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Elder Abuse, Neglect and Exploitation in Rural Settings

Geographic, economic and cultural factors make it particularly difficult to assist victims of elder mistreatment who live in rural communities. This annotated bibliography highlights the research that has been conducted regarding abuse, neglect, exploitation and self-neglect among the rural elderly, as well as research that illuminates the differences and similarities among rural, urban and suburban victims. A common theme is that elders living in rural communities have fewer available resources, and greater difficulty accessing those resources, than elders in non rural settings. Some materials outline practice approaches designed to overcome barriers to service use. Other articles address factors known to contribute to the risk of elder mistreatment, such as self-neglect, mental illness and caregiver burden, and the inadequacies of existing treatment and support systems in rural areas. A number of international studies are noted as well. Several articles that address the topic of domestic violence in rural settings that are not specific to elder abuse have been incorporated as the lessons learned from this field may be generalized to the study of elder mistreatment.

Most of the reference materials can be obtained through local university and community libraries or interlibrary loan services. Some must be ordered directly through the publisher or production company. When available, contact and pricing information is included with the abstract. Increasingly, many resources are available online, and the web addresses are also included.* If you have difficulty obtaining any of these materials, please contact the CANE office for assistance by emailing cane-ud@udel.edu or telephoning (302) 831-3525.

Note: This is a selected annotated bibliography, which does not include all published references related to this topic. The included references have been selected to provide readers with a current and comprehensive collection of articles representing a variety of perspectives on the subject. 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 www.elderabusecenter.org/default.cfm?p=cane.cfm .

(*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).

The National Center on Elder Abuse (NCEA) serves as a national resource for elder rights advocates, law enforcement and legal professionals, public policy leaders, researchers, and citizens. It is the mission of NCEA to promote understanding, knowledge sharing, and action on elder abuse, neglect, and exploitation.
The NCEA is administered under the auspices of the National Association of State Units on Aging.

NCEA Partners
  • National Association of State Units on Aging (NASUA), Lead Partner
  • American Bar Association (ABA) Commission on Law and Aging
  • Clearinghouse on Abuse and Neglect of the Elderly (CANE) at the University of Delaware
  • National Adult Protective Services Association (NAPSA)
  • National Committee for the Prevention of Elder Abuse (NCPEA)
This publication was made possible through the support provided by the National Center on Elder Abuse. Major funding for the National Center on Elder Abuse comes from the U.S. Administration on Aging, Department of Health and Human Services. Grant No. 90-AM-2792. Opinions or points of view expressed do not necessarily reflect the official position or policies of the U.S. Administration on Aging.


1. S6351-9
Butler, S. et al.
Depression and Caregiver Burden Among Rural Elder Caregivers
Journal of Gerontological Social Work; Vol. 46 (1), 47-62; 2005.
Journal article (research)
This article analyzes the results of a study addressing factors related to depression and caregiver burden among rural family caregivers of older adults. Members of the Maine Primary Partners in Caring (MPPC) project used a simple screening tool to identify those at risk for depression and caregiver burden (which not only impacts the health and well-being of the caregiver but may also have a negative impact upon the care recipient) in order to provide interventions before caregivers were in crisis. Sixty-two caregivers were identified as "at risk." Family support and knowledge regarding care provision appeared associated with decreased caregiver burden and depression, while isolation appeared associated with increased caregiver burden. Social workers can play a significant role in assisting rural caregivers in developing and expanding their support networks.

2. S6354-11
Grossman, S., Hinkley, S., Kawalski, A. & Margrave, C.
Rural Versus Urban Victims of Violence: The Interplay of Race and Region
Journal of Family Violence; Vol. 20 (2), 71-81; April 2005.
Journal article (research)
This study analyzed the circumstances and characteristics associated with victims of domestic violence who utilized support services in selected rural and urban regions of Illinois from 1990 through 1995. Results suggest that although demographic differences related to race were noted when comparing regional sub samples, circumstances of abuse were similar between urban and rural victims. However, although victims of both regions most often required personal and emotional support along with legal assistance, the needs of rural victims appeared more extensive; they required greater assistance with transportation, education, and additional services than did urban victims. Racial differences regarding specific issues are also discussed. (Note: Although the study sample included a small percentage of women aged 50 and over, this article is not specific to elders.)

