Research proposal on elder abuse

Ethical and Policy Issues in Research on Elder Abuse and Neglect

Research and Evaluation on the Abuse, Neglect, and Exploitation of

yet prevailing policies and practices in these adjacent domains are not fully applicable to elder mistreatment and have been controversial on their own terms. (it should be noted, however, that the scope and content of the definitions used in these studies vary, particularly with regard to financial abuse. feel they don't receive enough benefit or recognition from their relationship with the elderly person, so they resort to violence in an effort to obtain their "fair share. is some anecdotal evidence that institutional review boards have interpreted the common rule (the governing regulations on research ethics) in an unduly restrictive fashion, impeding potentially valuable research on elder mistreatment (see chapter 8). existing interventions to prevent or ameliorate elder mistreatment should be evaluated, and agencies funding new intervention programs should require and fund a scientifically adequate evaluation as a component of each grant. this is an equally vexing problem, since the definitions of the varying elements of elder abuse must be operationalized through the design and administration of a research instrument. is needed to help illuminate the characteristics of common injuries, such as their etiology, natural course, distribution, and severity so that the process of identifying cases of elder mistreatment can become more accurate and reliable. elder mistreatment: abuse, neglect, and exploitation in an aging america. who have produced a modest body of knowledge concerning the phenomenology, magnitude, etiology, and consequences of elder mistreatment. elder mistreatment: abuse, neglect, and exploitation in an aging america. is needed on the phenomenology and clinical course of elder mistreatment. a manual record matching of epese and connecticut ombudsman/elderly protective service records was done to determine if any cohort members had been seen by ombudsmen over an 11-year follow-up period from cohort inception (1982-1992 inclusive). response to elder mistreatment is an understudied area that should receive heightened attention by the national institute of justice and other funders of criminal justice research. as a result, elder mistreatment research has thus far been confined to a small community of. chapter 3 sketches a theoretical framework that may be useful in organizing research on the phenomenology and etiology of elder mistreatment in different settings and contexts. elder mistreatment: abuse, neglect, and exploitation in an aging america. elder mistreatment researchers have not been trained in methods of studying other forms of family violence, including sampling methodologies and measurement techniques. mistreatment in an aging america takes a giant step toward broadening our understanding of the mistreatment of the elderly and recommends specific research and funding strategies that can be used to deepen it. elder mistreatment: abuse, neglect, and exploitation in an aging america. cases where financial exploitation is combined with physical abuse or neglect typically involve financially dependent family members, particularly adult offspring, who have been cared for by the elderly person. long-term care for community-dwelling elders is provided in a traditional home setting, either in an older person’s own home, with or without a spouse, or in the home of a close relative., in most cases, the research data on elder mistreatment have not come directly from victims, but instead from professionals and outside observers. the late 1970s when congressman claude pepper held widely publicized hearings on the mistreatment of the elderly, policy makers and practitioners have sought ways to protect older americans from physical, psychological, and financial abuse. in the united states, 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 (see chapter 4)., the national response to elder mistreatment still remains weak and incomplete.” as discussed below, these terms refer to a category of conditions that has little in common with the conditions that bear on abuse and neglect of elder persons by other people. contrary to common belief, many elderly victims of physical abuse are high functioning. feasible, investigators should consult representative members of the populations being studied (elder persons and caregivers, nursing home residents and staff, etc. most important, the question of the extent of elder mistreatment cannot be answered by studies of reported cases. the abuser may be a long-term dependent of the victim because of health or financial issues and may take out resentment for this dependence on the elderly victim. elder mistreatment: abuse, neglect, and exploitation in an aging america. (it should be noted, however, that the scope and content of the definitions used in these studies vary, particularly with regard to financial abuse. while one set of investigators calls “withholding of personal care” physical abuse, a second researcher calls it active neglect; a third subsumes such actions under physical neglect; and yet a fourth considers such behaviors to be “psychological neglect.) despite attempts to estimate incidence and prevalence in other ways, random sample surveys of the elderly population alone allow for a more accurate assessment of the rate of elder mistreatment. yet, during the last 20 years fewer than 50 articles have addressed the shameful problem that abusers—and sometimes the abused themselves—want to conceal. recent research has shed some light on case characteristics common to different types of elder abuse.

Research and Evaluation on the Abuse, Neglect, and Exploitation of

Guidelines for evaluating and applying - ncpea

of inconsistencies in definition and measurement that have thus far characterized research on elder mistreatment. a two-stage interview process was used: screening to determine if the person was a victim of mistreatment (defined to include physical abuse and psychological abuse and neglect but excluding financial abuse), followed by in-depth interviews by telephone or in person. the recent history of child protection offers many lessons for specialists in elder mistreatment. a major advance has been the fielding of major population-based victimization surveys that have helped to establish reliable prevalence estimates of select problems, such as intimate partner violence and child physical and sexual abuse. this report presents a research agenda for consideration by the national institute on aging and other potential sponsors of research on elder mistreatment—a term we explain more fully in chapter 2. panel strongly encourages government agencies and private sponsors of elder mistreatment programs to give priority to interventions that emphasize specialized professional training and interdisciplinary collaboration. development of better definitions of mistreatment of the elderly should be an extremely high priority for researchers. researchers must be clear and explicit regarding what is included and excluded from the category of elder abuse in order to conduct any meaningful meta-analyses. is needed on the phenomenology and clinical course of elder mistreatment. research on risk and protective factors should take into consideration the clinical course of elder mistreatment. elder mistreatment: abuse, neglect, and exploitation in an aging america. investigators typically mail surveys to professionals and paraprofessionals, asking them about contacts with cases of elder abuse or neglect during a given time period. the statutes typically define abuse or mistreatment as a series of broad categories, such as physical abuse, psychological or emotional abuse, sexual abuse or exploitation, and fiduciary abuse or exploitation, as well as neglect.-based surveys of elder mistreatment occurrence are feasible and should be given a high priority by funding agencies. evolving understanding of elder mistreatment as a social problem has more recently been shaped by another image—the trapped victim of family violence. gerontologists who study elder mistreatment have tended to follow their interests in family caregiving and have seen the problem in this context. elder mistreatment: abuse, neglect, and exploitation in an aging america. overall, one-half of the responding agencies reported encountering elder abuse, ranging from over 90 percent of domestic violence agencies, to less than 30 percent for law enforcement, emergency services, medical clinics, and drug/alcohol agencies (fiegener et al. after cohort members who were seen by protective services for the elderly were identified, weighted survival curves from cohort inception were constructed for three subgroups of subjects: (1) those found to have sustained verified elder mistreatment (abuse, neglect, or exploitation) by another party (i. modules pertaining to elder mistreatment should be included in existing comprehensive geographic health and social surveys, including ongoing longitudinal studies of aging populations. elder mistreatment: abuse, neglect, and exploitation in an aging america. the prevailing understanding of the problem, and the social response to it, have gradually emerged over the past half-century, shaped by evolving social responses to child protection and family violence as well as by an intensifying concern about neglect and victimization of vulnerable elderly people. pediatrician henry kempe, the leader of the group and founder of the international society for prevention of child abuse and neglect, spearheaded a movement to adopt mandated reporting laws. elder mistreatment: abuse, neglect, and exploitation in an aging america. content  causes and characteristics of elder abuselearn moreread the research in brief understanding elder abuse: new directions for developing theories of elder abuse occurring in domestic settings. elder mistreatment: abuse, neglect, and exploitation in an aging america. should issue certificates of confidentiality designed to insulate elder mistreatment researchers from any legal obligation to disclose possible cases of mistreatment that otherwise may arise under state law, including tort “duty to protect” obligations as well as reporting statutes. for example, some states do not include psychological abuse within the definition, while others add more specific forms of mistreatment such as “unreasonable confinement” or “abandonment. elder mistreatment: abuse, neglect, and exploitation in an aging america. development of better definitions of mistreatment of the elderly should be an extremely high priority for researchers. gerontologists who study elder mistreatment have tended to follow their interests in family caregiving and have seen the problem in this context. bringing elder mistreatment into the domain of family violence widens the angle of the lens and thereby brings new ideas about etiology and prevention into view.” to some extent, this problem is a reflection of conceptual confusion: what type of behavior or condition is denoted by the concept of “abuse”? for example, records of patients at hospitals or social service agencies have been reviewed, and the percentage of elderly persons judged to have been abused is established. while one set of investigators calls “withholding of personal care” physical abuse, a second researcher calls it active neglect; a third subsumes such actions under physical neglect; and yet a fourth considers such behaviors to be “psychological neglect. interestingly, although a number of controlled studies were conducted in the late 1980s and early 1990s, there are virtually no examples of more recent case-control studies of elder mistreatment.

