Help for Elders and Families
FAQ's about Elder Abuse
Laws Related to Elder Abuse
National Action Agenda on Elder Abuse
Statistics, Research & Resources
Outreach to Special Populations
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
Kentucky Medical Association's Subcommittee on Domestic Violence
KMA Model Health Care Protocol on Abuse, Neglect & Exploitation - Child, Spouse/Partner, Adult & Elder
Kentucky Medical Association's Subcommittee on Domestic Violence; updated 2004.
As quoted from the purpose statement of this protocol: "...This model policy and protocol
information is provided: to facilitate, simplify, and standardize quality health care intervention for patients at risk of abuse, neglect or exploitation; to assist physicians to comply with standards, regulations and laws related to adult and child abuse, neglect and exploitation. These materials are to be used as guidelines to assist physicians to develop policies and procedures related to the needs of these patients. Every physician and facility administrator should have a mechanism established in which initial patient contact assesses for current and historical identification of abuse, neglect or exploitation..." The guidelines cover issues such as screening and assessment, examination and documentation, reporting, medical record keeping, insurance and legal issues (including consent), patient education, and referral. Interview and assessment forms are provided. (Note: This protocol is accessible online at: http://www.kyma.org/Committees/Protocol_Index.php . The entry has also 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 .)
Koenig, R. & DeGuerre, C.
The Legal and Governmental Response to Domestic Elder Abuse.
Clinics in Geriatric Medicine; Vol. 21 (2), 383-398; May 2005.
As quoted from the publisher, "Older Americans constitute the fastest growing segment of the United States population and may account for 20 percent of the Unites States population by 2050. The federal government has taken minimal action to identify and solve their problems. Due to the federal government's inaction, states have become the primary engine for combating abuse. This is most often seen through adult protective services, which primarily consist of mandatory reporting laws, involuntary interventions, and educational programs. Funding is the primary roadblock to the successful execution of state laws targeting domestic elder abuse. The proposed federal Elder Justice Act of 2003, if passed, may fill in the gaps of current federal legislation by implementing a uniform method of response to domestic elder abuse and providing funding to the states to rectify instances of abuse." (Note: This article is not currently available through CANE.)
A Forensic Medical Examination Form for Improved Documentation and Prosecution of Elder Abuse
Journal of Elder Abuse & Neglect; Vol. 15 (3), 109-119; 2003.*
This article describes the process of developing the "Forensic Medical Report: Elder/Dependent
Adult Abuse and Neglect" form, a tool intended to enhance the documentation, and ultimately the prosecution, of elder abuse and neglect cases. Although the tool was designed to meet the
legislative requirements of the state of California, it is adaptable for use in other locations. Members of the health care system, law enforcement, criminal justice system, social services, and forensic technology were represented on the multidisciplinary development team. Among the more complex issues raised was the need for an instrument that could be utilized in a number of health care settings; who would complete which portions of the form; what demographic data would be collected (and how this may advance further research in elder abuse). The most controversial issues were related to the assessment of cognitive ability, and to the length of the examination form. Revisions of the draft form were completed with input from approximately 200 reviewers throughout the state. The first part of the instrument documents demographic information, and includes a checklist to document concurrent forms of abuse. It also includes an assessment of independent and cognitive functioning. The second part provides detailed documentation of the physical status of the victim in terms of symptoms and injuries. Training will be conducted to develop a nucleus of skilled elder abuse forensic examiners throughout the state.
Kosberg, J. et al.
Study of Elder Abuse within Diverse Cultures
Journal of Elder Abuse & Neglect; Vol. 15 (3), 71-89; 2003.*
This overview highlights the challenges to cross-cultural and cross-national research on elder
abuse and neglect. In order to illustrate such issues, the authors consider ethnic and cultural
barriers to addressing elder abuse within U.S., the U.K. and Israel, as well as challenges to
conducting an international study. Variations in the definitions of elder abuse are analyzed and viewed as a significant impediment. Approaches to the study of elder abuse among the three
countries are compared.
Kosberg, J. & MacNeil, G.
The Elder Abuse of Custodial Grandparents: A Hidden Phenomenon
Journal of Elder Abuse & Neglect; Vol. 15 (3), 33-53; 2003.*
According to the U.S. 2000 census, 4.8 million children live with their grandparents, and in a third of these households neither parent is present. Legal mandates, increasing teen pregnancy and divorce rates, substance abuse, and financial strain are among the reasons that grandparents take on the responsibility of raising grandchildren. Using a family systems approach, a number of factors contributing to elder abuse among custodial grandparents are considered. High risk grandchildren may have behavioral and emotional problems due to impaired relationships with their parents or abandonment by their parents. Grandparents may be vulnerable due to increased financial, emotional and physical strain. Interaction with the child's parent may also increase the potential for abuse.
