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National Center on Elder Abuse (NCEA)
Annual Annotated Bibliography of Elder Abuse and Neglect Publications
July 2004 - June 2005
The following is an annotated bibliography of works published or appearing in print between July 2004 through June 2005.* Some deal directly with issues of elder abuse and neglect while others address issues (substance abuse, for example) that may contribute to elder mistreatment. Several entries have been included that address the preservation of elder rights (such as those addressing the voting rights of elders with dementia.)
Entries are categorized as National Center on Elder Abuse (NCEA) publications, research, scholarship, books and manuals, and hearings. The citations are alphabetized by author's name within the genre categories. A number of international references have also been included, as they contribute to the advancement of the study of elder mistreatment and the recognition of elder abuse, neglect and exploitation as a worldwide societal problem. (International entries are categorized as research, scholarship, or books and manuals; abstracts identify the originating country.)
Many readers use the CANE bibliography series to keep abreast of recently published
literature in the field. As a convenience, if a citation has previously appeared in a CANE bibliography, we have indicated the title of the bibliography at the end of the abstract. To access the CANE Bibliography Series visit the NCEA Web site at: http://www.elderabusecenter.org/default.cfm?p=cane.cfm
Most of these reference materials may be obtained through your 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 need assistance in obtaining any of these materials, please contact the CANE office at [email protected] or (302) 831-3525.
(To search for reference materials from previous years, please visit the CANE Web site at: http://db.rdms.udel.edu:8080/CANE . To access earlier annual reviews, visit the CANE Bibliography Series at: http://www.elderabusecenter.org/default.cfm?p=cane.cfm .)
*Although some publication dates may be earlier, these publications first appeared in print during this time frame.
**(Note: 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.)
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.
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.
I. Publications by the NCEA and Partner Organizations
American Bar Association Commission on Law and Aging for the National Center on Elder Abuse (NCEA)
2004/2003 State APS Law: Topics Covered in the Amendments
National Center on Elder Abuse; Washington, D.C.; 2005.
This chart lists the topics of amendments that were enacted in state adult protective services (APS) legislation during 2003 and 2004. It also identifies which states addressed each topic. In all, eighteen categories were recognized. The topics most commonly addressed were definitions of elder abuse and reporting. (Note: This chart is available online at the following NCEA web address: http://www.elderabusecenter.org/pdf/publication/APSLegSummaryChart.pdf .)
Clearinghouse on Abuse and Neglect of the Elderly (CANE)
Cane Bibliography Series
National Center on Elder Abuse (NCEA); Washington, D.C.; 2004-2005.
As part of its commitment to the National Center on Elder Abuse (NCEA) to promote the dissemination of current and relevant research on topics related to elder abuse, neglect and self-neglect, the Clearinghouse on Abuse and Neglect of the Elderly (CANE) produces a series of selected annotated bibliographies. The following bibliographies were developed and posted on the NCEA Web site from July 2004 through June 2005:
The Scope of Elder Abuse (May 2005)
The Role and Impact of the Long-Term Care Ombudsman (March 2005)
Ethical concerns in Addressing Elder Abuse -
Respecting Autonomy and Self-Determination While Providing Protection (December 2004)
Substance Abuse (December 2004)
Elder Sexual Abuse (December 2004)
National Adult Protective Services Association (NAPSA)
Filling the Gaps: Adult Protective Services Resource Development - A Training Curriculum and Trainer's Guide
National Center on Elder Abuse; Washington, D.C.; 2005.
This multi-media training curriculum is designed to teach adult protective services (APS) professionals how to effectively communicate the special emergency needs of clients; explore strategies to obtain necessary resources, including emergency APS funds and in-kind donations; and design a program to administer APS emergency resources. Both the training guide and accompanying power point presentation are available from the NAPSA Web site at: http://www.apsnetwork.org/Resources/publications.htm .
National Center on Elder Abuse (NCEA)
National Center on Elder Abuse Newsletter (NCEA E-News)
National Center on Elder Abuse (NCEA); Washington, D.C. 2004-2005.
This electronic newsletter is produced ten times a year, and is intended to provide current and pertinent information on topics related to elder abuse, neglect and self-neglect. It is intended for practitioners, advocates, researchers, and the public. Policy initiatives, legislative developments, state activities, promising practices, research and scholarship, training and education, funding opportunities and featured topics are highlighted in each issue. (Current and past newsletters can be accessed online at: http://www.elderabusecenter.org/default.cfm?p=newsletterarchives.cfm .)
National Center on Elder Abuse (NCEA)
15 Questions & Answers About Elder Abuse
National Center on Elder Abuse; Washington, D.C.; June 2005.
As quoted from the NCEA Web site: "This short booklet answers some of the most commonly asked questions about elder abuse: What is it? What are the warning signs? Who is most at risk? Who are the abusers? Are there laws that protect seniors? What steps can people take to protect themselves?" (Note: This booklet is accessible online at: http://www.elderabusecenter.org/pdf/publication/
National Center on Elder Abuse (NCEA)
NCEA Fact Sheet: Elder Abuse Prevalence and Incidence
National Center on Elder Abuse (NCEA); Washington, D.C.; 2005.
Although the exact prevalence and incidence of elder abuse and neglect in the U.S. are not known, this fact sheet provides a succinct overview of what is known regarding the scope of elder mistreatment. The terms "prevalence" and "incidence" are defined, and highlights of research from a variety of sources (including the National Elder Abuse Incidence Study, the University of Iowa Department of Family Medicine, the National Ombudsman Reporting System Data Tables, the National Association of Adult Protective Services, and Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America, National Academies Press, Inc.; Washington, D.C.; 2003) are outlined. (Note: This fact sheet is accessible online at: http://www.elderabusecenter.org/pdf/publication/FinalStatistics050331.pdf .)
