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August 23, 2006
NCEAThe Source of Information and Assistance on Elder Abuse
Clearinghouse on Elder Abuse and Neglect (CANE)|
A Partner of the
National Center on Elder Abuse (NCEA)
Annual Annotated Bibliography of Elder Abuse and Neglect Publications
July 2004 - June 2005
Arias, I., Jogerst, G., Brady, M. & Dyer, C.
Elder Abuse and the Law: New Science, New Tools
Journal of Law, Medicine & Ethics; Vol. 32 (4), S62-S63; 2004.
This article is a transcript from a panel discussion held at the Third Annual Partnership Conference on Public Health Law. Dr. Jogerst reported on a study that indicates that statutes that more specifically define elder abuse and neglect lead to higher rates of referral to adult protective
services (APS) and substantiation. Attorney General Brady reported upon Delaware's task force on elder abuse which undertook several initiatives, including the implementation of the Volunteer Senior Victim Advocate Program. And Dr. Dyer discussed the effectiveness of multidisciplinary teams as demonstrated by the Texas Elder Abuse and Mistreatment Institute (TEAM).
Bender, M. & Wainwright, T.
So Sad to See Good Care Go Bad - But is it Surprising?
Journal of Dementia Care; p27-p29, September/October 2004.
In this commentary, the authors argue that neglect and abuse in institutional care settings are not the results of evil individuals. Such mistreatment is systemically consistent with the marginalization of older individuals in society, compounded by the inadequacies of the health care industry. Noting that sociological research validates the impact of peer pressure and conformity upon individual behavior, they suggest that new staff will easily adapt to the values and practices of the care unit that he or she has recently joined. Low status of residents, the isolation of the units, and poor wages are among the risk factors that create an environment susceptible to the perpetuation of mistreatment.
Education and a Multi-Agency Approach Are Key to Addressing Elder Abuse
Professional Nurse; Vol. 20 (4), 39-41; December 2004.
After presenting an overview of elder abuse, this article discusses nurses' reluctance to address
elder abuse issues. Fear of repercussions for exposing abuse and lack of professional protocols
are among the reasons for this. Enhanced education and a multidisciplinary approach appear the
most promising means to strengthen prevention and encourage intervention.
What Residents and Relatives Tell Us They Want
Nursing & Residential Care; Vol. 7 (3), 115-117; March 2005.
In this commentary, residential care administrators are urged to communicate directly with
residents themselves, their family members and other visitors, and to incorporate their stated
concerns into ongoing service delivery. A caring staff, a friendly and well-kept environment, privacy and dignity, well cooked meals, and activities are among the recurrent themes noted by residents when surveyed regarding their standards for appropriate care. Demonstrating that their concerns have been heard is vital to the enhancement of residential care. (U.K)
Brown, K., Streubert, G. & Burgess, A.
Effectively Detect and Manage Elder Abuse
The Nurse Practitioner: The American Journal of Primary Health Care; Vol. 29 (8), 22-31; August 2004.
This continuing education article is designed to assist nurse practitioners in identifying elder abuse and initiating appropriate interventions. Guidelines are offered for examination of bruises, abrasions, lacerations, the condition of skin and genitalia, as well as injuries to the head, neck, chest wall, abdomen, extremities, and genitals. The authors note that decreased pain perception and memory impairment can contribute to difficulty in assessment. (Note: This article, along with instructions for CE credits, is currently available online at:
http://www.findarticles.com/p/articles/mi_qa3958/is_200408/ai_n9454134 . The entry has been included in the CANE bibliography entitled Identifying Elder Abuse: Tools, Techniques and Guidelines for Screening and Assessment, which is posted on the NCEA Web site at http://www.elderabusecenter.org/default.cfm?p=cane_ea_assessment.cfm .)
Brownell, P. & Podnieks, E.
Long-Overdue Recognition for the Critical Issue of Elder Abuse and Neglect: A Global Policy and Practice Perspective
Brief Treatment and Crisis Intervention; Vol. 5 (2), 187-191; 2005.
This article presents an overview of global initiatives involving the International Network for the Prevention of Elder Abuse (INPEA) to promote awareness of elder mistreatment. The
recommendations generated by the Second World Assembly on Ageing (Madrid, Spain, 2002) and "Missing Voices: Views of Older Persons on Elder Abuse" (World Health Organization/WHO and INPEA, 2002) are summarized. Pending initiatives include World Elder Abuse Awareness Day, to be held on June 15, 2006, and the ongoing, "A World View on Elder Abuse" project.
