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Elder Abuse: Types, Risk Factors and Measures

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Introduction

Elder abuse is one of the most common types of abuse that gets looked over by society. Many people would normally not suspect or even think an elderly person may be getting abused, but this is a serious topic in nursing homes, hospitals and even at their own home. The reason is as these elders are becoming victims of abuse is, they become older, they lose the ability to fight back. They are more physically frail, and they may be losing their ability to see or hear, which is making them more of a vulnerable target. Leaving openings for their relatives, friends, or even their caregivers at care facilities, to take advantage of them. Elder abuse can take place anywhere and, in many forms, such as physical, financial, sexual, psychological and neglect.

The Support of the Government

In most states, a person is considered elder when they reach an age of 60 years or older. Physical abuse makes up about eleven percent of verified cases and emotional abuse makes up about fifteen percent. Elder neglect, financial exploitation, and self-neglect are what makes up most of the remaining cases that Law Enforcement and Adult Protective Services see. In 2010 under President Barack Obama the elder justice act was Patch which was part of the Affordable Care Act. The elder justice act is a law that applies to seniors age 60 years and older. The Elder Justice Act seeks to give elders the knowledge and the correct and appropriate resources to protect themselves from past or future abuse. This act also gives law enforcement agencies a larger amount of funding and resources needed to protect and defend the elder abuse crises. The agencies are using this extra funding to train the officers on how to appropriately address an elder abuse case, but they are also using the money to support the elders that have fallen to victims of the crimes.

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Here in Michigan, the growing problem of elder abuse cases has led the government to create a task force. On March 25th, 2019, the Michigan Supreme Court along with the Michigan Attorney General has created the Michigan Elder Abuse Task Force. This task force is made up of 30 organizations including law enforcement, state agencies and advocacy groups all focusing their attention on physical abuse, financial exploitation, emotional abuse and neglect of elderly people in Michigan.

Physical Abuse and the Measures to Prevent It

Physical abuse is the most common form of elder abuse. Elder physical abuse is defined as any physical force that may result in injury, pain, or impairment that occurs in a domestic setting or in a residential facility. A study was done by the National Elder Abuse Incidence Study which found almost 450,000 were physically abused in some capacity in 1996. This number of elders who are getting abuse is only a growing number and the forms of abuse are also becoming worse.

With the increase of elder abuse cases across the country, the legislation has had the take actions to prevent future abuse cases. In 1991, all the stats had enacted mandatory reporting for elder abuse cases. Furthermore, all the states have also created adult protective custody services to provide support with the elder abuse cases. The legislation on many states has also created laws making acts against elders’ criminal. Like child abuse laws.

Abuse in Senior Care Facilities

Regarding abuse that occurs in an institutional setting. A survey that was focused on certified nursing assistants from ten different nursing homes found; about one in six nursing assistants reported engaging in physically abusive behaviors and about half of them reported yelling at residents in the previous 30 days. There has been some evidence found stating profit nursing homes have had more abuse complaints than nonprofit homes. Larger senior care facilities also have reported having higher rates of physical abuse complaints. It has been suggested that living in a nursing home alone is a risk factor for physical and emotional abuse.

Risk Factors

Not all elders experience being a victim of abuse. Certain factors can increase an older person’s risk of being victimized. Two risk factors that have been common among cases are the presence of Alzheimer’s and dependency. Individuals with Alzheimer’s and other forms of dementia are especially challenging to caregivers and may increase the chances of committing abusive acts. It has been reported in some situations, caregivers react with physical force when the senior is acting violently in result from there dementia. While in other cases, the caregiver’s aggression and anger are attached to the job itself, where they take their anger out on the patients.

The Role of Culture

Cultural factors may also play a role in elder abuse cases. Cultures that poses high respect for the elderly have lower elder abuse rates. While the cultures that devalue the elderly, have much higher rates of abuse and neglect upon people of senior age. Ageism refers to attitudes or practices that will always discriminate against the elderly population. Ageism attitudes create abusive behaviors from the nature of the discrimination behaviors. In addition, a culture’s level of willingness to help others is tied to elder abuse. For example, institutional abuses have been tied to a culture’s willingness to devote scarce financial resources to help those in need. The more charitable counties are, the lower their rate of institutional abuses. Similarly, putting a cultural value before high-quality health care places older individuals at risk for patient abuse. An estimated 90 percent of abuse cases reported to the adult protective services occur in a domestic setting.