3. S6233-10
Gunderson, A., Tomkowiak, J., Menachemi, N. & Brooks, R.
Rural Physicians' Attitudes Toward the Elderly: Evidence of Ageism?
Quality Management in Health Care; Vol. 14 (3), 167-176; July-September 2005.
Journal article (research)
Observing that ageism can negatively impact clinicians' decisions regarding health care services, with negative implications for older patients, this study was undertaken to examine the attitudes of rural physicians towards elderly patients in Florida. The "Health Professionals Beliefs and Opinions about the Elderly," an instrument comprised of 17 items measuring four factors (competence regarding health, patient intelligence, uniqueness of the elderly, and frustration with aging) was completed by 212 practitioners of family medicine, internal medicine and psychiatry. Results indicate that the participants reported ageist perceptions of nursing home residents and those aged 85 and older, regarding their intelligence and health competencies.

4. S6355-18
Harbison, J., Coughlan, S., Karbanow, J. & VanderPlaat, M.
A Clash of Cultures: Rural Values and Service Delivery to Mistreated and Neglected Older People in Eastern Canada
Practice; Vol. 17 (4), 229-246; December 2005.
Journal article (research)
In this exploratory study, the authors examine strategies for service delivery to abused and neglected older individuals from rural communities of eastern Canada. They note that the little research existing on rural victims of elder abuse tends to focus on the limits of resources available in these regions but neglects to consider the impact of cultural values that may also constitute service barriers. Health and social services professionals (including adult protective services professionals), law enforcement, and senior volunteers and advocates were interviewed. Among the themes noted across localities was the desire of older individuals in rural communities to maintain autonomy and privacy regarding family matters, including abuse. Participants echoed the desire to respect the rights and wishes of their clients while offering assistance. Collaboration across disciplines was noted as a means to enhance service provision in regions where resources were scarce. Establishing a relationship with the client was considered the most basic step in reducing resistance to help. A discussion of the legal mandate governing the reporting of elder abuse is also presented. (Canada)


5. P5996-11
Harbison, J., Coughlan, S., Karabanow, J. & VanderPlaat, M.
Offering the Help That's Needed: Responses to the Mistreatment and Neglect of Older People in a Rural Canadian Context
Rural Social Work; Vol. 9, 147-157; December 2004.
Journal article (research)
In this grounded theory analysis, researchers explore the efforts to address elder abuse, neglect and self-neglect occurring in rural Eastern Canadian communities. Interviews were conducted with 55 key informants from a variety of health and social service agencies, and focus groups were conducted with participants involved directly with elderly clients. Participants identified a number of limitations to providing assistance, including the restrictions of the Adult Protection Act which requires "just cause" and collateral investigation before an alleged victim can be approached; the ethical and practical issues surrounding competency; balancing autonomy with the client's best interest; and bureaucratic restrictions. Creativity and multidisciplinary collaboration were the most beneficial resources identified in outreach and intervention. (Canada)