Cambridge, P. & Parkes, T.
The Case for Case Management in Adult Protection
Journal of Adult Protection; Vol. 6 (2), 4-14; September 2004.
In this article, authors propose a return to a model of adult protective case management for all cases involving adult protection throughout the U.K.'s social services and health care systems. This approach has been transformed due to interagency collaborations and specialized client groups, such as mental health patients and adults with learning disabilities. As a result, standards for case responsibilities vary widely not only across agencies, but within agencies as well. The role of the specialist adult protection coordinator (APC), which exists in some social service districts, is highlighted. (U.K.)
Campbell, H., Tadros, G., Hanna, G. & Bhalerao, M.
Diogenes Syndrome: Frontal Lobe Dysfunction or Multi-Factorial Disorder
Geriatric Medicine; Vol. 35 (3), 77-79; 2005.
In this overview of Diogenes syndrome (DS), or severe self-neglect, the authors present information on co-existing medical and psychiatric conditions. Research indicates that many patients with DS also suffer from such conditions as cardiac failure, pneumonia, osteoarthritis, and gangrene. Little association has been found between DS and formal psychiatric diagnoses, and it is hypothesized that the condition is triggered by biological, psychological, or social stressors that exacerbate predisposing personality traits. A case study details the neurological assessment of a woman with significant personality and behavioral changes. The patient was found to have frontal lobe dysfunction, and the authors suggest that the presentation of DS may be indicative of other organic conditions. (Note: This entry is also included in the CANE bibliography, entitled Self-Neglect: An Update of the Literature - 2000-2005, which is posted on the NCEA Web site at: http://www.elderabusecenter.org/default.cfm?p=cane_selfneglectupdate.cfm .)
Senior Nurse Who Physically and Verbally Abused Elderly Residents
British Journal of Nursing; Vol. 13 (22), 1329; 2004.
This case study, based upon an actual abuse situation, presents the details of a senior nurse's
professional misconduct in a care home in the U.K. It appeared that the nurse became verbally and physically abusive in response to the arrival of new patients during an outbreak of influenza. The home was eventually closed and the nurse's name was removed from the register. (U.K.)
Collins, K. & Sellars, K.
Vertebral Artery Laceration Mimicking Elder Abuse
The American Journal of Forensic Medicine and Pathology; Vol. 26 (2), 150-154; June 2005.
This case study presents a forensic analysis of a 94 year old male resident, diagnosed with
dementia, who died due to vertebral artery laceration. While the case "mimicked" the signs of elder abuse, the autopsy indicated that death was not due to abuse. The authors emphasize that it is important for physicians and health care professionals to be aware of the potential for elder mistreatment, to be alert to the indicators and risk factors of elder abuse and neglect, and to be aware of differential diagnosis.
"Big Brother" and Grandma: An Argument for Video Surveillance in Nursing Homes
Elder Law Journal; Vol. 12 (1), 119-147; 2004.
This legal note considers the positive and negative aspects of the use of video surveillance
cameras in nursing homes as a preventative measure against elder abuse and neglect. Two types
of cameras are described, Web cameras and closed-circuit video cameras. Proponents of video
surveillance suggest that not only do they help to identify and document abusive acts, their
presence may deter abuse by discouraging potentially abusive caregivers from working in the
facilities that use them. Opponents of video surveillance suggest that what is viewed can be
misinterpreted or misleading. Furthermore, they suggest that such surveillance is no more effective in preventing elder abuse than they are in preventing convenience store robberies, despite widespread use. Issues related to privacy and costs are considered. Permissive legislation, which allows for the use of the technology but does not mandate the facility to provide the technology, does not ensure that all residents and families who want video surveillance have access to it. In conclusion, the author recommends mandatory legislation that places responsibility and cost for the technology onto the facility to provide equal access to all residents and families.
The Importance of Adult Guardianship for Social Work Practice
Journal of Gerontological Social Work; Vol. 43 (2/3), 117-129; 2004.
