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Elder Abuse: International and Cultural Perspectives - An Update of the Literature

45. P5228-20
Ho, B., Friedland, J. Rappolt, S. & Noh, S.
Caregiving for Relatives with Alzheimer's Disease: Feelings of Chinese-Canadian Women
Journal of Aging Studies; Vol. 17 (3), 301-321; 2003.
Journal article (research)
Noting that both the Chinese population and the elderly segment of society in North America are growing, this article explores the impact of culture, caregiver stress and social support upon Chinese-Canadian women caring for relatives with Alzheimer's disease. Twelve female, Chinese émigrés were interviewed regarding their experiences as caregivers, within the framework of the model of caregiver stress outlined by Pearlin et al. Secondary stressors, such as role strain and intra-psychic strain, were the main focus of five open ended questions. Inductive qualitative analysis revealed multiple common themes such as filial obligation, anticipation of the role, differences between Chinese and western attitudes towards caregiving, intergenerational and other family conflicts, work role conflicts, loss of self and "role captivity." One poignant sentiment held by many of these caregivers was that their own children would be unlikely to follow in their footsteps and likewise provide care for themselves. Mediating factors that emerged included positive attitudes as well as the presence of formal and informal supports that were culturally congruent with their values and circumstances. Despite the belief in filial obligation, most of these caregivers intended to institutionalize the care recipient when they could no longer provide adequately for their needs. The authors postulate that the acceptance of this outcome is likely due to the perception that institutionalization is an extension of already utilized formal supports. (Canada)

46. R6015-19
Kosberg, J. et al.
Study of Elder Abuse within Diverse Cultures
Journal of Elder Abuse & Neglect; Vol. 15 (3), 71-89; 2003.
Journal article (scholarship)
This overview highlights the challenges to cross-cultural and cross-national research on elder abuse and neglect. In order to illustrate such issues, the authors consider ethnic and cultural barriers to addressing elder abuse within U.S., the U.K. and Israel, as well as challenges to conducting an international study. Variations in the definitions of elder abuse are analyzed and viewed as a significant impediment. Approaches to the study of elder abuse among the three countries are compared. (International)

47. P5572-4
Lima, C., Levav, I., Jacobsson, L. & Rutz, W.
Stigma and Discrimination Against Older People with Mental Disorders in Europe
International Journal of Geriatric Psychiatry; Vol. 18, 679-682; 2003.
Journal article (research)
The Task Force on Destigmatization, established by the Mental Health Program of the World Health Organization/European Regional Office (WHO/EURO) in 2000, was charged with the duty to investigate and address the impact of stigma and discrimination of older mentally ill Europeans. WHO mental health representatives from seventeen countries were surveyed regarding both health care professional activities (such as research and teaching) and the public's attitudes towards elders with mental disorders. Among the results, two-thirds of the fifteen countries that had conducted psychiatric epidemiological studies included the elderly in the samples; the sixteen countries that include an old age psychiatry residency modality allow ten per cent curriculum time for such; two-thirds of the surveyed countries had specialized services (as compared to 100 per cent for children); and stigma is perceived as greater towards elders with psychosis and depression (and their families) than towards patients with Alzheimer's disease. (International)

48. P5248-12
Litwin, H. & Zoabi, S.
Modernization and Elder Abuse in an Arab-Israeli Context
Research on Aging; Vol. 25 (3), 224-248; May 2003.
Journal article (research)
In this study, the authors note that the Arab-Israeli culture is "a population in rapid transition from agrarian to urban culture." Two interrelated indicators of modernization are examined as factors related to elder abuse: urbanization and social isolation. In this control case study, a sample of abused elders (n=120) is compared with a control group of non-abused elders from the same population (n=120). Urbanization was operationalized by community type and social isolation was measured by five characteristics of social network. Among the findings, the Arab-Israeli elders who had been abused were more socially isolated than nonabused elders; they were more likely to reside in cities and have weaker social networks. The researchers conclude that the concept of modernization as a contributing social cause of elder mistreatment warrants further study. (Israel)