6. R6029-14
Oswald, R., Jogerst, G., Daly, J. & Bentler, S.
Iowa Family Physician's Reporting of Elder Abuse
Journal of Elder Abuse & Neglect; Vol. 16 (2), 75-88; 2004.
Journal article (research)
This study was designed to analyze Iowa family practitioners' knowledge of elder abuse and relevant reporting laws, to identify perceived barriers to reporting suspected mistreatment, and to examine factors associated with reporting suspected abuse in the clinical setting. Of the 1,030 members of the Iowa Academy of Family Practice Physicians solicited for the survey, 378 completed a mailed questionnaire regarding their general knowledge concerning elder abuse, and their experiences with suspected elder abuse cases during the past year. Overall, the participants appeared knowledgeable about elder abuse. Nearly half had observed at least one case of elder abuse during the past year, and 54 percent of those had made a report to the Iowa Department of Human Services. Respondents indicated that victims' denials, reporting by other officials, unrecognized signs of mistreatment at the time of examination, and the victim not being a dependent adult were the most common reasons for not reporting. The practice of routinely screening for elder abuse by asking direct questions and the presence of a reporting protocol were significantly associated with identifying mistreatment and reporting it. Of note, physicians practicing in rural communities demonstrated an increased likelihood of reporting elder abuse when compared to other participants, which is counter to the results of a previous study conducted by several of the authors (see CANE file #K4267-6 or item #18 of this bibliography).


7. P5615-19
Dimah, K. & Dimah, A.
Elder Abuse and Neglect Among Rural and Urban Women
Journal of Abuse and Neglect of the Elderly; Vol. 15 (1), 75-93; 2003.
Journal article (research)
The article dispels certain myths that traditional family values protect against domestic elder abuse in rural settings. In particular, social and geographic isolation can add to the potential for abuse while limiting the victims' ability to access intervention services. The study was designed to examine and compare patterns of abuse, neglect and exploitation between older rural and urban women. Six types of elder mistreatment are analyzed: physical abuse, emotional abuse, confinement, deprivation, passive neglect, and financial exploitation. Drawing upon data from the Illinois Elder Abuse and Neglect Program's "Abuse, Neglect, and Exploitation Tracking System" (ANETS), 1989-2001, the sample consists of 7,178 rural women and 7,614 urban women, aged 60 and over, who were identified as victims of abuse, neglect and exploitation. Rural victims demonstrated higher rates of physical abuse, emotional abuse and deprivation, while urban victims demonstrated higher rates of passive neglect. In both groups, abusers were typically non-caregiver children, with no legal responsibility for the victims. At least half of the abusers resided with their victims. Of note, most victims of both groups (88 percent of the rural sample and 86 percent of the urban sample) were willing to accept services.

8. P5670-5
Koch, S. & Nay, R.
Reducing Abuse of Older People with Dementia and Their Carers
Australasian Journal of on Ageing; Vol. 22 (4), 191-195; December 2003.
Journal article (research)
This study explores the phenomenon of elder abuse among people with dementia and their caregivers, paid and unpaid. Forums and in depth interviews were conducted throughout rural Victorian and metropolitan Melbourne areas with experts representing government, health and social service agencies regarding the nature and experience of abuse within these relationships. In all, 171 individuals participated and included one patient with dementia, 52 caregivers, 46 nurses (including RNs, managers, administrators, etc.), and other health and social service professionals. Content analysis of audiotaped sessions revealed several themes, including the need for a protocol for prevention and intervention, the need for sufficient staffing, greater awareness of available resources, and more education regarding cognitive impairment. Other key points from this research: Defining abuse is probably unnecessary; abusive/aggressive behaviors should be considered in the context in which they occur; and mandatory reporting is not essential. (Australia)


9. S6352-10
Stones, M. & Bedard, M.
Higher Thresholds for Elder Abuse with Age and Rural Residence
Canadian Journal on Aging; Vol. 21 (4), 577-586; 2002.
Journal article (research)
Despite a growing body of literature that addresses differences in perceptions regarding elder abuse, little theoretical analysis has been offered regarding these differences. The authors of this study attempt to view these differences from a threshold theoretical model, which assumes an underlying continuum of tolerance or acceptance of a range of behaviors. In this study, 572 participants (seniors and younger professionals from various occupations) from three regions of a Canadian province rated the 112 items of The Elder Abuse Survey Tool (EAST) according to perceived severity of abuse. Participants were from rural, mid-sized and urban communities. Results suggest that while participants shared common standards for evaluating the abusiveness of behavior, older participants and rural residents demonstrated higher thresholds regarding all categories of abuse. Implications for educating individuals regarding elder abuse are considered. (Note: This article is not currently available through CANE.) (Canada)