This article provides an overview of guardianship issues encountered through gerontological social work practice. The author points out that while guardianship can be viewed as a protection of incapacitated elders, third party interests, such as preservation of the estate, continue to be important factors in guardianship petitions. In the pre-adjudication phase of guardianship proceedings, social workers should consider whose interests are being served by the petition. Depending upon state statutes, they may also participate in the functional assessment of the proposed ward. During the adjudication phase, social workers may serve as advocates for the elder, or may act as court visitors. Post-adjudication, they may provide services to the ward, may become guardians in some cases, or may participate in the monitoring of the guardianship. The article concludes with a discussion of how social workers can assist in identifying alternatives to guardianship. (Note: This entry has also been included in the CANE bibliography, entitled Guardianship and other Legal Protections of Vulnerable Adults, which is posted on the NCEA Web site at: http://www.elderabusecenter.org/default.cfm?p=cane_guardianship.cfm .)
Understanding the Causes of Financial Elder Abuse - Aging Peter Pans Target Parents with Fiscal Abuse
CareManagement; August/September, 33-37; 2004.
Following a brief overview reporting the estimated magnitude of the problem of elder financial
abuse, the author suggests that many perpetrators share similar characteristics to the literary
character, Peter Pan. Such perpetrators are in their late 40's to early 60's, and may live at home and be dependent upon their parents for financial security. Sociological triggers for this dynamic are considered. Longer life expectancy indicates that many parents are living longer, but may still be dependent upon adult children for assistance and care. In addition, sociological influences (such as Dr. Spock's "permissiveness", the drug culture of the 60's and 70's, and the egocentricity of the "me" generation) may have contributed to the long-term dependence of adult children on their aging parents. The accumulation of assets among seniors makes them viable targets for exploitation. The impact of multiple caregiving responsibilities over significant time periods may add to the stress of adult children who are already impaired in some way. (Note: This article is accessible online at: http://www.asaging.org/elderabuse/documents/aging%20Peter%20Pan.pdf .)
Davies, R. & Jenkins, R.
Protecting People with Learning Disabilities from Abuse: A Key Role for Learning Disability Nurses
Journal of Adult Protection; Vol. 6 (2), 31-41; September 2004.
This article is an outgrowth of a Welsh study entitled, "Abuse of Adults with Learning Disabilities: Policy, Practice and Educational Implications in Wales." In order to protect the vulnerable from abuse, nurses must first be aware of the need for protection. Issues such as power imbalances and communication deficits contribute to the vulnerability of this patient population, and may also hinder prevention and detection of mistreatment. A theory of organizational corruption of care is detailed, and includes the neutralization of the normal moral concerns, management failure, the absence of mechanisms of accountability, and insulated, inward-looking organizational environments. Abuse training for nurses should be customized to the population being served. Nurses working with individuals with learning disabilities often provide education to their patients, and should address safety issues as part of prevention. (U.K.)
Elder Abuse: The Social Worker's Perspective
The Clinical Gerontologist; Vol. 28 (1/2),135-155; 2005.
This article is part of an issue that focuses on interdisciplinary analysis and intervention of elder abuse. In this entry, the perspective of the social worker is presented. The assessment and interventions for three case studies described are based upon the regulations and procedures of the Adult Protective Services (APS) in Cuyahoga County, Ohio. The following principles are examined: freedom over safety; self-determination; participation in decision-making; and least restrictive alternatives. Other themes that complicate the intervention in these elder abuse scenarios that are considered include homosexuality, substance abuse, domestic violence and socio-economic status. (Note: This issue was co-published simultaneously as a book entitled The Clinical Management of Elder Abuse, Anetzberger, G., ed.; The Haworth Press, Inc., Binghamton, NY; 2004. The book is not available through CANE; for further information, visit the Haworth Press, Inc. Web site at: www.haworthpress.com or telephone 1-800-429-6784 in the US/Canada or 607-722-5857 outside US/Canada. The entry has been included in the CANE bibliography, entitled Identifying Elder Abuse: Tools, Techniques and Guidelines for Screening and Assessment, which is posted on the NCEA Web site at http://www.elderabusecenter.org/default.cfm?p=cane_ea_assessment.cfm .)
Medical Implications of Elder Abuse and Neglect.
Clinics in Geriatric Medicine; Vol. 21 (2), 293-313; May 2005.