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1. Introduction | Elder Mistreatment: Abuse, Neglect, and Exploitation

the abuser is typically a family member, often the adult offspring of the victim. Elder Mistreatment in an Aging America takes a giant step toward broadening our understanding of the mistreatment of the elderly and recommends specific research and funding strategies that can be used to deepen it. they also vary in definitions of abuse, classification of abuse as civil or criminal, whether reporting is mandatory or voluntary, and the remedies or resources available when abuse is documented. an increasing number of elderly people reside outside traditional home settings in highly restrictive institutional environments (such as skilled or intermediate nursing facilities) or in less restrictive community-based residential settings, such as assisted living facilities, board and care homes, and adult foster homes. these laws, which were quickly adopted in all 50 states, rested on the premise that the abused child was an aberrant problem (amounting to several hundred egregious cases each year in the united states), and on the belief that the problem could be solved if health professionals brought those cases to the attention of social service authorities. of the weaknesses of elder mistreatment research are summarized below.. in cases of elder neglect, the victim may be physically frail or cognitively vulnerable. chapter 8 addresses concerns about protecting human subjects in elder mistreatment research, and chapter 9 identifies some necessary conditions for moving the field forward. studies of this kind are urgently needed: to date, no prospective study of elder abuse has been conducted. noted that very little is known about the phenomenology, magnitude, etiology, and consequences of elder mistreatment, and that almost nothing is known about the effects of interventions. elder mistreatment: abuse, neglect, and exploitation in an aging america. elder mistreatment: abuse, neglect, and exploitation in an aging america. elder mistreatment: abuse, neglect, and exploitation in an aging america. more about research on financial exploitation and hybrid cases of elder abuse. first major difficulty in analyzing results from previous research on elder abuse and neglect results from the poor definition of the term “elder abuse. these factors increase the pressures on families caring for their elderly relatives and also are likely to increase the demand for institutional care. overall, one-half of the responding agencies reported encountering elder abuse, ranging from over 90 percent of domestic violence agencies, to less than 30 percent for law enforcement, emergency services, medical clinics, and drug/alcohol agencies (fiegener et al. chapter 7 reviews policies and programs aiming to prevent or respond to elder mistreatment and identifies priorities for future research. pediatrician henry kempe, the leader of the group and founder of the international society for prevention of child abuse and neglect, spearheaded a movement to adopt mandated reporting laws. yet prevailing policies and practices in these adjacent domains are not fully applicable to elder mistreatment and have been controversial on their own terms. similarly, a survey of alabama physicians and registered and licensed practical nurses found that 38 percent of the physicians and 53 percent of the nurses had seen cases of elder abuse in the previous year (clark-daniels et al. elder mistreatment: abuse, neglect, and exploitation in an aging america. the number of cases of elder mistreatment will undoubtedly increase over the next several decades, as the population ages. researchers must be clear and explicit regarding what is included and excluded from the category of elder abuse in order to conduct any meaningful meta-analyses. in the late 1970s, the national spotlight was directed for the first time at what was characterized as systematic mistreatment of elderly people. elder mistreatment: abuse, neglect, and exploitation in an aging america. example of this problem is the lack of studies using the conflict tactics scale (straus, 1978; straus and gelles, 1990, 1992) to study elder mistreatment. trends highlight the growing challenge of ensuring the safety and protecting the other interests of elderly people in the diverse settings in which long-term care is provided. elder mistreatment: abuse, neglect, and exploitation in an aging america. elder mistreatment: abuse, neglect, and exploitation in an aging america. elder mistreatment: abuse, neglect, and exploitation in an aging america. these victims are generally aware that they are being mistreated, but their sense of parental or family obligation makes them reluctant to cut off the abuser. long-term care for community-dwelling elders is provided in a traditional home setting, either in an older person’s own home, with or without a spouse, or in the home of a close relative. researcher a includes physical abuse in her definition of elder abuse. furthermore, he decides that there must be at least two episodes of this behavior for it to be called physical abuse except for those items dealing with weapons, in which case one incident is sufficient. elder mistreatment: abuse, neglect, and exploitation in an aging america. 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CHAPTER 5 Abuse of the elderly

after cohort members who were seen by protective services for the elderly were identified, weighted survival curves from cohort inception were constructed for three subgroups of subjects: (1) those found to have sustained verified elder mistreatment (abuse, neglect, or exploitation) by another party (i. elder mistreatment has attracted sustained efforts from practitioners and some interest from policy makers over the past two decades, it has not received concomitant attention from researchers or from the agencies that provide research funding. they also vary in definitions of abuse, classification of abuse as civil or criminal, whether reporting is mandatory or voluntary, and the remedies or resources available when abuse is documented. elder mistreatment: abuse, neglect, and exploitation in an aging america. the occurrence of elder mistreatment in institutional settings, including hospitals, long-term care and assisted living situations, is all but uncharacterized and needs new study sampling and detection methods., in most cases, the research data on elder mistreatment have not come directly from victims, but instead from professionals and outside observers. the national elder abuse incidence study (national center on elder abuse, 1998). research on risk and protective factors should take into consideration the clinical course of elder mistreatment. of the data on risk factors and consequences of elder mistreatment are drawn from studies of clinical case samples. attention was paid to the problem of elder abuse before 1978 except for some intermittent articles published in british and american medical and social services journals. elder mistreatment: abuse, neglect, and exploitation in an aging america. future research in this area should go beyond archival data and should rely to a much greater extent on elder persons’ accounts of their experiences and on their perceptions regarding their own security. many of the preventive and protective tools developed in the context of intimate partner violence have now been directed to violence against elders. chapter 5 summarizes what is now known about risk factors for elder mistreatment and identifies priorities for future research. elder mistreatment: abuse, neglect, and exploitation in an aging america. the statutes typically define abuse or mistreatment as a series of broad categories, such as physical abuse, psychological or emotional abuse, sexual abuse or exploitation, and fiduciary abuse or exploitation, as well as neglect. however, because much elder mistreatment does not occur in family caregiving situations, this has been a serious limitation. elder mistreatment: abuse, neglect, and exploitation in an aging america. chapter 4 addresses the challenge of measuring the occurrence of elder mistreatment in the population, highlighting important epidemiological considerations in elder mistreatment research. conceptions of elder mistreatment, and the appropriate social responses to it, will also be shaped, inevitably, by the deep concerns that have emerged over the past decade in the field of child protection. there is a sizable body of unpublished reports and commentary on elder mistreatment, fewer than 50 peer-reviewed articles based on empirical research have been published in the field. improving our understanding of the complexity of elder abuse cases can help researchers both develop and evaluate theory-based explanations for abuse. elder mistreatment: abuse, neglect, and exploitation in an aging america. every state has enacted a statute authorizing or directing intervention in cases involving vulnerable adults, including the elderly, these statutes vary widely in almost every respect (see appendix b and tables in chapter 2). elder mistreatment: abuse, neglect, and exploitation in an aging america. every state has enacted a statute authorizing or directing intervention in cases involving vulnerable adults, including the elderly, these statutes vary widely in almost every respect (see appendix b and tables in chapter 2).” another group called elder neglect and abuse “a generic term that refers to the neglect and/or physical, psychological, or financial abuse of the older person. in this study, modeled after recent incidence studies of child abuse, the researchers identified a nationally representative sample of 20 counties in 15 states; for each county sampled, they collected data from the local aps agency as well as approximately 1100 professional “sentinels” having frequent contact with the elderly.. advisory board on child abuse and neglect, 1993) proposed a new national strategy designed to rely on voluntary action to make child protection a part of everyday life (see melton and barry, 1994, melton et al. to provide a typical example, in a survey on elder abuse funded by the administration on aging, a sample of professionals, including administrators and direct service workers from 16 types of agencies, was surveyed in each of pennsylvania’s 67 counties. elder mistreatment: abuse, neglect, and exploitation in an aging america. however, even if researchers embraced a common set of definitions for the elements of elder mistreatment and operationalized them the same way, that would still leave the problem of determining whether the instruments actually measure what they purport to measure (validity) and whether they can be reliably administered. at the present time, no measure of elder mistreatment has been validated, nor has any instrument been embraced by the field as a definitive measure of mistreatment, even within a narrow sphere. regardless of the occasional controversy over the scale, it is a hallmark instrument that has been used in scores of studies of child abuse. elder mistreatment: abuse, neglect, and exploitation in an aging america. as the state response continued to evolve in the early 1980s, many states required reporting of abuse, bringing the problem within the purview of adult protective services.