49. S6171-328
Malley-Morrison, K. & Hines, D.
Family Violence in a Cultural Perspective: Defining, Understanding, and Combating Abuse
Sage Publications, Inc.; 2003
Book (scholarship)
This book addresses family violence among four cultural groups in the U.S.: Native Americans, African Americans, Hispanic/Latinos, and Asian Americans. Child abuse, spousal or intimate partner violence (IPV), and elder abuse are analyzed using a "cognitive-affective-ecological framework" that examines historical and societal influences as well as interpersonal dynamics. Actual family case studies and personal reflections from members of each cultural group are featured. (U.S.) (Note: This book is not available through CANE. To purchase, contact Sage Publications, Inc., at 1-800-818-7243 or visit the Web site at http://www.sagepub.com/book.aspx?pid=9646 . Price: $40.95.)

50. P5464-12
Ockleford, E. et al.
Mistreatment of Older Women in Three European Countries - Estimated Prevalence and Service Responses
Violence Against Women; Vol. 9 (12), 1453-1464; December 2003.
Journal article (research)
The authors of this study sought to survey the experiences of mistreatment among older women from Ireland, Italy and the United Kingdom, in comparison with prevalence studies conducted in the U.S. In addition, they interviewed professionals who work with older women regarding their perceptions of elder abuse among their clientele, and the existence and accessibility of services for older battered women. The convenience sample of women, aged 60 and over, included 50 Irish, 50 Italian and 49 British participants. They completed a 34-item questionnaire addressing threats and experiences of physical abuse, psychological abuse and financial exploitation occurring since age 59. Fourteen percent were identified as having dementia but only one of these women reported being abused (7 percent). An overall prevalence of 14 percent of the total sample experienced threats of mistreatment, and 18 percent demonstrated an overall prevalence of actual abuse, with financial abuse being the most common. Spouses and other family members were the most common perpetrators of physical abuse, and others (outside the family and social network) were most commonly perpetrators of financial abuse (79 percent). While acknowledging serious limitations with regards to the type and size of the sample, the researchers indicate that this study identifies the need for further cross-cultural research and increased accessibility of services for older battered women. (International)

51. R6010-26
Podnieks, E. & Wilson, S.
An Exploratory Study of Responses to Elder Abuse in Faith Communities
Journal of Elder Abuse & Neglect; Vol. 15 (3), 137-162; 2003.
Journal article (research)
In this exploratory study, conducted jointly by Ryerson University, the Ontario Network for the Prevention of Elder Abuse, the Older Women's Network, and the Centre for Applied Family Research, faith leaders were surveyed regarding their perceptions of elder abuse. Forty-nine clergy members throughout the province of Ontario participated. Of the findings, two-thirds of the respondents were aware of (or suspected) at least one case of elder abuse among their followers. Lack of training and education regarding elder mistreatment along with confidentiality issues were viewed as significant barriers to appropriate responses. The survey instrument is included in the article. (Canada)

52. P5366-10
Yan, E. & So-Kum Tang, C.
Proclivity to Elder Abuse - A Community Study on Hong Kong Chinese
Journal of Interpersonal Violence; Vol. 18 (9), 999-1017; 2003.
Journal article (research)
As in other cultures, it is believed that while elder abuse exists in Chinese societies, it is under-reported. The researchers involved in this project suggest that studying the proclivity rates of elder abuse may provide additional information regarding the nature and scope of the problem. The study was designed to determine the proclivity rates of elder abuse in Hong Kong and to explore possible associations between attitudinal variables and childhood experiences of abuse and proclivity. Based upon the intergenerational theory of violence, researchers hypothesized that those participants exposed to family violence as children would report higher levels of proclivity towards various types of elder mistreatment. Based upon the ecological theory, they also hypothesized that participants with negative attitudes towards the elderly, modernity, and filial piety would also demonstrate greater proclivity. A convenience sample of 464 Chinese residents of Hong Kong, aged 18-70, completed the mailed survey. Among the results, there was a 20 percent proclivity rate towards verbal abuse (including spiteful statements, insults and shouting), a 2.4 percent proclivity towards physical abuse. A high level of childhood experience of abuse and negative attitudes towards the elderly were the most salient predictors for proclivity to elder abuse. (Hong Kong)


