Types of Abuse and Neglect Discussion Project
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Types of Abuse and Neglect Discussion Project
Elder abuse can take various forms such as physical, psychological or emotional, sexual and financial abuse. It can also be the result of intentional or unintentional neglect of an older adult by the caregiver.
PHYSICAL ABUSE
Physical abuse is abuse involving contact intended to cause feelings of intimidation, injury, or other physical suffering or bodily harm. Physical abuse may include any kind of physical assault such as hitting, beating, pushing, kicking, pinching, burning or injuring with an object or a weapon.
INDICATORSMalnutrition or dehydration. Withholding food or water as a punishment or act of cruelty is not that uncommon. Sudden weight loss, cracked lips, dry mucus membranes, the inability to produce tears can all be indicators for these conditions.
Open wounds or sores on the body can indicate lack of proper care in cases of bedridden elderly. They can also indicate the results of abusive behavior by a caregiver that has used cigarettes to burn the elder, stabs using pencils or some other small, sharp object, or the intentional cutting with sharp objects.
Welt marks that could be the result of brushes, belts, extension cords or other such objects being used to beat the elder person.
Bruises, welts or actual rope burns near the wrists or ankles that would indicate the use of restraints.
Hair loss in sudden patch like areas. This could be a sign of someone grabbing, pulling or actually yanking the hair out.
Fractures of bones that can’t be explained in which caregivers and even the elderly my avoid discussions of.
Inescapable signs such as bite or burn marks, finger prints, scratches, black eyes or broken noses and/or fingernails.
SEXUAL ABUSE
Sexual abuse is forcing a person to take part in any sexual activity without his or her consent, including forcing them to participate in conversations of a sexual nature against their will; may also include situations where person is no longer able to give consent.
INDICATORSGenital pain or bleeding
Bruises on external genitalia or inner thighs
Difficulty walking or sitting
Torn, stained, or bloody underclothing
Sexually transmitted diseases
EMOTIONAL OR PSYCHOLOGICAL ABUSE
Emotional abuse is more than just name calling, insults, or verbal jabs at another person. Whether intentional or not, emotional abuse includes any incident which degrades, humiliates, threatens, isolates or controls another person. It may also include a pattern of other abuses such as insults, criticisms, emotional manipulation, blame, neglect, aggressive demands or expectations, harassment, terrorizing as well as ignoring.
INDICATORSemotional upset or agitation;
fearful behavior, especially around certain individuals;
withdrawal and apathy;
unusual behavior such as sucking, biting, and rocking;
an elder’s report of verbal abuse or mistreatment.
anxiety
fear
FINANCIAL ABUSE OR MATERIAL ABUSE
Financial abuse is the theft or conversion of money or other property by caregivers, relatives, or other people the person trusts. It is the improper use of an elder’s funds, property or resources through fraud, false pretenses, embezzlement, conspiracy, and falsifying records, coerced property transfers or denial of access to assets.
INDICATORSSuspicious changes in wills, power of attorney, titles, and policies.
Unpaid bills or lack of medical care despite adequate income or resources.
Addition of names to the elder’s signature card.
Anxiety when discussing about financial matters.
NEGLECT
Neglect was defined as the “repeated deprivation of assistance needed by the older person for important activities of daily living”. Neglect can be deliberate or unintentional, but even in the latter case serious consequences for the individual can potentially arise.
Kosberg(1990) identifies several components that typify elderly abuse namely1:
Active Neglect which is characterised as the intentional withholding of items necessary for daily living such as food, medicine, companionship and bathroom assistance. As such, the abuser is aware of the consequences of the neglectful behaviour.
Passive Neglect which is non- intentional, non-malicious withholding of basic necessities and/or care because of lack of experience, information or ability. The abuser is often unaware of the neglect or its consequences due to lack of experience as caregiver or because of certain deficits in mental functioning. This form of abuse reflects a lack of intentionality (Kosberg/ Garcia, 1995).
4Kosberg /Garcia (1995) ‘Strengthening Ageing Families, Diversity in Practice and Policy-pg 64-65’
Neglect may include:Unusual weight loss, malnutrition, dehydration
Untreated physical problems, such as bed sores
Unsanitary living conditions: dirt, bugs, soiled bedding and clothes
Being left dirty or unbathed
Unsuitable clothing or covering for the weather
Unsafe living conditions (no heat or running water; faulty electrical wiring, other fire hazards)
Desertion of the elder at a public place
INDICATORS
Unusual weight loss, malnutrition, dehydration
Untreated physical problems, such as bed sores, rashes, lice on the elderly
Unsanitary living conditions: dirt, bugs, soiled, bedding and clothing
Unsuitable clothing or covering for the weather
SELF NEGLECT OR ABUSE
It is characterized as abusive or neglectful conduct of an older person directed at himself or herself that threatened his or her health or safety.
