4 Elderly Abuse
The terms “elder abuse” are general terms that represent all types of mistreatment or abusive behaviour towards older adults (Wolf, 2000). Unfortunately, no consistent definition of elder abuse exists. Furthermore, consistent views of the forms of mistreatment do not exist in the research literature (Lachs & Pillemer, 1995; Blakely & Dolon, 2002). Variations in conceptual approaches to abuse have resulted in a variety of definitions of abuse that make comparisons of definitions across studies confusing (Peake, Oelschlager & Kearns, 2000; Bergeron, 2001; Wilber & McNeilly, 2001). Overall, some researchers have referred to the confusion in defining elder abuse as “definitional disarray,” which seems a fitting description based upon the current literature (Gordon & Brill, 2001, p. 184).
The group project clearly defined and sought to communicate the meaning of elderly abuse and its primary forms, as they are listed below. This part of the project was successful as the questionnaire results indicate that the majority of respondents were subsequently able to list its different forms and had acquired an understanding of the phenomenon.
4.1 Physical Abuse
Physical abuse is defined as the “use of physical force that may result in bodily injury, physical pain, or impairment” (Tatara et al., 1996, p. 3). Physical abuse includes intentional acts of physical violence causing physical pain or injury (Lachs & Pillemer, 1995; Welfel, Danzinger & Santoro, 2000).
4.2 Psychological Abuse
Psychological abuse is “the infliction of anguish, pain, or distress through verbal or nonverbal acts” (Tatara et al., 1996, p. 3). Welfel et al. (2000) describe psychological abuse as any action that causes fear, isolation, confusion or disorientation in an older person. It can be characterised by habitual verbal aggression, insults, threats, intimidation, humiliation and harassment (Welfel et al., 2000).
4.3 Fiduciary Abuse
Financial exploitation is defined as “the illegal or improper use of an elder's funds, property, or assets” (Tatara et al., 1996, p. 3). This type of abuse usually involves secondary gains for the person or caretaker committing the exploitation. The most common form of fiduciary abuse is theft of pension checks, or other money, the use of threats to enforce signing of changing of wills, and coercion in any other financial matters (Lachs & Pillemer, 1995).
4.4 Neglect
Neglect has been found to be the most common type of elder maltreatment, accounting for almost half (49.9%) of elder abuse reports (Tatara et al., 1996). It is “the refusal or failure to fulfil any part of a person's obligations or duties to an elder” (Tatara et al., 1996, p. 3). Neglect involves a failure to provide essential medical or psychological care for an older person, such as food, water, clothing, shelter, personal hygiene, medicine, comfort and personal safety.
5 Etiology and Risk Factors of Elder Abuse
As regards the etiology of elderly abuse, it was difficult for the group members to effectively explain it to the audience. This is not just due to the inherent complexity of the phenomenon but, importantly, time constraints. Simply stated, there was not enough time to enter into a discussion with the audience on the etiology of elderly abuse and, hence, this study will now seek to correct this deficit.
To effectively understand elder mistreatment, it is important to understand its underlying origins and consequences. It is often difficult to generalise from previous research those most likely to be at risk for the various types of elder abuse (Schiamberg & Gans, 2000; Wilber & McNeilly, 2001). While abuse and neglect may occur in any given context, with or without the presence of risk factors, it is important for mental health professionals to have knowledge about the assessment and accurate identification of potential high risk situations. Assessment and the ability to recognise specific predisposed conditions for abuse may aid mental health professionals in identifying potentially abusive situations and targeting interventions towards those most at risk of abuse (Campbell & Browne, 2001).
Understanding the etiology of elder mistreatment is a critical part of understanding elder abuse and neglect. However, clinicians and researchers should be cognizant of the fact that there does not appear to be any single theoretical explanation for elder abuse, and that these proposed theories do not fully determine causation (Kapp, 1995; Ansello, 1996). Instead, some researchers suggest it is more useful to develop an integrated theoretical model using each of the hypotheses proposed that describe the potential interactions between different factors or variables, and to use this model alongside the known correlates of abuse to help guide assessment, intervention, legislation and policy (Gordon & Brill, 2001). Knowledge of these proposed theories and risk factors provide clinicians with a foundation for understanding human behaviour and motivation in situations of abuse, and can only enhance assessment and interventions in practice.
