1999

Volume 11 Number 2

Self-Neglect: An Overview, by James G. O'Brien, MD; Jane M.Thibault, PhD; L. Carolyn Turner, MA; and Heather Laird-Fink, MD

ABSTRACT. Initially described in 1953, the concept of self-neglect is complex. Definitional problems exist because it can be redefined by changes in context. This article examines the epidemiology, etiology, detection, ethical/legal issues, management/intervention, and outcome. Prevention is particularly difficult given the nature of the problem, the poorly understood etiology, and the slow insidious progression of the syndrome before it reaches public attention. This complexity is compounded by the fact that respect for autonomy and personal rights is given paramount importance over paternalism when an intervention at an earlier stage could potentially result in a better outcome.

Key words: self-neglect, autonomy, competency, recluse, "Diogenes Syndrome"

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Indirect Life-Threatening Behavior in Elder Patients, by Jane M. Thibault, PhD; James G. O'Brien, MD; and L. Carolyn Turner, MA

ABSTRACT. Older adults frequently engage in such indirect life-threatening behaviors as extreme lack of self-care, refusal to eat, refusal to take medications, and failure to comply with an understood medical regimen. These behaviors are often classified as non-compliance or passive suicide. Analysis of such phenomena reveals that these actions can represent attempts by the person to gain control of and to ameliorate a negative life situation. A case is presented which demonstrates the ultimate outcome of engagement in such behavior when it is misinterpreted and left untreated. The functions of indirect life-threatening behavior are discussed.

Keywords: self-neglect, passive suicide, non-compliance, personal control

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Ethics & Aging: Confronting Abuse and Self-Neglect, by Paul D. Simmons, PhD and James G. O'Brien, MD

ABSTRACT. Self-neglect inevitably poses ethical dilemmas for those involved in providing help. The balance between respect for the autonomy of the victim and the desire to act in a beneficent manner oftentimes results in disagreement and tension. The issue of refusal of treatment and the determination of decisional capacity are explored. Advocacy for the victim in the least intrusive manner is recommended.

Key words: Self-neglect, ethics, beneficence, patient autonomy

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Alcohol Abuse and Self-Neglect in the Elderly, by Richard D. Blondell, MD

ABSTRACT. Approximately 1% to 3% of elderly in the United States suffer from the consequences of excessive alcohol consumption. Many more drink amounts of alcohol that place them at risk for alcohol-related problems. Alcoholism is thought to be a significant contributor to the etiology of self-neglect among older adults. Affected individuals can suffer from malnutrition, develop chronic health problems, acquire unintentional injuries, become depressed, neglect their health care needs, and isolate themselves from friends and family. Premature death can result. Professionals who provide services to elderly people with alcohol-related problems have a critical role to play by screening these individuals for an alcohol use disorder and encouraging them to participate in treatment. Identification of and intervention for an alcohol use disorder may contribute to the prevention of self-neglect among older adults.

Key words: alcoholism, alcohol abuse, elderly, geriatrics, self-neglect.

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Community Dimensions of Elderly Self-Neglect, by Mary C. Sengstock, PhD, CCS; Jane M. Thibault, PhD; and Rochelle Zaranek, MSW

ABSTRACT. Much recent literature has focused on the impact of self-neglecting behavior on elders. Little attention, however, has been paid to the impact of this phenomenon on the communities in which self-neglecting elders live. Family members, neighbors, and service professionals can all be adversely affected by the behavior of these patients. This article reflects on the ways in which the community is affected by elder self-neglect and discusses the inherent conflicts between protecting the rights of the individual and the rights of the community.

Key words: self-neglect, community types, individual rights, community rights

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Volume 11 Number 3

Awareness of Formal and Informal Sources of Help For Victims of Elder Abuse Among Korean Americans and Caucasian Elders in Los Angeles, by Ailee Moon, PhD and Teresa Evans-Campbell, MSW

ABSTRACT. This study examines and compares the awareness of formal and informal sources of help for victims of elder abuse and the factors that might influence this awareness among Korean American and Caucasian elders. The study sample consisted of 95 Korean American and 90 Caucasian elders age 60 or older living in Los Angeles County, California in 1997. It shows that overall, Korean American respondents were significantly less aware of the four general and specific sources of help measured - general formal and informal sources, the Elder Abuse Hotline, and the Adult Protective Services (APS). Findings further suggest that most respondents in both groups have little or no knowledge of the two elder abuse-specific sources of formal help, the Hotline and APS. Logistic regression analysis on 12 independent variables reveal ethnicity and income as significant predictors of respondentsÕ awareness of available help. The implications of the study results for strategies for early intervention and prevention of elder abuse are also discussed.

