates.: www.NAELA.org [22]
Conclusion
Elder abuse is a serious human rights violation and is seriously underreported in the U.S. Bruising patterns can be an indication of physical abuse, and if abuse is suspected, interview the elder in a private area to ask questions about their wellbeing and treatment. If abuse is suspected, all providers and caretakers have a duty to report to the authorities. Not reporting can be more serious than reporting suspected abuse.
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