Stiegel, L., Bueno, J. & VanCleave, E., of the American Bar Association Commission on Law and Aging for the National Center on Elder Abuse (NCEA)
Analysis of 2004 State Legislation Amending Adult Protective Services Laws
National Center on Elder Abuse (NCEA); Washington, D.C.; 2005.
This paper provides analysis of the state amendments to adult protective services (APS) laws that were enacted in 2004. A summary of legislative changes occurring in seven states (Virginia, Texas, Maine, Massachusetts, South Carolina, Kansas, and Iowa) are included. Issues addressed include the following: definitions of elder abuse; mandatory and voluntary reporting; elder abuse fatality review teams; and civil liability. The paper concludes with a chart of amendment categories and the corresponding states that addressed the issue. (This paper summarizes only those amendments directly addressing APS legislation; other state legislative activity related to elder abuse is not included.) (Note: This paper is available online at: http://www.elderabusecenter.org/pdf/publication/APSLegSummary2004.pdf .)
Teaster, P. B., Nerenberg, L., Stanis, P., Stansbury, K., for the National Committee for the Prevention of Elder Abuse (NCPEA)
An Adult Protective Services View of Collaborative Efforts with Mental Health Services
National Committee for the Prevention of Elder Abuse (NCPEA); Washington, D.C.; 2005.
The purpose of this study was to gather input from representatives of mental health services (MHS) and adult protective services (APS) regarding the need for collaboration when assisting abused and neglected elders. As quoted from the introduction: "...The study objectives were to: identify situations where APS and MHS interface; determine common elements for successful
collaboration between APS and MHS; discover impediments to collaboration for both APS and MHS and determine remedies for those impediments; and to provide guidance to APS and MHS
professionals for developing collaborative services..." Twenty-four participants, members of the National Association of Adult Protective Services Administrators (NAAPSA) and the American Society of Aging Mental Health Special Interest Group, were surveyed regarding elements of collaboration, program characteristics, funding sources, roles within collaboration, barriers to collaboration, and best practices. Of the findings, although a third of the respondents indicated that a Memorandum of Understanding (MOU) was in place, working arrangements for the most part were informal; collaboration most frequently developed in response to a "case gone wrong"; and respondents reported various means for maintaining client confidentiality (client consent forms, MOUs, and specifically designed confidentiality or non-disclosure forms). A major challenge identified was the variation in perspectives regarding what constitutes an emergency. Strengths included improved communications and relationships among agencies serving at-risk adults and improved role clarification. (Note: This publication is accessible from the NCEA Web site at: http://www.elderabusecenter.org/pdf/APSMHSFinal041014.pdf .)
Twomey, M., of the San Francisco Consortium for Elder Abuse Prevention for the National Center on Elder Abuse (NCEA)
Teleconference Summary: "Working with the Faith Community on Elder Abuse Prevention"
National Center on Elder Abuse (NCEA); Washington, D.C.; 2005.
Recognizing that more people turn to clergy than other professional helping groups, the National Center on Elder Abuse hosted two nationwide teleconferences in the spring of 2004 to discuss the role that faith based communities can play in addressing elder abuse. This publication summarizes the content of these teleconferences. Elizabeth Podnieks reported findings from exploratory research conducted in Ontario, Canada, and Lisa Curtis reported on Denver's Clergy Against Senior Exploitation (CASE) project. Recommendations were made to enhance outreach to faith communities, for educating clergy, and for recognizing the special needs of elders. (Note: This publication is available on the NCEA Web site at: http://www.elderabusecenter.org/pdf/publication/
The following publications use a scientific method to obtain results. The results are usually quantifiable, and the methodology can be replicated and tested for validity and reliability.
A Study of Elder Abuse and Risk Factors in Japanese Families: Focused on the Social Affiliation Model.
Geriatrics and Gerontology International; Vol. 4 (S1), S262-S263; 2004.
This two-part study was designed to assess risk factors for elder abuse in Japanese families. In the first phase, a survey was mailed to 3,600 residents of an agricultural village to elicit perceptions regarding elder caregiving (response rate not given). Responses suggested that people who thought that family should take on caregiving responsibilities also believed that elders should "obey the family's opinions" without expressing their own. They also felt that there was great stigma attached to not caring for elders, and that caregiving was an extreme burden. The second phase involved home visits with community-dwelling frail elders (n=78). A total of 14 elders were found to be victimized, representing a prevalence rate of 17.9 percent among the sample. Half were victims of emotional abuse, six were neglected, and three were physically abused. Those who were senile, incontinent, who wandered, who overate, and who had lost their social roles were more likely to be abused. Logistical analysis revealed that wandering due to senility, caregiver's health problems, and caregiver's misunderstanding of the elder's condition were significant predictors of abuse.
Beach, S. et al.
Risk Factors for Potentially Harmful Informal Caregiver Behavior
Journal of the American Geriatrics Society/JAGS; Vol. 53 (2), 255-261; February 2005.