Causes and Characteristics of Elder Abuse

elder mistreatment: abuse, neglect, and exploitation in an aging america. this also helped to broaden the constituencies interested in research and program development to include gerontologists and the expanding network of service providers and advocates for the elderly. researcher b also includes physical abuse in his definition of elder abuse. about the use of civil justice interventions and their effectiveness in preventing exploitation and other harm to elders should be jointly sponsored by the national institute of justice and the administration on aging.” as discussed below, these terms refer to a category of conditions that has little in common with the conditions that bear on abuse and neglect of elder persons by other people. they specify different ages or circumstance under which a victim is eligible for protective services, often differentiating between in-home and institutional abuse. elder mistreatment: abuse, neglect, and exploitation in an aging america. congressman claude pepper held widely publicized hearings, calling attention to the “hidden problem” of elder abuse in the nation’s families, including what one witness characterized as “granny battering” (wolfe, this volume). an effort to generate a national estimate of the occurrence of elder abuse and neglect based on case-identification by professional “sentinels,” the national center of elder abuse, in conjunction with westat, inc. mistreatment in an aging america will be of interest to anyone concerned about the elderly and ways to intervene when abuse is suspected, including family members, caregivers, and advocates for the elderly. this report presents a research agenda for consideration by the national institute on aging and other potential sponsors of research on elder mistreatment—a term we explain more fully in chapter 2. elder mistreatment: abuse, neglect, and exploitation in an aging america. elder mistreatment: abuse, neglect, and exploitation in an aging america., what are the characteristics of locations, conditions, situations, and relationships in which the elderly are most vulnerable to mistreatment? for example, fewer than 15 studies on elder mistreatment have been funded by the national institute on aging (nia) since 1990, and support from other agencies has been even less substantial. better data on the true prevalence of elder mistreatment are needed in deciding what action government ought to take. elder mistreatment studies have relied so heavily on reports from professionals, crucial data about abuse situations have been missed. elder mistreatment: abuse, neglect, and exploitation in an aging america. furthermore, the technology for studying family violence has been developed and refined not by gerontologists, but by child abuse and intimate partner researchers. as the state response continued to evolve in the early 1980s, many states required reporting of abuse, bringing the problem within the purview of adult protective services. a two-stage interview process was used: screening to determine if the person was a victim of mistreatment (defined to include physical abuse and psychological abuse and neglect but excluding financial abuse), followed by in-depth interviews by telephone or in person. evolving understanding of elder mistreatment as a social problem has more recently been shaped by another image—the trapped victim of family violence., what are the characteristics of locations, conditions, situations, and relationships in which the elderly are most vulnerable to mistreatment? Yet, during the last 20 years fewer than 50 articles have addressed the shameful problem that abusers—and sometimes the abused themselves—want to conceal. although the total federal contribution to research on elder mistreatment is uncertain, expenditures by nia, the lead agency for aging research, have totaled million during the last 12 years (1990–2001). on the extent of elder mistreatment in the general population are sparse. has been almost no effort to evaluate intervention programs for elder abuse. using a patient-based approach to study elder mistreatment is also fraught with potential for sample bias, in that if an older adult does not have a doctor or. the prevailing understanding of the problem, and the social response to it, have gradually emerged over the past half-century, shaped by evolving social responses to child protection and family violence as well as by an intensifying concern about neglect and victimization of vulnerable elderly people. many of the preventive and protective tools developed in the context of intimate partner violence have now been directed to violence against elders. elder mistreatment: abuse, neglect, and exploitation in an aging america. this page find information on:understanding the causes of elder abusecase characteristics of elder abuse in domestic settingsunderstanding the causes of elder abusebecause concern for elder abuse as a criminal issue is a fairly recent development, there are gaps in our knowledge about the extent and causes of such abuse. this is an equally vexing problem, since the definitions of the varying elements of elder abuse must be operationalized through the design and administration of a research instrument. elder mistreatment: abuse, neglect, and exploitation in an aging america. some population surveys have subsequently been fielded, many of them have excluded from the sample potential respondents who may be at high risk for abuse or neglect—e. similarly, the biggest increase in reporting occurred when sexual abuse was “discovered” early in the 1980s (weisberg, 1984), and criminal prosecution became a common feature in the child protection system.

