2001

Volume 13 Number 1

Stress, Conflict, Elder Abuse and Neglect in German Nursing Homes: A Pilot Study Among Professional Caregivers, by Thomas Goergen, PhD

ABSTRACT: A questionnaire survey on elder abuse and neglect in residential settings was conducted among a convenience sample of 80 people working in German nursing homes. Data on nursing staff's experiences of stress and conflict at their workplaces, self-reported incidents of abuse and neglect of nursing home residents, incidents observed as witnesses and subjective theories about causes and motives underlying violence in nursing homes are reported. Whereas 59% report physical or verbal aggression by residents during the previous 2 months, 79% indicate having abused or neglected a resident at least once during that period; 66% witnessed victimizations of residents by colleagues. Different types of neglect and verbal/psychological abuse are most common. Subtypes of elder abuse and neglect show differential correlation patterns with measures of work stress. Subjects attribute abuse and neglect not only to staff shortage and work overload but also to a number of factors in the offender's personality on the one hand and at the political and social level on the other. From a motivational point of view, abuse and neglect are regarded as instrumental acts to reduce workload and as effects of pent-up aggression and inner tensions.

Key words: Theories, causes, resident aggression, self reported incidents, witnesses to abuse

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Patterns of Elder Abuse and Neglect in an Illinois Elder Abuse and Neglect Provider Agency: A Comparative Analysis, by Keren Patricia Dimah, MPA, MPH

ABSTRACT: The primary objectives of this study were: (a) to examine patterns of substantiated elder (persons 60 years and older) abuse and neglect among blacks in one provider agency of the Illinois Elder Abuse and Neglect Program and (b) to determine how those patterns differ between blacks (n=48) and non-blacks (n=59). With the exception of income and emotional abuse, African-American victims did not differ significantly from victims of other ethnic groups in demographic characteristics or their experience of physical abuse, physical neglect, confinement, deprivation, and financial exploitation. Approximately 53.0% of black perpetrators were females and 57.0% of non-black perpetrators were males. About 65.0% of black abusers were informal caregivers and 54% of the non-black abusers were informal caregivers. Close to 96.0% of black male abusers and 88.9% of the black female abusers had black victims. Similarly, 97.1% of non-black male abusers and 100.0% of non-black female abusers had non-black victims. For older African-Americans, the finding shave brought us closer to understanding patterns of abuse and neglect among a segment of the population that is rapidly expanding. Studying elder mistreatment among African-Americans is the first step toward implementing appropriate prevention and treatment programs.

Key words: Elder mistreatment, elder abuse, blacks, whites, African-Americans, non-blacks, older adults, aging

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Taking Care of My Parents' Friends: Non-Kin Guardians and Their Older Female Wards, by Judith C. Barker, PhD and David King, MA

ABSTRACT: Examination of a total of 472 Probate Court records for 1996 and 1997 in a Northern California county revealed that 26 (6%) cases involved non-kin, non-professional guardians, such as friends or neighbors. There is currently a very sparse literature on this less common but nonetheless important type of guardians who report a heightened sense of awareness and concern over possible accusations of elder abuse or neglect. Of these 26 guardians, eight were interviewed about how these relationships began, what the guardians do for their wards, what motivations and rewards guardians feel, and how fear of accusation about elder abuse shapes the relationship. All wards in the interview sample were female, aged 83 to 97 years, with a moderate-sized estate (median value $210,000). Most (75%) of the guardians were males who had known their wards since childhood, and who became involved as caregivers decades later. Caregiving initially involved limited assistance, mainly with finances, but soon moved to include a wider range of activities. Guardians assiduously and deliberately act in ways that document good intentions and honorable actions with respect to frail elderly wards and their estates.

Key words: Guardianship, unrelated caregivers, frail elders

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Japanese Older People's Perceptions of "Elder Abuse" by Noriko Tsukada, PhD, Yasuhiko Saito, PhD and Toshio Tatara, PhD

ABSTRACT: This study examined the proportion of Japanese older people who have heard of elder abuse and their perceptions of elder abuse by using data collected from a nationally representative sample of more than 4,000 Japanese older people in 1999. Approximately one half of the older people in this study had heard of elder abuse. Among those, about 18% knew elder abuse victims. Further, the definitions of elder abuse among these older people included psychological abuse, neglect, physical abuse, and financial abuse. Based on the study findings, it is strongly recommended that preventive measures as well as public education programs be implemented to help prevent, detect, and treat elder abuse in a timely manner.