Sexual Abuse

There are two key agencies that have responsibilities for investigating sexual abuse. The first is law enforcement that has jurisdiction to investigate a complaint of sexual abuse or rape across all aged victims. Sexual abuse is not a legal term but is used to describe sexual behavior that is considered criminal by state and federal law. Elements of criminal sexual behavior such as rape usually require that the act was non-consensual or forced. The second investigative agency is Adult Protective Services and is typically the agency that is the first to report of elder mistreatment on vulnerable and older adults. Elder sexual abuse for Adult Protective Services staff is usually defined as non-consenting sexual contact of any kind. This type of elder abuse constitutes less than 1% of all cases reported and substantiated by the Adult Protective Services. Despite the small number of proved cases, researchers and physicians acknowledge that these estimates represent only the most evident cases that are reported. This number is not considering all the non-reported cases that go unnoticed.

Elders who are victims of sexual abuse cases usually do not seek psychological services following the sexual abuse and if they do, symptoms are often no reported full by the victims or they are under-diagnosed by psychological service. Older adult victims are also reluctant to report emotional or psychological difficulties in general, but they are often particularly concerned about not being understood credibility or they will feel shame that is associated with sexual assault. Elders reported to the Adult Protective Services staff that they were most at risk from family members. Additionally, the National Center on Elder Abuse reported that the perpetrator is a family member in two-thirds of known cases of abuse and neglect, being identified as spouses or adult children.

Nursing homes are not immune to elder sexual abuse as both staff and other residents were identified as being perpetrators. In a study the was completed by Adult Protective Services, sexual abuse in both domestic and institutional settings, noted that the offender was often the resident in the same nursing home as the victim or the perpetrator was a facility staff person. The most common sexual abuse acts involved sexualized kissing, fondling and unwelcome sexual interest in a woman’s body. The researchers also noted that women between the ages of 80 and 89 were more likely to experience multiple types of abuse than those between 70 and 79 and those who required assistance to experience more than one type of sexual abuse than those who did not need assistance.

In research that was completed, there were a small number of cases in which nursing home records were available or notes of interviews that were conducted with family members. This information provided informal recorded by caregivers of the elder’s response and behaviors following the abuse that had occurred. Following a sexual abuse, family members reported the daily realities for the elders that differed from their behavior before the abuse and that became lasting ways of life for the elder. These changes included fears of going to sleep, nightmares, fear of getting a sexually transmitted disease, anxieties about leaving their residence and a decrease in enjoyment of activities like visiting with friends. Memories of the perpetrator often surface as unwanted thoughts which then leads to psychological abuse. When one abuse occurs to an elder, there are often side effects to the abuse, more times than not, leading to psychological abuse. Some elders clothed themselves with layers of clothing or refused to put on nightclothes. There are several reports of residents in nursing homes who made attempts to escape after the abuse occurred.

There is evidence that shows adults aged 60 and older may be victims of sexual abuse in their own homes, in nursing homes, and in the community and this shows that age is no protection against becoming a victim of sexual abuse. A study that was done by the minority staff of the Special Investigations Division of the House Government Reform Committee found that 30% of nursing homes in the United States were cited for almost 9,000 instances of sexual abuse cases.

Many of the cases of elder sexual abuse occur based on the same reasons that it occurs to younger people. This sexual abuse could be between strangers or acquaintances where a sexual predator criminally violates another person, or in an established relationship where one partner forces sexual activity upon another against their will. However, there are many aspects of elder sexual abuse are unique just to elders. These attacks have a vulnerable population that is being targeted. The average age of the victims in a study was around 78 years old. Many elders were Caucasian, and a majority of the victims were female. Age did not prevent an offender from committing a sexual act on an elder. The age of the offenders of these elder victims ranged from 13 to 90 years old.

Many victims can have dementia or other conditions that make them both vulnerable and unable to communicate that they have been sexually assaulted. This is what could be a reason that they were targeted in the first place. Another unique aspect of elder sexual abuse are situations in which patients with Alzheimer’s Disease or related dementias develop heightened sexual urges because of their disease. This is taking another look at the issue. In a senior care facility, the aggressor is not always a caretaker. It can be a patient engaging in abusive behavior on another patient. In nursing homes and other institutional settings, this can lead to a sexual assault by one resident on another because many patients with dementia are typically living close together. In the community settings, this can be extremely distressing to an older spouse who is trying to care for such a patient.