,

Elder Mistreatment: Using Theory in Research

elder mistreatment: abuse, neglect, and exploitation in an aging america. best, studies of professional experience provide impressionistic estimates and opinions about the prevalence, correlates, and consequences of elder mistreatment. retrospect, it appears that elder mistreatment became identified as a national concern when it was conceptualized as an “aging” issue, rather than as an undifferentiated component of adult protection. panel strongly encourages government agencies and private sponsors of elder mistreatment programs to give priority to interventions that emphasize specialized professional training and interdisciplinary collaboration. for example, some researchers have used the term “abuse” tautologically; for example, one group of researchers defined elder abuse as “an abusive action inflicted by the abusers on adults 60 years of age or older. she matched a group of elders receiving protective services with a group from the community who were receiving traditional services, finding that those who were receiving protective services had a higher mortality rate and higher nursing home placement rate than those who were receiving. elder mistreatment researchers have not been trained in methods of studying other forms of family violence, including sampling methodologies and measurement techniques. one of the reasons for this situation is that so little funding has been available for research on elder mistreatment. addition to improved household and geographically referent sampling techniques, new methods of sampling and identifying elder mistreatment victims in the community should be developed in order to improve the validity and comprehensiveness of elder mistreatment occurrence estimates. in recognition of these deficiencies, the national institute on aging requested the national research council to commission this study as the first step in an effort to broaden and deepen knowledge about the mistreatment of elders. this suggests that researchers, policy makers, and other consumers of research on elder mistreatment must pay careful attention to the definitions and measures of any studies on which they rely. in the united states, 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 (see chapter 4). researcher b also includes physical abuse in his definition of elder abuse.” moreover, statutes sometimes distinguish between degrees of mistreatment according to the perpetrator’s culpability or state of mind; for example, the law may distinguish among willful infliction of physical abuse, negligently causing physical injury, and failure to prevent it.. advisory board on child abuse and neglect, 1993) proposed a new national strategy designed to rely on voluntary action to make child protection a part of everyday life (see melton and barry, 1994, melton et al. for example, some states do not include psychological abuse within the definition, while others add more specific forms of mistreatment such as “unreasonable confinement” or “abandonment. for example, some researchers have used the term “abuse” tautologically; for example, one group of researchers defined elder abuse as “an abusive action inflicted by the abusers on adults 60 years of age or older. however, this model does not fit all situations and types of elder abuse., the national response to elder mistreatment still remains weak and incomplete. the occurrence of elder mistreatment in institutional settings, including hospitals, long-term care and assisted living situations, is all but uncharacterized and needs new study sampling and detection methods. elder mistreatment: abuse, neglect, and exploitation in an aging america. studies are especially weakened by their inclusion of the category “self-abuse” or “self-neglect. noted that very little is known about the phenomenology, magnitude, etiology, and consequences of elder mistreatment, and that almost nothing is known about the effects of interventions. the 1994 national long term care survey indicated that more than 7 million americans, mainly family members, provided 120 million hours of care to elders with functional disabilities living in the community. she then proceeds to define physical abuse as a single incident in which the elder is hit, bit, punched, kicked, threatened with a weapon, or has a weapon used on him or her. researcher a includes physical abuse in her definition of elder abuse. elder mistreatment: abuse, neglect, and exploitation in an aging america. (in relation to child abuse, for example, see the 1995 gallup poll, finding that far more of america’s children are victims of physical and sexual abuse than officially reported—gallup poll, 1995. elder mistreatment: abuse, neglect, and exploitation in an aging america. elder mistreatment: abuse, neglect, and exploitation in an aging america. elder mistreatment: abuse, neglect, and exploitation in an aging america. and institutional review boards (irbs) need clearer guidance (without rigid rules) concerning two issues that tend to recur in elder mistreatment research: conditions under which research can properly go forward with participants whose decisional capacity is impaired, and the proper responses to evidence of mistreatment elicited during the course of the study. but researchers have too often used these professional surveys to estimate the incidence or prevalence of elder mistreatment, or to establish its causes. existing interventions to prevent or ameliorate elder mistreatment should be evaluated, and agencies funding new intervention programs should require and fund a scientifically adequate evaluation as a component of each grant. several studies have attempted to go beyond previous efforts by interviewing the victims themselves and including a control group of nonabused elderly persons (bristowe and collins, 1989; paveza et al. Elder Mistreatment in an Aging America will be of interest to anyone concerned about the elderly and ways to intervene when abuse is suspected, including family members, caregivers, and advocates for the elderly.

Elder Abuse in the Nursing Home Setting: Social Workers

it is generally acknowledged that these findings detect only the most overt cases and thus significantly underestimate the incidence of elder mistreatment. elder mistreatment: abuse, neglect, and exploitation in an aging america. she matched a group of elders receiving protective services with a group from the community who were receiving traditional services, finding that those who were receiving protective services had a higher mortality rate and higher nursing home placement rate than those who were receiving. chapter 4 addresses the challenge of measuring the occurrence of elder mistreatment in the population, highlighting important epidemiological considerations in elder mistreatment research. mistreatment in an aging america takes a giant step toward broadening our understanding of the mistreatment of the elderly and recommends specific research and funding strategies that can be used to deepen it. however, in a pioneering study, lachs and colleagues retrospectively linked adult protective services data to a prospective study—the new haven epese study (established population for epidemiologic studies in the elderly) as the basis for this research,Suggested citation: "1. elder mistreatment: abuse, neglect, and exploitation in an aging america. and institutional review boards (irbs) need clearer guidance (without rigid rules) concerning two issues that tend to recur in elder mistreatment research: conditions under which research can properly go forward with participants whose decisional capacity is impaired, and the proper responses to evidence of mistreatment elicited during the course of the study. but researchers have too often used these professional surveys to estimate the incidence or prevalence of elder mistreatment, or to establish its causes. example of this problem is the lack of studies using the conflict tactics scale (straus, 1978; straus and gelles, 1990, 1992) to study elder mistreatment. thus both researchers have included physical abuse in their studies—indeed, it may be the sole focus of each researcher’s study—but the measure of physical abuse differs across the two studies. also, the field of research has relied heavily on the caregiver stress model, which holds that elder abuse can be attributed to the stress associated with providing care and assistance to frail, highly dependent elderly people. when data are reported to some central repository, unless the repository has imposed a specific definition for each of the forms of abuse, the same statutory element will trigger reports in different categories of cases in different states. elder mistreatment: abuse, neglect, and exploitation in an aging america. conceptions of elder mistreatment draw on a diverse array of images (the forgotten and helpless nursing home resident, the battered granny, the stressed caregiver, the abusing spouse). tensions and policy adaptations in the field of child protection appear to be highly relevant to elder protection at this moment in the evolution of research and public policy in this nascent field. these laws, which were quickly adopted in all 50 states, rested on the premise that the abused child was an aberrant problem (amounting to several hundred egregious cases each year in the united states), and on the belief that the problem could be solved if health professionals brought those cases to the attention of social service authorities. this suggests that researchers, policy makers, and other consumers of research on elder mistreatment must pay careful attention to the definitions and measures of any studies on which they rely. research on the phenomenology of elder mistreatment is a critical early step in the further development of the field. elder mistreatment: abuse, neglect, and exploitation in an aging america. for example, the definition of emotional abuse in several states includes “ridiculing or demeaning an infirm adult, making derogatory remarks to an infirm adult or cursing or threatening to inflict physical or emotional harm on an infirm adult,” whereas other states require proof of “extreme emotional distress or harm” (see appendix b). elder mistreatment: abuse, neglect, and exploitation in an aging america.) despite attempts to estimate incidence and prevalence in other ways, random sample surveys of the elderly population alone allow for a more accurate assessment of the rate of elder mistreatment. trends highlight the growing challenge of ensuring the safety and protecting the other interests of elderly people in the diverse settings in which long-term care is provided. development of widely accepted operational definitions and validated and standardized measurement methods for the elements of elder mistreatment is urgently needed to move the field forward.. advisory board on child abuse and neglect issued a highly publicized and rarely disputed declaration of a national emergency in the child protection system. elder mistreatment: abuse, neglect, and exploitation in an aging america. for example, many researchers refer to the entire range of problems experienced by elders as “abuse,” including lack of proper housing, untreated medical conditions, and lack of social services.. advisory board on child abuse and neglect (1990) attributed the emergency to the errant design of the child protection system itself: the system has become preoccupied by investigation (rather than prevention and treatment), and community responsibility for ensuring the safety of dependent children has effectively, if unintentionally, been diverted to a small social service agency. chapter 3 sketches a theoretical framework that may be useful in organizing research on the phenomenology and etiology of elder mistreatment in different settings and contexts. some population surveys have subsequently been fielded, many of them have excluded from the sample potential respondents who may be at high risk for abuse or neglect—e. elder mistreatment: abuse, neglect, and exploitation in an aging america. million in 2001; this is a modest sum even in comparison to the underfunded domain of child abuse research, on which federal agencies spend . elder mistreatment: abuse, neglect, and exploitation in an aging america. on the effects of elder mistreatment interventions is urgently needed. one of the reasons for this situation is that so little funding has been available for research on elder mistreatment.