53. P5714-228
Beechem, M.
Elderly Alcoholism Intervention Strategies
Charles C. Thomas Publisher, LTD., Springfield, IL; 2002.
This book (intended for students of gerontology, and health and social service professionals working with older individuals) presents an overview of alcohol abuse in elders. After describing the relatively brief history of the recognition of the problem, the author addresses such topics as the impact of alcohol abuse on the aging process and the problems in using traditional assessment and intervention strategies with seniors. One chapter is dedicated to providing culturally specific treatment for older people of color, gays and lesbians, and the homeless, and also discusses gender related treatment issues. Other chapter topics include practice values and attitudes, treatment strategies, spiritual issues, relapse, suicide, and model programs. (U.S.) (Note: This book is not available through CANE. For more information, visit Charles C. Thomas Publisher online at: www.ccthomas.com .)

54. S6170-17
Dimah, A. & Dimah, K.
Gender Differences among Abused Older African Americans and African American Abusers in an Elder Abuse Provider Agency
Journal of Black Studies; Vol. 32 (5), 557-573; May 2002.
Journal article (research)
Drawing upon data from an Illinois service provider agency, this study was designed to address the gender differences among male and female African American elder abuse victims and perpetrators. Forty-eight cases of substantiated abuse were analyzed, involving 35 female and 13 male victims. The only significant difference in type of abuse experienced was that males experienced intentional physical neglect more frequently (85 percent) than female victims (42.9 percent). Among the findings related to perpetrators (n=24 males and 24 females), more female abusers were related to their victims compared to male abusers, and more females abusers than males were legally responsible for their victims. Nearly two-thirds of both male and female perpetrators were informal caregivers for their victims. The most commonly experienced abuse was financial exploitation, effecting over 53 percent of all male and 54 percent of all female victims. Implications regarding living arrangements are also discussed. (U.S.)

55. P5864-13
Kosberg, J., Lowenstein, A., Garcia, J. & Biggs, S.
Challenges to the Cross-Cultural and Cross-National Study of Elder Abuse
Journal of Social Work Research and Evaluation; Vol. 3 (1), 19-31; 2002.
Journal article (scholarship)
This article presents an overview of some of the difficulties inherent in the study of cross-cultural and cross-national issues in elder abuse. Although cultural sensitivity is essential to identifying and addressing elder abuse, the authors point out that ethnic diversity is even more complex when considering the regional, economic and background differences of various members throughout one country. Variations in the definitions of elder mistreatment also contribute to difficulty in drawing upon international studies. The authors describe and compare research efforts in the U.S., Israel, and the U.K. (International)

56. N4988-40
Krug, E. et al, eds., for the World Health Organization (WHO)
World Report on Violence and Health - Chapter 5 - Abuse of the Elderly
World Health Organization (WHO); Geneva, Switzerland; 2002.
Agency report
This chapter is taken from the first world report on violence, a universal health threat. Written primarily by the late Rosalie Wolf, the entry describes the evolution of recognition of elder abuse as a social problem and provides information on national and regional responses from the U.S., the U.K., Canada, Australia, New Zealand, Latin America and the Caribbean, Argentina, Brazil, Asia and Africa. Health care, the legal system, public education, and abusive traditions are among the topics highlighted. The Japan Elder Abuse Prevention Centre and Health Canada's two-part educational project are among the model programs described. (International) (Note: This chapter, along with the entire report, may be accessed at http://www5.who.int/violence_injury_prevention .)