This research was designed to examine risk factors for potentially harmful behavior by informal caregivers in the community. The primary focus was on the relationship between the
caregiver's physical and mental status and lower quality care, which may be a precursor to elder
abuse and/or neglect. The sample consisted of 265 caregiver-care recipient dyads who participated in the Family Relationship in Later Life Project. Participants were recruited through various community and medical referral sources, through formal service networks, through media initiatives, etc., and were drawn from the areas surrounding the University of Pittsburgh, the University of Georgia, and the Universe of Texas Southwestern Medical Center. Each member of the dyad was interviewed separately and simultaneously, typically in the care recipient's home. Forty-nine percent of the caregivers were spouses, 36 percent were adult children, and 15 percent were other friends and family members. Participants self-rated their physical health status, researchers evaluated the cognitive status of both caregivers and care recipients, and then screened caregivers for depression. Participants were interviewed regarding the level of care recipient needs for assistance with ADLs and IADLs. They were also questioned about indicators of psychological abuse (such as screaming and yelling, threats, verbal abuse) and physical mistreatment (including withholding food, hitting, shaking, and handling roughly). The most prevalent potentially harmful behavior was yelling and screaming (reported by 22.2 percent of the participants) while physical indicators were reported by one percent. Significant risk factors identified include: higher levels of care recipient needs; spousal caregiving relationships; higher degrees of caregiver cognitive impairment; higher degrees of caregiver physical symptoms; and caregivers at risk for clinical depression. Physicians and other practitioners are urged to provide education to informal caregivers as well as support through referral for diverse, and higher intensity, early interventions (such as counseling, support groups, skills training, case management, respite care, etc.) (Note: This entry is also included in the CANE bibliography, entitled Informal Caregiving for Dependent Elders: The Association with Elder Abuse, Neglect, and the Well-Being of Older Individuals, 2000-2005, posted on the NCEA Web site at: http://www.elderabusecenter.org/default.cfm?p=cane_informal.cfm .)
Bell, B., Oyebode, J. & Oliver, C.
The Physical Abuse of Older Adults: The Impact of the Carer's Gender, Level of Abuse Indicators, and Training on Decision Making
Journal of Elder Abuse & Neglect; Vol. 16 (3), 19-44; 2004.
This study was designed to examine the impact of occupation, training, caregiver's gender, and
level of abuse indicators, on social workers' and home healthcare assistants' decisions to take action regarding suspected elder abuse. Data was drawn from 302 questionnaires completed by female social workers, care managers, and home care assistants working with older adults in two local social services departments. Participants answered questions regarding their response to one of four vignettes of suspected elder abuse. The vignettes varied in the degree of abuse
indicated, and the gender of the caregiver of the dementia client. The questionnaire also included questions regarding the participant's level of experience in addressing elder abuse as well as their level of training in dealing with elder mistreatment. Among the findings, 70 percent of the social workers had direct experience with elder abuse cases, compared to only 30 percent of the home care assistants; social workers also reported a higher level of training in addressing cases of elder abuse. Results suggest that both occupational groups were more likely to suggest formal action (including referral to adult protective services) if the caregiver was male, and both groups were more likely to decide upon formal action in scenarios where higher levels of indicators of physical abuse were presented. While social workers were more likely to suggest further information gathering if the caregiver was male, home care assistants were more likely to suggest further assessment if the caregiver was female. Higher levels of training were associated with a greater likelihood to recommend both further assessment and formal action. (Note: This entry is also included in the CANE bibliography entitled Informal Caregiving for Dependent Elders: The Association with Elder Abuse, Neglect, and the Well-Being of Older Individuals, 2000-2005, posted on the NCEA Web site at: http://www.elderabusecenter.org/default.cfm?p=cane_informal.cfm .)
Boldy, D. et al.
Addressing Elder Abuse: Western Australian Case Study
Australasian Journal on Ageing; Vol. 24 (1), 3-8; March 2005.
A questionnaire regarding the prevalence and characteristics of elder abuse was mailed to over
1,000 organizations and 129 general practitioners (GPs) throughout Western Australia. Analysis of the 340 completed and returned surveys revealed that there were 182 substantiated and 253
suspected cases of abuse throughout the region, suggesting an estimated prevalence rate of 0.58
percent. Women and individuals over 75 were at increased risk of abuse, and financial abuse was
identified as the most common form of mistreatment. Perpetrators were most commonly adult
children and other relatives of the victims. Recommendations include the need for increased
awareness and education among professionals dealing with elders, along with respite care,
advocacy and counseling.
Bredthauer, D. et al.
Factors Relating to the Use of Physical Restraints in Psychogeriatric Care: A Paradigm for Elder Abuse
Zeitschrift fur Gerontologie und Geriatrie; Vol. 38 (1), 10-18; 2005.
This study addresses the use of physical restraints among geropsychiatric patients. An
observational study was conducted on 129 patients admitted over a four month period to a
geropsychiatric unit of an acute psychiatric care facility in central Germany. Thirty percent of the patients were physically restrained by use of bed rails, trunk and limb belts, and chair-tables (known as geri-chairs). Forty-eight percent of those restrained were patients with severe cognitive impairment. While there was no significant difference between the frequencies of falls among restrained and unrestrained patients, fall related fractures (two) only occurred in patients who had been restrained. Results suggest that physical restraint use remains a common practice, despite a lack of evidence that it is effective in terms of fall prevention and controlling behavioral disturbances.
Brozowski, K. & Hall, D.
Growing Old in a Risk Society
Journal of Elder Abuse & Neglect; Vol. 16 (3), 65-81; 2004.
The primary goal of this paper is to examine the interpersonal risk factors for emotional elder abuse in Canada. Weighted data from 2,366 responses of elder participants of the 1999 Canadian General Social Survey on Criminal Victimization was analyzed. The survey operationalized emotional elder abuse as attempts to limit the elder's contact with family and/or friends, efforts to damage or destroy the elder's property or possessions, efforts to harm or threaten to harm someone the elder is close to, or insults towards the elder. Among the findings, elders who were isolated from external supports and elders who had a change in marital status were more likely to experience emotional elder abuse. Differences between those seniors who were abused by their children and those abused by others are also considered.
Brownell, P. et al.