10. N4765-11
Krishnan, S., Hilbert, J. & VanLeeuwen, D.
Domestic Violence and Help-Seeking Behaviors Among Rural Women: Results from a Shelter-Based Study
Family and Community Health; Vol. 24 (1), 28-38; April 2001.
Journal article (research)
There has been little research on rural patterns of domestic violence, despite early indications that rates are commensurate with urban and suburban rates. This article reports on the help-seeking behaviors of 100 rural women admitted to a domestic violence shelter in southern New Mexico. The sample was predominantly Hispanic (72 percent) and under 30 (52 percent). Nearly all participants had experienced physical, verbal and emotional abuse and more than half had experienced sexual abuse. Almost half of the women experienced suicidal thoughts or behaviors. Approximately 40 percent of all participants sought counseling services and over half reported their abuse to law enforcement (the most common assistance requested), but ethnic differences regarding other services sought were noted. Hispanic participants were more likely to seek restraining orders and non-Hispanics were more likely to seek medical attention. The researcher emphasizes the importance of replicating this research, and incorporating these culturally specific findings into customized intervention strategies. (Note: Not specific to elder abuse.)

11. L4539-13
Lawrence, S. & McCulloch, B.J.
Rural Mental Health and Elders: Historical Inequities
Journal of Applied Gerontology; Vol. 20 (2), 144-169; June 2001.
Journal article (scholarship)
This comprehensive historical overview of mental health treatment in America focuses on the inequities of service delivery to the rural, elderly mentally ill. The initial view that mental health impairment was an individual, not a societal, problem managed informally within the family and community, gave way to institutionalization as population shifted from mainly rural to urban areas. In the latter half of the 20th century, de-institutionalization began with the premise that the mentally ill would be best served in the community through Community Mental Health Clinics (CMHCs) and then Community Support Programs (CSPs). However, the chronic mentally ill continue to appear underserved while many have become "criminalized" and incarcerated and others have become homeless. In this article, barriers to rural elderly mental health services utilization, such as stigmatization, financial limitations, isolation, transportation difficulties, availability of services, lack of service coordination and ageism on the part of clinicians, are explored.

12. N4746-11
Quandt, S., Arcury, T., McDonald, J. et al.
Meaning and Management of Food Security Among Rural Elders
The Journal of Applied Gerontology; Vol. 20 (3), 356-376; September 2001.
Journal article (research)
This article discusses the concept of food insecurity (the inadequate or uncertain availability of a satisfactory food supply, a necessary part of maintaining adequate health and nutritional status) among the rural elderly. The research was gathered in an ongoing ethnographic study of 145 residents, aged 70 or older, of two North Carolina counties. The sample was comprised of African Americans, Native Americans and European Americans of both genders. While an approximate 12 percent incidence of food insecurity was reported, the interview process identified a number of themes that appear to indicate that this may be an underestimate. Avoidance of credit, and beliefs in providence and "making do" were observed across all population groups. The means to prevent food insecurity, such as food gifts, may be inherent to the social environment, but may be unpredictable and unreliable.
13. N4582-7
Rathbone-McCuan, E.
Mental Health Care Provision for Rural Elders
The Journal of Applied Gerontology; Vol. 20 (2), 170-183; June 2001.
Journal article (scholarship)
Beginning with an overview of the impact of mental illness on our nation's elderly population, this article discusses the strengths and weaknesses of service delivery in rural areas where there is a higher proportion of both elderly and poor residents. Although amendments in the 1970s to the Community Mental Health Centers Act (1963) authorized specialized treatment for the aged, these initiatives were not realized due to lack of federal funding. The effects of de-institutionalization of state mental hospitals upon long-term care facilities and the development of HMOs as service providers are also discussed.

