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Emotional Distress and Elder Abuse
by Rosalie Wolf, Ph.D.
National Center on Elder Abuse Newsletter
December 1999/January 2000
Although clinical records and case studies have documented the severe emotional distress experienced by older persons as a result of mistreatment, relatively few studies have dealt with the consequences of elder abuse on the victim. "Consequences" in this context refers to the psychosocial impact of the mistreatment on the victim rather than the physical effects such as bruises, fractures, malnutrition, "bed sores," etc.
Several early studies comparing abused and non-abused elders receiving care found a larger proportion of the abused elders suffered from depression than the non-abused elders.1-2 Similarly, abused and non-abused elders identified in a random sample community survey also differed with regard to level of depression, with the victims showing higher levels even when other variables that are known to be related to depression, such as health, age, gender, and marital status,3 were controlled. Using an elderly sub-sample from the National Family Violence Resurvey data, one investigator showed that those respondents reporting violence in their marital relationship had higher levels and frequency of depression than those in nonviolent relationships.4 Because of the cross-sectional nature of these research efforts, it cannot be stated with certainty that depression was the result of the mistreatment. Is it possible that the abused elders are individuals who are more likely to be depressed even before the mistreatment?
Some insight into the answer to the question comes from a report in a clinical journal that described the case histories of two women in their 70s who had been admitted to a geropsychiatric unit for treatment of depression.5 Both had been abused by their husbands throughout their married life (a combined total of 80 years). The reasons for remaining in these abusive relationships were much the same as those identified with younger battered women: low self-esteem, passive interpersonal style, social isolation, limited social skills, but also, reflective of their generation, a strong sense of loyalty and the stigma of divorce. Interestingly, both women became clinically depressed after the abuse had stopped, in one case because the husband became very ill and in the other, because the husband died. The therapists hypothesize that when the women were placed in an unfamiliar role or had to assume a new set of responsibilities, they lost their familiar pattern of relating, could no longer cope, and became depressed.
Other symptoms of emotional distress such as fear, shame, guilt, alienation, and posttraumatic stress disorder have also been postulated as the sequelae of elder mistreatment but have not been the subject of systematic investigation.
The topic of emotional distress was recently addressed in a 1999 study.6 Researchers in the Netherlands examined data from a survey of elders living in Amsterdam to determine risk indicators for elder mistreatment in the community. Depressive symptoms emerged as a risk indicator for physical aggression and financial mistreatment. A year later they re-interviewed the victims and found 77 who had been victimized in the intervening year. The 77 made up the sample for a second analysis along with a comparison group of non-victims.
The main research questions were: (1) Do victims of elder mistreatment suffer from more psychological distress than non-victims? (2) Do certain aspects of social support, coping style, mastery (being in control of one's life) and perceived self-efficacy (realizing the behavior needed to achieve a goal) directly or indirectly influence psychological distress in victims of elder mistreatment? Selected to measure psychological distress was a 12-item scale that ranged from mild emotional distress to psychiatric disorders, such as depression. Examples included "Have you recently had difficulty in concentrating?" "Have you been sleeping badly because you have been worrying?"
Compared to non-victims, the victims of elder mistreatment had significantly higher levels of psychological distress and lower scores on social support, mastery, and perceived self-efficacy. Victims who received more social support showed less psychological distress. Social supports had a positive effect on the level of psychological distress in victims but not in non-victims, indicating that victims benefit more from the social supports they receive than non-victims. Low feelings of mastery and a negative perception of self-efficacy were directly related to psychological distress in both the victim and non-victim; that is, these coping styles are independent of mistreatment. A more negative perception of the ability to cope is associated with psychological distress in general.
In spite of limitations of the study (including: did not follow sample over a long period of time, under representation of severely mistreated victims in the sample, measurement issues), the authors have demonstrated that elder mistreatment does affect the psychological health of the victims and that social supports and feelings of mastery and self-efficacy are beneficial to emotional well-being. They suggest that if it is not possible to mitigate the cause of mistreatment, then social supports should be provided to the victim at home or support groups be organized so that victims may be helped to become more competent or self-efficacious in dealing with the mistreatment.
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