INDICATORSAbsence of necessities including food, water, heat
Inadequate living environment evidenced by lack of utilities, sufficient space, and ventilation
Animal or insect infestations
Signs of medication mismanagement, including empty or unmarked bottles or outdated prescriptions
Poor personal hygiene including soiled clothing, dirty nails and skin, matted or lice infested hair, odors, and the presence of faeces or urine
Unclothed, or improperly clothed for weather
Bedsores, skin rashes
Dehydration, evidenced by low urinary output, dry fragile skin, dry sore mouth, apathy, lack of energy, and mental confusion
Untreated medical or mental conditions including infections, soiled bandages, and unattended fractures
Absence of needed dentures, eyeglasses, hearing aids, walkers, wheelchairs, braces, or commodes
Exacerbation of chronic diseases despite a care plan
Worsening dementia
Behavioral indicators
Observed in the caregiver/abuser
Expresses anger, frustration, or exhaustion
Isolates the elder from the outside world, friends, or relatives
Obviously lacks care giving skills
Is unreasonably critical and/or dissatisfied with social and health care providers and changes providers frequently
Refuses to apply for economic aid or services for the elder and resists outside help
VIOLATION OF RIGHTS
This is characterized- most dramatically- by efforts to force an elderly relative from his or her dwelling and/or to force the person into another setting (most often an institutional setting) without any forewarning, explanation, or opportunity for input or against the relative wishes. Being ‘’at the end of one’s rope’’ does not necessarily mean the caregiver will take the proper precaution in addressing caregiving responsibilities. (Kosberg/Garcia,1995).
CAUSES OF ELDER ABUSE AND NEGLECT
There is no one explanation for elder abuse and neglect. Elder abuse is a complex problem that can emerge from several different causes and that often has roots in multiple factors. Researchers who have studied elder abuse across cultures have identified several important factors associated with it. The following explanations on causes of elder abuse and neglect are suggestive of the reasons why family members would engage in such abusive behavior ( Kosberg/Garcia 1995).
FAMILY SITUATIONS
Family situations that can contribute to elder abuse include discord in the family created by the older’s person’s presence, a history and pattern of violent interactions within the family, social isolation or the stresses on one or more family members who care for the older adult, and lack of knowledge or caregiving skills.
Intergenerational and marital violence can persist into old age and become factors in elder abuse. In some instances, elder abuse is simply a continuation of abuse that has been occurring in the family over many years. Family stress is another factor that can trigger elder abuse. When a frail or disabled older parent moves into a family member’s home, the lifestyle adjustments and accommodations can be staggering.
In some instances, the financial burdens of paying for health care for an aging parent or living in overcrowded quarters can lead to stress that can trigger elder abuse. Such a situation can be especially difficult when the adult child has no financial resources other than those of the ageing parent.
Sometimes, there may be marital stress between an older couple when they must share a home with their adult children. Or, the new living arrangements could cause tension between an adult child and his or her spouse. When problems and stress mount, the potential for abuse or neglect increases.
SOCIAL ISOLATION
Social isolation can provide a clue that a family may be in trouble, and it also can be a risk factor for abuse. Social isolation can be a strategy for keeping abuse secret, or it can be a result of the stresses of caring for a dependent older family member. Isolation is dangerous because it cuts off family members from outside help and support they need to cope with the stresses of caregiving. Isolation also makes it harder for outsiders to see and intervene in a volatile or abusive situation to protect the older person and to offer help to the abuser.
DEPENDENCY
Dependency is a contributing factor in elder abuse. When the caregiver is dependent financially on an impaired older person, there may be financial exploitation or abuse. When the reverse is true, and the impaired older person is completely dependent on the caregiver, the caregiver may experience resentment that leads to abusive behavior. In such a situation, maltreatment of the elder may occur.
PATHOLOGICAL CAREGIVERS
Elderly persons can be maltreated by family members who exhibit abnormal and deviant behavior including drug dependencies, alcoholism, mental illness and cognitive problems (Quinn & Tomita, 1986). These people who are ill-suited to provide care, turn out to be abusing caregivers and have a tendency to use violence to solve prolems; others are less aware and have little control over their actions. Sometimes the person being cared for may physically abusive to the caregiver, especially when the older person has Alzheimer’s or another form of dementia.