57. P5493-27
Nahmiash, D.
Powerlessness and Abuse and Neglect of Older Adults
Journal of Elder Abuse & Neglect; Vol. 14 (1), 21-47; 2002.
Journal article (research)
In this qualitative study, fourteen in-depth interviews with abused and neglected dependent adults, and two with their abusers, are analyzed for causal themes related to powerlessness. The research is based upon the theory that older adults are rendered powerless when they have insufficient resources and are susceptible to systemic problems, such as ageism. It draws upon an ecological framework of interaction among individual, interpersonal and environmental risk factors. The interactions are considered through the macro (societal), exo and meso (systems within society) and micro systems (such as the parent-child relationship). Participants lived in the community, were selected through social service and health agencies in the Montreal area, and represented six different ethnic groups. Of the victims, two were male and twelve female; one male and eleven of the females described themselves as caregivers as well as care recipients. Both abusers were under 55 and were daughters of their victims. The impact of history is demonstrated by the holocaust survivor as she describes the circumstances which affected her mothering of her now sexually abusive son, and which contributes to her unwillingness to abandon him. Case studies highlight issues related to gender, ethnicity, and a sense of powerlessness in dealing with the health care system. (Canada)

58. P5027-2
Nelson, D.
Violence Against Elderly People: A Neglected Problem
The Lancet; Vol. 360 (9339), 1094-1095; 2002.
Journal article (scholarship)
This succinct overview highlights a number of global publications addressing the worldwide incidence of elder abuse. The World Report on Violence (WHO), Missing Voices (WHO and the International Network for the Prevention of Elder Abuse) and HelpAge International reports are featured. Experts indicate that ageism among medical professionals is a significant barrier to prevention and detection. (International)

59. P5773-26
Old Age Psychiatry of the World Psychiatric Association and the World Health Organization (WHO)
Reducing Stigma and Discrimination Against Older People with Mental Disorders
World Health Organization (WHO); Geneva, Switzerland; 2002.
Agency report
The World Health Organization and the World Psychiatric Association collaborated with other NGOs to produce this technical consensus statement, which promotes discussion aimed at reducing the stigmatization of older people with mental illness. The authors point out that to date, attention to the concept of stigmatization regarding the mentally ill has been directed towards younger individuals. Older individuals experiencing mental illness are likely to be dually stigmatized, as both older and mentally ill people are routinely marginalized in society. Causes of this discrimination are discussed, including ignorance, fear, drive for conformity, internalization, cultural influences, social and economic instability, a lack (or perceived lack) of preventative strategies and interventions, and gender biases. Consequences include negative attitudes such as prejudice, ageism, damaging self-beliefs, secrecy and distortions regarding costs of care and treatment. Such discrimination is not only directed at the mentally ill but at their families and mental health professionals as well. Negative attitudes impact upon quality of health care, and at times, undermine the credibility of elders when describing instances of abuse and mistreatment. One section of the paper addresses specific stigmas attached to depression, dementia, delirium, psychosis, anxiety, substance abuse, personality disorders, and learning disabilities. Recommendations for future action are outlined for policy makers, NGOs, professionals, families and informal caregivers, the public, elders with mental illness, the media and the corporate sectors. (International) (Note: This paper is available online at http://www.who.int/mental_health/media/en/499.pdf .)

60. P5064-14
Yan, E., So-Kum Tang, C. & Yeung, D.
No Safe Haven - A Review on Elder Abuse in Chinese Families
Trauma, Violence, & Abuse; Vol. 3 (3), 167-180; July 2002.
Journal article (scholarship)
This overview presents a socio-cultural perspective of aging in Chinese societies, with an
emphasis on the changing family dynamics that leaves elders vulnerable to abuse, neglect and impoverished mental health. A sense of diminished worth, coupled with limited resources, appear to be factors in higher rates of suicide and attempted suicides when comparing Chinese elders to those of other populations. Existing (though scant) research on the prevalence of elder abuse in Hong Kong, Taiwan and the People's Republic of China are reviewed. Data suggests that most perpetrators of abuse are the adult offspring of the victims. (Asia)


61. L4508-10
Dimah, K.
Patterns of Elder Abuse and Neglect in an Illinois Elder Abuse and Neglect Provider Agency: A Comparative Analysis
Journal of Elder Abuse and Neglect; Vol. 13 (1), 27-44; 2001.
Journal article (research)
This study was designed to examine patterns of elder abuse among African-Americans in comparison with patterns of abuse among non African-American victims . The sample (including 59 African-American and 48 non-African-American victims of substantiated domestic abuse) was drawn from clients of an Elder Abuse Provider Agency (EAPA) in Illinois and the data used was collected during the investigation of abuse allegations. The findings of this study point out gender and racial differences between primary abusers, but did not demonstrate that African Americans are significantly more susceptible to financial exploitation, as had been previously suggested in the literature. Since data on self-neglect is not routinely collected in this process, this issue could not be addressed. (U.S.)