Financial Abuse

As an elders’ physical and mental health deteriorates, the responsibilities go to their children, an advisor, attorney or caregiver, to manage their finances when they become unable to. The challenge of settling an estate can be handled with care and with the best interest of the elder, or it can present a lucrative opportunity to those who would seek profit from individuals who are either incapable of knowing when they are being taken advantage of. Some elders know they are being taken advantage of, but they are unwilling the report the incident because they are a family member or a loved one. This dilemma is not only taking advantage of the elder’s financial position, but it is also causing the elder a psychological abuse that put them in an extremely hard decision mindset. Letting the loved one continue to take advantage or report them to the authorities.

The amount of wealth determined to have been lost due to individuals taking advantage of elder’s finances is staggering. Elder Financial Exploitation committee in Utah found that elder residents of Utah lost as much as $52 million in the exploitation in elders alone. Many state legislatures across the country have enacted laws that help victims and law enforcement overcome the challenges of bringing financial exploitation cases in civil and criminal court.

According to a MetLife Insurance study, Family, friends, and neighbors are taking on average $145,000 from elders that they associate with. This is all done without the elders even knowing that they are being victims of the crime. Around $95,000 are taken from elders by complete strangers. Most of these numbers are the typical phone scams that elders fall for.

Because many seniors live on fixed incomes, they often interested to increase the value of their estate and ensure they have enough money to meet basic needs. In investment scams, offenders often can persuade an elderly to invest in real estate, annuities, physical materials, or stocks and bonds by promising then unrealistically high rates of returns. The investments in return often consist of fake items, unlivable property, shares in a nonexistent company, or nothing at all.

Elderly aged individuals also often fall for mind games. These frauds generally do not involve a product or service but instead, they include a large array of dishonest scenarios to get cash from the elderly. The offender often pretends to be in a position of authority, or a trustworthy figure in the community, putting together a story to get the victim to hand over cash, then disappearing. For example, the offenders of typical lottery scam claim to have won the lottery, but they don’t have a bank account to deposit the winnings. The offender promises the victim an amount of money in exchange for use of his or her account. After the elderly victim makes a good-faith payment to the offender, the victim never hears from the offender again.

Unlike strangers, family members, as well as caregivers, often have trust and an ongoing relationship with the elderly. Financial exploitation happens when someone steals, withholds, or misuses the elderly victims’ money, property, or valuables for personal advantage or profit, and to the disadvantage of the elder.

Another way elders’ financial assets are being taken advantage if is through power of attorney and durable power of attorney. These legal arrangements give a person the authority and ability to manage an elder’s affairs on the elder’s behalf. When used properly, the legally appointed person makes decisions that are in the elder’s best interest. Misuse arises when the agent can persuade the elder to sign the documents which in return are truly decisions that benefit the appointed person. This is extremely difficult to notice because the elder is putting all their trust in faith into this person and the fact that they are going to take advantage of them is not on their mind. It’s also something that law enforcement struggle to deal with because the power of attorney has the legal authority to use the documents.

Issues can arise when distinguishing between an unsmart or unintended financial decision. A legitimate financial transaction or an unfair transaction resulting from an unnecessary influence such as duress, fraud, or lack of informed consent can be difficult to make a case for elder abuse. Suspicious dealings may be in the best interest of the elder but just guided by poor advice. Generally, financial exploitation involves a pattern of behaviors, rather than just one single incident. This would most likely rule out the unknowing defense to a case. These issues can cause law enforcement agencies to run into many difficulties while protecting elders from those that would seek to exploit them. They are struggling to find a way to better identify when an elder is being taken advantage of. It makes it difficult when the elder is unaware that they are even being taken advantage of, or they are unwilling to report to assist law enforcement in the investigation due to a connection with the person.

Researchers agree that elder fraud is extremely underreported, which is problematic on several levels. First, the failure to report financial fraud means that the help of police, adult protective services, family members and others are not mobilized to stop the abuse from continuing to occur. Second, even if intervention is not necessary, the underreporting of these crimes makes it very difficult for law enforcement efforts to proceed because of a lack of information on the targets, methods, and perpetrators. When these incidents are reported even when they want nothing done. It allows law enforcement the opportunity to familiarize themselves better with the growing issue which they lack the understanding in greatly. Finally, the lack of reporting may encourage the offenders to victimize others.

