Crisis Intervention-Ch 9, Maltreatment of the Elderly Flashcards
Elder maltreatment is the most recent form of abuse and neglect in family settings to capture the attention of members of the public and policy makers.
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Most older American (age 65 and older) are healthy and live on their own, but after age 80, the risk of _______ due to chronic disease and disorders increases.
impairment
Bernard Baruch said that “old age is always 15 yrs older than I am.”
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in 1999, there were 34.5 million people over 64 representing about one of every 8 Americans
The aging of America section
As the baby boom, generation ages, older population is predicted to grow to
70 million persons by 2030. one of every 5 Americans. will be 65 and older.
In 1999, the 65-74 age group had 18.2 million persons, 75-84 age group had 12.1 million persons and 85+ age group had 4.2 million persons
The aging of America section
greatest growth since 1900 has been the 85+ age group, often called the _____
“Old old”
General characteristics and trends with which intervener should be familiar. Following descriptions are taken from the A Profile of Older Americans: 2000 by the Administration on Aging
- Gender- in 1999, 141 older women for every 100 older men.
- Marital status- 77% of older men were married in 1999, versus 43% of older women. Half of older women were widows, 4 times as many widows as widowers.
- Living Arrangements- most older persons do not live in nursing homes or other institutions. 1.1% age 65-74 live in nursing home, compared to 4.5% age 75-84 and 19% of persons over 84. Of 21 million older persons were head of households, almost 80% were homeowners.
- Poverty- older persons less likely to live in poverty than younger persons. Highest poverty rate was experienced by older Hispanic women who lived alone.
- Geographic Distribution- half of older population lives in nine states,led by California, Florida, New York, Texas and Pennsylvania. Florida has highest % of population age 65 or older. followed by Penns, Rhode Island, West Virginia, Iowa and N Dakota
- Health- Most older Americans are in good health, but a higher %have health problems who are less than 65.
who quoted “ Grow old along with me! The best is yet to be, The last of life, for which the first was made.”
Robert Browing
who quoted “Growing old is like being increasingly penalized for a crime you haven’t committed.”
Anthony Powell
Older persons are admired for their ___,___ and ___
wisdom,maturity and experience
_____ of the one hundred members of US Senate are 60 yr old or more, as were ___ of the 11 Presidents who have held office since WW11
45, 5
A process of systematic stereotyping of and discrimination against people because they are old, just as racism and sexism accomplish this with skin color and gender. Older people are categorized as senile, rigid in though and manner, old fashioned in morality and skills.
Ageism
quinn and Tomita note that ageism is a
time bomb
Whitton identified a ___________as dominating the medical literature of the first half of the twentieth century.
Decline and failure model of aging
As is true of most forms of prejudice, ____ creates self-fulfilling prophecies.
ageism
perhaps the most common effect of ageist attitudes is to lead the intervener to stereotype the older person as “too old” to comprehend what is happening. The ________ is violated more often in dealing with elderly clients.
Right of self-determination
Older persons are victimized in three different circumstances
- Crimes against the elderly
- domestic maltreatment- in their homes by members of family or caretakers
- institutional maltreatment- nursing homes or assisted living facility
Landmark study of the incidence of domestic elder abuse and neglect.The research was conducted by
National Center on Elder Abuse NCEA
” the use of physical force that may result in bodily injury, physical pain or impairment.
NCEA definition of Physical abuse
“nonconsensual sexual contact of any kind with an elderly perons.
NCEA definition of Sexual abuse
the infliction of anguish, emotional pain or distress.
NCEA definition of “emotional or psychological abuse
“the refusal or failure to fulfill any part of a persons obligation or duties to an elder.
NCEA definition of Neglect
the desertion of an elderly person by an individual who has assumed responsibility for providing care or by a person with physical custody of an elder.
NCEA definition of Abandonment
The illegal use of an elders funds, property or assets
NCEA definition of Financial or Material Exploitation
behaviors of an elderly person that threaten his/her own safety.
NCEA definition of Self-neglect
according to NCEA, the most important indicators of maltreatment are
frequent unexplained crying and unexplained fear of or suspicion of particular persons in the home.
Specific indications for each form of maltreatment
- Physical abuse- bruises, black eye, lacerations, rope marks, broken eyeglasses, signs of being restrained. Behavioral indications of abuse include report of abuse by victim, changes in elders behavior, caregivers refusal to allow visitors to see elder.