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SOCIAL-RELATIONAL RISK FACTORS FOR PREDICTING ELDER

nursing home population tends to be older and more severely disabled than elders residing elsewhere, with about half of the residents being 85 or older and about half having five adl limitations, in 1996 (stone, 2000); still, four out of five elderly persons with adl or iadl impairments lived in the community setting (alecxih et al. attention was paid to the problem of elder abuse before 1978 except for some intermittent articles published in british and american medical and social services journals. similar progress has not occurred in the field of elder mistreatment. problem arises for all of the types of elder mistreatment typically investigated, including neglect and financial exploitation. as a result, elder mistreatment research has thus far been confined to a small community of. spouse abuse and other varieties of intimate partner violence have received increasing professional and political attention since the 1980s, leading to a wide variety of interventions and a substantial investment in research (national research council, 1996; national research council and institute of medicine, 1998). elder mistreatment: abuse, neglect, and exploitation in an aging america. best, studies of professional experience provide impressionistic estimates and opinions about the prevalence, correlates, and consequences of elder mistreatment.-based surveys of elder mistreatment occurrence are feasible and should be given a high priority by funding agencies.” similarly, some researchers define physical abuse in terms of actions: hitting, pushing, choking, etc. addition to improved household and geographically referent sampling techniques, new methods of sampling and identifying elder mistreatment victims in the community should be developed in order to improve the validity and comprehensiveness of elder mistreatment occurrence estimates.. advisory board on child abuse and neglect issued a highly publicized and rarely disputed declaration of a national emergency in the child protection system. in 1996, according to the projections based on this study, about 450,000 persons age 60 or older experienced abuse or neglect in family settings, about 16 percent of whom were in the aps report files. is widely recognized that reported cases are highly selective samples, and that there is a large reservoir of unreported and undetected cases of elder mistreatment about which very little is known. who have attempted to conduct research on elder abuse report that they have sometimes been hindered by a lack of cooperation from agencies responsible for identifying and treating victims of mistreatment. most of the studies are weakened by their undifferentiated treatment of various types of abuse and neglect. elder mistreatment: abuse, neglect, and exploitation in an aging america. elder mistreatment: abuse, neglect, and exploitation in an aging america. investigators believe that victims and family members are not suitable respondents for interview studies of elder mistreatment, because they are not reliable respondents, because they are not willing to be interviewed, or because they are incapable of giving the necessary consent. elder mistreatment: abuse, neglect, and exploitation in an aging america. as a result, elder mistreatment remains hidden, poorly characterized, and largely unaddressed—more than two decades after the pepper hearings first exposed it to public view. elder mistreatment: abuse, neglect, and exploitation in an aging america. she then proceeds to define physical abuse as a single incident in which the elder is hit, bit, punched, kicked, threatened with a weapon, or has a weapon used on him or her. elder mistreatment studies have relied so heavily on reports from professionals, crucial data about abuse situations have been missed. elder mistreatment: abuse, neglect, and exploitation in an aging america. studies are especially weakened by their inclusion of the category “self-abuse” or “self-neglect. Elder Mistreatment in an Aging America will be of interest to anyone concerned about the elderly and ways to intervene when abuse is suspected, including family members, caregivers, and advocates for the elderly. to such shortcomings, existing studies have not provided adequate data needed to answer three important public policy questions about elder abuse and neglect:Suggested citation: "1. it is to some extent the state of the art, but some elder mistreatment researchers do not seem to be aware of it..Elder mistreatment: abuse, neglect, and exploitation in an aging america. of elder abuseidentifyingcauses and characteristicscurrently selectedaddressing mistreatmentfinancial exploitationsexual abuseperpetratorsother web resources. a manual record matching of epese and connecticut ombudsman/elderly protective service records was done to determine if any cohort members had been seen by ombudsmen over an 11-year follow-up period from cohort inception (1982-1992 inclusive). at the present time, no measure of elder mistreatment has been validated, nor has any instrument been embraced by the field as a definitive measure of mistreatment, even within a narrow sphere.. advisory board on child abuse and neglect (1990) attributed the emergency to the errant design of the child protection system itself: the system has become preoccupied by investigation (rather than prevention and treatment), and community responsibility for ensuring the safety of dependent children has effectively, if unintentionally, been diverted to a small social service agency. about the use of civil justice interventions and their effectiveness in preventing exploitation and other harm to elders should be jointly sponsored by the national institute of justice and the administration on aging. an effort to generate a national estimate of the occurrence of elder abuse and neglect based on case-identification by professional “sentinels,” the national center of elder abuse, in conjunction with westat, inc.

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Perceived Effectiveness of Elder Abuse Interventions in

current system for protection of elders and other vulnerable adults grew from the child protection system, which itself is only about 40 years old in its modern form. chapter 5 summarizes what is now known about risk factors for elder mistreatment and identifies priorities for future research. for example, records of patients at hospitals or social service agencies have been reviewed, and the percentage of elderly persons judged to have been abused is established. conceptions of elder mistreatment, and the appropriate social responses to it, will also be shaped, inevitably, by the deep concerns that have emerged over the past decade in the field of child protection. conceptions of elder mistreatment draw on a diverse array of images (the forgotten and helpless nursing home resident, the battered granny, the stressed caregiver, the abusing spouse). or studies use as a “measure” of abuse whether a professional has identified an elderly person as “abused”—thereby embracing without further clarification the discretionary judgments of clinicians and caseworkers applying the ambiguous statutory definitions. for example, the definition of emotional abuse in several states includes “ridiculing or demeaning an infirm adult, making derogatory remarks to an infirm adult or cursing or threatening to inflict physical or emotional harm on an infirm adult,” whereas other states require proof of “extreme emotional distress or harm” (see appendix b). elder mistreatment: abuse, neglect, and exploitation in an aging america. as a result, elder mistreatment remains hidden, poorly characterized, and largely unaddressed—more than two decades after the pepper hearings first exposed it to public view.” moreover, statutes sometimes distinguish between degrees of mistreatment according to the perpetrator’s culpability or state of mind; for example, the law may distinguish among willful infliction of physical abuse, negligently causing physical injury, and failure to prevent it. elder mistreatment: abuse, neglect, and exploitation in an aging america. this produces an incomplete picture of the dynamics fueling elder abuse. of those adl-impaired elderly people living in community settings, 37 percent report that they need help but do not receive it or receive less help than is needed (stone, 2000). elder mistreatment: abuse, neglect, and exploitation in an aging america..Elder mistreatment: abuse, neglect, and exploitation in an aging america. lists of injuries to define physical elder abuse, such as cuts, fractures, bruises, and burns. the emergence of the juvenile court in the early part of the 20th century represented a significant assertion of collective responsibility for protecting and “saving” children who had become ungovernable by their parents; over the following decades, the jurisdiction of the juvenile courts gradually reached children who were neglected or abused by their parents (platt, 1969). yet, during the last 20 years fewer than 50 articles have addressed the shameful problem that abusers—and sometimes the abused themselves—want to conceal. they specify different ages or circumstance under which a victim is eligible for protective services, often differentiating between in-home and institutional abuse. the late 1970s when Congressman Claude Pepper held widely publicized hearings on the mistreatment of the elderly, policy makers and practitioners have sought ways to protect older Americans from physical, psychological, and financial abuse.” similarly, some researchers define physical abuse in terms of actions: hitting, pushing, choking, etc. there is a sizable body of unpublished reports and commentary on elder mistreatment, fewer than 50 peer-reviewed articles based on empirical research have been published in the field. elder mistreatment: abuse, neglect, and exploitation in an aging america. finally, in 1989, pepper succeeded in including creation of a national center on elder abuse as an amendment to the older americans act. nursing home population tends to be older and more severely disabled than elders residing elsewhere, with about half of the residents being 85 or older and about half having five adl limitations, in 1996 (stone, 2000); still, four out of five elderly persons with adl or iadl impairments lived in the community setting (alecxih et al. abuse and severe physical abuse) has not adopted the “perpetrator-victim” model commonly embraced by advocates for battered women (melton and andrews, 2000). preparatory funding should be provided to develop and test measures for identifying elder mistreatment. elder mistreatment: abuse, neglect, and exploitation in an aging america.” another group called elder neglect and abuse “a generic term that refers to the neglect and/or physical, psychological, or financial abuse of the older person. to some extent, it is also traceable to the variations and ambiguities of the state statutes that direct or authorize interventions in cases of elder abuse or neglect. the majority of research on elder mistreatment has focused on victims; the motivations of abusers and the relationship between abuses and victims have received little attention. elder mistreatment: abuse, neglect, and exploitation in an aging america. the late 1970s when Congressman Claude Pepper held widely publicized hearings on the mistreatment of the elderly, policy makers and practitioners have sought ways to protect older Americans from physical, psychological, and financial abuse. adequate long-term funding commitment to research on elder mistreatment must be made by relevant federal, state, and private agencies to support research careers and to develop the next generation of investigators in the field. the field lacks an adequate guiding theory to explain the range of causes behind elder abuse and promote systematic data collection. Yet, during the last 20 years fewer than 50 articles have addressed the shameful problem that abusers—and sometimes the abused themselves—want to conceal.