Many of the elderly victims do not report fraud because they feel ashamed that they were taken advantage of. They fear others will think they cannot care for themselves any longer, which might result in family placing them in a nursing home or a long-term care facility. Many victims are not aware of the abundant support resources or do not know how to gain access to them. In the case of financial exploitation, many of the victims have close ties to the offenders and may feel protective. They may want to stop the exploitation and recover their assets, but not want the offender to be punished for their wrongdoing. Many victims believe that they are at least somewhat to blame for the abuse that had occurred. This can mix with the psychological abuse as well because they get into a mind game where they start to blame themselves for the acts that others commit against them.

Professionals who can detect forms of abuse specifically financial abuse, such as bankers, attorneys, and accountants are often slow to report suspected abuse cases. Their brief, random at times, interactions with the elderly and their lack of experience and expertise of possible financial exploitation or criminal conduct can create barriers in reporting the possible cases. Even if they suspect abuse is occurring, there often is no specific protocol for reporting it within their specific careers.

When elderly victims do report when they have fallen to be a victim of fraud or financial exploitation, the report quality often makes investigation difficult. If the elder is cognitively impaired, the victim may not remember important details, or they may not be able to recount the sequence of events that occurred. Victim interviewers should put victims at ease and provide enough time to accurately recall what had occurred. If they are not allocated a reasonable amount of time, the reports may lack important details needed to fully resolve the case. Given that the complex cases that revolve around fraud and other financial exploitation cases may take years to end up going to trial, it is possible that a victim’s mental or physical health will decline to the point that they cannot testify in court against the abuser. This makes it even harder to continue with the case to find a just outcome for the victim.

Who Becomes the Victim?

Over time, with the reports that have been collected, they have been able to identify a possible stereotype of elderly fraud victims. These are elderly victims that are mostly poorly informed around the issue of miss used finances. Socially isolated individuals have a raised chance of becoming victims. Also, elders suffering from mental deterioration or seniors who believe in politeness and manners that interfere with their ability to detect fraud. They have a mindset that everyone is good and it going to help them. It was found in a study that people with dementia and other cognitive impairments usually plays a role in elder fraud and financial exploitation. For the seniors who have advanced impairments, responses and investigations that require their participation may have limited effectiveness when attempting to resolve the case. However, more recent studies have also found leading stereotypes in the characters on the elder populations. The study found that many potential victims are more educated, informed, and socially active than previously supposed. A major AARP survey had identified elderly fraud victims as relatively affluent and well-educated people, with strong networks of family and friends. The studies have also found that seniors who partake in active social lives and they are able to experience a broad array of purchasing situations may be vulnerable to fraud simply because of increased exposure to the field. On the other hand, the elders who are socially isolated may also be just as vulnerable because they are less likely to seek any advice before making a purchase. The sales pitch itself could possibly address an unmet need for the elder, resulting in their them feeling either obligated cause they need the item or the buy it out of compassion due to a connection to the salesperson.

The more socially isolated elder individuals are, the more at risk they become to be victims of physical abuse. Socially isolated seniors are less likely to be protected by family members, law enforcement professionals, or other guardians that the elder has. Isolation is such an extreme problem in elder abuse cases that studies show; when individuals are actively isolating older people to gain power and control over their lives, this amounts to emotional abuse. It is also claimed that the isolation this is found in the long-term-care facilities may place the residents at a higher risk for maltreatment.

The After Effects

As in a case that involves the emotional abuse of elders, the elder who is a victim sexual abuse will be given a government-assigned caregiver who is placed in charge of investigating the incident father. This caregiver will talk to the elderly person to discover what happened at the time of the incident. They will also ask questions concerning the elder’s mental stability, current living situations, and the relationships that are present in the elder’s life. At this point, they are becoming more concerned with the psychological state of the elder. Yes, they are concerned about the actual abuse that has occurred, but they can be stopped when discovered. The after effects are greatly affecting the elders for years.

Older physical and emotional abuse victims commonly feel guilt and shame in what has happened to them. Many blame them self for their victimization, especially if they see themselves as a burden to their caregivers, meaning they think they are too much work to take care of. Others experience shame, particularly when their adult children are the perpetrators that are taking advantage of them. The older victim is usually feeling responsible for their victimization and may be ashamed that they raised a child capable of abusing others as well as their own parent. In this respect, leading them to not reporting, holding the knowledge in continues to eat away at them because it’s something that is always on their mind.