Disposable Humanity - Do Elders Have a Duty to Die?
NAELA News Vol. 16 (4), 14-15; August 2004.
This essay considers ways in which existing legal theory suggests that the life of an elder is not highly valued in our society, particularly regarding end of life issues. (Note: This article is accessible online at: http://www.naela.com/pdffiles/NNews8-04.pdf .)
Lachs, M. & Pillemer, K.
The Lancet; Vol. 364 (9441), 1263-1272; October 2 2004.
In this overview, the authors present a summary of recent international research and clinical
findings regarding elder abuse. It is intended to assist physicians and other health care
professionals in the identification of elder mistreatment, and to offer guidance in intervention. Definitions, estimates of prevalence, and risk factors are reviewed. A comprehensive discussion is provided regarding the efficacy of formally screening asymptomatic patients for elder abuse. Authors also provide a table that describes a proposed medical assessment of elder abuse, linking specific recommendations with particular areas of concern. The importance of multidisciplinary interventions in treatment planning is discussed, along with the need to determine if patients refusing interventions have the cognitive capacity to do so. (Note: This entry has also 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 .)
Elder Abuse: Making a Difference
Clinical Geriatrics; Vol. 12 (2), 37-40; December 2004.
By focusing on a case study of an older patient, the author provides an overview of how physicians, social workers and other health care professionals may encounter elder mistreatment and successfully intervene. Practitioners are reminded that red flags indicating financial exploitation as well as physical abuse, neglect, self-neglect and sexual abuse may be observed in the clinical setting. Reporting suspected abuse is considered the most valuable intervention that a clinician can make, and information for accessing the appropriate local reporting agency through the Eldercare Locator directory is provided. (Note: This article is accessible online at:
Self-Neglect: The Role of Judgements and Applied Ethics
Nursing Standard; Vol. 19 (18), 45-51; January 2005.
Intended for continuing professional development of nurses, this overview discussion of self-
neglect presents a framework for management in an interdisciplinary context. Nurses view self-
neglect as a self-care deficit, "...the failure to engage in self-care activities that adequately regulate functioning, supply adequate levels of food, take actions to prevent, alleviate, cure or control conditions which affect life, health, and well-being..." The author points out that "the war against dirt and body fluids" is the cultural context in which self-neglect is measured. Findings from literature reviews are presented regarding the decision making processes used by professionals in choosing interventions. Evaluation of risk to self and others are considered along with the need to balance the individual's right to autonomy with the rights of neighbors and the community. (U.K.) (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 .)
An Ethical Dilemma in Elder Abuse
Journal of Gerontological Social Work; Vol. 43 (2/3), 165-173; 2004.
This case study analysis provides an illustration of some of the ethical challenges encountered by social workers when addressing elder abuse. A model of ethical justification (developed by
Beauchamp and Childress) is applied to resolve conflicts involving the principles of beneficence, which may be considered paternalistic, and the need to respect the client's autonomy or right to self-determination. In this case, the social worker's ethic of care allowed her to demonstrate the necessary loyalty and persistence to overcome the client's initial service refusal.
On Phenomenology and Classification of Hoarding: A Review
Acta Psychiatrica Scandinavica; Vol. 110 (5), 323-337; 2004.
This article presents a survey of the literature in order to describe the clinical spectrum of the phenomenon of hoarding. The identified articles are categorized as either empirical studies
focusing specifically on hoarding behaviors in humans; empirical studies focusing on other
conditions that appear relevant to hoarding (such as Obsessive-Compulsive Disorder or OCD); case studies, reviews and theoretical publications (which comprises more than half of the existing literature). The author notes that there is no consensus in the literature in terms of the assessment of hoarding; relatively few researchers use instruments designed to specifically measure hoarding. Thematically, the literature can be divided into references that address elders (and usually entail the concept of Diogenes syndrome or self-neglect) and studies concerning OCD. The author concludes that hoarding is a complex phenomenon, and recommends that clinicians assess each of the following components of the behavior along with the individual's accompanying thoughts and emotions: the act of collection or acquisition; the behavior of storing and keeping unnecessary objects; and the severe neglect that may result. In particular, the assessment should be made while considering the concepts of compulsion, impulse control issues, and stereotypic, ritualistic behaviors and tics. (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_hoarding.cfm .)
Malks, B., Buckmaster, J. & Cunningham, L.