As quoted from the publisher, "...Recognition of elder abuse and neglect among health care professionals has been a relatively recent phenomenon. Each year, millions of elderly persons suffer as the result of abuse and neglect. Their quality of life is severely jeopardized in the form of worsened functional status and progressive dependency, poorly rated self-health, feelings of helplessness, and from the vicious cycle of social isolation, stress and further psychological decline. Other medical implications of abuse and neglect include higher health systems use in the form of frequent ER visits, higher hospitalization, and higher nursing home placement; most importantly, it is an independent predictor for higher mortality. Physicians are well situated in detecting and reporting suspected cases and taking care of the frail elders who are victims of abuse and neglect, but there are barriers on the individual level, and there is a broader need for system change. Through education, training, and reinforcement, there are strategies to get health care professionals more involved and provide effective management protocols and guidelines for us to advocate for our patients in the current epidemic of elder abuse and neglect." (Note: This article is not currently available through CANE.)
The Stamm Case and Guardians ad Litum
Elder Law (published by the Elder Law Section of the Washington State Bar Association); Vol. 16 (1), 3, 6 and 7; Winter 2004-2005.
This article provides highlights from the rulings of the Guardianship of Stamm v. Crowley case (Washington, 2004) which limit the admissibility of testimony by guardians ad litem in guardianship cases. The ruling also provides "...that a guardian ad litem is not to testify as to his or her assessments of credibility..." Implications for legal practice in guardianship cases are discussed. (Note: This article is accessible online only through the WSBA Elder Law newsletter at: http://www.wsba.org/lawyers/groups/elderlaw/elderlawwinter05.pdf . The entry has also been included in the CANE bibliography, entitled Guardianship and other Legal Protections of Vulnerable Adults, which is posted on the NCEA Web site at: http://www.elderabusecenter.org/default.cfm?p=cane_guardianship.cfm .)
Dyer, C., Heisler, C., Hill, C. & Kim, L.
Community Approaches to Elder Abuse
Clinics in Geriatric Medicine; Vol. 21 (2), 429-447; 2005.
Health care professionals, including physicians, may be the only noncaregivers with whom elder
abuse victims have contact. This article presents an overview of interdisciplinary team approaches to elder abuse in the community. Medical case management teams typically receive referrals from adult protective services (APS) and perform comprehensive geriatric assessments (CGA), including social and functional status as well medical assessments. Legal intervention teams address financial management, probate and guardianship, housing and other legal issues. Fiduciary abuse specialist teams (FASTs), first established in California, address financial exploitation of the elderly. Criminal prosecution teams, fatality review teams (FRTs), code enforcement teams, and victim advocacy associations are also discussed. A case study is presented to highlight the role of the physician in a multidisciplinary intervention in the case of caregiver neglect.
Confronting the Sexual Abuse of Women with Disabilities
Applied Research Forum - National Electronic Network on Violence Against Women
Violence Against Women Online Resources; January 2005.
This paper provides an overview of the sexual abuse of women with disabilities. One of the earliest studies involved an analysis of records from the Seattle Rape Relief Center (May 1977 through December 1979) that indicated there were over 300 sexual abuse cases involving women with physical and/or cognitive impairments. Less than a third of these women reported the abuse to authorities. Difficulties in conducting research with this population are highlighted, and include not only the diversity of the women in terms of age, ethnicity, gender identity, etc., but also the diversity of the physical and developmental conditions that they experience. While some research suggests that women with physical disabilities experience sexual abuse at rates similar to women without disabilities, it also indicates that these women experience such abuse for longer durations. Research also indicates that 70 percent of women with developmental disabilities experience sexual abuse. The majority of the perpetrators appear to be male caregivers and male family members; relatively few appear to be strangers. They often seek out victims they perceive as powerless. Centralized tracking of perpetrators, improved service response (for example, more accommodating medical examination equipment and techniques), research on the impact of abuse, and public awareness campaigns that include women with disabilities are among the recommendations presented. (Not specific to elders.) (Note: This paper is accessible online at: http://www.vawnet.org/SexualViolence/Research/VAWnetDocuments/
The 'Hidden Crime' of Elder Abuse
Canadian Nursing Home; Vol. 16 (1), 23-26; March/April 2005.