CAREGIVER STRESS
When caregivers are thrust into the demands of daily care for an elder without appropriate training and without information about how to balance the needs of the older person with their own needs, they frequently experience intense frustration and anger that can lead to a range of abusive behaviours.
CULTURAL ISSUES
Certain societal attitudes make it easier for abuse to continue without detection or intervention. These factors include the devaluation and lack of respect for older adults and society’s belief that what goes on in the home is a private, “family matter.” Certain cultural factors, such as language barriers, make some situations more difficult to distinguish from abuse or neglect, and it is important not to ignore abuse by attributing the cause to cultural differences. However, before reporting abuse, anyone working with older people should be sensitive to cultural differences and not mistake these for abuse or neglect. Definitions of what is considered “abuse” varies across diverse cultural and ethnic communities.
Lack of respect for the elderly may contribute to violence against older people. When older people are regarded as disposable, society fails to recognize the importance of assuring dignified, supportive, and nonabusive life circumstances for every older person.
The idea that what happens at home is “private” can be a major factor in keeping an older person locked in an abusive situation. Those outside the family who observe or suspect abuse or neglect may fail to intervene because they believe “it’s a family problem and none of my business” or because they are afraid they are misinterpreting a private quarrel. Shame and embarrassment often make it difficult for older persons to reveal abuse. They don’t want others to know that such events occur in their families.
Religious or ethical belief systems sometimes allow for mistreatment of family members, especially women. Those who participate in these behaviors do not consider them abusive. In some cultures, women’s basic rights are not honored, and older women in these cultures may not realize they are being abused. They probably could not call for help outside the family and may not even know that help is available.
THEORIES OF ELDER ABUSE AND NEGLECT
A number of theories have been promoted or proposed to explain elder abuse (Phillips, 1986).
Social exchange theory suggests that all social interactions between persons involve rewards and punishments. In the case of elder abuse, the victim is dependent on the abuser for care( reward). However, the abuser does not feel that the victim reciprocates with equal rewards and thus withholds care or ‘’punishes ‘’the victim.
Situational theory suggests that caregiver stress and excessive demands may cause the caregiver to ultimately lash out, however, Phillips has some difficulties in proving this theory due to lack of clarity on explanations on elder abuse.
Symbolic interactionism proposes that social interaction is
They are abandoned by their kids, single and thus have financial problems and no one to care for them and their welfare. no one to share sorrow.have health problems they cannot handle alone. have no support.Read more: http://wiki.answers.com/Q/The_major_problems_faced_by_the_elderly_in_any_society#ixzz1E6mU22P0
CHAPTER 3
Methodology
CHAPTER THREE
Methodology
Methodology is defined as a ‘general approach to studying research topics ( Silvermen 2000.88) through which data are collected. It can be said that methodology pertains to the ways of producing and analyzing data so that theories can be tested, accepted and rejected.
Methodology is concerned with both the detailed methods through which data are collected and the more general philosophies upon which the collection and analysis of data are based”. ( M.Haralambos and Holborn, 1990)
Objectives of the Survey
The main objective of the survey was to obtain an overview of the intervention mechanism in particular the roles and actions taken by the MOSS, the present trends of elder abuse based on findings from secondary data and the role of the WEPPU in addressing the problem of the elderly so that they can age in “Dignity, Respect and with a Smile “.
Sample
The survey population targeted was the elderly aged 60 and above. It was rather impossible to survey the whole population because it is very costly and time consuming. The target population for this study was from a convenience sample which is a non-probability sampling technique where people are selected because of their convenient accessibility and proximity to the researcher as the issue chosen (Joan Joseph Castillo (2009). The sample chosen was selected from the lists of reported cases of repeated abuse of the WEPPU who receive complaints from elderly persons who are in need of protection or assistance, from police records, complaints from hotlines, neighbours and by elderly who are self abused. Some 25 elderly people who live in institutions were also interviewed. The respondents were first contacted and the aim of the study was explained to them and their consents were obtained.
In pilot studies, convenience sample is usually used because it allows the researcher to obtain basic data and trends regarding his study without the complications of using a randomized sample.
Two key approaches are qualitative and quantitative
One of the key determinants of an approach is the nature of the research project and the choice of the research method influences the way in which the researcher collects data. In this research, qualitative approach was utilized as it helps to probe into the feelings, attitudes and understand non-verbal experiences of respondents. It also creates openness by encouraging people to expand on their responses that can open up new topic areas not initially considered.