Combating Elder Financial Abuse - A Multi-Disciplinary Approach to a Growing Problem
Journal of Elder Abuse & Neglect; Vol. 15 (3), 55-70; 2003.*
This article provides an overview of the Santa Clara County's Financial Abuse Specialist Team
(FAST), which was developed to address the increasing problem of financial exploitation among
vulnerable adults and the elderly. The team provides a rapid response by freezing assets before the elder or vulnerable adult becomes financially destitute. As of February 2004, this multidisciplinary team had prevented the loss of/and or recovered over $106 million. (Note: The FAST video can be obtained by contacting the Department of Justice's Office of Victims of Crime at 1-800-627-6872 or by ordering from the Web site at: http://puborder.ncjrs.org .)
Doctors, Elder Abuse, and Enduring Powers of Attorney
The New Zealand Medical Journal; Vol. 117 (1202); September 2004.
Intended for physicians, this article presents a discussion of the shortcomings of New Zealand legislation regarding the means of protecting people with diminished decision making capacity. The Protection of Personal and Property Rights Act (PPPR Act, 1988), administered by the Family Court, allows for surrogate decision making by either a court appointed welfare guardian and/or property managers, or through an enduring power of attorney (EPA, which is comparable to a "durable power of attorney" in the U.S.) appointed by an individual (called a "donor" in New Zealand, known as a "grantor" in the U.S.) prior to incapacitation. Welfare guardians are instructed to consult with the person for whom they act and to encourage the incapacitated adult to make his or her decisions whenever possible. Attorneys named in the EPA are not specifically instructed to consult with the donor or promote his or her welfare. However, anyone suspecting mistreatment of the donor by the attorney can request a court review of the appointment. A recent study of elder abuse committed through misuse of the EPA identified two broad categories of mistreatment: financial impropriety and failure to provide appropriate care. Recommendations to enhance the protection of incapacitated elders include the need for monitoring of the mental status of the donor at the time of an appointment of an attorney, and the need for the donor to obtain legal advice upon the appointment of an attorney. (Note: This article is available online at: http://www.nzma.org.nz/journal/117-1202/1080/ . 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 .)
Elder Abuse: The Physician's Perspective
The Clinical Gerontologist; Vol. 28 (1/2), 83-103; 2005.
This article is part of an issue that focuses on three case studies in order to analyze and clinically manage elder mistreatment employing a multidisciplinary approach. The physician's role is highlighted in this entry. The responsibilities to thoroughly and objectively document any observations related to suspected abuse or neglect, to assess whether or not the patient is in immediate danger, and to report suspected abuse to adult protective services (APS) are paramount. Barriers to assessment are also outlined, and include the difficulty of identification of elder abuse in the presence of chronic diseases. Issues addressed in the discussion of the case involving self-neglect include the need to evaluate substance abuse, depression, functional and decisional capacity, and cognitive impairment. In the case study of the victim of domestic violence who is now the neglectful (and potentially abusive) caregiver of her terminally ill spouse, the doctor is cautioned to focus on his current needs rather than past actions, to directly communicate with the patient regarding his wishes (not through his caregiver) and to be aware of increased signs of caregiver burden. In the case study of the abusive and neglectful adult daughter of the Alzheimer's patient, the physician is urged to continue to attempt direct communication with the patient, to maintain an ongoing monitoring of the home situation, the patient's behavior and functioning, including her need for increased supervision, to monitor and treat underlying medical conditions that may contribute to problematic behaviors, and, if victimization is known or suspected, to refer to APS for investigation and intervention. Interventions are recommended in the context of Ohio state statutes. (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 also 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 .)
A Comparison of Three Measures of Elder Abuse
Journal of Nursing Scholarship; Vol. 36 (3), 247-250; 2004.
This paper presents a comparison of three elder abuse assessment tools: the Indicators of Abuse
(IOA), the Elder Abuse and Neglect Assessment (EAI), and Elder Abuse Screening Test (EAST). The article provides a description of the three instruments (including format, scoring, strengths and weaknesses, and advantages and disadvantages in administration) and reviews the validity studies for each. Although no assessment tool has been fully researched for use in long-term care populations, the author indicates that the EAI has the best potential for use in institutional settings. (Note: This entry has also 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 .)
What Self-Neglecting Clients Have to Teach Us
Victimization of the Elderly and Disabled; Vol. 7 (3), p35, 36, 44, 45; September/October 2004.
