Sunday, January 15, 2006

elder abuse

In spite of the considerable publicity given to elder abuse, the prevalence of this problem is not well established scientifically. One study gave an estimate of a 4 percent abuse rate in the elderly population in the United States, but this was done in a single city, Washington, D.C., and only 16 percent, or 73, of the people surveyed answered the question on abuse. Another study done in New Jersey found a much lower rate-IS cases per 1,000 older persons, or 1.5 percent.
The most statistically valid study was done in Boston in 1987. It produced estimates of 32 cases per 1,000, or a 3.2 percent rate of abuse. The study reported the following rates of types abuse: physical violence in 20 cases per 1,000; chronic verbal aggression in 11 cases per 1,000; and neglect in 4 cases per 1,000. (These figures are as given in an article by Pillemer and Finkelhor; discrepancy in figures may be due to the presence of more than one type of abuse in a single case.) A city like Boston does not represent the entire U.S. statistically, but if the 3.2 percent figure were to hold nationally it would represent close to one million cases of abuse. Instances of abuse generally fall into the categories found in Boston. Physical abuse is most common, and involves shoving, hitting, physically restraining, or sexually abusing the victim. A second type of abuse is psychological, and it may include neglect of the older person's presence or needs, treating the older person as a child, or inflicting verbal abuse-swearing, screaming, and verbal cruelty. Another type is monetary, and arises when family members steal or manage older people's financial resources without proper consent. Outright neglect constitutes yet a fourth type of abuse, and includes: failure to provide bodily care and toileting; allowing bedding to become filthy; or withholding of food, medications, eyeglasses, access to medical treatment, and other necessities.
Publicity about abuse has laid the blame, falsely in most cases, at the door of adult children who are financially pinched and overburdened by the obligation to care for an older parent. According to the Boston study this stereotype is highly inaccurate- 58 percent of the cases of abuse were committed by a spouse and only 24 percent by adult children. The fact is that elders are most likely to be abused by people with whom they live, and those who are not living alone most often reside with their spouse, not with their children. Further, cases of abuse often involve alcoholism and drug use by the abusers.
Though frail and dependent older women are portrayed as the main victims, the Boston study found that it was husbands who were most often abused-52 percent of the victims were males compared to 48 percent females. The probable reason for this is that older women more often live alone so are not exposed to people who might abuse them. Older men, on the other hand, are often married; and, ill and dependent, they may be living with a spouse who is herself old and under stress due to the problems of caregiving.
It is possible that some abused elders fail to report that they are experiencing problems out of fear of reprisal, concern about the legal consequences for the abuser, or to avoid the risk of being removed to an institutional setting. Currently, 41 states have laws that mandate reporting cases of elderly abuse and neglect. Many of these laws, however, provide no penalty for perpetrators. Efforts to control abuse have extended to the federal level, where legislation to create a national center to conduct research and disseminate information on abuse has been introduced in Congress annually since 1981. Authors of this legislation and critics of federal inaction predict that incidents of abuse will increase as the longevity and numbers of older people continue to grow.
Beck, C. M., and Phillips, L. R. Abuse of the Elderly. J. of Gerontological Nursing. 9: 97- 102 (1983).
Pillemer, K., and Finkelhor, D. "The Prevalence of Elder Abuse: A Random Sample Survey." The Gerontologist: Vol. 28, No.1, 51-57 (1988).
Quinn, M. and Tomita, S. Elder, Abuse and Neglect. New York: Springer Publishing Co., 1986.

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