62. P5075-8
Huber, R., Borders, K., Netting, F. & Nelson, H.
Data From Long-Term Care Ombudsman Programs in Six States: The Implications of Collecting Resident Demographics
The Gerontologist; Vol. 41 (1), 61-68; 2001.
Journal article (research)
One sociological theory, the "leveling theory," proposes that social inequities are mitigated by aging issues, while the "double jeopardy" theory suggests that aging exacerbates such social inequalities. This article reports upon research that was designed to examine the value of collecting demographic information on ombudsmen reporting documentation. Using the National Ombudsman Reporting System (NORS), 23,787 complaints were analyzed from six states (1996) to identify any possible links between gender, race and types of complaints lodged, verified and completely resolved. The findings indicate that a higher percentage of minorities (all residents not identified as Caucasians) had verified complaints; however, a lower percentage of these complaints were fully resolved. Information regarding specific types of complaints most frequently lodged by which age-gender group is included. (U.S)

63. P5481-17
Kim, J. & Sung, K.
Marital Violence Among Korean Elderly Couples: A Cultural Residue
Journal of Elder Abuse & Neglect; Vol. 13 (4), 73-89; 2001.
Journal article (research)
This study draws upon data from the Korean National Family Violence Survey. Eighty-eight male and 56 female participants aged 60 and over were surveyed by telephone regarding their experiences of domestic violence occurring during the preceding 12 months. Researchers used the Conflict Tactic Scale (CTS) to assess violence. Data revealed an intimate partner violence rate of 21.5 percent. While most of the incidents reported were relatively minor, 5.6 percent of the occurrences were threats or assaults involving the use of weapons. Unlike previous studies, socioeconomic factors did not appear associated with rates of abuse. (Korea)

64. S6207-10
Moon, A., Tomita, S. & Jung-Kamei, S.
Elder Mistreatment Among Four Asian American Groups: An Exploratory Study on Tolerance, Victim Blaming, and Attitudes Toward Third-Party Intervention
Journal of Gerontological Social Work; Vol. 36 (1/2), 153-169; 2001.
Journal article (research)
This multicultural study was designed to compare differences among four Asian groups (American-born Chinese Americans, n=50; American-born Japanese Americans, n=48; first-generation Korean Americans, n=95; and first-generation Taiwanese Americans, n=80) in their response to several aspects of elder mistreatment. Participants, aged 60 and over, were asked to respond to fourteen statements regarding tolerance, victim blaming and attitudes towards third-party intervention in elder mistreatment examples. Significant differences were observed among the U.S. born Chinese and Japanese Americans and the first generation Korean and Taiwanese Americans; the U.S. born Asians were more likely to tolerate verbal abuse but less likely to tolerate financial abuse. The American born Asians were also less likely to blame the victims and were more amenable to third party intervention. Traditional and cultural influences are described that may contribute to the unique responses of each group.


65. V48
Goldman Institute on Aging
When Help Was There: Four Stories of Elder Abuse
Fanlight Productions, Boston, MA; 2000
This 19 minute video explores cultural diversity and various aspects of physical, emotional and financial elder abuse. Four case studies are presented: an Hispanic mother living in fear of her mentally ill adult son; a Chinese immigrant couple who are displaced by their son-in-law; an African-American woman who has been physically abused by her husband for forty years; and a White man who is financially exploited by a younger "friend." The vignettes also demonstrate how each person finds assistance. (U.S.) (Note: For more information on this video, contact Fanlight Productions, 4196 Washington St., Suite 2, Boston, MA 02131, telephone (617) 469-4999 or visit the Web site at www.fanlight.com. )

