RECOGNIZING AND REPORTING ELDER ABUSE

BY VINCENT J. VITIELLO

Some are beaten, are swindled out of life savings, are belittled or called names, are denied proper medical care or sufficient food, live in deteriorated and infested housing that threatens their health and safety, are denied the right to decide where to live or with whom to spend time, decay in waste and want because they are unable to meet personal needs, and have no one around to help. Elder abuse takes many forms, and it can threaten any older American.¹

DEFINITION OF ELDER ABUSE

Recognizing the importance of using standard definitions of elder abuse for compiling national data, the National Aging Resource Center on Elder Abuse developed the following seven categories of domestic elder maltreatment:

• Physical abuse: nonaccidental use of physical force that results in bodily injury, pain, or impairment.
• Sexual abuse: nonconsensual sexual contact with an older person.
• Emotional or psychological abuse: willful infliction of mental or emotional anguish by threat, humiliation, intimidation, or other verbal or nonverbal abusive conduct.
• Neglect: willful or nonwillful failure by the caregiver to fulfill the caregiving obligation or duty.
• Financial or material exploitation: unauthorized use of funds, property, or any of an older person’s resources.
• Self-abuse and self-neglect: abusive or neglective conduct of an older person directed at self that threatens health or safety.
• All other types: domestic elder abuse that does not fit into the previous six categories.²

In 1998, the National Center on Elder Abuse at the American Public Human Services Association conducted the National Elder Abuse Incidence Study (NEAIS), which estimates that at least one-half million older persons in domestic settings were abused or neglected or experienced self-abuse and self-neglect during 1996 and that for every reported incident of elder abuse, neglect, or self-neglect, approximately five incidents go unreported. Through this study, it was also learned that female elders are abused at a higher rate than males, after accounting for their larger proportion in the aging population; the oldest elders (80 years and over) are abused and neglected at two to three times their proportion of the elderly population; in almost 90 percent of the elder abuse and neglect incidents with a known perpetrator, the perpetrator is a family member, and two-thirds of the perpetrators are adult children or spouses; and victims of self- neglect are usually depressed, confused, or extremely frail.

POLICY CONCERNS OF ELDER ABUSE

All 50 states have legislation mandating some form of community-based adult protective services and obligatory reporting laws. State and local offices on aging are also mandated to provide some services to elderly crime and abuse victims through local aging networks; however, one of the most controversial public policy issues concerning elder abuse is that of mandatory reporting by certain categories of professionals such as public safety personnel, social workers, and nurses and physicians. Thus far, most states have enacted mandatory reporting laws requiring the aforementioned professionals to report elder abuse cases to some designated authority or central state registry, with sanctions to be applied for failure to do so and protection from liability for violating any profession mandated confidentiality; but, the position of opponents in states that have not adopted mandatory reporting laws is that mandatory reporting is intrusive, ageist, and inappropriate as a response to the problem of elder abuse. It is also thought to reflect a bias toward viewing all older persons who are victims of abuse as judgment impaired and unable to take full responsibility for making decisions on how to live their lives.³

It is important to note that, even with mandatory reporting of elder abuse, the following issues must be considered: Competent abuse victims cannot be forced to accept services since they have the right to make their own life choices, and family caregivers of adults are not legally responsible for them in the same way as parents are responsible for the care of their children. Consequently, there are no easy answers for combating elder abuse. (3)

Set aside from any moral or idealistic obligation parents may have for their children, there is an obligation that supercedes any other-a legal obligation. Until children reach the age of 18, parents are legally bound to provide and ensure their welfare. Unlike children, though often treated as such, the elderly have no one to guarantee their welfare, housing, medical needs, proper nourishment, or quality of life. They become objects within the hustle and bustle of society; and, if they are not fortunate to have some connection to humanity, they will simply wither away.

ASSESSMENT/SIGNS OF ELDER ABUSE

Detecting elder abuse after it occurs is an important role for those in the helping professions, including those in the public safety sector, who function in situations in which the problem can be observed. Generally, there are two areas for detection: physical symptoms and behavioral symptoms.⁴ The former refers to obvious physical signs of maltreatment such as bruises, abrasions, burns, and so on. The latter pertains to the demeanor of the older person such as withdrawal, embarrassment, depression, rigorous denial, and so on. Although there is no assurance that these symptoms are necessarily related to elder abuse-except in cases in which there has been an accident or a fall or there is a general personality trait-you should refer the existence of such symptoms to the appropriate agency.