Grandparents Raising Grandchildren: The Risks of Caregiving
Journal of Elder Abuse & Neglect; Vol. 15 (3), 5-31; 2003.
This exploratory research was conducted jointly by the Fordham University Graduate School of
Social Service, the New York City Department for the Aging and the New York City Administration for Children's Services to gain insight into the phenomenon of elder abuse among custodial grandparents. Focus groups were conducted with grandparents raising grandchildren and child welfare workers in order to compare their perceptions on the prevalence of elder mistreatment among this population; to identify grandchildren's behaviors associated with abuse; to identify currently available and appropriate services; and to identify services that may be helpful but are not currently available. Grandparent groups were comprised mainly of African-American, African-Caribbean and Hispanic women, ranging in age from 61 through 80. The professional groups were comprised of employees from various settings and from diverse educational and cultural backgrounds. Participation was on a voluntary basis. Transcript analysis revealed a number of similarities when comparing the grandparent groups with the professional groups, including the concept that grandparents do not understand the social environment in which their grandchildren live. Both groups identified physically, psychologically and financially abusive behaviors yet differed in their definitions of these types of abuse. Child welfare workers perceived the problems to be less pervasive than did the grandparents. Although social workers tended to focus more on formal services available, both groups identified a number of the same services, including counseling, faith-based services, support groups, and school personnel. Respite services, greater recognition of this group of caregivers, and psychiatric services for troubled grandchildren were identified as unmet needs. The article concludes with a discussion regarding the impact of cultural influences in this context.
Burgess, A., Hanrahan, N. & Baker, T.
Forensic Markers in Elder Female Sexual Abuse Cases
Clinics in Geriatric Medicine; Vol. 21 (2), 399-412; May 2005.
This article summarizes the findings of the National Institute for Justice's sponsored working group, convened to develop a framework to establish a national database to track the following types of information: mechanisms and patterns of injury in elder sexual abuse cases; forensic evidence; characteristics and behavioral patterns of perpetrators; characteristics and behavioral patterns of the victims; the criminal justice process; and outcomes of elder sexual abuse cases. The multidisciplinary working group was comprised of representatives from health, social service, law enforcement, criminal justice, and other fields, who were experienced in elder sexual abuse case work. Participants submitted 125 cases for retrospective analysis to determine forensic markers unique to elder sexual abuse. Samples included both substantiated and unfounded or nonprosecuted cases. Although African American, Hispanic and Asian victims were identified, victims were predominantly Caucasian, and nearly half suffered from a mental or physical disability. Those victimized sustained a broad range of injuries stemming from many types of abuses. Of note, elderly victims were not typically assessed for post-traumatic stress disorder (PTSD) or other psychological consequences to the assault. Offender characteristics were also analyzed. Among the findings, 44 percent of the perpetrators were reportedly under the influence of drugs or alcohol at the time of the incident, and 44 percent of the offenders had multiple offenses. Information is also presented concerning the relationship between offenders and victims.
Learning from Rowan Ward - Developing an Audit Tool to Improve the Systems and Processes for Quality of Care and Safety of Service Users
Journal of Adult Protection; Vol. 6 (4), 22-26; December 2005.
The report by the Commission for Health Improvement (CHI, 2003), identified nine characteristics that were underlying the poor care and mistreatment of patients in Rowan ward, a geropsychiatric mental health ward in Manchester, England. This article profiles the development of an audit tool, based upon input from the report, that can be used to self-evaluate programs serving vulnerable populations. The tool allows for the evaluation of seven areas of governance: assessment and planning, the role of service users in planning, consent to treatment, complaints policy, arrangements for service users' views, arrangements for care providers' views, and arrangements for relatives' views. The tool has been posted on the National Institute for Mental Health in England (NIMHE) Web site and is being pilot tested by a number of services. (U.K.)
Castle, N. & Lowe, T.
Report Cards and Nursing Homes
The Gerontologist; Vol. 45 (1), 48-67; 2005.
This article presents an overview of nursing home report cards (sometimes referred to as consumer reports or provider profiles), which are designed to provide the public with information regarding the institution's quality of care. The authors identified 19 states that produce report cards (AZ, CO, FL, IL, IN, IO, MD, MA, MS, NV, NJ, NY, OH, PA, RI, TX, UT, VT and WI) which are accessible online. The reports were then compared on the basis of content presented (major categories of both background and qualitative information), the presentation format, and the potential usefulness of the information in helping consumers to make decisions. Results indicate that there are substantial differences in the content of existing report cards. For example, several states list only one or two quality data elements, while Maryland and Ohio provide 27 and 34, respectively. However, data sources are not substantially different; most data is derived form annual licensure and recertification inspections. Only two states rely upon primary data such as resident or family satisfaction surveys. A discussion summarizing the usefulness of individual report cards based upon the following criteria is provided: ease of use; whether it addresses diversity among the target audience; whether it assists consumers in understanding key fundamentals; whether it assists consumers in determining preferences; whether it minimizes complexity; if it explains how quality measures chosen may affect residents; and if it incorporates the web design into manageable segments. In addition to the state report cards, the authors also include information on report cards sponsored by eight additional organizations, including Centers for Medicare and Medicaid Services (CMS) and the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO).
Community and District Nursing Association (CDNA)
CDNA Elder Abuse Survey - draft report (U.K.)