14. K4267-6
Jogerst, G., Dawson, J., Hartz, A., Ely, J. et al.
Community Characteristics Associated with Elder Abuse
Journal of the American Geriatrics Society; Vol. 48 (5), 513-518; 2000.
Journal article (research)
Iowa is a rural state with many older residents. This study was designed to analyze community characteristics such as county demographics and health and social service resources associated with rates of elder abuse. Data from 99 counties from 1984 through 1993 were analyzed. Factors associated positively with reported or substantiated cases of elder abuse include higher levels of population density, reported rates of child abuse, and children living in poverty.
15. M102-00
Maxwell, M.S. & O'Rourke, K.S.
Domestic Violence: A Competency-Based Training Manual for Animal Abuse Investigators
Rural Victimization Project, Institute for Family Violence Studies, School of Social Work, Florida State University; 2000.
Manual (online resource)
As quoted from the Introduction: "Over the past decade, the link between animal abuse and domestic violence has become clearer. Numerous studies have found violent criminals and serial killers to be common perpetrators of animal abuse, and since abusers aim to hurt anything victims hold dear, family pets are also popular targets. As a result, the Institute decided to train Animal Abuse Investigators to identify human abuse while investigating animal abuse. As these investigators make home visits, they would be in a unique position to identify and assist isolated rural victims of abuse who might otherwise go unnoticed..." Each chapter is a training module that covers such topics as the link between animal abuse and human abuse, the dynamics of domestic violence (DV), the impact of DV upon animals (including the manners in which animals are abused, neglected and abandoned, used in threats, and trained to perpetrate abuse), addressing rural barriers, the role of animal abuse investigators (identification of abuse, safety planning and referral), and community resources. Pre- and post-tests, self-quizzes, exercises and case studies are provided. This tutorial is an outgrowth of the Institute's Animal Abuse Investigator Training Pilot Project, which was initiated in 2000. Detailed resource appendices (including a video list) are included. {Available online at http://familyvio.ssw.fsu.edu/rural/animal.html or for $30.00 (outside of Florida) / $25.00 (in Florida) from: Institute of Family Violence Studies, FSU School of Social Work,
C-2500 University Center, Tallahassee, FL 32306-2750, telephone: 850 644-6303. Not specific to elder abuse.}
16. M101-00
Maxwell, M.S. & O'Rourke, K.S.
Domestic Violence: A Competency-Based Training Manual for Community Mental Health Center Staff
Rural Victimization Project, Institute for Family Violence Studies, School of Social Work, Florida State University; 2000.
Manual (online resource)
This manual was designed to help community mental health professionals identify and provide treatment and referral for rural clients who are victims of domestic violence (DV). Topics include basic education regarding DV, and overcoming rural barriers in order to access resources. Each chapter is a training module, covering the dynamics of DV, issues for mental health counselors (including insufficient time, myths regarding abuse, and fear of involvement, safety, and confidentiality), treatment interventions, safety planning, working with children exposed to DV, substance abuse issues, and follow-up. Counselors are instructed in the RADAR protocol: Routine Screening, Ask Direct Questions, Documentation, Assess Client Safety, and Review Client Options and Referrals. Pre- and post-tests, quizzes, exercises and case studies are included. This tutorial is an outgrowth of the Institute's Community
Mental Health Counselor Training Pilot Project, which was initiated in 2000. Detailed resource appendices (including a video resource list) are included. {Available online at http://familyvio.ssw.fsu.edu/rural/community.html or for $30.00 (outside of Florida) / $25.00 (in Florida) from: Institute of Family Violence Studies, FSU School of Social Work, C-2500 University Center, Tallahassee, FL 32306-2750, telephone: 850 644-6303. Not specific to elder abuse.}