Recent Canadian statistics indicate that 24 percent of elder mistreatment is being perpetrated by unrelated caregivers, suggesting that abuse is a concern in nursing homes, assisted living
facilities and among long-term care patients in the community. This article examines factors that place residents with dementia at risk for elder abuse and neglect. Inappropriate use (or over use) of medication and toxic work atmospheres (including facilities that are understaffed, inadequately supervised, have frequent staff turnover, or are inappropriately managed, or that employ staff who are ageist or inadequately trained) are among the risk factors identified. Care staff are instructed to ask to see the facility's policy regarding abuse and neglect, and are reminded that having a cognitive impairment does not mean that a resident is not credible or capable of disclosing mistreatment. (Canada)
Elder Abuse in Africa: What Policy and Legal Provisions are there to Address the Violence?
Journal of Elder Abuse & Neglect; Vol. 16 (2), 17-32; 2004.
This overview of the phenomenon of elder abuse and neglect in Africa describes the types of
mistreatment identified and theoretical explanations for the abuse, and reviews policies and
legislation addressing the problem. Elders are among the poorest residents and most have no
income security. Political and economic instability, natural calamities and disasters, diseases and epidemics, intergenerational burdens and gender inequities exacerbate the vulnerability of elders. Older women appear to twice as vulnerable as their male counterparts. Violence towards elders are classified as economic (aimed at gaining assets), social, community, political and witchcraft-related. (Violence related to witchcraft occurs when a frail older women with particular physical traits is scapegoated as the cause of misfortunes that befall a community; as a result, the woman may be ostracized or banished, lynched, tortured, injured or murdered.) While the constitutions of a number of African countries ensure protections of the rights of all citizens, none specifically address the rights of elders. Recommendations are detailed and include the need for international and nongovernmental organizations (NGOs) to promote human rights for elders, and to utilize media and other mechanisms for advocacy and increased public awareness. (Africa)
Challenging Poor Practice, Abusive Practice and Inadequate Complaints Procedures: A Personal Narrative
Journal of Adult Protection; Vol. 6 (3), 34-44; November 2004.
This narrative describes the admission of a man with learning disabilities to an inpatient mental health unit, initially for five to seven days, which stretched into nearly a year long series of institutional placements. The author, sister of the patient, describes the series of events that ensued following the patient's initial accident and her efforts to report poor and abusive treatment to the Manchester social services department. Poor communication, misdiagnosis, lack of monitoring psychotropic medication, overmedication, abrupt placement transitions, psychiatrist-centered treatment, and an unwillingness to include family in the treatment and discharge planning for the patient resulted in an escalating deterioration of his physical and mental health. The complaint procedure was initially ineffective, as two conducted investigations were deemed inadequate and poor in quality. The family persisted until the complaint was taken up by the review panel wherein their concerns, and the concerns of the patient, were finally acknowledged. (U.K.) (Not specific to elders.)
Prevention and Treatment of Two Critical Health Care Issues: Substance Abuse and Elder Abuse (Module 3 from "Native American Elders Health Care Series")
South Dakota State University; 2004.
This web-based, multi-media training module (part of the South Dakota State University "Native
American Elders Health Care Series") outlines the changes in Native American culture that have
increased the risk for elder abuse and elder substance abuse. Changes in family systems, stress, and economic difficulties are among identified risk factors. Nurses are urged to be prepared to assess patients for these problems routinely, and to be aware of the possibility of pre-existing depression. Ambivalence on the part of Native American elders complicates the process of treatment and service delivery. Practical, culturally appropriate nursing interventions for elders at risk are discussed. (Note: This training module is accessible online at http://learn.sdstate.edu/share/Module3.html . Nursing CEUs are available for a fee.)
Franks, M., Lund, D., Poulton, D. & Caserta, M.
Understanding Hoarding Behavior Among Older Adults: A Case Study Approach
Journal of Gerontological Social Work; Vol. 42 (3/4), 77-107; 2004.
This article presents four case studies of older compulsive hoarders who became involved with
adult protective services (APS) due to various crises. Two of the cases involved older, single females living alone, one case involved a couple, and one case involved a single male. The article describes the conditions of the dwellings (with photos), the histories of the elders, and the interventions applied. Both older women were relocated to subsidized housing, the older man was placed under guardianship and died while hospitalized, and the couple was placed in a nursing home. Two of the houses had to be destroyed, and one was in such a state of disrepair that it was significantly devalued when sold. The authors provide several warning signs for earlier recognition and recommend enhanced education and coordination of services between social and public health agencies in order to identify cases before they become crises. (Note: This entry has also 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_selfneglectupdate.cfm .)
Fulmer, T., Guadagno, L., & Bolton, M.