This draft report presents the results of the Community and District Nursing Association (CDNA) Elder Abuse Survey. Three-thousand nine-hundred and twenty-two surveys were mailed to members of the CDNA. Two-hundred seventy-six responses were received, representing a seven percent return rate. Of the respondents, 40 percent had witnessed or were aware of elder abuse occurring during 2004. A major finding was that nearly half of the respondents knew more than one patient who had been abused. Verbal abuse was most commonly observed, followed by emotional abuse and physical abuse. Eighty-two percent of the incidents were known to have occurred in the patients' homes. While 77 percent of the abusive incidents were perpetrated by family members, half of the respondents indicated that they were aware of abuse perpetrated by professional caregivers. Nearly two-thirds of the incidents were reported to social services, and approximately half were reported to general practitioners. Eighty-eight percent of the respondents indicated that they were in need of more training regarding elder abuse. (Note: The results of this survey are posted online at: http://www.thecampaigncompany.co.uk/cdna/ .)
Daly, J., et al.
APS Workers Job Requirements Associated with Elder Abuse Rates
Social Work in Health Care; Vol. 40 (3), 89-102; 2005.
This research was designed to evaluate the relationship of educational requirements for adult
protective services (APS) workers with rates of reported, investigated and substantiated domestic elder abuse. State APS worker requirements were identified through state APS statute and regulations analysis, supplemented by information from the National Center on Elder Abuse (NCEA) list serve membership, and follow-up contacts with state APS administrators. Data on elder abuse reports (or allegations of abuse, neglect, exploitation, sexual abuse, abandonment, emotional abuse, etc., made to APS), investigations, and substantiations for each state and the District of Columbia (for 1999 or FY 1999-2000) was collected through research undertaken by the Department of Family Medicine, University of Iowa. There were no significant differences in report, investigation and substantiation rates or substation ratios by states with regulation requirements for baccalaureate degree or social work licenses versus those not requiring baccalaureate degrees or social work licenses. However, investigation rates were significantly higher for states requiring social work degrees compared to states with no such requirement. Of note, the substantiation ratio was higher for states that did not require a social work degree or license. The authors suggest that this may be due to differences in professional orientations in addressing elder abuse, as social workers may be inclined to investigate and offer interventions, rather than focus on criminal aspects of elder abuse substantiation.
Daly, J. & Jogerst, G.
Association of Knowledge of Adult Protective Services Legislation with Rates of Reporting of Abuse in Iowa Nursing Homes
Journal of the American Medical Directors Association; Vol. 6 (2), 113-120; March/April 2005.
This study analyzes the association between the knowledge of nursing home administrators and
directors of nursing regarding dependent adult protective services laws and the rate of reporting suspected abuse. Five-hundred and ninety-eight nursing home administrators and directors of nursing, representing 369 of Iowa's 409 Medicare certified nursing homes, completed the Iowa Dependent Adult Abuse Nursing Home Questionnaire, a two part survey that tested the respondent's knowledge of the state's dependent abuse laws, collected data concerning incidents and reporting of incidents in the respective nursing home, and gathered demographic data. The mean rate of abuse incidents within nursing homes was 17.9 per 1,000 residents; mean rate of reports was 15.9 per 1,000; and the mean rate of substantiated incidents was 4.5 per 1,000. Results indicate that greater knowledge of adult protection laws was associated with higher incident and report rates among directors of nursing, and being male and having a higher level of education was associated with higher substantiation rates among administrators. The authors note that Iowa is the only state that requires training and education for mandatory reporters, and the participants appeared quite knowledgeable about abuse legislation; most respondents answered nine of eleven questions correctly.
Aging in the Shadow of the Law: The Case of Elder Guardianship in Israel
Journal of Aging & Social Policy; Vol. 16 (4), 59-77; 2004.
This article presents the results of a quantitative analysis of a random sample of 523 cases of adult guardianship in Israel (Haifa, Nazareth, and the Krayot areas) from 2000 through 2002. The following issues were considered: the personal and social characteristics of those elders whose guardianship cases were reviewed in Family Court; the reasons for requesting guardianship; the characteristics of the legal process of guardianship appointment in Israel, and the extent to which alternatives are considered; and the typical rulings on guardianship cases. Among the findings, guardianship was typically assigned to individuals who were older than 74, single, poor, and living in institutions (such as retirement homes, hospitals, and nursing homes). Although reasons for requesting guardianship were complex and unique, most often the proceedings were triggered by health-related declines. In none of the reviewed cases was the potential ward represented by an attorney or present during the court proceedings. In most cases the guardian appointed was a family member, and very few cases reviewed revealed specific legal limitations. The authors suggest that ageism is a significant factor in this process. A number of recommendations are proposed for the reform of the guardianship process, particularly the need for due process and comprehensive assessment of the proposed ward. (Note: This citation has been included in the CANE bibliography entitled Guardianship and other Legal Protections of Vulnerable Adults, posted on the NCEA Web site at http://www.elderabusecenter.org/default.cfm?p=cane_guardianship.cfm .)
Drennan, V. et al.
The Workforce in Health and Social Care Services to Older People: Developing an Education and Training Strategy
Nurse Education Today; Vol. 24 (5), 402-408; July 2004.
In England, national policy development is aimed at improving health and social care services for older citizens, yet carrying out such goals at a local level appears overwhelming. This article reviews the local initiatives of London's Workforce Development Confederation. Each confederation is charged with the responsibility of developing training and education for employees in these sectors. Researchers reviewed the local Health Improvement and Modernisation Plans (HIMPS) and then conducted interviews with selected stakeholders. Of the findings, the HIMPS were considered non-specific in terms of guidance for future planning. Stakeholders' perceptions indicated that overcoming ageism was a top priority, followed by improving staffing recruitment and retainment, and ensuring "an effective skill mix in service teams." (U.K.)
Erlingsson, C., Carlson, S., & Saveman, B.