Key words: Japanese elders, elder abuse, definitions of elder abuse, domestic settings

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Elder abuse: A Survey of Managers of Residential Care Facilities in Wellington, New Zealand, by Mark Weatherall, BA, MBChB, FRACP

ABSTRACT: The aim of this study was to establish the occurrence of elder abuse in facilities providing residential care in Wellington, New Zealand, provide examples of the types of elder abuse, and identify the action taken as a result of elder abuse. All licensed facilities providing residential care in Wellington were contacted. Face to face interviews with the manager of the facility were conducted. Twenty-six managers responsible for 27 facilities were interviewed. Ninety-two percent of the managers were able to identify at least one resident in the last year who had been subjected to elder abuse. For 31% of facilities, elder abuse was a factor in admission of at least one resident to the facility. The most frequently identified form of abuse was psychological abuse followed by financial and physical abuse. When asked to identify the person responsible for a particular instance of abuse, a spouse, child or another relative was nominated in 63% instances. Services which arrange extra home support or respite care, "service co-ordination and assessment" services, were the most frequent contact for particular instances of abuse followed by direct discussion with family and contact with the police. The Elder Abuse Program run by Age Concern New Zealand was infrequently contacted by residential care facilities although the Age Concern program is well known to these facilities.

Key words: Elder abuse, residential settings, nursing staff, care

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Volume 13 Number 2

Elder Abuse Identification and Referral: The Importance of Screening Tools and Referral Protocols, by Georgia J. Anetzberger, PhD, ACSW

ABSTRACT: Barriers exist with regard to elder abuse identification and reporting nationwide and in individual states like Ohio. Screening tools and referral protocols have been shown to be helpful in overcoming some of these barriers. However, existing instruments typically lack three qualities: (1) distinction as to types, signs, and risk factors of elder abuse; (2) inclusion of domestic violence in late life as a specific aspect of elder abuse; and (3) delineation of appropriate state laws and community services for effective intervention. This article discusses a project to develop, test, and disseminate screening tools and a referral protocol for improving the identification and reporting of elder abuse and domestic violence in late life by Ohio service providers. The impetus, goal, and organization of this 18 month initiative are described.

Key words: Elder abuse, domestic violence in late life, barriers to abuse identification and reporting, screening tools, referral protocols

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Screening Tools and Referral Protocol for Stopping Abuse Against Older Ohioans: A Guide for Service Providers, by David M. Bass, PhD, Georgia J. Anetzberger, PhD, ACSW, Farida K. Ejaz, PhD, LISW, and Kamla Nagpaul, MSW, LISW.

ABSTRACT: Screening Tools and Referral Protocol for Stopping Abuse Against Older Ohioans; A Guide for Service Providers (STRP) represents the product of an 18 month project aimed at improving the identification and reporting of elder ause and domestic violence in late life. This article presents each component of STRP, describing it in detail and suggesting when and how it can be used. Recommendations also are offered for the replication of STRP in other locales as well as for its further evaluation. (Full set of materials including Appendices can be obtained from the Benjamin Rose Institute.)

Key words: Elder abuse, domestic violence in late life, screening tools, referral protocols.

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Evaluating the Ohio Elder Abuse and Domestic Violence in Late Life Screening Tools and Referral Protocol, by Farida K. Ejaz, PhD, LISW, David M. Bass, PhD, Georgia J. Anetzberger, PhD, ACSW, and Kamla Nagpaul, MSW, LISW

ABSTRACT: This article describes the evaluation processes employed in the Ohio project to develop and test screening tools and referral protocols on elder abuse and domestic violence. Three focus groups and a Roundtable of experts were utilized to develop the materials in the first year. In the second year, a formal quantitative evaluation that involved 160 practitioners in Ohio was implemented to review the materials and to use them with clients. Findings from the quantitative evaluation were incorporated to make changes that led to a final document that was much simpler, less lengthy, and relevant to beginning practitioners.

Key words: Evaluation of tools and protocol, focus groups, quantitative methods

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Application of Elder Abuse Screening Tools and Referral Protocol: Techniques and Clinical Considerations, by Kamla Nagpaul, MSW, LISW

ABSTRACT: This article discusses the techniques and clinical considerations in using elder abuse screening tools and referral protocol recently developed by The Benjamin Rose Institute and a multidisciplinary statewide roundtable for Ohio service providers. Various constructs of abuse on these tools are matched with case situations to demonstrate the practitioner's clinical decision-making process with reference to identifying abuse and selecting an appropriate referral source. In addition, clinical limitations and ethical dilemmas for practitioners in application of the tools and referral protocol are considered.