Key words: formal and informal help, elder abuse hotline, adult protective services

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Prevalence of Elder Mistreatment as Reported by Social Workers in a Probability Sample of Adult Day Health Care Clients, by Terry Fulmer, RN, PhD, FAAN; Mildred Ramirez, PhD; Susan Fairchild, MPH; Douglas Holmes, PhD; Mary Jane Koren, MD; and Jeanne Teresi, EdD, PhD

ABSTRACT. There are growing numbers of Adult Day Health Care (ADHC) programs providing needed health services to community-dwelling elderly. Therefore, ADHC staff are in an opportune position to identify and to intervene in suspected elder mistreatment (EM) cases. In this paper, prevalence estimates of EM are reported for a probability sample of ADHC clients in New York State, using data provided during a social worker informant interview. The abuse "signs and symptoms" items in the social worker informant interview schedule were divided into two categories: 1) physical indicators and 2) clientÕs behavioral indicators. Physical indicators included unexplained bruises and welts, unexplained burns, unexplained lacerations or abrasions, human bite marks, and frequent injuries that are "accidental" or "unexplained." Client's behavioral indicators included apprehension, being frightened, and afraid to go home. EM prevalence for all 8 items was 12.3 percent. When "apprehensive" was excluded, the EM prevalence was 3.6 percent in this sample. These findings suggest that ADHC provides a point of contact for the assessment and intervention of EM which might otherwise be overlooked among elders who are often isolated or homebound.

Key words: cognitive impairment, physical indicators, behavioral indicators, assessment

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Dependency, Cultural Identification, and Elder Abuse Among Americans of Mexican Heritage, by Mary Lou Franco, MCJ; Tara Gray, PhD; Peter Gregware, PhD; and Jon'a Meyer, PhD

ABSTRACT. We interviewed professional caregivers who work with elderly Americans of Mexican ancestry. These caregivers were employed at nursing homes or in home health care agencies. They were interviewed about the impact of dependency and cultural identification on elder abuse and its reporting. They described abusers who were often dependent in terms of living arrangements and finances on the elders they abused. The caregivers who identified as "Hispanic" rather than "Mexican-American" said that people in their culture would be more likely to report abuse. Among the caregivers who were themselves Americans of Mexican heritage, this was the case: those who identified as "Hispanic" rather than "Mexican-American" were twice as likely to report abuse, even though far fewer had direct knowledge of the abuse.

Key words: elder abuse, Mexican-American, Hispanic

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Awareness of Elder Abuse among Community Health and Social Care Staff in Northern Ireland: An Exploratory Study, by John Mc Laughlin, MSW and Helen Lavery, MSW

ABSTRACT. This article reports on one of the first surveys of multidisciplinary staff awareness of elder abuse in this region of the United Kingdom (UK). Forty staff from eight professional groups in the Southern Health and Services Board area were surveyed about their knowledge of elder abuse, the types of help they thought they could offer the abused and the abuser and the level of abuse in their current caseload. Thirty-five per cent of respondents had cases of physical, psychological, financial and sexual abuse as well as care-giver neglect of people aged 65 and over on their caseloads. The findings suggest that while staff had differing levels of awareness of elder abuse, further training is necessary.

Key words: elder abuse, multidisciplinary staff awareness, Northern Ireland, policy and procedures, training

Volume 11 Number 4

An Evaluation of a Client-Centered Case Management Program for Elder Abuse, by Dana Vladescu; Kimberly Eveleigh, MSc; Jenny Ploeg, RN, PhD; Christopher Patterson, MD, FRCPC, FACP

ABSTRACT: Short-term outcomes of a case management program for competent, community-dwelling abused elderly persons were assessed. The intervention provided by Case Managers consisted of five components: (a) helping the client set long and short-term goals, (b) providing information about services and legal rights, (c) explaining and discussing options to decrease abuse, (d) supporting the client in deciding to take action or not, and (e) involving others in the plan of care. Retrospective data were collected from 26 client records. Intervention outcomes were assessed by determining the number of cases in which abuse was eliminated or decreased at case closure and the reasons for case closure. In 34.6% of the cases, abuse was completely eliminated, while in 30.8% of cases there was some improvement in the situation.