- Sexual Abuse- bruises around breasts or genitals, venereal disease or genital inflections, vaginal or anal bleeding. reports of sexual asslt or rape by victim
- Emotional/psychological abuse- emotional agitation, extreme withdrawal and nonresponsiveness, elders reports.
- Neglect- dehydration, malnutrition, bedsores, poor hygiene, untreated health problems, unsafe or unsanitary living conditions and elders report
- Abandonment- Desertion of an elder
- Financial or material exploitation- sudden changes in banking practices, addition of names on signature cards, changes in will, dissappearance of funds or possessions
- self neglect- older person not taking care of oneself
Much maltreatment of elders in domestic settings goes unreported and undetected, creating a ______ of maltreatment like that found for other crimes.
“dark figure”
Tatura, found that on ____ % of elder abuse reports are made by elders themselves.
5%
Victims sometimes fear retaliation from the abuser. Victim is dependent on the abuser, victim fear that abuser will be incarcerated.
Dark Figure of Elder Maltreatment sec.
Older persons cannot report financial abuse because they are not aware of it. The “old-old” (persons over 80) are among the most frequent victims of maltreatment.
Dark Figure of Elder Maltreatment sec
NCEA suggests an “iceberg” analogy to understand the dark figure of elder maltreatment.
Cases of maltreatment that are substantiated by APS are the visible tip of the iceberg.
National Elder Abuse Incidence Study
Collected data from local Adult Protective Service agencies and from “sentinels”.
sentinels are
persons from agencies that have frequent contact with the elderly and who were specialized trained by National Center for Elder Abuse.
NEAIS indicated that in 1996, an estimated ____ persons age 60 and over experienced abuse, neglect or self-neglect.
551,011.. 21% of cases were substantiated by APS
of the 551,011 estimated cases of maltreatment in 1996, 73% involved some form of abuse, 73% involved neglect or abandonment, 25% involved self-neglect.
Distrution of types of maltreatment section
APS agencies received an estimated 236,479 reports of maltreatment in 1996 and 115,110 were substantiated. 48.7%
distribution of types of maltreatment section
most common types of maltreatment attributed to others in substantiated APS reports were
neglect, emotional/psychological abuse, financial/material exploitation and physical abuse
Characteristic of Victims
- age- “old-old”, over age 80 were most likely to be victims of most kinds of abuse. However, sentinel data indicated that physical, financial, and emotional abuse were more common among those who were 60 to 70 yrs old
- gender- majority of victims were women. three-fourths of emotional/psycho abuse, 70% of physical abuse and over 60% of neglect.
MEN were majority of victims of abandonment - Income- most victims $5000 to $14,999 regardless of form of maltreatment. Income of $15,000 or more was reported less
- Race- African Americans comprised of 8.3% of elderly population in 1996.
- self-care- one-half of victims of abuse were unable to care for themselves and additional 23% were only somewhat able to do so.
- Confusion and Depression- 10% of national elderly population is estimated to suffer from dementia, 60% of maltreatment victims experienced some degree of confusion. Victims of elder maltreatment also were more likely than all elders to suffer from depression
Characteristics of Perpetrators
- Gender- Men were perps of maltreatment in 52.5% of substantiated cases. 63% reported by sentinels. Males most frequent of abandonment, physical abuse, emotional abuse and financial/material exploit. Women were slightly more likely than men to be involved in neglect
- Age- one-third of perps were over 60, 38% between 41 and 59, remainder under 40.
- Race- three-fourths of perps of abuse were White and 18% were black.
- Relationship to victim- over 90% of perps of maltreatment were related to victim. nearly half (47.3%) were children and 19% were spouses.
The sentinel data also showed that ______ were most often the perpetrators of maltreatment
family
Elder maltreatment first became an issue about 25 yrs ago when congressional hearings on “parent battering” raised public concern
Explanation for Elder Maltreatment section
Explanation for Elder Maltreatment: two models
Caregiver Stress
Power and Control
In explaining elder maltreatment, _______is related to victim dependency.
caregiver stress
The focus on the victim is clear in the definition of adult protective services as “ those services provided to older people and people with disabilities who are, or are in danger of being mistreated or neglected, are unable to protect themselves and have no one to assist them”
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what percentage of those over age 85 live in nursing homes.s
19%
In contrast to the caregiver stress model, the power-control model treats elder abuse as analogous to, and often synonymous with, intimate-partner violence against women.