Assessment of elder abuse should entail pursuing an adequate explanation for the cause of an injury. Questions that provide clues pertaining to the existence of maltreatment are those that determine where the accident occurred, exactly what the victim was doing at the time of the injury, and what time the accident happened. Obviously, your suspicion should be aroused if the answers become illogical or implausible.

In addition, the following medical incidents may be significant: repeated visits to emergency rooms, accident-prone history, soft-tissue injuries, chronic pain, self-destructive behavior, eating and sleeping disorders, depression, substance abuse, and sexual abuse.⁵

Signs of elder abuse may be quite obvious or subtle.⁶ Obvious signs include bruises and head, chest, abdominal, and bone injuries. Subtle signs include undernourishment and a failure to thrive.

Inflicted bruises are usually found on the buttocks and lower back, genitals and inner thighs, cheeks and earlobes, and upper lip; inside the mouth; and on the neck. Pressure bruises caused by the human hand may be identified by oval grab marks, pinch marks, handprints, linear marks, and bruises that encircle the trunk.

Burns are a common form of abuse and are typically caused by contact with cigarettes, matches, heating devices, heated metal, forced immersion in hot liquids, chemicals, and electrical power sources.

Injuries to the head from direct blows are generally a high cause of mortality in the abused elderly. Specific head injuries also include lacerations and the pulling of hair from the scalp. Bleeding from the nose, wounds, burns of the lips and tongue, missing or loose teeth, broken bones in the face, and bruises in the corners of the mouth may indicate abuse.

Lack of hygiene, poor dental hygiene, poor temperature regulation in the home, and lack of reasonable amenities in the home may be indicative of neglect.

It is sad to think that elder individuals, who for all intents and purposes made our country what it is today, are viewed as a burden. These individuals have endured hard times, fought in wars, lived through the Depression, and witnessed overwhelming changes in society. Elders possess a gift like no other-life experience. Society could benefit greatly from these individuals, but we often allow these most precious resources to become useless entities.

It seems unlikely that the problem of elder abuse will soon disappear. Indeed, it is suspected that the problem will likely increase. Smith et al provide the following reasons for such a dire projection: the growth in the number and proportion of the elderly, especially the oldest of the old and those who are the most impaired and in greatest need of care; the fact that social changes are resulting in a decrease in the desire of families to take on caregiving responsibilities for the elderly; the decrease in the availability of family caregivers, given an increase in the likelihood of women working outside the home; and the economic conditions in society that result in high levels of poverty and unemployment.⁷ Therefore, firefighters and emergency medical service personnel must be vigilant and astute in their detection of elder abuse as well as in the reporting of suspected incidents of abuse, whether it is done because of a legal requirement or a moral obligation.

References

1. Harel, Z., P. Ehrlich, & R. Hubbard. The Vulnerable Aged: People, Services and Policies (New York: Springer, 1990), 140-141.
2. Tatara, T. Guidelines for Gathering and Reporting Domestic Elder Abuse Statistics, Washington, DC, National Aging Resource Center on Elder Abuse, 1990.
3. Brownell, P. “Elder Abuse: Policy and Practice for Social Workers.” In I.A. Gutheil (ed.), Work with Older People. (New York: Fordham University Press, 1994), 102.
4. Kosberg, J.L., “Preventing Elder Abuse: Identification of High Risk Factors Prior to Placement,” The Gerontologist; 1988, 28, 43-50.
5. McSwain, N., R. White, J. Pateras, & W. Metcalf. The Basic EMT. (St. Louis, Missouri: Mosey Lifeline, 1997), 503-504.
6. Brower, B., L. Jacobs, & A. Pollak. Emergency Care and Transportation of the Sick and Injured. (Sudbury, Mass.: Jones and Bartlett, 1999), 303.
7. Smith, G.C., S. Tobin, E.A. Robertson-Tchaba, & P.W. Power. Strengthening Aging Families: Diversity in Practice and Policy. (Thousand Oaks, Calif.: Sage, 1995), 77.

VINCENT J. VITIELLO is a captain/executive officer with the township of Maplewood (NJ) Fire Department. He is a state-certified fire official and fire instructor. He has bachelor’s degrees in health and physical education from William Paterson University and in fire safety administration from New Jersey City University and is a licensed social worker with master’s degrees in public administration from Kean University and in social work from Fordham University.