Term papers on americas economy, current system for protection of elders and other vulnerable adults grew from the child protection system, which itself is only about 40 years old in its modern form. the number of cases of elder mistreatment will undoubtedly increase over the next several decades, as the population ages. legal foundation for modern policies and programs for elder protection was put in place after world war ii, particularly during a burst of national energy geared toward remediation of endemic social problems during the 1970s. although initial federal action did not occur until significantly later, with the adoption of the child abuse prevention and treatment act of 1974 (nelson, 1984), that legislation also required states to adopt mandated reporting and investigation as the primary strategy for protecting children. chapter 7 reviews policies and programs aiming to prevent or respond to elder mistreatment and identifies priorities for future research. the projected growth in the elderly population, long-term care for elderly people with disabilities has become an increasingly urgent policy concern (institute of medicine, 2001; stone, 2000). the pepper hearings also cast the problem of elder abuse in a particular light—as a complication of caregiving. elder mistreatment: abuse, neglect, and exploitation in an aging america. the pepper hearings also cast the problem of elder abuse in a particular light—as a complication of caregiving. for example, many researchers refer to the entire range of problems experienced by elders as “abuse,” including lack of proper housing, untreated medical conditions, and lack of social services. for example, fewer than 15 studies on elder mistreatment have been funded by the national institute on aging (nia) since 1990, and support from other agencies has been even less substantial. elder mistreatment: abuse, neglect, and exploitation in an aging america. elder mistreatment: abuse, neglect, and exploitation in an aging america. research on the phenomenology of elder mistreatment is a critical early step in the further development of the field. in recognition of these deficiencies, the national institute on aging requested the national research council to commission this study as the first step in an effort to broaden and deepen knowledge about the mistreatment of elders. is some anecdotal evidence that institutional review boards have interpreted the common rule (the governing regulations on research ethics) in an unduly restrictive fashion, impeding potentially valuable research on elder mistreatment (see chapter 8).., pillemer, 2001; national institute of justice, 2000) have repeatedly lamented the weakness of the research base for designing programs and informing policy on the wide variety of overlapping problems, ranging from granny battering to neglect by nursing homes, that are grouped under the rubric of elder mistreatment. elder mistreatment: abuse, neglect, and exploitation in an aging america. the “three model projects on elder abuse,” funded by the administration on aging,Suggested citation: "1. examining risk indicators and risk and protective factors for different types of elder mistreatment are urgently needed. Elder Mistreatment in an Aging America takes a giant step toward broadening our understanding of the mistreatment of the elderly and recommends specific research and funding strategies that can be used to deepen it. the panel recommends that the national institute of aging, in collaboration with the office of human research protections and other sponsors of elder mistreatment research, undertake a consensus project to develop ethical guidelines and provide necessary clarification. elder mistreatment: abuse, neglect, and exploitation in an aging america. elder mistreatment: abuse, neglect, and exploitation in an aging america. when data are reported to some central repository, unless the repository has imposed a specific definition for each of the forms of abuse, the same statutory element will trigger reports in different categories of cases in different states. better data on the true prevalence of elder mistreatment are needed in deciding what action government ought to take. tensions and policy adaptations in the field of child protection appear to be highly relevant to elder protection at this moment in the evolution of research and public policy in this nascent field. adequate long-term funding commitment to research on elder mistreatment must be made by relevant federal, state, and private agencies to support research careers and to develop the next generation of investigators in the field. response to elder mistreatment is an understudied area that should receive heightened attention by the national institute of justice and other funders of criminal justice research. feasible, investigators should consult representative members of the populations being studied (elder persons and caregivers, nursing home residents and staff, etc. elder mistreatment: abuse, neglect, and exploitation in an aging america. is widely recognized that reported cases are highly selective samples, and that there is a large reservoir of unreported and undetected cases of elder mistreatment about which very little is known. elder mistreatment: abuse, neglect, and exploitation in an aging america. elder mistreatment: abuse, neglect, and exploitation in an aging america. investigators typically mail surveys to professionals and paraprofessionals, asking them about contacts with cases of elder abuse or neglect during a given time period. elder mistreatment: abuse, neglect, and exploitation in an aging america. Term papers on mary vs little lamb company - agencies should give priority to the design and fielding of national prevalence and incidence studies of elder mistreatment. elder mistreatment: abuse, neglect, and exploitation in an aging america. panel recommends systematic, theory-driven longitudinal research, both qualitative and quantitative, exploring the changing dynamics of elder people’s relationships and the risk of mistreatment, as they are affected by changing health status, social embeddedness, and caregiving and living arrangements, in both domestic and institutional contexts. meanwhile, congressman pepper continued to agitate for a federal response to elder mistreatment. examining risk indicators and risk and protective factors for different types of elder mistreatment are urgently needed. panel recommends systematic, theory-driven longitudinal research, both qualitative and quantitative, exploring the changing dynamics of elder people’s relationships and the risk of mistreatment, as they are affected by changing health status, social embeddedness, and caregiving and living arrangements, in both domestic and institutional contexts. more robust response to elder abuse will need to be guided by theory that accounts for both the victim and the abuser, including their cognitive functioning, the types of abuse, the domestic setting, and the nature of their relationship. the measurement issues have been satisfactorily addressed, a comprehensive national prevalence study of elder mistreatment should be undertaken. similar progress has not occurred in the field of elder mistreatment. legal foundation for modern policies and programs for elder protection was put in place after world war ii, particularly during a burst of national energy geared toward remediation of endemic social problems during the 1970s. most of the studies are weakened by their undifferentiated treatment of various types of abuse and neglect. the emergence of the juvenile court in the early part of the 20th century represented a significant assertion of collective responsibility for protecting and “saving” children who had become ungovernable by their parents; over the following decades, the jurisdiction of the juvenile courts gradually reached children who were neglected or abused by their parents (platt, 1969). the panel recommends that the national institute of aging, in collaboration with the office of human research protections and other sponsors of elder mistreatment research, undertake a consensus project to develop ethical guidelines and provide necessary clarification. elder mistreatment: abuse, neglect, and exploitation in an aging america. the earliest stages of elder abuse research, surveys of professionals have been used to shed light on the prevalence of elder abuse and on risk factors. to some extent, it is also traceable to the variations and ambiguities of the state statutes that direct or authorize interventions in cases of elder abuse or neglect. meanwhile, congressman pepper continued to agitate for a federal response to elder mistreatment. million in 2001; this is a modest sum even in comparison to the underfunded domain of child abuse research, on which federal agencies spend . is needed to help illuminate the characteristics of common injuries, such as their etiology, natural course, distribution, and severity so that the process of identifying cases of elder mistreatment can become more accurate and reliable. interestingly, although a number of controlled studies were conducted in the late 1980s and early 1990s, there are virtually no examples of more recent case-control studies of elder mistreatment. elder mistreatment: abuse, neglect, and exploitation in an aging america. of the data on risk factors and consequences of elder mistreatment are drawn from studies of clinical case samples.., pillemer, 2001; national institute of justice, 2000) have repeatedly lamented the weakness of the research base for designing programs and informing policy on the wide variety of overlapping problems, ranging from granny battering to neglect by nursing homes, that are grouped under the rubric of elder mistreatment. elder mistreatment: abuse, neglect, and exploitation in an aging america. even though it is only a partial explanation of elder mistreatment, this picture seemed to resonate with congress and the media (wolfe, this volume). problem arises for all of the types of elder mistreatment typically investigated, including neglect and financial exploitation. the 1994 national long term care survey indicated that more than 7 million americans, mainly family members, provided 120 million hours of care to elders with functional disabilities living in the community.., nonself-neglect), (2) those seen by protective services for corroborated self-neglect, or (3) other members of the cohort who had no contact with elderly protective services. elder mistreatment: abuse, neglect, and exploitation in an aging america. on elder mistreatment is in an early stage, reflecting its relatively recent recognition as a distinct—and important—social problem. as the elderly person declines in health and becomes more socially isolated, he or she relies more on the abuser for care, resulting in a mutual dependency. however, because much elder mistreatment does not occur in family caregiving situations, this has been a serious limitation. to such shortcomings, existing studies have not provided adequate data needed to answer three important public policy questions about elder abuse and neglect:Suggested citation: "1. who have attempted to conduct research on elder abuse report that they have sometimes been hindered by a lack of cooperation from agencies responsible for identifying and treating victims of mistreatment. of inconsistencies in definition and measurement that have thus far characterized research on elder mistreatment. an increasing number of elderly people reside outside traditional home settings in highly restrictive institutional environments (such as skilled or intermediate nursing facilities) or in less restrictive community-based residential settings, such as assisted living facilities, board and care homes, and adult foster homes..