The purpose is to provide complex textual descriptions of how people experience a given research issue and what are their feelings and insight.
Its weaknesses are that its findings cannot be generalized and standardized as in a quantitative approach.
Methods of data collection
The method used for collecting data in this research is the face- to-face interview by using a questionnaire.
Interviews can be either structured, unstructured or semi-structured.
The semi-structured interview has been used as it has no strict order and manner of using the same word of asking the questions as in a structured interview. The researcher and the interviewee can talk overtly regarding certain questions.
Both open-ended and close-ended questions have been used in the questionnaire.
Open-ended questions provide greater freedom of expression and no bias due to limited response ranges. Open-ended questions allow respondents to include more information, including feelings, attitudes and understanding of the subject. This allows researchers to better access the respondents’ true feelings on an issue. Surveys that use open-ended questions can be used more readily for secondary analysis by other researchers than surveys that do not provide contextual information about the survey population. Close-ended questions are more specific, thus more likely to communicate similar meanings. http://answers.yahoo.com/question/index?qid=20090519132741AAeKJF8 ( advantages and disadvantages of close and open questions –yahoo answers 19 May 2009-03/03/2011-14 hr
For this study, both the primary and secondary data has been used to carry out the study on elderly abuse and neglect. Primary data was collected by means of survey questionnaires with both closed and open ended questions. Secondary data was obtained from the Ministry of Social Security, National Solidarity and Senior Citizens & Reforms Institutions, the Central Statistics Office, internet Sources, magazines downloading and books. As an officer of the Ministry of the Social Security, it was fairly easy for me to have access to this information. The elderly was interviewed at their place of residence and some at the institutions and the medium of communication was the Mauritian Creole. Length of interview ranged from 20 to 30 minutes per respondent.
Advantages of using face- to face interview to administer a questionnaire.Appendix 1
Questionnaire on elderly abuse and neglect
Section A: Profile of respondentsSex
Male
Female
Age
A .60-64
65-69
70-74
75-79
80 and above
Ethnic Group:………………………………………………………………………………
Marital status
Single
Married
Separated
Widow
Widower
Other
Educational background
None
Primary
Secondary
Tertiary
Family details
Nuclear
Extended
Single
Description of family members
Number of boys:…………………..
Number of girls:……………………
- a) Do you own any property?
If yes, give details………………………………………………………………………..
9) Sources of incomeBasic Retirement Pension
Occupational pension
Help from children
Present job
Other sources
Section B:Health status
10) Do you suffer from any disabilities?Yes
No
11) If yes, please specify……………………………………………………………………
12) Do you suffer from any chronic illness?Diabetes
High blood pressure
Cardio vascular disease
Cancer
13) Are you doing any remunerated work?
Yes
No
14) If yes, please specify……………………………………………………………………
Section C:Particulars of Accomodation of Household
15) Types of your dwelling:Own premises
Free sheltered by………………………………………………………………..
Rented dwelling, rent paid Rs………………………………………..p.m
Section D: Abuse and Neglect
16) Do you think that many elderly are being abused by their caregiver or their family in our society?Yes
No
17) Are you aware of any elderly who is subject to abuse in your neighbourhood?
Yes
No
18) Have somebody ever hit, slapped, pushed or beaten you?
Yes
No
19) If yes, please specify………………………………………………………………………..
………………………………………………………………………………………………………..
20) How often do these abuses and neglect occur?Everyday
Several times in a week
Several times in a month
Once in a month
Rarely
21) How do you feel of being abused by your family members or caregiver?
……………………………………………………………………………………………………………….
……………………………………………………………………………………………………………….
……………………………………………………………………………………………………………….
22) Have you ever heard that there is an Act in Mauritius to enhance the protection of the elderly against any form of abuse or neglect?Yes
No
23) Having heard of the Act, will you share the information with someone whom you know is being abused?
Yes
No
THANKING YOU FOR YOUR PARTICIPATION
http://alzheimers.about.com/od/frustration/a/def_elderabuse.htm access on 17/02/2011-11.40 a.m
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_076197 21/02/2011-11.08 a.m
http://books.google.co.uk/books?hl=en&lr=&id=NE7hb2dS5bwC&oi=fnd&pg=PR9&dq=causes+of+elder+abuse+and+neglect&ots=BweSxDpmVU&sig=bR1fIlEhmWhLKlCUVERifkGAWFM#v=onepage&q&f=false Quinn & tomita ,1997
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