Elder Abuse Risk Indicators and Screening Questions: Results from a Literature Search and a Panel of Experts from Developed and Developing Countries
Journal of Elder Abuse & Neglect; Vol. 15 (3), 185-203; 2003.*
One of the major goals of the Global Response Against Elder Abuse (GREAT) is the development of a universal elder abuse detection instrument. This article describes the first steps of the initiative: a literature search and a modified Delphi process to identify consensuses and divergences among experts throughout the world on risk indicators. In all, 565 risk indicators, 17 instruments, and 67 screening questions were identified throughout the literature search. These items formed the basis for the Delphi panel questionnaires. Consensus existed for the following risk indicators: a history of violence or addiction; an isolated and physically impaired abused elder; a hostile abuser; and physical markers of abuse such as fractures, dehydration, burns, etc. The article details differences that existed among the results from the literature search and the Delphi process, as well as differences observed among experts depending upon the development status of their country.
Erlingsson, C., Saveman, B., & Berg, A.
Perceptions of Elder Abuse in Sweden: Voices of Older Persons
Brief Treatment and Crisis Intervention; Vol. 5 (2), 213-227; 2005.
This article reports the findings of a focus group study conducted in Sweden as part of a global
initiative to address elder abuse from the perspectives of older individuals. Six focus groups
including 37 participants were conducted throughout the southern regions of Sweden. Qualitative content analysis of the group interviews revealed the themes of causes, conceptions, consequences and coping strategies related to elder abuse and neglect. In addition to changes in societal and family structures, individual factors, such as substance abuse on the part of the perpetrator, were identified as causes of mistreatment. While a number of types of abuse were identified, elders most commonly identified physical assault as a result of robbery, and fear was the most common consequence. Coping strategies were individualized and included taking responsibility to report abuse and to obtain medical care. Societal interventions were also recommended, and included enhanced education to improve intergenerational relationships, and the provision of support and advocacy. Ageism and gender issues were also considered. (Sweden)
Fear, T. et al.
Home or Hell: Older Tenants' Experiences in the Private Rented Sector
Journal of Adult Protection; Vol. 6 (2), 15-20; September 2004.
This article reports upon the findings of a research project, supported by Help the Aged, designed to identify the main forms of abuse and harassment experienced by older tenants in private rented sectors throughout different areas in England. In addition, the study examined the extent of landlord harassment, abuse and exploitation, and sought to identify unscrupulous practices in order to develop effective prevention strategies. Among the types of harassment identified were irregularities in rent collection (including additional fees for rent collection, changes in fee payment processes, erratically scheduled collections), untimely or inadequate responses to repair requests (or no effort to make repairs), repairs followed by exorbitant rent increases, and disputes over privacy. Renters also encountered problems with other tenants who were involved in prostitution and illegal drug use. Recommendations include the need for collaboration among health and social services (including public health agencies) and housing agencies. (U.K.)
Frost, R., Steketee G. & Grisham, J.
Measurement of Compulsive Hoarding: Saving Inventory-Revised
Behaviour Research and Therapy; Vol. 42 (10), 1163-1182; 2004.
Although a number of studies appear to validate the internal reliability of The Hoarding Scale (Frost & Gross), it has a number of limitations. This article reports upon the development and testing of an instrument (also designed by the authors) intended to focus more explicitly on the content of the major symptoms of compulsive hoarding, reflect symptoms versus beliefs, allow for the assessment of an unspecified range of objects hoarded, and reflect the degree of distress and/or impairment that results in severe cases. The Savings Inventory-Revised (SI-R) was tested through factor analysis and a series of studies with hoarding participants, obsessive-compulsive (OCD) participants, community controls and elders. The 23-item SI-R (included) was found to be a valid and reliable assessment tool for compulsive hoarding. In addition, findings suggest that hoarding associated with OCD may have different causes and manifestations than hoarding not associated with OCD. (Note: This entry has been included in the CANE bibliography entitled Compulsive Hoarding - A Form of Self-Neglect (1995-2005), which is posted on the NCEA Web site at: http://www.elderabusecenter.org/default.cfm?p=cane_hoarding.cfm .)
Glajchen, M. et al.
Development of a Brief Assessment Scale for Caregivers of the Medically Ill
Journal of Pain Symptom Management; Vol. 29 (3), 245-254; March 2005.
This article reports upon the development of an assessment tool designed to measure caregiver burden and its impact upon caregiver well-being. Based upon the results of a literature review and content analysis of focus group interviews with formal and informal caregivers, researchers compiled a list of 35 negative items and 8 positive items related to aspects of caregiving. This item pool was administered to a sample of 102 informal caregivers, along with a validation battery of questionnaires that measured perceived burden, caregiver physical and mental health, satisfaction with patient's medical care, and various aspects of quality of life. Through factor analysis, the item pool was reduced to the 14-item Brief Assessment Scale for Caregivers (BASC) which includes a subscale for measuring negative personal impact (NPI). Results confirm the construct validity of this instrument and the NPI subscale. (Note: This entry is also included in the CANE bibliography entitled Informal Caregiving for Dependent Elders: The Association with Elder Abuse, Neglect, and the Well-Being of Older Individuals, 2000-2005, posted on the NCEA Web site at: http://www.elderabusecenter.org/default.cfm?p=cane_informal.cfm .)
A Multi-Method Study on Elder Abuse and Neglect in Nursing Homes
Journal of Adult Protection; Vol. 6 (3), 15-25; November 2004.
