9 Abuse in Later Life

Chapter Objectives Discuss various categories of elder abuse. Give examples of forms of violence against older adults that are unique to the population. Discuss the differences in civil versus criminal action in cases of abuse against older adults. Explain the problems for the elder community in accessing criminal justice interventions.

Introduction Older adults are the least likely to become victims of violent crime in the U.S. Property crime, not personal violence, typically provides the highest percentage of crime against persons age 65 or older. Bureau of Justice Statistics. (BJS). (2012). Violent crime against the elderly reported by law enforcement in Michigan, 2005–2009. Special Report: National Incident-Based Reporting Sustem . Washington, DC: Department of Justice.

Prevalence Older adult abuse is defined to include individuals who are 60 or 65 years and older. The private nature of elder abuse makes it difficult to determine the exact numbers of individuals who are affected.

Categories of Abuse Maltreatment falls within three categories: Family or domestic elder abuse Maltreatment by someone who has a special relationship with the older person Institutional elder abuse Abuse of an older adult who lives in a long-term care facility, nursing home, or residential care facility Self-neglect or self-abuse Behavior of an older adult that threatens his or her own health or safety

Forms of Elder Abuse Physical Abuse Inflicting or threatening to inflict physical pain or injury on a vulnerable older adult, or depriving that person of a basic need. Includes battering, assault, and inappropriate restraint. Physical abuses range from slapping or shoving to restraining with ropes or chains. When a caregiver or other person uses enough force to cause injury or unnecessary pain, even if the harm was not intentional

Forms of Elder Abuse Emotional/Psychological Abuse Willful infliction of mental or emotional anguish by threat, humiliation, intimidation, or other abusive conduct Most difficult type of abuse to identify Includes verbal or nonverbal acts May involve name-calling, using intimidating and threatening language, or causing fear, mental anguish, and emotional pain to the older adult See box on page 5

Forms of Elder Abuse Sexual Abuse Nonconsensual sexual contact of any kind Older victims are less likely to report sexual abuse than are younger victims Acts range from sexual exhibition to inappropriate touching, photographing the person in suggestive poses, and forcing the person to look at pornography May involve rape, sodomy, or coerced nudity

Forms of Elder Abuse Financial Exploitation Illegally taking, misuse, or concealment of funds, property, or assets of a vulnerable older adult Also known as fiduciary abuse, financial abuse, economic abuse, and financial mistreatment Covers a broad range of conduct that is difficult to define and to prove It is rarely possible to prove criminal knowledge of incompetence and intent

Forms of Elder Abuse Neglect Refusal or failure by those responsible to provide food, shelter, health care, or protection for a vulnerable older adult Warning signs include sunken eyes or loss of weight, extreme thirst, and bedsores Occurs when a caregiver is unable or unwilling to provide the necessary care for an older adult for whom he or she is responsible Can occur even when there is no willful desire to inflict physical or emotional distress

Forms of Elder Abuse Symptoms for neglect include the following: Withdrawal or denial of health services Untreated injuries and illnesses Denial of adequate food Lack of proper hygiene

Forms of Elder Abuse Abandonment Intentional and permanent desertion of an older adult in any place (such as a hospital, nursing facility, shopping center, or public location) or leaving the person without the means or ability to obtain necessary food, clothing, shelter, health care, or financial support. Stiegel, L., & Klem, E. (2007). Reporting requirements: Provisions and citations in adult protective services laws, by state. Retrieved from http://www.americanbar.org/content/dam/aba/migrated/aging/docs/MandatoryReportingProvisionsChart.authcheckdam.pdf

Vulnerability and Undue Influence Older adults who are dependent on others for basic care are particularly vulnerable. Many victims are people are frail, vulnerable, and cannot help themselves. Older adults may not seek help due to: Uncertainty about whom to talk to Uncertainty about what can be done Fear of not being believed Fear of getting involved

Vulnerability and Undue Influence Occurs when people use their role with the older adult to exploit the trust, dependency, and fear of others. Deceptive use of power is used to gain control over the decision-making of the vulnerable adult. Vulnerability is not related to the person’s intelligence. Cognitive impairment may make the manipulation easier to accomplish.

Consequences of Elder Abuse Severe emotional distress, higher rates of depression, higher rates of suicide Loss of dignity and misplaced feelings of self-blame and guilt Shame discussing the crime or participating in a medical exam with law enforcement and medical personnel Feelings of embarrassment that family members and/or neighbors will find out abuse occurred

Civil Versus Criminal Action The determination of civil versus criminal action for abuse against older adults is extremely complex. Threats of abandonment or commitment to an institution make many older adults reluctant to follow through with criminal court proceedings. Institutional settings prefer to handle their own “problems” and historically do not pursue criminal avenues for redress.

Mandated Reporting Mandatory reporting laws Legally require physicians, nurses, social workers, and others designated by the state to report suspected abuse against older adults to adult protective services. Persons required by law to report suspected abuse or neglect vary by state. The reporter is required to document when he or she saw abuse taking place or when there is a reasonable belief that it is occurring. Stiegel, L., & Klem, E. (2007). Reporting requirements: Provisions and citations in adult protective services laws, by state. Retrieved from http://www.americanbar.org/content/dam/aba/migrated/aging/docs/MandatoryReportingProvisionsChart.authcheckdam.pdf

Police Response Law enforcement is encouraged to use a multidisciplinary approach in investigations. Overlapping responsibilities of multiple state agencies is recommended. An appropriate course of action may be difficult to determine in neglectful situations. If probable cause to believe a crime has been committed does exist, officers must consider existing domestic violence law in their state.