Like elderly fraud victims in many situations, seniors that are exploited by relatives and caregivers are different in a significant number of ways. There is no aspiration for monetary gain when they are creating their victim. The elder victims might only have a fear what the offender could do to them if they do not comply with the offender’s demands. This type of abuse is extremely hard to tell. There is no physical signs or paper trail to determine or investigate what is happening. This is leaving the reporting aspect up to the elder alone. They may also have long-term emotional ties to the offender that create conflict about reporting abuse and may cause them to feel protective of the offender once the abuse is discovered. The elders that are cognitively and physically impaired may feel overwhelmed just for the fact that they must have some traveling involved. The traveling to the police station, district attorney’s office, or court alone can cause more stress to the victim’s mental state the will in result cause additional hard to the victim.

Elder Neglect

Elder neglect is a type of abuse in which a caregiver or a person providing care fails to give the elderly person the proper care they deserve the receive. Elder neglect occurs when a caretaker fails to properly provide the services that are standard for the elder. A caretaker could be a family member or a staff member an elder residential facility. Neglect can occur when the caretaker is not providing the elder with medications or properly feeding and can be as simple as not getting the elder proper bathing or dress. The caretaker may not give the elder the treatments they need or give them the wrong amount of medicines.

Victims of elder neglect are often senior aged people who are living in facilities that provide basic medical and human needs, and they are unable to care for themselves daily. Elder neglect is often associated and committed with other types of abuse, often time physical abuse. This violation in the criminal justice system is often stated as Elder Abuse and Neglect. There are some law enforcement agencies that make distinctions between the two terms. For example, elder abuse typically implies that the person was physically harmed in some way; elder neglect suggests that the person didn’t receive proper care and attention they deserve.

The exact cause of why elder neglect occurs is still not known and not enough research has been done to determine it. Some studies suggest that poor or crowded living conditions may be one of the reasons why it occurs. From the few studies that have been completed. Researchers have determined a few possible factors that may result in an elder becoming a victim of neglect. These factors include, the elder has a long-term condition, such as dementia, or diabetes that required more attention from family or staff; the elder has no family that is willing to care for them; the caretaker is involved heavily with drugs or alcohol, or the caretaker has a historywith violence.

Conclusion

Elder abuse is a substantial problem in the United States and it often goes unreported, unnoticed and unrecognized. Elder abuse can be physical, sexual, financial, psychological or neglect. Many times, when one of these forms of abuse occurs, there are either multiple other forms that happen or result from the initial form of abuse. Immediate care, overnight housing, and care in a safe location, in addition to long-term care, may be necessary when these types of abusive actions are taken upon an elder. Elder abuse may be a minor issue that can be easily resolved, or it can result in severe and life-threatening complications that are not recoverable for the elderly. The more knowledge health care providers and law enforcement members have, the more likely they are to institute strategies for abuse prevention and management. No matter how minor or severe the abuse, they have a duty to assess elderly patients according to recommended protocols and report suspected abuse.

Annotated Bibliography

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  2. DelCarmen, T., MD, & LoFaso, Veronica M., MS, MD. (2014). Elder Neglect. Clinics in Geriatric Medicine, 30(4), 769-777.
  3. Dimah, A. & Dimah, K. (2002). Gender Differences Among Abused Older African Americans and African American Abusers in an Elder Abuser Providing Agency. Journal of -Black Studies, 32(5), 557-573
  4. Golding, J., John A. Yozwiak, Terrri L. Krinstle, & Marsil, D. (2005). The Effect of Gender in the Perception of Elder Physical Abuse in Court. Law and Human Behaviors, 29(5), 605-614
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  6. Kong, J., & Jeon, H. (2018). Functional decline and emotional elder abuse: A Population-Based Study of Older Korean Adults. Journal of Family Violence, 33(1), 17-26
  7. LeHudson, N. (2015). Advocating for Elders Suffering Financial Abuse and Exploitation. GPSolo, 32(6), 18-21
  8. McMillion, R. (2015). Show of Support – Financial Commitment by Congress to Address Elder Abuse Issues is an Encouraging Step. ABA Journal, 101(2), 70-71
  9. Midgley, E. (2017). Elder Abuse. InnovAit, 10(2), 105-111
  10. Ramsey-Klawsnik, H. (2004;2003). Elder sexual abuse within the family. Journal of Elder Abuse & Neglect, 15(1), 43-58
  11. Redmond, M. (2015). Representing Elder Physical Abuse Victims. GPSolo, 32(6), 14-17
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