Key words: Clinical practice, assessment, problem identification, elder abuse

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Volume 13 Number 3

Another Look at the Helpfulness of Occupational Groups in the Discovery of Elder Abuse and Neglect by B.E. Blakely, PhD and Ronald Dolon, EdD

ABSTRACT: This paper summarizes the results of a 1997 survey of 395 adult protective services workers in 43 states that produced ratings of the helpfulness of 17 occupational groups in the detection of cases of elder abuse and neglect, respectively. Data are also presented on ratings of the overall awareness of the public and professional workers about elder abuse and neglect and on efforts to improve awareness of these forms of elder mistreatment. Findings suggest that many occupational groups were more helpful in detecting elder abuse and neglect in the late 1990s than was the case at earlier points in time

Key words: Abuse, detection, domestic violence, neglect, perception, public, occupations, victims

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Study of Service Delivery by Community Mental Health Centers as Perceived by Adult Protective Services Investigators by Valerie Nash Chang, PhD and Roberta Greene, PhD

ABSTRACT:This article provides the results of a qualitative research study to determine the views of Indiana Adult Protective Service (APS) investigators regarding the services and staff of Indiana Community Mental Health Centers (CMHC) with which they interact. Service difficulties and strengths are identified as well as recommendations for improving coordination between the two programs. Many of the problems experienced by APS investigators relate to gaps in services for older adults. Multidisciplinary teams providing in-home evaluations, referral, and treatment are recommended.

Key words: Adult protective services, endangered adults, community mental health clinics

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Correlates of Reported Complaints by Volunteers in an Ombudsman Program in Nursing Facilities by Pat M Keith, PhD

ABSTRACT: This research investigated predictors of reported complaints by volunteers in an ombudsman program in nursing facilities using questionnaire data from 633 volunteers and 1,886 records. Age, role orientation of volunteers, profit-nonprofit status of facilities, informal ties with facility staff, and volunteers' views of their work experiences were examined in relation to the number of complaints. A unique feature of the research was linking characteristics of volunteers and perceptions of their experiences with an objective indicator of their actual practices. Tests of three hypotheses indicated that identification with advocacy, negative perceptions of work experiences, and fewer informal relationships with nursing facility staff increased reported complaints. Implications for practice are noted.

Key words: Ombudsman programs, nursing facilities, volunteers, resident complaints, role orientation of volunteers.

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Understanding Differences in Opinion and 'Facts' Between Ombudsmen, Police Chiefs, and Nursing Home Directors by Brian K. Payne, PhD

ABSTRACT: Past research has considered whether those involved in responding to elder abuse perceive and respond to elder abuse in similar ways. The current research builds on this past research by considering whether differences between the groups are based on opinions or misperceptions. Surveys of 119 police chiefs and 73 nursing home directors from four states, and 205 ombudsmen from twenty-six states were gathered and analyzed. Results suggest that the differences between the groups are based more on misinformation (e.g., beliefs about crime patterns and the quality of nursing homes) rather than opposing philosophies (e.g., beliefs about issues that stem from individuals' values).

Key words: Elder abuse, victimization, criminology, law enforcement

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The Clinical Epidemiology of Crime Victimization in Older Adults: A Multidisciplinary Pilot Study by Mark S. Lachs, MD, MPH; Carolyn Bove, BA; Melvin H. Wearing, BS; Christianna Williams, MS; Ronet Bachman, PhD; and Leo M. Cooney, MD

ABSTRACT: Background: Older adults remain the least studied demographic group with respect to crime victimization; the health consequences of crime are unkonown in this population. Purpose: To estimate the prevalence and types of police-older adult interaction in a well-characterized observational cohort of community-dwelling older adults. Design: Pilot observational cohort study. Population: A random sample (n=200) of the New Haven EPESE cohort, 2,812 community dwelling older adults who were 65 or older in inception year 1982.

Key words: Clinical epidemiology, victimization, law enforcement

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BOOK REVIEWS

Male Victims of Elder Abuse:Their Experiences and Needs, by Jacki Pritchard. Reviewed by Jordan I. Kosberg, PhD, ACSW

Ending Elder Abuse: A Family guide, by Diane S. Sandell and Lois Hudson. Reviewed by Carolyn Thornhill, MA

Volume 13 Number 4

Evaluation of the Impact of a Volunteer Ombudsman Program: The Rhode Island Experience by Rachel Filinson, PhD

ABSTRACT: The research assessed the impact of a major innovation in the Long-Term Care Ombudsman Program that occurred in Rhode Island in 1997-the introduction of a volunteer component in which community members were trained and certified as advocates for residents in long-term care. Based on reports to the state ombudsman office, the findings indicated that the placement of volunteer ombudsman was associated with the generation of more complaints and more serious complaints about the facilities in which they were placed, some of which could not be resolved despite the greater intensity of interventions applied in these cases. Dat derived from nursing home inspections revealed a negative and significant correlation between the length of time a volunteer had been at a facility and the number of deficiencies.