In this commentary, an adult protective services (APS) professional describes the lessons learned while dealing with an older, self-neglecting couple who were also compulsive hoarders. Through case study analysis, she examines the following themes: the need to balance protection with self-determination; the importance of multidimensional assessment which considers the interaction between environment, mental and physical health, and risk; the inadequacy of the current mental health system to deal with self-neglecting clients who are experiencing chronic as opposed to acute problems; and the difficulty of defining successful outcomes in light of recidivism associated with compulsive hoarding. (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_hoarding.cfm .)
Elder Abuse: The Nurse's Perspective
The Clinical Gerontologist; Vol. 28 (1/2), 105-133; 2005.
This article is part of an issue that utilizes three case studies to analyze elder mistreatment employing a multidisciplinary approach. This entry describes the issues nurses encounter throughout the process. The author describes how assessment of elder abuse and neglect differs from other nursing assessments. For example, resistance by the patient to elder abuse assessment and intervention is not uncommon. Specifically, it is recommended that the nursing assessment involve consideration of the patient's physical status (such as nutrition, hydration, bruises and injuries, etc.), degree of frailty, caregiver's understanding of the patient's needs, living conditions (especially life threatening circumstances), history of violence on the part of the caregiver, and decisional capacity. (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 also 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 .)
Elder Abuse, Neglect, and Exploitation (from Myers on Evidence in Child, Domestic and Elder Abuse Cases)
Aspen Publishers, New York, NY; 2005
This chapter addresses issues that the attorney may encounter when handling cases of elder
abuse and neglect. An overview of the topic of elder mistreatment is presented, followed by a
discussion of the human aging process, including medical conditions (such as dementia and
delirium) that may develop and trigger changes in memory and other aspects of daily functioning. The evaluation of decision-making capacity is crucial to cases in which an elder's autonomy is at stake, and the author discusses components of effective assessment. Aspects of medical evidence (related to falls, pressure sores, malnutrition and dehydration, bruises, abrasions and lacerations, and physical restraints) that are essential to prosecution of abuse and neglect cases are highlighted. Scheduling, availability to testify, preservation of testimony (depositions and video testimony), and practical courtroom accommodations (for example, allowing a support person to accompany an elderly witness) for older victims and witnesses are among the issues examined. The chapter concludes with recommendations regarding the prosecution of financial exploitation and undue influence. Relevant state statutes and case laws are cited throughout to illustrate concepts and strategies. (Note: This chapter, available through CANE, is taken from the two volume set entitled, Myers on Evidence in Child, Domestic and Elder Abuse Cases, Aspen Publishers, NY. The entire two volume set can be ordered online at www.aspenpublishers.com or by telephone at 1-800-638-8437. Price: $295.00.)
Avoiding Systemic Neglect and Abuse in Older People's Inpatient Mental Health Care Settings
Journal of Adult Protection; Vol. 6 (4), 27-32; December 2004.
In this article, the author describes how the tendency to move away from patient centered care
toward an overemphasis on the needs of the institution can create an environment for abuse and
neglect of elderly mental health inpatients. The development of a forum to address inpatient mental health care for older individuals is outlined. The forum operates on three levels: locally, it involves working units within a hospital setting; a governance group is created from the local forums; and a regional forum is convened by the National Institute for Mental Health in England (NIMHE). The forum is empowered to implement national policy guidelines established for the care and treatment of older mental health patients. Configuration, membership, accountability and authority, procedures and collaboration are discussed as key elements of successful initiatives. (U.K.)
National Committee for the Prevention of Elder Abuse (NCPEA)
2005 White House Conference on Aging Post-Event Summary Report
Washington, D.C.; March 2005.
As quoted from the report, "The principal result of this Mini-Conference was the production of a proposed Resolution to Promote Elder Justice and Protect Against Elder Abuse, Neglect and Exploitation for consideration and adoption by the delegates at the 2005 White House Conference on Aging. This proposed resolution represents a collaborative effort and reflects the input from members of the Elder Justice Coalition (200 organizations and 169 individuals), the Board of Directors of the National Committee for the Prevention of Elder Abuse, and participants at the Mini-Conference..." (Note: This report is accessible online at the NCPEA Web site at: http://www.preventelderabuse.org/whcoaging2005.html)
National Guardianship Network (NGN) Members: National Academy of Elder Law Attorneys (NAELA), National Guardianship Association (NGA), and the National College of Probate Judges (NNCPJ)
National Wingspan Implementation Session: Action Steps on Adult Guardianship Progress
As quoted from the Introduction: "...In 2001, the Second National Guardianship Conference, known as the Wingspan Conference," convened a multidisciplinary cadre of experts to make
recommendations on adult guardianship law, policy and practice. The Wingspan Conference
resulted in 68 recommendations in the areas of diversion and mediation; due process; agency
guardianship and guardianship standards; monitoring and accountability; lawyers as fiduciaries or counsel to fiduciaries; and guardianship overview issues...In 2004, the National Academy of Elder Law Attorneys, National Guardianship Association and National College of Probate Judges took up the challenge by convening a Wingspan Implementation Session at their joint conference...aimed to develop a blueprint for action at the national, state and local levels..." This paper outlines recommendations for meeting goals in the following areas: interdisciplinary committees; interstate jurisdiction, data collections and funding; training, certification and judicial specialization; appropriate and least restrictive guardianships; and guardianship monitoring. (Note: This paper is accessible online at: http://www.abanet.org/aging/wingspanfinal0405.pdf . 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 .)