Contrary to the hypothesis that dependent victimss cause caregiver stress, some researchers have concluded that it is the perpetrators of abuse who are dependent on the victim rather than vice versa
Because elder maltreatment is viewed as intimate partner violence, response to it should be to protect the safety of victims and enforce the law against perps.
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NEAIS data:
Caregiver stress model is supported by findings that:
- physical abuse is rarest form of abuse and neglect is the most common form of maltreatment. Neglect can be indicative that caregiver is overwhelmed with meeting the needs of victim
- those unable to care for themselves are overrepresented among victims of maltreatment. The power-control model stresses the abusive behavior toward competent victims
- confusion and depression by victims could be the product of maltreatment rather than a factor contributing to caregiver stress
- In cases of neglect, perps are more likely to be women than men, which is in accord with image of stressed caregiver.
- Children of victims are most often identified as the perps of all forms of maltreatment. The power-control model emphasizes the role of male intimate partners in perpatrating maltreatment
NEASIS data:
findings are in accord with power-control model
- abuse is most common among victims between 60 and 70. Victims in this age range are likely to be mentally and physically competent
- most victims are women. women also likely to be victims of physical and emotional abuse
- Men are more likely than women to be perps of abuse of all kinds.
Steinmetz has described the “double direction violence” as a common occurrence in cases of elder abuse.
both caretakers and elderly dependents use conflict tactics, such as screaming, yelling, hitting and slapping to control one another.
Impaired Abuser:
risk factors
- alcohol and drug abuse
- mental disturbances-abuser emotionally dependent as well as financially dependent on the elder.
- elderly caregivers- caregivers who are of advanced age themselves.
Some observers distinguish between elder abuse and adult abuse.
involves maltreatment of mentally retarded or mentally ill adults.
APS agencies often provide services for adults who are not competent to mange their own affairs.
National Association of Adult Protective Service Administration defines adult protective services as
those services provided to elder people and people with disabilities who are, or are in danger of being mistreated or neglected, are unable to protect themselves, and have no one to assist them
APS agencies receive reports of maltreatment, investigate the reports and provide case planning, monitoring and evaluation. APS also provides or arranges for
medical
social
legal
law enforcment services
What state led the way in dealing with financial abuse of older persons.
California
who has developed training curriculum and model departmental policy statement on elder treatment
Police Executive Research Forum
what states created special units to investigate crimes against the elderly.
law enforcement agencies in
Florida, California, Illinois, Delaware
In working with older persons, interveners should not forget the general principle that intervention is a
collaborative process..restoring control to the person in crisis is always preferable to the interveners taking control of the victims life.
For every sort of maltreatment, statements from the victim should be given
great weight
as a general rule, ________________, regardless of whether caregivers encourage the intervener to discount the complaints.
complaints of maltreatment by older persons should be taken at face value
Establishing control and direction:
direction phase of crisis intervention involves collaborating with the person in crisis to develop an intervention plan.
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As its guiding value, the NAAPSA states that “every action taken by APS must balance the duty to protect the safety of vulnerable adults with the adults right to self-determination.
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Recognizing that the interests of the adult are the first concern of any intervention
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In working with elderly victims of maltreatment, Brandl suggest two general goals that intervener should keep in mind
- breaking the victim’s isolation
2. empowering the victim
____involves negative stereotypes about the elderly, often based on the assumption that advanced age is inevitably associated with physical and mental decline.
Ageism
_____ is the most common form of maltreatment.
Neglect
persons over age _____, ______ and ________are at high risk of maltreatment.
80, women and persons who were unable to care for themselves
Most perps are related to the victim and men are more likely to perpetrate maltreatment than women.
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two general models inform both the explanation and response to elder maltreatment.
- caregiver stress model- interaction between dependent victims and overwhelmed caregivers.
The response to this is to provide services to both. - power-control model- perps need to exert control over victim. Response, victim protection and holding perps accountable.
Primary responsibility for dealing with elder maltreatment belongs to APS. All 50 states have enacted laws requiring that incidents of elder maltreatment be reported.
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AS general principle, interveners should seek to balance the goals of protecting safety with protecting self-determination. Breaking isolation and empowering victims are especially relevant in case of physical abuse and neglect.
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