Elder Mistreatment in Women
Journal of Obstetric, Gynecologic and Neonatal Nursing/JOGNN; Vol. 33 (5), 657-663; September/October 2004.
This summary presents an overview of what is known regarding elder abuse among women. It also addresses the distinctions in elder mistreatment (EM) and domestic violence in older women (DVOW), and differences in research paradigms. The authors define DVOW as "cases of intimate partner violence where the woman is older, usually over the age of 65." EM includes abuse, neglect, exploitation, and/or abandonment of older adults, in which an adult has unmet care needs. According to the authors, a caregiving relationship (formal or informal) "...must be in place for an allegation of EM to be made..." The authors note that women over age 50 are much less likely to report intimate partner violence than younger women. Research addressing elder abuse has historically focused on concepts of vulnerability, dependency, and caregiving concerns, while theories on DV deal with objectification of women, power and control issues, and self-esteem problems. The authors recommend the development of a more collaborative approach for assessment of both EM and DVOW based upon a family violence framework. They also stress the importance of accurately identifying the nature of the abusive behavior in order to design appropriate interventions.
The Role of the Doctor in the Institutional Abuse of Older People: A Psychodynamic Perspective
Journal of Adult Protection; Vol. 6 (4), 16-21; December 2005.
Using a psychodynamic framework, this article considers the role of the physician in institutional abuse of older patients. Health care professionals must be aware of all feelings (even negative) regarding patients in order to accept them without acting out with malice or aggression. Ageism, which is dehumanizing, is considered as a potential prejudice doctors may experience. Countertransference, which occurs when the practitioner sees and reacts to the patient as if he or she represents an individual from his or her personal life, is also considered as a possible contributing factor towards mistreatment. Questions are raised regarding the imbalance of power experienced in institutional settings, along with issues of dependency. Inappropriate use of psychotropic medication is also discussed.
Governor's Elder Abuse Task Force (Oregon, Governor Kulongoski)
Governor's Elder Abuse Task Force - Final Report (State of Oregon)
This report contains the findings and recommendations of Oregon's Governor's Elder Abuse Task Force. Among the recommendations are the need for the development of a quick response for criminal background checks; the development of a registry of perpetrators who have abused
vulnerable adults; the development of a criminal history registry; the creation of a list of crimes (including sex abuse, etc.) that potentially disqualify individuals from employment in care provision settings; the development of a notification system by the Department of Corrections (DOC) to nursing facility administrators when a predatory sex offender is being placed in that facility; the recruitment of county medical examiners for multidisciplinary teams (MDTs); the development of memorandums of understanding (MOUs) between agencies involved in MDTs; the prioritization of victim's services; enhanced training; increased coalition building and public awareness campaigns. Specific statutory changes are also outlined. (Note: This report can be accessed online at: http://governor.oregon.gov/Gov/pdf/elder_abuse_report.pdf .)
Gorbien, M. & Eisenstein, A.
Elder Abuse and Neglect: An Overview
Clinics in Geriatric Medicine; Vol. 21 (2), 279-292; 2005.
This article provides an overview of elder abuse, neglect and self-neglect. Occurrence rates of
abuse in the U.S., Canada, the Netherlands, and Great Britain are discussed. Offender
characteristics are also summarized. Problems in identification and reporting of suspected abuse are cited, particularly as they relate to physicians. The topics of elder mistreatment among special populations (patients with dementia, depression, and residents of long-term care facilities) are also considered, along with the role of the geriatrician in addressing elder abuse and neglect.
Combating Elder Abuse
Nursing; Vol. 34 (10), 47-51; 2004.
This overview on elder abuse and neglect is intended for nurses providing care for older patients. Warning signs for various types of mistreatment are listed, but practitioners are cautioned against assuming all that geriatric patients with bruising and skin tears have been victimized. Practical advice is provided on interviewing, documenting, reporting suspected abuse, and educating patients.
Protecting Vulnerable Adults from Abuse: A Case Study
British Journal of Community Nursing; Vol. 9 (8), 342-345; 2004.
This article presents a case study of neglect in order to focus on the community nurse's duty to protect vulnerable adults. The patient had suffered a stroke and sustained significant communication deficits. She was living at home with her daughter, son-in-law and their family, appeared malnourished and was left alone for long periods of time. When the district nurse and social worker recommended nursing home placement, the family refused. Legal alternatives for the protection of the vulnerable should be considered when such negotiations fail. The National Assistance Act 1948, the Mental Health Act 1983, and declamatory relief are presented as potential means to arrange a more suitable placement. (U.K.)