Creating an Intergenerational Learning Community for the Study of Elder Abuse
Journal of Elder Abuse & Neglect; Vol. 16 (2), 33-49; 2004.
Observing the limitations of teaching about the topic of elder abuse through literature only, this article describes an educational experience for undergraduate social work students in Israel. The course structure was designed to reflect the principles of contemporary social work through the integration of practice-oriented instruction while providing direct contact with elders through intergenerational, team teaching. The instructional concept of andragogy (which "...brings the accumulated life experience and accumulated knowledge of both the teacher and the students into the learning process...") is described as it is applied in this project. A summary of ideas developed by the student group as a result of this educational process is presented, and reflects an emphasis on prevention of abuse and exploitation through the empowerment of the aging individual, and the need to draw upon the expertise of elders in developing policy response to elder mistreatment. (Israel)
Ozer, E. & Weiss, D.
Who Develops Posttraumatic Stress Disorder?
Current Directions in Psychological Science; Vol. 13 (4), 169-172; 2004.
This article presents discussion regarding the causes of post-traumatic stress disorder (PTSD)
and factors associated with which abuse and trauma victims develop it. Models of trauma response presented include cognitive and emotional reactions to the trigger (such as the inability to assimilate the violation into their world view) and biological models (focusing on the triggers of the hypothalamic-pituitary-adrenal or HPA axis). The authors reviewed literature on the following classifications of predictors of PTSD: historical characteristics, trauma severity, psychological processes during and immediately after the trauma (such as peritraumatic dissociation, in which one may experience a sense of "unrealness" or an altered sense of self), and support and life stress following the trauma. Although peritraumatic dissociation appeared to have the strongest correlation with PTSD, neither this nor other predictors were necessary or sufficient for developing PTSD. Other issues considered are the variability in defining the traumatic event, and the role of ongoing exposure to trauma. (Note: This article is not specific to elder abuse.)
Law Enforcement and Adult Protective Services Working Together: A Team Approach to Elder Abuse Cases
Age in Action; Vol. 19 (3), Summer 2004.
This article highlights the Central Virginia Task Force on Older Battered Women (OBW Task
Force), a regional coalition of aging, domestic violence (DV), law enforcement, and legal services agencies dedicated to raising awareness of the needs of women who experience DV and sexual assault in later life. Established in 1998, the project focuses on developing collaborative and interdisciplinary community responses to address violence against older women. A case study is presented from Henrico County that illustrates how adult protective services (APS) and the police department conducted a joint investigation of a sexual assault of a 65 year old assisted living facility resident. The following key elements for successful collaboration were identified: the need for all members to understand and respect the expertise and distinct role of each member; the need for investigators to attempt to conduct joint interviews whenever possible; and to ensure that time and
resources are shared effectively. (Note: This article is available online only at:
Older Women, Domestic Violence, and Elder Abuse: A Review of Commonalities, Differences and Shared Approaches
Journal of Elder Abuse & Neglect; Vol. 15 (3), 163-183; 2003.*
This article examines the similarities and differences between two forms of adult abuse: elder
abuse and neglect, and domestic violence (DV). Traditionally, sociological frameworks have been applied to address elder abuse, while feminist perspectives have been applied to DV. The role of gender in both forms of mistreatment is discussed. Commonalities include the need to empower both victims of elder abuse and DV, and to provide interventions such as support groups and safe havens. Common abuser characteristics have also been noted, including substance abuse history and history of interpersonal problems. Legal orders and sanctions have proven effective in addressing both problems. Differences exist, however, not only in the form of risk factors but in terms of what is considered a positive resolution. In many cases, interventions in elder abuse are designed to empower the client to be able to stay in the home, while DV clients are encouraged to leave the abusive situation.
The Importance of Recognizing Abuse of Older People
British Journal of Community Nursing; Vol. 10 (4), 185-186; 2005.