Key words: Ombudsman, volunteer, long-term care, nursing home, quality of care

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A Critical Analysis of Telemarketing Fraud in a Gated Senior Community by Wendy Reiboldt, PhD and Ronald E. Vogel, PhD

ABSTRACT: Fraudulent telemarketers have increasingly victimized older citizens (in this study, age 56 and older). This study tested key variables reported in the literature as being related to elderly telemarketing victimization. Data were collected from a large (n = 8,197), gated, middle-class community reported to be highly targeted by telemarketing scammers. Using a probability sample of 374 residents and rigorous follow-up techniques, the researchers found very few victims (n = 25) and were not able to ascertain a cohesive victim profile. Only one variable (believing what a salesperson tells you over the phone is true) affected victimization. Respondents who believed what telemarketers told them was true were significantly more likely to be victimized.

Key words: Senior citizen victimization, telemarketing fraud, fraud, elderly victimization, elderly victim profile

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Statute Definitions of Elder Abuse by Jeanette M. Daly, RN, PhD and Gerald Jogerst, MD

ABSTRACT: Differences in elder abuse definitions hinder the comparison of research and state elder abuse data (Jogerst, Daly, Brinig et al., in press). The purposes of this paper are to describe and summarize the elder abuse definitions in the state statutes and present current definitions used in practice, education, and research. The definitions of elder abuse for the 50 state and District of Columbia laws addressing protective services for domestic elder abuse were analyzed. No one single term describing elder abuse was used uniformly across all statutes. “Abandonment,” “mental anguish,” “exploitation,” “neglect,” “self-neglect,” and “sexual abuse” were predominant terms used in the statutes. It is unlikely that legislation for the 50 states and District of Columbia would be implemented to change the statutes definitions of elder abuse but it is possible to develop a list of definitions that can be used as model definitions for researchers, practitioners, and for future policy changes.

Key words: Elder abuse, definition, statute

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National Elder Abuse Questionnaire: Summary of Adult Protective Service Investigator Responses by Gerald Jogerst, MD; Jeanette M. Daly, PhD, RN; and Jerry J. Ingram, MSW

ABSTRACT: The purpose of this paper is to characterize investigative structures and investigator characteristics for each APS office in all 50 states and the District of Columbia. Through mailed questionnaires and follow-up telephone calls, 1,409 questionnaires were completed for a return rate of 80%. The mean age of respondents was 46.4 years and ninety-nine percent of the respondents worked full-time and has been in his or her current position for an average of nine years. Half of the respondents reported using abuse screen or risk factor instruments when investigating an alleged elder abuse report. Seventy-three percent reported that they investigate only adult and elder allegations. Sixty percent of the respondents reported that a formal training program for elder abuse evaluations was in place for employees with an average length of two to four days. Sixty-nine percent of the investigators consider an elder to be “better off” most of the time following intervention, and that this improved status was a direct result of the resources provided. Nearly three-fourths of investigators reported that elder abuse was under reported in their area. Those on the front lines, the APS investigators, provide valuable insights regarding the systems in which they work.

Key words: Elder abuse, adult protective service investigator, national survey

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Marital Violence Among Korean Elderly Couples: A Cultural Residue by Jae Yop Kim, PhD and Kyu-taik Sung, PhD

ABSTRACT: This study examined the prevalence of marital violence among Korean elderly couples based on data from a national sample. Wife abuse was the most frequently manifested form of marital violence. Findings suggest that wife abuse has become a serious problem. Socioeconomic factors were not associated with wife abuse, suggesting that it was a universal phenomenon among Korean elderly males, not specific to a certain social class or group. Influences of traditional male-centered culture are suggested to be a major factor causing this serious lingering problem. Cultural traits associated with wife abuse and interventions needed for the prevention of wife abuse are disscussed.

Key words: Wife abuse, family violence, cultural residue of marital violence, aging in Korea

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BOOK REVIEWS

Elder Abuse: Practitioner's Guide, by Bridget Penhale, Jonathan Parker with Paul Kingston. Reviewed by Maxine Lithwick

Good Practice with Vulnerable Adults, by Jessica Kingsley. Reviewed by Ji ll Manthorpe