This study reports upon elder abuse and neglect among nursing home residents in the region of
Hesse, Germany. Data was gathered through a variety of methods. In-depth interviews were
conducted with 251 individuals (residents, staff members, and others) from eight nursing homes in the area; 361 professional caregivers from 27 nursing homes were surveyed; data was analyzed from 188 nursing home control agency site visits; and 35 prosecutor's case reports were examined. In terms of the results from the interviews, although respondents' summary judgments indicate that the experience of nursing home care was positive overall, 70 percent of the nursing staff reported that they themselves had acted abusively or neglectfully on at least one occasion. More than half had witnessed psychological abuse and/or verbal aggression, 47 percent witnessed paternalism or infantilization, 39 percent had witnessed neglect, 35 percent had witnessed psychosocial neglect, and 21 percent had observed physical abuse. One in five had observed inappropriate use of chemical restraints. Results from the survey indicate 71 percent of the participants reported at least one act of abuse or neglect during the previous year, and more than half had observed neglect and nonphysical abuse. Most frequently reported abusive and neglectful acts included yelling and cursing at the resident, not changing the resident's position in a timely manner, neglecting oral hygiene, ignoring the resident (intentional), and handling the resident roughly (intentional). In addition, the nursing staff estimated that only one in three severe acts of physical abuse were reported to the management, and that most cases of inappropriate use of restraints were unnoticed. Substance abuse on the part of staff, physically aggressive behavior by residents, caregiver burnout, and the ratio of residents to registered nurses were among the greatest predictors of abuse and neglect. Evidence of elder abuse and neglect was identified in over one-third of the 188 site inspections conducted. Analysis of court cases revealed barriers to police investigations and prosecutions of institutional elder mistreatment, including impairment (or even death) of witnesses and victims, poor documentation, and insufficient evidence. The article concludes with a summary of the strengths and weaknesses of each of these methodological approaches within this research context.
Golding, J. et al.
Perceptions of Elder Neglect in the Courtroom
Journal of Elder Abuse & Neglect; Vol. 16 (1), 23-46; 2004.
Noting the importance of elder abuse and neglect cases reaching court in order to enhance
societal awareness of these problems, this study addresses perceptions about elders that may impact how cases are handled by law enforcement and prosecutors. In this study, 98 undergraduates read variations of mock jury trial summaries of a neglect case. In the scenario, the client was either 76 or 86, and had either a physical disability or a cognitive impairment. Participants were more likely to render a guilty verdict and rate the perpetrator's guilt higher when the victim had a physical impairment. Other factors, such as gender of the participant and the amount of exposure he or she had with elders, were also considered. The article provides an overview of relevant legislation that has impacted the prosecution of elder abuse.
Guadagno, L. et al.
Using PDAs for Data Collection
Applied Nursing Research; Vol. 17 (4), 283-291; November 2004.
In recent years, personal digital assistants (PDAs) have been used for data collection in research projects, with several advantages and disadvantages noted. This article reports upon the use of PDAs for data collection in a study on elder neglect. PDAs were used to collect patient data regarding caregiver neglect in four emergency departments (ED) throughout the country. Technical protocols for entering data and uploading information to a central data collection server are described. Although screeners did not initially have difficulty using the PDA during the six hour training, this became more cumbersome when collecting data in the ED, and eventually all screeners collected data on paper and later entered it into the PDA. Loss, technical malfunctions (including battery failure) and obsolescence of equipment were experienced during the project, and special precautions were needed to ensure confidentiality. However, the accuracy of the data collection and the speed with which information can be uploaded to a central data bank are among the reasons that this technology holds potential for researchers.
Hanrahan, N., Burgess, A. & Gerolamo, A.
Core Data Elements Tracking Elder Sexual Abuse
Clinics in Geriatric Medicine; Vol. 21 (2), 413-427; 2005.
This article reports upon the development of a screening tool as part of a project designed to identify core data elements of elder sexual abuse. In 2002, experts in the field (including health care professionals, investigators and prosecutors) provided 125 case descriptions of female elder sexual abuse for analysis. Researchers used the Comprehensive Sexual Assault Assessment Tool (CSAAT) to document four aspects of each case: victim characteristics, offender characteristics, investigative data, and case disposition. Based upon case analysis by the panel, the tool was revised for use with elders (Comprehensive Sexual Assault Assessment Tool - Elder or CSAAT-E). Key changes in the instrument include the need to document the time frame of the crime (time of examination relative to disclosure), the victim's physical and mental status (pre- and post-assault), severity of injury, the setting of the crime, the outcomes related to assault, as well as the offender's history of interpersonal violence and/or substance abuse, and mental or physical limitations of the perpetrator. The CSAAT-E requires greater detail regarding forensic evidence, documents data correlating mortality and adverse outcomes (injuries, changes in mental status, etc.) related to the sexual abuse, and documents information regarding victim's status at case closure as well as prosecution details.
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.
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 convened among participants involved directly with 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)
The Perceived Likelihood of Dental Hygienists to Report Abuse Before and After a Training Program
Journal of Dental Hygiene; Vol. 79 (1), 1-12; Winter 2005.
In this study, dental hygienists were asked to rate the likelihood of reporting suspected family violence, child abuse and elder abuse before and after receiving training on the issue. Twenty-five hygienists participated, and of these, five had previously encountered and reported mistreatment. While 40 percent of the respondents indicated that they would definitely report suspected abuse prior to the training, 100 percent indicated that they would report abuse as a result of the in-service. In addition, results indicate that 96 percent of the participants felt competent in knowing how to report abuse following the training, compared to 40 percent prior to training.
Holkup, P. et al.
Community-Based Participatory Research: An Approach to Intervention Research with a Native American Community
Advances in Nursing Science; Vol. 27 (3), 162-156; July-Sept 2004.