Hall, Ryan, Hall, Richard., & Chapman, M.
Exploitation of the Elderly - Undue Influence as a Form of Elder Abuse
Clinical Geriatrics; Vol. 13 (2), 28-36; 2005.
This article presents an overview of undue influence, which involves the manipulation and coercion of a vulnerable adult in order to gain his or her assets. Although there
are numerous variations in state legislation addressing the prosecution of this form of financial exploitation, many require evidence of the victim's diminished capacity and some place a heavy burden of proof in establishing that the assets were not transferred voluntarily, knowingly, or with proper intent. Risk factors for victims are outlined, and include advanced age, frailty, being female and unmarried, being cognitively impaired, socially isolated (in particular, being estranged from children), financially independent, and being susceptible to deception and/or intimidation. Perpetrator characteristics are also highlighted, for both male and female abusers. Perpetrators are predatory and display patterns of victimization, typically by acting to isolate a vulnerable victim and then cultivate the role of advisor, advocate, caregiver, or protector, so that the victim becomes increasingly dependent. Medication is also used to gain control of the victim. Similarities between the dynamics in the victim-abuser relationship and the Stockholm syndrome are considered. A case study is presented that illustrates the model of undue influence established by the expert, Dr. Margaret Singer. In addition to reporting the suspected exploitation to the designated protective services agency, other recommendations are made for physicians and health care practitioners. (Note: This article is available online at: http://www.hmpcommunications.com/cg/attachments/3773.pdf .)
Hamilton, R., for the Maine Elder Death Analysis Review Team (MEDART)
Maine Elder Death Analysis Review Team 2003 Annual Report
Maine Elder Death Analysis Review Team (MEDART); 2004.
In March, 2003, Maine was selected as one of four demonstration sites for the American Bar
Association Commission on Law and Aging's "Promising Practices in the Development of Elder
Abuse Fatality Review Teams." The ABA stated goal was "...to expand the fatality review team
concept to deaths resulting from elder abuse in order to foster examination of and improvement in response of adult protective services, law enforcement officers, prosecutors, victim services, health care providers and others to the growing number of victims of abuse..." The Maine Elder Death Analysis Review Team (MEDART) is comprised of representatives of the offices of the state medical examiner, attorney general, victim advocacy program, assisted living services, state police, Ombudsman program, sheriff's association, chief of police association, and behavioral and developmental services. This report provides case summaries for the two completed reviews from 2003. Recommendations generated by these reviews are outlined, and include: the need for hospital policy regarding a family's legal right to make medical determinations when legal authority to do so has not been established; to develop hospital procedure for the enforcement of ethics committees' recommendations; for strengthening existing legislation and therefore penalties for the endangering of a dependent person; the requirement of health care professionals to attain education regarding issues of dehydration and malnutrition among elderly and dependent adults; and to develop a system of required referral to APS for Mainecare (Medicaid) recipients who have not had a provider claim filed in over three years. (Note: This report is accessible online at http://www.maine.gov/ag/dynld/documents/MEDART03.PDF .)
Hansberry, M., Chen, E. & Gorbien, M.
Dementia and Elder Abuse
Clinics in Geriatric Medicine; Vol. 21 (2), 315-332; May 2005.
As quoted from the publisher, "Dementia and elder abuse are relatively common and under-diagnosed geriatric syndromes. A unique relationship is observed when the two entities coexist. Special issues can confound the care of the dementia patient suspected of being abused. Impaired language or motor abilities to communicate abusive situations to a third party, lack of decisional capacity to address the abusive situation, disinhibited behavior that contributes to a cycle of violence, and coincident depression of the abused elder complicate the diagnosis and management of elder abuse. Education of the caregiver and attention to caregiver stress, including depression, may prevent onset and perpetuation of abuse." (Note: This article is not currently available through CANE.)
Nursing Homes Subjected to New Covert Monitoring and Surveillance
Long-Term Care Interface; Vol. 6 (1), 22-25; 2005.
This article describes several initiatives launched in New Mexico and California to investigate elder abuse and neglect in nursing facilities. In New Mexico, recent investigations have involved an undercover agent posing as a resident and reporting back to the Department of Aging and Long-Term Services. Representatives of the nursing home industry object to this tactic, in part because such a resident requiring services takes care time away from a staff already stretched thin. In California, Operation Guardians used a minicam in an investigation that resulted in charges against twelve employees. Coroners' investigations and surprise visits are also discussed.
