Written by Stephaine Craig
The research that has been undertaken in relation to violence in adolescents, young adults and women is far more advanced than on elder abuse (Yaffie, Lithwick, Wolfson, & Davis, 2008). Elder abuse is a major public health issue in New Zealand and worldwide. As our population ages, elder abuse is going to become a greater problem therefore it is important for the general population as well as health professionals to have more of an awareness and understanding on this issue. This can be accomplished through identifying and reporting any incidence of elder abuse people may come across.
There are consequences that result from elder abuse for the older adults experiencing it. They may be more susceptible to long term physical and mental health issues; they may have effects on their living situation and finances as well as family relationships and support they require due to the abuse. The victim of abuse may be required to live in a rest home due to the effects of the abuse and possible lack of support at home, along with an increased risk of premature death (Ministry of Health, 2007).
Evidence supports that older adults are more vulnerable to elder abuse in either rest homes or their own homes within the community. The Action on Elder Abuse report outlines that most cases of abuse occur in older adults’ own homes (Action on Elder Abuse, 2004). Elder abuse is a widespread issue in society today that requires more attention and awareness to help identify and prevent it from happening. This paper focuses on these issues.
The Action on Elder Abuse Report (2004) defines elder abuse as ‘a single or repeated act or lack of appropriate action occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person’ (Action on Elder Abuse, 2004). Five main categories of abuse have been recognised as physical, psychological, financial/material, sexual and neglect. There is the exception with some literature including verbal abuse as a category or it is included into psychological abuse. In this review verbal abuse will be included as a separate form of abuse due to what was found in the literature.
Abusers or perpetrators may be anyone involved in an older adults’ care. This can be a caregiver or a nurse if the person lives in a rest home or it can be a family member or carer going into the person’s home to assist with activities of daily living (Gray-Vickrey, 2004). Studies indicate abusers to those living in rest homes are 62 percent likely to be a nurse or caregiver caring for that person. The perpetrators are not only nurses or caregiving staff. It is prevalent that 23 percent of the perpetrators are family members to their elders living in rest homes (Action on Elder Abuse, 2004). The Ministry of Health indicates the majority of abusers to the older adults are family members and their sons and daughters are most likely to be the abusers (Ministry of Health, 2007). Evidence states it is true that most reported cases of elder abuse involve a relative abusing an older adult at home (Gray-Vickrey, 2004).There are different views from each study I have reviewed indicating the highest prevalence of each category of abuse. Age Concern New Zealand’s elder abuse and neglect services found that between the years of 1998 and 2001 psychological abuse was reported 56 percent, then financial/material abuse 46 percent, followed by physical abuse at 22 percent, neglect including both active and passive at 18 percent and sexual abuse at three percent (Ministry of Health, 2007). There is a limited amount of research completed on the Maori population and the prevalence of elder abuse. Maori service providers across the country indicate that overall, financial and psychological abuse are the prominent forms of elder abuse over physical and sexual abuse (Ministry of Health, 2007).
A similar trend of Age Concern New Zealand’s data has shown in the Action of Elder Abuse Report that psychological abuse is the most reported form of abuse, followed by financial abuse and physical abuse as third (Action on Elder Abuse, 2004). Whereas, research from general older population surveys indicates the most prominent categories of abuse were psychological, financial and verbal abuse with neglect and physical abuse the least presented (Cooper, Selwood, & Livingston, 2008).
A study by Heath, Kobylarz, Brown and Castano (2005) on the interventions from home-based geriatric assessments of adult protective service clients suffering elder mistreatment, elder neglect is more common in the community setting and it is the caregivers who are the perpetrators of this. Caregivers may be a family member or a paid carer coming into the person’s home to assist them with their needs. This study showed that self-neglect was most prominent among the older adult population with 76 percent of abuse occurring, followed by caregiver neglect at 47 percent. This is a very high percentage of neglect occurring in the home setting for an older adult. Financial/material abuse occurred at 29% and physical abuse at 15%.
Neglect is the most common form of abuse within the older adult population in New Zealand according to the (Families Commission, 2008) and is further defined as neglect that is further defined into passive or active neglect. Passive neglect is due to the lack of knowledge and skills of the carer while active neglect is intentionally depriving the needs of an older person (Families Commission, 2008).Meeting the basic needs of a person when caring for them should be priority of care as it is the means for survival. According to Maslow’s hierarchy of needs the most basic needs for survival are physiological needs (McCormack & Crisp, 2009). This is the first level of need for any person to survive, it includes oxygen, water, food, warmth, shelter, elimination as well as safety and security. If these needs are not met for the older adults being cared for in either the rest home or community settings, the carer is neglecting that person therefore, this is an implication on practice. Ritchie (2011) outlines in her article how nurses are ‘neglecting the basics’ of care. Having a lack of care leads to the deprivation of care a person needs and results in neglect.Research from Action on Elder Abuse (2004) and Heath et al. (2005) reveals some statistics on the cases of elder abuse reported to Age Concern, helplines and Adult Protection Services, but it is difficult to distinguish how many incidences are actually reported. According to the National Elder Abuse Incidence study in the United States only 21 percent of the 550,000 older adults who had experienced elder abuse were reported (Heath et al., 2005). There have not been any population-based studies conducted in New Zealand but research estimates that between two and five percent of the New Zealand older population may have experienced some kind of abuse (Ministry of Health, 2007).