6 Health Promotion Model
Even though the project was a health promotion activity, there was no opportunity to expound upon the implications of health promotion or to explain the health promotion model which most ideally addressed the concerns of elderly abuse. This section of the research will address this shortcoming.
According to health promotion scholars and theoreticians, the role of nurses in promoting health awareness is second to none and, indeed, it may very well be argued that health promotion is an integral component of nursing professionals’ responsibilities towards their communities (Naido and Wills, 1998; Naidoo and Wills, 2000; Bunton and MacDonald, 2002). Nurses are perfectly situated to fulfil the aforementioned responsibility due to their professional experience, professional knowledge, education, training and continued exposure to, and interaction with, patients (Naidoo and Wills, 1998; Naidoo and Wills, 2000; Bunton and MacDonald, 2002). Naidoo and Wills (1998), however, argue that the ability of nurses to effectively engage in constructive health promotion activities is immediately predicated on their knowledge of the problem which they are addressing and their awareness of the various health promotion models and the their foundational theories. The implication here is that effective health promotion activities are dependent upon correlating the health problem in question with a health promotion model which most ideally addresses its concerns. Of equal importance, according to several health scholars (Naidoo and Wills, 1998; Naidoo and Wills, 2000; Bunton and MacDonald, 2002) is that nurses adhere to the ethical principles which govern their profession as they selected and implement the health promotion model and confront the health concern in question. As Naidoo and Wills (1998) argue, their regular communication and interaction with patients has, to a large part, ingrained the importance of adhering to the relevant ethical principles in nurses and, indeed, their experience with patient communication and interaction places them in a position where they are able to promote awareness of health issues and do so within an ethical context. In relation to elderly abuse, the implication here is that if nurses are to play an effective role in the confrontation of this problem, they must be aware of the different types of abuse, as outlined in the preceding section, and its etiology.
While acknowledging the presence of numerous health promotion models, all of which can contribute to the ability of nurses to effectively promote awareness of the elderly abuse problem, very few adequately address the concerns of elderly abuse. That does not mean to imply that if utilised they would not contribute to the effective promotion of awareness of the problem of elderly abuse but it means that it is necessary to search for a model which more precisely addresses the concerns of this problem. This is where the applied ecological bi-focal health promotion model fits in.
Schiamberg and Gans (2000) proposed an applied ecological bi-focal framework for understanding contextual risk factors and the intergenerational interactions between an aged individual (usually a parent) and adult caregiver (usually an adult child). In their model, emphasis has been placed on the bi-focal nature of elder abuse risk in that of the victim and the caregiver simultaneously. Given the complexity of elder mistreatment and variety of relevant risk factors noted in the literature, the applied ecological approach best addresses an organised and efficient understanding of elder abuse in context. The applied ecological bi-focal model (Schiamberg & Gans, 2000) provides a framework for organising risk factors of elder abuse into environmental systems, where the elder is the focus of the model. The four levels of environment, or systems, used to organise risk factors of elder abuse in this model are: (a) the microsystem, (b) the mesosystem, (c) the exosystem, and (d) the macrosystem. By organising risk factors into these various systems it allows for a clear understanding of how each risk factor may be considered mutually exclusive from those in different environments, as well as collectively. The implementation of this model can substantially contribute to both the ability of nurses to identify abused elderly patients and to educate their elderly patients on the phenomenon of elderly abuse.
7 Conclusion
It is important to note that even though the elderly abuse questionnaire we distributed as a group indicated a majority awareness of the implications of the phenomenon, it indicated that only a minority was aware of how they should respond to the problem. This evidences a need for the promotion of awareness of the critical nature of the problem, not just amongst patients but, importantly, amongst nursing professionals. It is, thus, that nursing students and nursing practitioners must be identified as the target of an elderly abuse health promotion and awareness campaign. This campaign will fulfil the dual purposes of educating them about the risk factors and the appropriate response to cases of elderly abuse which come to their attention. It is within the context of the stated that it is imperative that the selected health promotion model be utilised vis-à-vis nurses, necessitating educating them about elderly abuse, its causal factors, revealing signs and appropriate responses.
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