This brief article presents an overview of elder abuse for home care and community nurses. Signs and symptoms of abuse are presented, and the responsibility of the nurse to protect and promote the dignity and well-being of all patients is emphasized. Results from the Community and District Nursing Association (CDNA) survey on elder mistreatment are also summarized, including the finding that two-thirds of all participants indicated that they had encountered abuse on a regular basis. (U.K.)
Quinn, K. & Zielke, H.
Elder Abuse, Neglect, And Exploitation: Policy Issues
Journal Clinics in Geriatric Medicine; Vol. 21 (2), 449-457; May 2005.
As quoted from the publisher: "Elder abuse remains a rapidly growing but largely invisible national policy issue. As the number of elderly persons increases, so will elder abuse, neglect, and financial exploitation. This has implications not only for the victims and the programs struggling to protect them but also for publicly funded programs such as Medicare and Medicaid. The urgent problem is to address elder abuse on a national level in a comprehensive and informed way to prevent the untold suffering of hundreds of thousands of older persons who deserve to live their final years with dignity and security." (Note: This article is not currently available through CANE.)
Rabiner, D., O'Keefe, J. & Brown, D.
A Conceptual Framework of Financial Exploitation of Older Persons
Journal of Elder Abuse & Neglect; Vol. 16 (2), 53-73; 2004.
In this article, the authors present an applied ecological framework for studying factors associated with both victims and perpetrators of elder financial abuse. Microlevel (or microprocess) factors include the individual characteristics of both victim and offender as well as the interpersonal dynamics of their relationship, including status inequality, and power and exchange interactions. According to the literature, microprocess factors associated with victim vulnerability include advanced age, social isolation, and loneliness. According to the National Elder Abuse Incidence Study (NEAIS) older White females living alone are the most vulnerable to financial exploitation. Abuser characteristics associated with all types of elder mistreatment include substance abuse, mental health problems, gambling behaviors and financial problems. Macrolevel factors impacting the detection of and intervention in elder financial abuse include cultural norms regarding elders, public policies (including reporting statutes), criminal remedies (i.e. prosecution), civil remedies (including legal protections, such as Powers of Attorney and Guardianship), and prevention initiatives (including efforts to raise public awareness, decrease social isolation, and implement safeguards in handling routine financial matters.) (Note: This article includes an essay linking it to a companion piece by the same authors, "Financial Exploitation of Older Persons: Policy Issues and Recommendations for Addressing Them," JEAN, Vol. 16 (1), 2004. See entry 63 of this summary, CANE file number R6024-22, for additional details.)
Sentencing Lockdown - What is the Impact of Blakely on Sentencing in Tennessee?
Tennessee Bar Journal; August 2004.
This article discusses the impact of the decision in the Supreme Court Case, Blakely v.
Washington, on Tennessee sentencing guidelines. The case questioned the constitutionality of a
Judge's ability "...to impose higher sentences when there are statutory enhancement factors such as the presence of a gun or where the victim was particularly vulnerable, e.g. an elderly person..." The decision held that "...every defendant has the right to insist that the prosecutor prove to a jury all facts legally essential to the punishment..." The author compares the federal sentencing guidelines with Tennessee sentencing guidelines, which were reformed in 1989 to allow for increased sentences according to enhancement factors specifically outlined in the statute. The author suggests that there are several reasons why Tennessee sentencing will not be altered significantly by the Supreme Court ruling. Waiver forms in plea bargains can be amended to waive the right to a jury trial not only regarding guilt but also regarding sentencing enhancement factors. In addition, the author also points out that Tennessee has relatively high sentencing minimums and wide sentencing ranges, and that a single criminal episode usually involves multiple charges which can result in consecutive sentences. In conclusion, the author recommends an amendment to the 1989 Sentencing Act which would allow for a "bifurcated jury trial where - after guilt is assessed - the jury determines only the existence of statutory enhancement factors...the judge may then impose a sentence considering only those factors that the jury determined were proven by the government beyond a reasonable doubt..."
When Elders Lose Their Cents: Financial Abuse of the Elderly
Clinics in Geriatric Medicine; Vol. 21 (2), 365-382; May 2005.
As quoted from the publisher: "Elder financial abuse is one of the most difficult types of elder abuse to diagnose given its lack of overt physical symptomatology. Unusual bank account activity, sudden changes of beneficiaries or agents in estate planning or advance directive documents, and worsening of medical conditions due to lack of follow-up or unfilled prescriptions are indicators of potential financial abuse. Federal laws are aimed at education and prevention (not treatment), whereas state laws are more comprehensive. Criminal and civil legal remedies exist to bring the abuser to justice, but the emotional trauma of financial exploitation lasts a long time." (Note: This article is not currently available through CANE.)