Through analysing the literature on elder abuse within New Zealand and globally it has enabled me to come up with some recommendations related to both the practice and community settings where older adults live. Firstly, through the evidence from the research, it is clear that raising awareness on elder abuse within both of these settings is crucial for health professionals and the general population to combat this public health issue. Raising awareness can be accomplished through educating programmes in the practice setting of rest homes where caregivers and nurses work together to assist in the needs of the older adult population.
The literature by McGarry and Simpson (2009) and Action on Elder Abuse Report (2004) states that teaching sessions for staff need to occur throughout all practice settings for staff to be able to identify, manage, report and prevent abuse from happening. Practical and theoretical skills need to be educated to all practising in the older adult health sector (Action on Elder Abuse, 2004). Nurses are one of the main groups of health professionals who can identify and prevent abuse as they work in practice and community settings. Also highlighted in the articles, is that elder abuse is an increasing issue in our society and it is important to prevent and raise awareness of this issue to combat it.
A second recommendation is appropriately training staff on how to practise at an appropriate standard for the care of older adults. This should be aimed specifically at caregiving staff within rest homes and personal caregivers in community settings. Teaching older adults about elder abuse and how they can avoid the issue before it becomes a reality would also be helpful (Gray-Vickrey, 2004). A study by Gray-Vickrey between 1999 and 2001 in the United States revealed why abuse occurs in nursing homes and is associated with stress, burnout, patient aggression and negative attitudes towards the elderly from staff (Gray-Vickrey, 2004). Therefore, there is a need for staff training on the care of older adults and elder abuse. The Action on Elder Abuse Report (2004) indicates that paid staff is the highest group of perpetrators for practising poorly. As poor practice can result in forms of abuse especially neglect as indicated throughout certain studies, training and educating staff working in this sector appropriately for their job is very important and is a crucial part of combating elder abuse.
A third recommendation from the research is to screen older adults for abuse when they use health services mainly in primary health care settings due to the older population having more contact with primary health care settings than other health settings (Perel-Levin, 2008). Screening for elder abuse is a way to identify, manage and prevent the occurrence or the reoccurrence of elder abuse. It is the first step involved in detecting the issue and follow up can then be arranged if necessary. Some older adults may feel too vulnerable to speak up about abuse that may be happening to them but if screening was completed every time they attended health care services, the person may feel safer and more comfortable to say something. The article by Gray-Vickrey includes ways to screen older adults for abuse. It involves certain questions to ask a person if they have been abused. Another set of questions help to identify potential neglect and financial abuse while another set asks questions around injury referring to physical abuse (Gray-Vickrey, 2004).
In conclusion, what forms of abuse do older adults experience in rest homes and community settings is answered through completing this literature review. It does not specifically answer the issue within the New Zealand context as there is limited research on this issue in our country; therefore more research needs to be undertaken. This review has revealed that elder abuse may be acted through five main categories of abuse including psychological, financial/material, physical, sexual and neglect. These five forms of abuse happen in both rest homes and community settings worldwide. According to the New Zealand Families Commission report the main form of abuse experienced by the New Zealand older adult population is neglect (Families Commission, 2008). Psychological abuse is the second most common form of abuse in both rest homes and community settings. The recommendations to combat elder abuse include raising awareness of the issue, staff training and educating on aging and elder abuse and to screen for elder abuse are required.
Action on Elder Abuse (2004). Hidden voices: Older people’s experience of abuse. United Kingdom: Help the Aged Publishing.
Cooper, C., Selwood, A., & Livingston, G. (2008). The prevalence of elder abuse and neglect: a systematic review. Journal of Age and Aging, 37, 151-160.
Families Commission (2008). Elder abuse and neglect: exploration of risk and protective factors. Wellington: Author.
Gray-Vickrey, P. (2004, October). Helping abuse victims, part 2: Combating elder abuse. Journal of Nursing 2004, 34(10), 47-51. United States: Springhouse Corporation.
Heath, J. M., Kobylarz, F. A., Brown, M., & Castano, S. (2005, September). Interventions from home-based geriatric assessments of adult protective service clients suffering elder mistreatment. Journal of the American Geriatrics Society, 53(9), 1538-1542. United States: Blackwell Publishing Ltd.
McCormack, B., & Crisp, J. (2009). Potter and Perry’s fundamentals of nursing. In J. Crisp & C. Taylor (Eds.), Critical inquiry and practice development (pp.55-74). (3rd ed.). Australia: Elsevier Mosby.
McGarry, J., & Simpson, C. (2009, February). Identifying, reporting and preventing elder abuse in the practice setting. Journal of Nursing Older People. 21(1), 33-39. United Kingdom: RCN Publishing Company.
Ministry of Health. (2007). Family Violence Intervention Guidelines: Elder abuse and neglect. Wellington: Author.
Perel-Levin, S. (2008). Discussing screening for elder abuse at primary health care level. Switzerland: World Health Organisation Press.
Ritchie, L. (2011, October). Neglecting the basics of nursing. Journal of Kai Tiaki Nursing New Zealand, 17(9), 32. New Zealand: New Zealand Nurses Organisation.
Yaffie, M., Lithwick, M., Wolfson, C., & Davis. M. B. (2008). A global response to elder abuse and neglect: building primary health care capacity to deal with the problem worldwide: main report. Switzerland: World Health Organisation Press.