Key words: elder abuse, intervention, evaluation, case management, competent, client-centered

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The Financial Abuse of Mentally Incompetent Older Adults: A Canadian Study, by John B. Bond, Jr., PhD; Rosemarie Cuddy, LLB; Gloria L. Dixon, MSW; Karen A. Duncan, PhD; and Doreen L. Smith, PhD

ABSTRACT: This article reports the results of a pilot study on the financial abuse of mentally incompetent seniors. The objectives of the study were to: (1) establish the incidence of suspected financial abuse among the clientele of the Office of Public Trustee, Province of Manitoba, (2) identify the characteristics of mentally incompetent older adults most at risk, and (3) identify indicators of financial abuse. Approximately 20% of the cases opened in a one year period were under suspicion of abuse. Findings were consistent with those of other research projects on elder abuse, in general, showing an overrepresentation of women over the age of eighty as victims of financial abuse. Unpaid personal care home bills when money should have been available was the most common indicator. In addition to providing a list of indicators of financial abuse that are of potential use to professionals devising prevention programs, practical implications for service providers are presented.

Key words: elderly financial abuse, Canada, dementia, guardianship

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Meeting the Needs of Abused Older Women? A British Columbia and Yukon Transition House Survey, by Jill Hightower, MA; M.J. (Greta) Smith; Carol A. Ward-Hall; and Henry C. Hightower, PhD

ABSTRACT: Older women victims of violence by a partner or family member are more often categorized as victims of elder abuse, not victims of family violence. Their needs are assessed, if at all, by social and health service agencies, often with little knowledge or understanding of domestic violence, while domestic violence policy initiatives, advocacy, and services focus on younger women and children. A survey of domestic violence services in British Columbia and the Yukon found that women over 60 years of age were a very small fraction, generally less than two percent, of women served, and those 50 to 59 years of age were also substantially under-represented. Only four percent of respondents had special services for older women. Comments from respondents confirm that abused older women face enormous difficulties in trying to establish a safe and secure future. It was also evident that better interaction is needed between those providing support and advocacy for abused women, and those who provide health and social services for older persons. A majority of the shelters provided community education to a wide range of agencies. Most have only partial accessibility to women with mobility handicaps.

Key words: older women, domestic violence, shelters, family violence, numbers served, British Columbia, Yukon

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The Changing Career of "Elder Abuse and Neglect" as a Social Problem in Canada: Learning from Feminist Frameworks? by Joan Harbison, PhD

ABSTRACT: "Elder Abuse and Neglect" was constructed as a social problem by experts and has largely been a product of "expert" knowledge building and intervention. The idea of woman abuse as a social problem, on the other hand, originated with women themselves. The paper examines the changing social context in which some older people are currently seeking ownership of responses to mistreatment. It explores emerging criticisms of present constructions of "elder abuse and neglect" and the needs they imply, and links these to feminist frameworks. It then considers the appeal and utility of these frameworks for older women active in the fight against mistreatment.

Key words: "elder abuse and neglect," feminist frameworks, social construction, ageism

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Mental Health and Criminal Justice Issues Among Perpetrators of Elder Abuse, by Pat Brownell, PhD; Jacquelin Berman, PhD; and Aurora Salamone, MPS

ABSTRACT: Recent studies on elder abuse suggest that the pathology or impairment of the abuser may be a stronger predictor of elder abuse than characteristics of the victim. To examine the relationship between elder abuse, abuser pathology, and the criminal justice system, the New York City Department for the Aging (DFTA) undertook a survey of older victims of reported domestic abuse seeking assistance from the DFTA Elderly Crime Victims Resource Center. Preliminary findings from the survey indicate that impaired abusers were significantly younger than unimpaired abusers and more likely to live with their elderly victims, to be unemployed, and to have a history of involvement with the criminal justice system.

Key words: drug abuse, alcohol abuse, incarceration, types of abuse, services

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The Mistreatment of Older Adults: Perpetrator-Victim Relationships and Interventions, by Maxine Lithwick, MSW; Marie Beaulieu, PhD; Sylvie Gravel, MSc; in collaboration with Silvia M. Straka, MSW

ABSTRACT: The characteristics of the mistreatment of older adults were investigated in a sample of 128 older adults identified as potential mistreatment cases in three community-based agencies in Quebec. Practitioners completed questionnaires to collect quantitative and qualitative data. The study also examined: 1) difficulties in identifying mistreatment, 2) interventions and outcomes, and 3) reasons for the refusal of services. The major finding (with important implications for practice) was that the type of mistreatment varied according to perpetrator. A harm reduction model is suggested as a useful approach to guide interventions.

Key words: elder abuse, mistreatment, harm reduction, interventions, abuser profile

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