adult protection is a poorly funded system, and congressman pepper’s single-minded emphasis on the abuse, exploitation, and neglect of vulnerable elderly people has not been sustained by his successors in congress or by a public preoccupied with youthfulness and ill at ease with aging. mistreatment in an aging america will be of interest to anyone concerned about the elderly and ways to intervene when abuse is suspected, including family members, caregivers, and advocates for the elderly. who have produced a modest body of knowledge concerning the phenomenology, magnitude, etiology, and consequences of elder mistreatment. (in relation to child abuse, for example, see the 1995 gallup poll, finding that far more of america’s children are victims of physical and sexual abuse than officially reported—gallup poll, 1995. should issue certificates of confidentiality designed to insulate elder mistreatment researchers from any legal obligation to disclose possible cases of mistreatment that otherwise may arise under state law, including tort “duty to protect” obligations as well as reporting statutes. abuse and severe physical abuse) has not adopted the “perpetrator-victim” model commonly embraced by advocates for battered women (melton and andrews, 2000). the recent history of child protection offers many lessons for specialists in elder mistreatment. elder mistreatment: abuse, neglect, and exploitation in an aging america. of those adl-impaired elderly people living in community settings, 37 percent report that they need help but do not receive it or receive less help than is needed (stone, 2000). research is needed to improve and develop new methods of screening for possible elder mistreatment in a range of clinical settings. the “three model projects on elder abuse,” funded by the administration on aging,Suggested citation: "1. elder mistreatment: abuse, neglect, and exploitation in an aging america. elder mistreatment: abuse, neglect, and exploitation in an aging america. elder mistreatment: abuse, neglect, and exploitation in an aging america. elder mistreatment: abuse, neglect, and exploitation in an aging america. on elder mistreatment is in an early stage, reflecting its relatively recent recognition as a distinct—and important—social problem. elder mistreatment: abuse, neglect, and exploitation in an aging america. the late 1970s when congressman claude pepper held widely publicized hearings on the mistreatment of the elderly, policy makers and practitioners have sought ways to protect older americans from physical, psychological, and financial abuse. elder mistreatment: abuse, neglect, and exploitation in an aging america.” to some extent, this problem is a reflection of conceptual confusion: what type of behavior or condition is denoted by the concept of “abuse”? several studies have attempted to go beyond previous efforts by interviewing the victims themselves and including a control group of nonabused elderly persons (bristowe and collins, 1989; paveza et al. adult protective services programs and other elder abuse service programs have been characteristically reluctant to assist researchers in research activities, and especially research that involves interviews with victims and their families. although initial federal action did not occur until significantly later, with the adoption of the child abuse prevention and treatment act of 1974 (nelson, 1984), that legislation also required states to adopt mandated reporting and investigation as the primary strategy for protecting children. elder mistreatment: abuse, neglect, and exploitation in an aging america. researchers have adapted a number of existing theories of interpersonal violence to supplement the study of elder abuse and have proposed a range of explanations:abusers have learned from the behavior of others around them that violence is a way to solve problems or obtain a desired outcome. to provide a typical example, in a survey on elder abuse funded by the administration on aging, a sample of professionals, including administrators and direct service workers from 16 types of agencies, was surveyed in each of pennsylvania’s 67 counties. such hybrid cases are unique in many ways and tend to have worse outcomes for victims than other kinds of elder abuse, perhaps because the abuse is accompanied by the stress of financial loss. general, methods that have been used successfully to investigate other forms of family violence have not been applied to research on elder mistreatment. adult protection is a poorly funded system, and congressman pepper’s single-minded emphasis on the abuse, exploitation, and neglect of vulnerable elderly people has not been sustained by his successors in congress or by a public preoccupied with youthfulness and ill at ease with aging. in this study, modeled after recent incidence studies of child abuse, the researchers identified a nationally representative sample of 20 counties in 15 states; for each county sampled, they collected data from the local aps agency as well as approximately 1100 professional “sentinels” having frequent contact with the elderly. furthermore, the technology for studying family violence has been developed and refined not by gerontologists, but by child abuse and intimate partner researchers. elder mistreatment: abuse, neglect, and exploitation in an aging america. however, even if researchers embraced a common set of definitions for the elements of elder mistreatment and operationalized them the same way, that would still leave the problem of determining whether the instruments actually measure what they purport to measure (validity) and whether they can be reliably administered. elder mistreatment: abuse, neglect, and exploitation in an aging america. elder mistreatment: abuse, neglect, and exploitation in an aging america. thus both researchers have included physical abuse in their studies—indeed, it may be the sole focus of each researcher’s study—but the measure of physical abuse differs across the two studies.