Sammin, K. & Hurme, S.
Guardianship and Voting Rights
Bifocal; Vol. 26 (1), p1, 11-14; Fall 2004.
This article provides a discussion of the loss of voting rights as a result of guardianship. The article identifies four statutory categories: states that encourage voting; those that encourage disenfranchisement; those that do not constitutionally bar individuals under guardianship from voting; and those states that encourage retaining voting with other rights. Case law is cited to illustrate various legal aspects of the issues. The authors advocate that the persons under guardianship should retain the right to vote unless the court has specifically stipulated that they cannot. (Note: This article, as part of the entire Bifocal publication, can be accessed online at: http://www.abanet.org/aging/261.pdf . 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 .)
Saxena, S. & Maidment, K.
Treatment of Compulsive Hoarding
Journal of Clinical Psychology; Vol. 60 (11), 1143-1154; 2004.
This article provides an overview for the clinical treatment of compulsive hoarding. A
comprehensive assessment of the patient's history and presenting problem is essential, and
should include information regarding the amount of clutter, the patient's beliefs about possessions, information processing deficits, avoidance behaviors, daily, social and occupational functioning, medication compliance, and level of insight. The authors describe a partial hospitalization program for obsessive-compulsive disorders that employs intensive multimodal treatment to address hoarding behaviors. Treatment consists of cognitive-behavioral therapy or CBT (including exposure and response prevention, or ERP) daily for approximately six weeks. 156. In addition, when indicated, patients were prescribed medications (antidepressants, antipsychotics, etc.). CBT focuses on discarding, organizing, preventing incoming clutter, and introducing alternative behaviors. Before and after photos are used to emphasize the positive gains made throughout the treatment, and upon discharge from the partial hospital program patients are encouraged to continue with weekly CBT on an out-patient basis. A case study is presented that illustrates a successful outcome; at four months post-discharge the patient was continuing to make progress with weekly out-patient support. (Note: This article is not specific to elders. The 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_hoarding.cfm .)
Elder Abuse: The Attorney's Perspective
The Clinical Gerontologist; Vol. 28 (1/2), 55-82; 2005.
In this article, the author analyzes (from the attorney's perspective) three elder abuse case studies presented for multidisciplinary consideration within the context of Ohio state law. She begins with a discussion about ethical considerations prevalent in elder law: the need to focus on the client's best interest; the need to preserve client confidentiality, with certain noted exceptions; the need for zealous representation; and the need to maintain normal attorney-client relationships even when the client has a disability, unless the client cannot act in his or her own interest. Key elements of the Ohio Revised Code's elder abuse laws are described, including the distinctions between the concepts of "non-support" versus "neglect". By statute, attorneys are required to report suspected elder abuse, regardless of how they become aware of the situation. Ethical dilemmas arise when the suspected mistreatment comes to light within the context of the attorney-client relationship. Issues of competency and autonomy, at the heart of guardianship law, are also discussed. Features of Ohio law that enhance the guardianship process are highlighted, including the appointment of an investigator in such proceedings. (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 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 .)
Shibusawa, T., Kodaka, M., Iwano, S. & Kaizu, K.
Interventions for Elder Abuse and Neglect with Frail Elders in Japan
Brief Treatment and Crisis Intervention; Vol. 5 (2), 203-211; 2005.
With the increase in formal home health care services, Japanese health and social services
professionals are becoming more aware of elder mistreatment. Currently, there is no formal
notification system for reporting elder abuse and neglect, and there are no investigatory agencies (such as Adult Protective Services) in Japan. This article describes the crisis intervention strategies implemented by social workers at Home Care Support Centers in response to cases of elder abuse and neglect encountered in family caregiving situations. A summary of Japanese research is provided, which has been based mainly on surveys of formal service providers, and suggests that most elder mistreatment occurs within a caregiving context, though not most commonly the result of caregiver burden or stress. Adult children providing care, including a high percentage of daughters-in-law, are the most common perpetrators. The three case illustrations presented demonstrate a spectrum of abuse, ranging from unintentional mistreatment to neglect and physical abuse, and also highlight cultural issues that must be considered when attempting to intervene. Interventions also vary according to the type of abuse and the family and client's willingness to accept services. Ongoing monitoring, the provision of support services (such as formal in-home health care) and the separation of victim and perpetrator through institutionalization are the interventions implemented in these case studies. (Japan) (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 .)
Cultural Issues and Elder Mistreatment
Clinics in Geriatric Medicine; Vol. 21 (2), 355-364; 2005.