66. P5057-27
HelpAge International
Older People in Disasters and Humanitarian Crises: Best Practice Guidelines
HelpAge International, London, U.K.; 2000.
Agency report
This publication explores the difficulties is serving older people facing disastrous and humanitarian crises, and the best practices guidelines that were developed as a result of this HelpAge International research project. Elders tend to become more isolated and marginalized in these circumstances. Gender issues are also considered. Recommendations include outreach education to non-governmental agencies supplying relief, consultation with elders regarding needs, incorporating contributions of older individuals into relief efforts, and sensitivity to cultural concerns whenever possible. Appendices include vulnerability checklists for individuals and communities. (International) (Note: This publication may be accessed online at: http://www.helpage.org/Resources/Manuals/ .)

67. P5077-5
Joseph Rowntree Foundation
Meeting the Needs of Chinese Older People
Joseph Rowntree Foundation; September 2000.
Research synopsis
This is a research synopsis of the report, "Chinese Older People: A Need for Social Inclusion in Two Communities," (Wai Kam Yu, published for the Foundation by the Policy Press). The research involved interviews and focus groups with one hundred older Chinese residents (aged 60 and older) of South Yorkshire, London and Glasgow. Ninety-seven percent of the participants reported that social services were difficult to use, with language as a major obstacle. While they expressed feelings of isolation regarding British culture, it appears that the Chinese community is not sufficiently able to meet the needs for caring and socialization. (U.K.) (Note: This synopsis can be accessed online at http://www.jrf.org.uk/Knowledge/findings/socialcare/920.asp .)

68. & 69. P5083-103 and P5087-69
Morgan Disney & Associates, with Cupitt, L. & Associates, Council on the Ageing
Two Lives - Two Worlds Older People and Domestic Violence - Volumes 1 and 2
Status of Women, Partnerships Against Domestic Violence, Australia;
November 2000.
Agency reports
Statistics indicate that in Australia, one-third of all victims of domestic violence are older women. This multi-method, qualitative, exploratory study garnered input from 162 individuals aged 50 and over regarding their experiences of domestic violence. The research took place from November 1999 through June 2000, and consisted of in-depth interviews, responses from a national phone-in, and focus groups. Although the project was designed to reach older women, researchers were also contacted by 22 male victims of domestic violence. Professionals and representatives of community organizations also contributed. In particular, this report examines the increased difficulties that older battered women face, in part due to socialization that included the widespread acceptance of violence. The experiences of violence within lesbian couples, of Aboriginal and Torres Strait Islander women, and of foreign born victims, are highlighted within the case studies. The role of gatekeepers, family, friends, clergy, physicians and others are considered, and recommendations are made for more effective outreach and the provision of services and support. Volume Two presents the literature survey regarding the relationship between domestic violence and elder abuse, along with a secondary data analysis of the ABS Women's Safety Australia research project on the occurrence of domestic violence in Australia. Attachments include the scoping paper which outlines the purpose and structure of the project, the survey instrument for phone-in interviews, and the questions for focus groups of professionals and participants. (Australia) (Note: Volume 1 is available online at http://tinyurl.com/q5sas) and Volume 2 is available at http://tinyurl.com/ntkts.)

For earlier references on these topics, please review the following CANE bibliographies:

Elder Abuse: A Global Issue (July 2002)

Cultural Issues in Elder Abuse (July 2002)

To search for additional references on this and other topics related to elder abuse, please visit the CANE Web site at:
http://db.rdms.udel.edu:8080/CANE . To search the CANE Bibliography Series, go to http://www.elderabusecenter.org/default.cfm?p=cane.cfm .

Additional Online Resources:

International Network for the Prevention of Elder Abuse

Age Concern

HelpAge International

World Health Organization/WHO

(Web addresses may change without notice. If an address provided is no longer accurate, we recommend using a generic search engine, such as Google, to find a current link. If you cannot locate the online publication, contact the CANE offices for assistance by e-mailing cane-ud@udel.edu or telephoning (302-831-3525).

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