17. M33-238
Maxwell, M.S. & O'Rourke, K.S.
Domestic Abuse in Later Life - A Competency-Based Training Manual for Meals on Wheels Volunteers & Other Elder Services Staff
Rural Victimization Project, Institute for Family Violence Studies, School of Social Work, Florida State University; 1999.
Manual (online resource)
This manual was designed to train Meals on Wheels volunteers in rural communities to identify and refer victims of abuse to appropriate social service agencies. Each chapter is a training module that covers topics such as the dynamics of domestic violence (DV), the impact of abuse on elderly victims, elder self-neglect and financial abuse, the impact of mistreatment on nutritional outcomes, the identification and overcoming of rural barriers in order to access resources, and the role of the Meals on Wheels volunteer. Detailed resource appendices (including a video list) are included. {Available online at http://familyvio.ssw.fsu.edu/rural/elderly.html or for $30.00 (out of Florida) / $25.00 (in Florida) from: Institute of Family Violence Studies, FSU School of Social Work,
C-2500 University Center, Tallahassee, FL 32306-2750, telephone: 850 644-6303.}

18. V44
Florida State University School of Social Work
Escaping the Shadows: Identifying and Assisting Victims of Elder Domestic Abuse
FSU School of Social Work; 1999.
This video is an adjunct to the training manual, "Domestic Abuse in Later Life - A Competency-Based Training Manual for Meals on Wheels Volunteers & Other Elder Services Staff." (Running time: 20:19. For ordering information contact: Institute for Family Violence Studies, FSU School of Social Work, C-2500 University Center, Tallahassee, FL 32306-2750, telephone 850-644-6303.)

19. K4236-10
Schaffer, J.
Older and Isolated Women and Domestic Violence Project
Journal of Elder Abuse & Neglect; Vol. 11 (1), 59-77; 1999.
Journal article (research)
This report documents the results of an Australian organized national phone-in designed to elicit responses to a questionnaire from older and isolated women who live with domestic violence. A copy of the questionnaire is included as an appendix. Significant themes and responses that emerged from the phone-in are reported, as are the logistics of organizing a phone-in of this magnitude. Themes identified by older women are listed and discussed and issues for women from rural and remote communities are explored in detail. Recommendations are made for policy development, improved service provision, and prevention strategies. (Australia)


20. N4559-6
Cupitt, M.
Identifying and Addressing the Issues in Elder Abuse: A Rural Perspective
Journal of Elder Abuse & Neglect; Vol. 8 (4), 21-30; 1997.
Journal article (research)
This article reports the findings of a study of domestic elder abuse in rural communities in New South Wales, Australia. During May of 1995, twenty community nurses and home care workers visited a total of 598 clients and assessed them for victimization of physical, financial, psychological/emotional abuse, neglect and self-neglect. A total of 33 (5.5 percent) elders were identified as experiencing some form of abuse, with nearly half (15) experiencing psychological abuse, and one-third (12) experiencing financial abuse, 9 experiencing physical abuse, 9 being neglected, 3 experiencing self-neglect and 1 experiencing a violation of rights. The findings for this non-metropolitan population are similar to findings of prevalence and type of abuse in metropolitan areas; however, lack of services and geographic isolation create barriers to prevention and treatment for those in rural communities. Respite care was considered the most needed but unavailable resource. (Australia)

21. N4686-20
Robison, D., Bubb, J., Beach, G. et al.
Elder Abuse Prevention Campaigns for Special Audiences: African American, Hispanic and Rural (From Understanding and Combating Elder Abuse in Minority Communities).
Presented at a national conference sponsored by the NCEA and the Archstone Foundation, Long Beach, CA; 1997.        
This presentation reports on the "Elder Pennsylvanians Deserve Honor and Respect, Not Abuse" campaign, an outreach approach customized for African Americans, Hispanics and the rural elderly. It was presented as a model to be adapted for use in other Communities. Focus groups and telephone interviews were conducted to identify local perceptions of elder abuse and neglect. Three major themes emerged: the need to define elder abuse; the target audience needed to be broader than the elderly alone; the campaign should not further stigmatize the intended target groups. The use of radio, specialized newspapers and direct mail were effective in conveying the campaign while grass roots organizations, churches and social organizations were viable platforms for outreach programs. It is also noted that if an outreach campaign is successful, the request for services may surpass available resources; therefore, contingency planning for a positive response should be part of the development strategy.        

