Understanding Elder Abuse (Part Two)

A new review article explores the complex issues surrounding elder abuse

Posted Aug 10, 2016

Continued from Part One

In the previous installment, I discussed the different kinds of abuse that elderly people often experience.  Unfortunately, recognizing the signs of abuse and learning how to take action can be far more difficult than you might think.

As Karen Roberto points out in her new American Psychologist article on the complexities of elder abuse, there is no one "gold standard" test to determine whether someone is being abused.  Despite different screening measures being available for health care professionals,  it is usually left up to concerned friends or family to investigate any suspected abuse that may be taking place.   Though many elderly people experiencing abuse can be perfectly willing to provide details if they are asked directly, it is hardly uncommon for victims of abuse to hide what is happening due to fear or shame.

In many different jurisdictions, there are also mandatory reporting rules requiring health care professionals, including medical doctors and psychologist, to report cases of elder abuse whenever they have cause to suspect that abuse or neglect is taking place.  In the province of Ontario where I practice, mandatory reporting only applies for elderly residents of long-term care facilities or retirement homes.   For cases of elder abuse taking place in private homes,  no mandatory reporting laws exist though victims, or people acting on their behalf, can report the abuse directly to police. health, or social services.

Once the abuse is reported, whatever investigation proceeds will often depend on the nature of the abuse and which laws have been broken.  Most cases of elder abuse that occur in the community are investigated by Adult Protective Services (APS).  The APS worker looking into the suspected abuse usually begins by asking  permission to investigate from the older adult directly or a legal guardian.  In cases where permission is denied and evidence exists showing that someone is at risk of being harmed, case workers can get a court order or, if necessary, involved the police in the investigation. 

Once the APS worker is satisfied that enough proof exists, then proper action can be taken.  This can involve either removing the elderly person to a safer setting or else removing the perpetrator.   For cases of financial, physical, or sexual abuse, criminal charges can also be laid though this often requires many months to be resolved and, if the case goes to trial, then the process can be much longer.   Many victims of abuse may prefer not to lay charges, especially if a family member is involved.  

No matter how the abusive situation is ultimately resolved, older victims usually benefit from counseling to help cope with the trauma and stress that often arises from abuse.  Depending on what is available in the community, counseling can take the form of group or individual therapy, case management, and referrals to victim services in the community.   How effective counseling can be in helping victims of abuse will vary from case to case and often depends on how receptive the victim is to the counseling and whether there are additional issues such as dementia or depression

To help recruit and train more mental health professionals concerning elder abuse, the Administration for Community Living has established the National Center on Elder Abuse (NCEA).   A multi-disciplinary alliance providing expertise in elder abuse, neglect, and exploitation, the NCEA maintains an online database of  materials for training in the treatment and prevention of elder abuse.   The American Association of Retired Persons  (AARP) also provides legal and educational resources for older adults dealing with different kinds of exploitation.

But there is much more that still needs to be done to eradicate elder abuse.  While the Elder Abuse Justice Act of 2009 represents a good beginning, including providing federal resources for the prevention, detection, treatment, understanding, and, where appropriate, prosecution of elder abuse,  numerous challenges  lie ahead. 

In concluding her article, Karen Roberto summarized what needs to be done as follows:

  • Developing a universally accepted definition of what constitutes elder abuse.  This includes recognizing that elder abuse can occur even for people who might not technically be regarded as seniors (younger than sixty in some cases) which can affect the kind of services that might be available.
  • Disentangling the different social, cultural, and relational issues that places older adults at risk for abuse.  High-risk groups include rural elders, older adults with cognitive impairments, or older adults belonging to different religions, ethnic, or sexual minorities.   Providing effective treatment and intervention means understanding why some elders are particularly vulnerable.
  • Expanding efforts at understanding who is most likely to abuse older adults in their charge, whether they be family members, volunteers, or support workers.   Developing effective treatment programs means learning how and why abuse occurs.
  • Documenting the real costs of elder abuse. The economic burden, including the emotional burden that victims and family members are forced to bear, needs to be taken into account when drawing up  new laws and policies.
  • And, finally, we need to establish which treatment approach works best in helping victims and perpetrators alike.  Not only is this essential in training mental health professionals, but also in getting needed financial support from various levels of government.

By 2050, the number of people aged 65 and over will have risen to over 80 million in the United States alone.  This is almost double the current percentage of older adults (43.1 million in 2012).   As Baby Boomers grow older, the demand for care, and the burden this will place on families, will almost certainly lead to a dramatic rise in elder abuse cases over the next few decades.   Developing better treatment and prevention will literally be a matter or life and death in the years to come. 

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