Community-based participatory research (CBPR), a form of action research which emphasizes the involvement of members of the study population, is a promising approach for reaching vulnerable populations. The model incorporates local knowledge and perceptions while fostering creativity in utilizing existing resources. This article describes the framework of CBPR and details how the approach was recently applied in the Caring for Native American Elders study. In this application, a Native American social worker, experienced in family conferencing in child protective services cases, teamed with researchers to adapt the intervention for use in elder abuse cases. Flexibility, self-awareness, collaboration, ethical sensitivity, cultural sensitivity, time constraints and project sustainability are among the concepts considered. The process of establishing evaluation criteria for the project is also discussed.
Iecovich, E., Lankri, M. & Drori, D.
Elder Abuse and Neglect - A Pilot Incidence Study in Israel
Journal of Elder Abuse & Neglect; Vol. 16 (3), 45-63; 2004.
This pilot study was intended to measure the incidence of elder mistreatment in Beer Sheva, a
southern Israeli city. It was also designed to identify characteristics of both victims and
perpetrators, and to identify family pathology that contributed to risk of mistreatment. Prior to the study, only a handful of abuse cases among the city's 24,200 elders had been reported to health and social services professionals. In the initial phase of the research, a series of multidisciplinary meetings were convened to gather input, raise awareness, and develop a systematic referral process to the local Social Service Center for Elderly Persons. All professionals and paraprofessionals working with elders were asked to complete a formal referral to social services if elder abuse was suspected. In cases where there was a strong suspicion of mistreatment, a specially trained social worker conducted an in-home assessment. If mistreatment was substantiated, an intervention plan was implemented. One-hundred and twenty new cases were identified throughout the area from December 2001 through December 2002, suggesting a citywide incidence rate of .5 percent. Unmarried women who were frail, disabled, and living with others were at greatest risk for all types of abuse and neglect. Of the identified cases, mental abuse (including verbal abuse and threats) was most commonly reported (65.8 percent) followed by physical abuse (59.3 percent). Forty percent reported financial exploitation. Neglect was substantiated in nearly one-fourth of all cases. Two cases of sexual abuse (rape by adult sons) were also reported. Family conflicts were the most commonly reported risk factors for elder abuse, while caregiving for dependent elders appeared to be the least commonly reported. (Israel)
Jacoby, L., Bishara, A., Hessels, S. & Toth, J.
Aging, Subjective Experience, and Cognitive Control: Dramatic False Remembering by Older Adults
Journal of Experimental Psychology: General; Vol. 134 (2), 131-148; 2005.
This article describes the phenomenon of "false remembering" that older adults may be susceptible to, and may result in increased vulnerability to scams. The misinformation effect can occur when a false claim (such as stating that a higher estimate was originally quoted for repair work) is presented and distorts or confuses the individual's memory of an event. In a series of four experiments, researchers focused on distinguishing recollection (a consciously controlled use of memory) from automatic influences of memory. Findings suggest that older adults are more susceptible to interference effects (such as of the introduction of misleading information, or a false prime). The possibility of being influenced by a false prime that may lead to a decrease in recollection, which can lead to susceptibility to false remembering, is also considered.
Sexual Abuse of Elderly People: Would We Rather Not Know the Details?
Journal of Adult Protection; Vol. 6 (2), 21-30; September 2004.
This exploratory study was designed to analyze sexual harassment, inappropriate touching and
extreme sexual violence perpetrated against elders. Fifty-two case records of elder sexual abuse, randomly selected from predominantly criminal justice agencies, were examined in order to determine the range of sexually abusive behaviors and the context in which they occurred. In
addition, semi-structured interviews were conducted with professionals working with sex offenders and involved in the development of treatment programs, and focus groups were conducted with professionals working with elders in residential and long-term care settings. One-third of the cases involved reported sexual abuse occurring in residential care settings. These victims were predominantly female, and abusers were fellow residents, staff members, or family members or other visitors. One case illuminated the complexity of addressing sexuality and the need for intimacy among elders with questionable decision-making capacity. The study also describes cases of elder sexual abuse occurring in the community. Rarely, the perpetrators were professional home care providers. Case examples depict sexual harassment towards patients, and also situations wherein caregivers were encouraged or drawn into abusive behavior patterns. Paid caregivers were also uncertain as to how to proceed when encountering evidence of sexual abuse of patients by family members. Cases were also reported involving elders living independently in the community, without formal care. In many of these assaults, offenders admitted that it was not the vulnerable appearance of the elder, but of the home, that caused them to target the particular victim. Poor documentation in case records, an inability to substantiate allegations in some cases, and ageism were problems identified through the study. (This article is based upon research conducted through the University of Nottingham with funding from the Nuffield Foundation, 2003-2004). (U.K.)
Jogerst, G., Daly, J., Koll, S. & Hildreth, L.
Public Forums to Advance Dependent Adult Abuse Policy
Social Work in Health Care; Vol. 40 (2), 89-102; 2004.
Statewide forums were conducted in Iowa to gather input in formulating public policy addressing
adult abuse. In order to determine how participants perceived change in the adult protective
services (APS) system, the Iowa Dependent Adult Protective Advisory Council conducted a survey of 1,000 attendees and aging services professionals five years after the forums. The 69-item questionnaire represented issues identified as significant through the initial meetings. More than half of the 301 respondents ranked 94 percent of the initial issues as important. Abuse awareness issues were rated as most significant. For each item, approximately half of the respondents did not know if a change in policy had occurred. Findings suggest that no significant changes have occurred in the legislation, but coordination has been implemented regarding prevention and intervention among the Iowa Department of Human Services (IDHS) and the Iowa Department of Elder Affairs (IDEA). Training and education, reporting, public awareness, and assessment procedures remain significant areas in need of improvement.
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