In this overview, the author draws upon her experiences as a physician, as well as her personal background as an African-American growing up in a rural community, to illustrate how cultural influences impact elder abuse and neglect. Not only do cultural groups define abuse differently, cultural norms may influence whether or not mistreatment is reported, of if help from "outsiders," such as protective services professionals, is acceptable. Community and family expectations, limited social supports and financial resources may contribute to risk of abuse, neglect and exploitation. The author also emphasizes that there is a tendency to take a generalized approach to understanding ethnic backgrounds that may hinder service delivery. For example, it is overly simplistic to assume that all Native Americans share the same cultural background, when in reality there are hundreds of tribal communities. The importance of addressing macro levels of mistreatment among populations, such as the gay/lesbian/transgendered and the hearing impaired, is also discussed.
Smith, A. & Sabatino, C.
Voting by Residents of Nursing Homes and Assisted Living Facilities: State Law Accommodations
Bifocal; Vol. 26 (1), p1, 2, 4-10; Fall 2004.
This article presents an overview of states' efforts to accommodate voters living in nursing homes, assisted living facilities, and other institutional care settings. Of the 25 states that responded to the American Bar Association Commission on Law and Aging survey, 23 states have absentee voting procedures for residential care facility voters. There is great variation in procedures for assisting these individuals in voting, although some are applicable to all voters or all absentee voters. Some states stipulate that assistance can be provided only by election officials; other states allow the voter to choose anyone for assistance; still other states restrict the assistance to specific categories of individuals. A table is included that identifies the relevant state statutes and describes the voting procedure. (Note: This article, as part of the entire Bifocal publication, can be accessed online at: http://www.abanet.org/aging/261.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 .)
How Protected are the Vulnerable?
Nursing & Residential Care; Vol. 6 (9), 418-419; September 2004.
In this brief analysis, the author highlights some of the reasons that elder mistreatment has been difficult to address in the U.K., including the fact that abuse is wide ranging in nature, that most occurs in the victim's home, and that elder issues are perceived as a relatively low priority. A recent Health Select Committee report may bring about positive policy changes, in part because it has raised the visibility of the problem. Although the government's reaction to the recommendations has been disappointing thus far, new initiatives are being implemented, such as the Protection of Vulnerable Adults (POVA) scheme, which bans known abusers from working with vulnerable adults. (U.K.)
Policy and Practice Go Hand in Hand
Nursing & Residential Care; Vol. 6 (12), 574-575; December 2004.
In this commentary, the author highlights two recent developments in the U.K. that indicate that elder abuse has become more recognized as a social problem in need of attention. She discusses the policy discussion paper from Action on Elder Abuse entitled, "Placing Elder Abuse within the Context of Citizenship," and a directory of best practices produced by the Practitioner Alliances Against Abuse of Vulnerable Adults (PAVA) for best practices in adult protection. (U.K.)
Fighting Elder Abuse
Nursing Spectrum; April 11 2005.
This article presents an overview of elder abuse and neglect for home care nurses. Training and
education initiatives from the Metropolitan Jewish Health System (MJHS) are described, and
include a preceptorship program which pairs newly hired nurses with a staff development specialist. The specialist is not only an experienced nurse but is also skilled at assessing the patient's home environment for risk factors, signs and symptoms of abuse, neglect, and self-neglect. Reporting issues related to New York legislation are discussed. (Note: This article is accessible online at:
Studdert, D. & Stevenson, D.
Nursing Home Litigation and Tort Reform: A Case for Exceptionalism
The Gerontologist; Vol. 44 (5), 588-595; 2004.
In this discussion, the authors argue that extending conventional medical malpractice tort reform to the nursing home sector is ill advised for a number of reasons. They begin with a comparison of acute care and nursing home litigation. While most acute care claims are initiated directly by the patients themselves, nursing home litigation is typically initiated by residents' family members, and the allegations are usually related to abuse and neglect versus procedural mistakes or errors. In such cases, the primary defendant is the nursing facility itself. Like claims involving acute care, only ten percent of nursing home claims reach court. However, those that do reach court are much more likely to result in compensation, with higher average settlements than acute care settlements, and with a greater likelihood of noneconomic and punitive damages awarded. Much emphasis on tort reform has been placed on the capping of noneconomic damages (those not related to lost income due to the injury), which accounts for approximately 80 percent of the residents' awards nationally. Likewise, punitive damages are often targeted by tort reform, and such awards are also more prevalent in nursing home litigation. In addition, differences in the nature of the claims and injuries (more than half of the nursing home claims involve deaths, compared to less than 20 percent of acute care claims), suggest that tort reform should not be uniformly applied to nursing home litigation.
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