22. K4260-17
Rosenblatt, D. & Durance, P.
Reporting of Possible Elder Abuse and Adult Protective Services Responses: Impact of County Socioeconomic Status
Journal of Mental Health and Aging; Vol. 3 (3), 277-293; 1997.
Journal article (research)
In this study, Michigan's Department of Social Service (DSS) records from 9 metropolitan, 10 medium urban, 28 medium rural and 36 small counties (1989 through 1993) were analyzed to consider the effect of county size and socioeconomic status on the reporting of suspected elder abuse. Michigan state reporting rates were similar to national averages but varied across counties. Reporting rates were highest in small counties, followed by poor counties and medium wealth counties, and lowest in metropolitan counties. Medium rural, medium urban and rich counties had similar reporting rates, and reporting rates did not change throughout the five-year period analyzed.

23. J3981-4
White, R.
Rural Home Care: Social Work Intervention in Social Isolation and Safety Concerns
CARING Magazine; p28-p34 January 1997.
Journal article (scholarship)
Rural home care is challenging in many ways due to the complexities of the environment. Two main areas of concern are social isolation and an unsafe home environment. Cognitive functioning, self-esteem and limited resources are factors that may contribute to compromised safety in the home. The role of the social worker in networking with other health and social services as well as non-profit agencies is considered.


24. S6349-17
Buckwalter, K., Campbell, J., Gerdner, L. & Garand, L.
Elder Mistreatment among Rural Family Caregivers of Persons with Alzheimer's Disease and Related Disorders
Journal of Family Nursing; Vol. 2 (3), 249-265; August 1996.
Journal article (scholarship)
Drawing upon the experiences of rural caregivers assisting Alzheimer patients, this article presents four case studies that illustrate characteristics of victims, perpetrators, and family systems that may contribute to elder abuse. A number of risk factors associated with abuse are considered, including denial, and maladaptive personality characteristics of the caregiver, anxiety, and lack of knowledge. The role of nurses and other health and social service providers in addressing elder mistreatment is also considered. (Note: This article is not currently available through CANE.)


25. I3769-17
McCulloch, B.
The Relationship of Family Proximity and Social Support to the Mental Health of Older Rural Adults: The Appalachian Context
Journal of Aging Studies; Vol. 9 (1), 65-81; 1995.
Journal article (research)
This study examines the relationship of family proximity and social support upon the mental health of older rural Appalachian adults. In particular, the research addresses the relationship of family proximity upon the older individual's perception of social support and upon the individual's symptoms of depression and anxiety. While findings indicate that family proximity was not significantly related to either the perception of social support or the mental health of the older person, social support is a significant predictor of mental health.


26. I3691-14
Griffin, L.
Elder Maltreatment among Rural African-Americans
Journal of Elder Abuse & Neglect; Vol. 6 (1) 1-17; 1994.
Journal article (research)
This exploratory study of ten abused African-American elders and six perpetrators examines not only the nature of the abuse but the thoughts held by the victims and the essence of the victim-perpetrator relationships. Extensive interviews were conducted with the alleged victims and perpetrators who resided in three rural eastern North Carolina counties. The following major themes were identified: there is a relationship between social conditioning and abusive behavior among rural African-Americans; physical elder abuse is particularly unacceptable among rural African-Americans; poverty is pervasive in these scenarios; perpetrators appear dependent upon victims; non-traditional family constellations are common among rural African-Americans; victims are geographically isolated from formal and informal support services and networks; minimalization and rationalization is operant among both perpetrators and victims; and psychological demoralization is problematic for rural African-American families.


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 www.elderabusecenter.org/default.cfm?p=cane.cfm .

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