elder mistreatment: abuse, neglect, and exploitation in an aging america. abuse can be attributed to both the victim's and the abuser's social and biomedical characteristics, the nature of their relationship, and power dynamics, within their shared environment of family and friends. using a patient-based approach to study elder mistreatment is also fraught with potential for sample bias, in that if an older adult does not have a doctor or. general, methods that have been used successfully to investigate other forms of family violence have not been applied to research on elder mistreatment. of professionals and agency records are justified in those situations in which investigators specifically want to know how professionals view elder mistreatment. spouse abuse and other varieties of intimate partner violence have received increasing professional and political attention since the 1980s, leading to a wide variety of interventions and a substantial investment in research (national research council, 1996; national research council and institute of medicine, 1998). almost every state has required reporting of suspected cases of elder mistreatment, but little is known about the effects of these requirements (national research council and institute of medicine, 1998). the projected growth in the elderly population, long-term care for elderly people with disabilities has become an increasingly urgent policy concern (institute of medicine, 2001; stone, 2000). elder mistreatment: abuse, neglect, and exploitation in an aging america. research is needed to improve and develop new methods of screening for possible elder mistreatment in a range of clinical settings. retrospect, it appears that elder mistreatment became identified as a national concern when it was conceptualized as an “aging” issue, rather than as an undifferentiated component of adult protection. almost every state has required reporting of suspected cases of elder mistreatment, but little is known about the effects of these requirements (national research council and institute of medicine, 1998). the earliest stages of elder abuse research, surveys of professionals have been used to shed light on the prevalence of elder abuse and on risk factors. these factors increase the pressures on families caring for their elderly relatives and also are likely to increase the demand for institutional care. bringing elder mistreatment into the domain of family violence widens the angle of the lens and thereby brings new ideas about etiology and prevention into view. elder mistreatment: abuse, neglect, and exploitation in an aging america. despite using different methods, these studies each reported that the prevalence of elder abuse falls in the 3-5 percent range. despite using different methods, these studies each reported that the prevalence of elder abuse falls in the 3-5 percent range. elder mistreatment has attracted sustained efforts from practitioners and some interest from policy makers over the past two decades, it has not received concomitant attention from researchers or from the agencies that provide research funding. investigators believe that victims and family members are not suitable respondents for interview studies of elder mistreatment, because they are not reliable respondents, because they are not willing to be interviewed, or because they are incapable of giving the necessary consent. this also helped to broaden the constituencies interested in research and program development to include gerontologists and the expanding network of service providers and advocates for the elderly. the emerging image was that of an impaired victim, usually an elderly parent being cared for by an adult caregiver who wasn’t able to manage the caregiving because of stresses in life, on the job, and in the family. elder mistreatment: abuse, neglect, and exploitation in an aging america.., nonself-neglect), (2) those seen by protective services for corroborated self-neglect, or (3) other members of the cohort who had no contact with elderly protective services. although various versions of a national center followed, the current national center on elder abuse was established in 1998. has been almost no effort to evaluate intervention programs for elder abuse. elder mistreatment: abuse, neglect, and exploitation in an aging america. after summarizing the social context within which the field has developed, this chapter assesses the present state of knowledge, identifies some of the problems that must be addressed if the field is to move forward, and locates the problem of elder mistreatment in a larger set of challenges confronting an aging society. elder mistreatment: abuse, neglect, and exploitation in an aging america. elder mistreatment: abuse, neglect, and exploitation in an aging america. preparatory funding should be provided to develop and test measures for identifying elder mistreatment. the emerging image was that of an impaired victim, usually an elderly parent being cared for by an adult caregiver who wasn’t able to manage the caregiving because of stresses in life, on the job, and in the family. many factors in elder abuse arise through individual, relationship, community and societal influences. lists of injuries to define physical elder abuse, such as cuts, fractures, bruises, and burns. similarly, a survey of alabama physicians and registered and licensed practical nurses found that 38 percent of the physicians and 53 percent of the nurses had seen cases of elder abuse in the previous year (clark-daniels et al. or studies use as a “measure” of abuse whether a professional has identified an elderly person as “abused”—thereby embracing without further clarification the discretionary judgments of clinicians and caseworkers applying the ambiguous statutory definitions.  The research paper and the world wide web- for example, some investigators have asserted that the abused elderly tend to be physically or mentally impaired or both. that is, all forms of mistreatment are lumped together, despite evidence that the forms of abuse and neglect differ substantially. elder mistreatment: abuse, neglect, and exploitation in an aging america. in the late 1970s, the national spotlight was directed for the first time at what was characterized as systematic mistreatment of elderly people. of professionals and agency records are justified in those situations in which investigators specifically want to know how professionals view elder mistreatment. after summarizing the social context within which the field has developed, this chapter assesses the present state of knowledge, identifies some of the problems that must be addressed if the field is to move forward, and locates the problem of elder mistreatment in a larger set of challenges confronting an aging society. okar, 1981), he stated that elder abuse was increasing and recommended that congress act immediately to help the states identify and assist elder abuse victims. modules pertaining to elder mistreatment should be included in existing comprehensive geographic health and social surveys, including ongoing longitudinal studies of aging populations. however, in a pioneering study, lachs and colleagues retrospectively linked adult protective services data to a prospective study—the new haven epese study (established population for epidemiologic studies in the elderly) as the basis for this research,Suggested citation: "1. studies of this kind are urgently needed: to date, no prospective study of elder abuse has been conducted. future research in this area should go beyond archival data and should rely to a much greater extent on elder persons’ accounts of their experiences and on their perceptions regarding their own security. elder mistreatment: abuse, neglect, and exploitation in an aging america. most important, the question of the extent of elder mistreatment cannot be answered by studies of reported cases. elder mistreatment: abuse, neglect, and exploitation in an aging america. although the total federal contribution to research on elder mistreatment is uncertain, expenditures by nia, the lead agency for aging research, have totaled million during the last 12 years (1990–2001). on the extent of elder mistreatment in the general population are sparse. elder mistreatment: abuse, neglect, and exploitation in an aging america. first major difficulty in analyzing results from previous research on elder abuse and neglect results from the poor definition of the term “elder abuse. although various versions of a national center followed, the current national center on elder abuse was established in 1998. similarly, the biggest increase in reporting occurred when sexual abuse was “discovered” early in the 1980s (weisberg, 1984), and criminal prosecution became a common feature in the child protection system. elder mistreatment: abuse, neglect, and exploitation in an aging america. for example, some investigators have asserted that the abused elderly tend to be physically or mentally impaired or both. finally, in 1989, pepper succeeded in including creation of a national center on elder abuse as an amendment to the older americans act. development of widely accepted operational definitions and validated and standardized measurement methods for the elements of elder mistreatment is urgently needed to move the field forward. okar, 1981), he stated that elder abuse was increasing and recommended that congress act immediately to help the states identify and assist elder abuse victims. a major advance has been the fielding of major population-based victimization surveys that have helped to establish reliable prevalence estimates of select problems, such as intimate partner violence and child physical and sexual abuse. the measurement issues have been satisfactorily addressed, a comprehensive national prevalence study of elder mistreatment should be undertaken. furthermore, he decides that there must be at least two episodes of this behavior for it to be called physical abuse except for those items dealing with weapons, in which case one incident is sufficient. chapter 8 addresses concerns about protecting human subjects in elder mistreatment research, and chapter 9 identifies some necessary conditions for moving the field forward. even though it is only a partial explanation of elder mistreatment, this picture seemed to resonate with congress and the media (wolfe, this volume). in 1996, according to the projections based on this study, about 450,000 persons age 60 or older experienced abuse or neglect in family settings, about 16 percent of whom were in the aps report files. the national elder abuse incidence study (national center on elder abuse, 1998). on the effects of elder mistreatment interventions is urgently needed. elder mistreatment: abuse, neglect, and exploitation in an aging america. characteristics of elder abuse in domestic settingselder abuse cases tend to be multidimensional. agencies should give priority to the design and fielding of national prevalence and incidence studies of elder mistreatment.

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