Ethical Moment - Dentistry and the Law
Journal of the American Dental Association (JADA); Vol. 135, 1172-1173; August 2004.
In this brief advice column entry, a case of suspected elder abuse (and child abuse) is examined according to ethical standards in dentistry.
Jonson, H. & Akerstrom, M.
Neglect of Elderly Women in Feminist Studies of Violence - A Case of Ageism?
Journal of Elder Abuse & Neglect; Vol. 16 (1), 47-63; 2004.
This article provides a discussion regarding the underreprestentation of older victims in the
feminist analysis of violence against women, with an emphasis on the Scandinavian perspective.
Scandinavian feminist research that addresses gender and violence rarely includes findings
regarding older battered women, and bibliographies do not include a special category for elderly victims. The authors consider the possibility that feminism is a form of ageism that serves to further marginalize older women. A recent study in Sweden that addresses elder abuse of both men and women is highlighted. While the vulnerability of older women is the main result of the study, findings indicate that 16 percent of the older women who were surveyed were victimized and 13 percent of the older men were also victimized. The fact that there are male victims and female offenders threatens the feminist perspective that suggests that violence among elders can be attributed to the general dominance of men over women in society. (Sweden)
Joshi, S; Flaherty, JH
Elder Abuse and Neglect In Long-Term Care
Clinics in Geriatric Medicine; Vol. 21 (2), 333-354; May 2005.
As quoted from the publisher, "Patient and caregiver education and other interventions targeted toward risk factors or types of abuse or neglect play an invaluable role in preventing elder abuse and mistreatment." (Note: This article is not currently available through CANE.)
Elderly People at Risk: A Norwegian Model for Community Education and Response
Journal of Adult Protection; Vol. 6 (3), 27-33; November 2004.
While Norway has an effective social welfare system, particularly addressing the needs of children and battered women, elder abuse services are in need of development. This article reports on a Norwegian initiative designed to promote public awareness of elder abuse and neglect as well as the development and implementation of appropriate interventions. After providing a brief history of the Norwegian response to the recognition of elder abuse as a societal problem, the author describes the Elder Protective Services project which is located in the Senior Citizen Centre of an administrative district of Oslo. A guiding principle of the program is that elder protection should be an integral part of routine health and social service care. The initial phase of the project involved the designation of a key worker, who served as a liaison with other health and welfare professionals. It also included the distribution of education materials to families, human service organizations, the media, law enforcement and seniors themselves through a variety of settings. Through analysis of the cases identified as a result of the project, policy developers learned that many cases of elder abuse involved long-standing domestic violence, and other cases of marital conflict were exacerbated by late life transitions, such as retirement and illnesses. Adult children (particularly sons) with social or psychological problems were also identified as abusers. The project has been successfully replicated in the three other districts of Oslo. The article also describes the Norwegian Centre on Violence and Traumatic Stress. (Norway)
Karlawish, J. et al.
Addressing the Ethical, Legal, and Social Issues Raised by Voting by Persons with Dementia
Journal of the American Medical Association/JAMA; Vol. 292 (11), 1345-1350; September 2004.
This article examines the ethical and legal complexities of voting by individuals with dementia. Informal and formal care providers are faced with the question of whether these individuals should be precluded from voting, or assisted in casting a ballot. The autonomy of the person with dementia and the integrity of the electoral process are at the heart of the discussion. The development of a method to assess voting capacity, the identification of appropriate means to assist the cognitively impaired in voting, and the development of consistent and practical policies for voting in long-term care settings are also considered. (Note: The entry has also been included in the CANE bibliography, entitled Guardianship and other Legal Protections of Vulnerable Adults, which is posted on the NCEA Web site at: http://www.elderabusecenter.org/default.cfm?p=cane_guardianship.cfm .)
Changing Family Structure and Elder Abuse Issues in Japan
Geriatrics and Gerontology International; Vol. 4 (S1), S226-S228; 2004.
In this commentary, the author presents a brief overview of Japanese elder abuse research, and
highlights concerns regarding older Japanese females, who are no longer guaranteed care by their
families as a result of societal changes. She considers poor, older women as victims of societal
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