Journal

Elder Abuse and Neglect 

By Jason Helm

 Abstract

 Elder abuse and neglect is a form of abuse that has more recently come to the public’s attention.  Abuse is defined as misuse, perversion; unjust or corrupt practice; reviling; insulting or unkind speech. Neglect is defined as a form of abuse that consists of a failure to fulfill care-taking and protective responsibilities, which leads to injury or distress. The term abuse typically includes both active abuse and neglect. The three broad categories of abuse include physical abuse, psychological abuse, and the violation of personal rights. State law requires that caregivers report any signs of abuse to the proper authorities.  Abuse is a power struggle between the victim and the abuser where the abuse exerts their authority over an individual through physical, mental, or emotional means.  Due to various reasons, the victim is often reluctant to report abuse that is happening to them.  This is why identification and reporting is important.  Elder abuse is not only important because we want to protect those we love, but also because we all will grow old and may depend on others for our safety and well being.

Introduction

          Typically when one hears the term domestic abuse the first thoughts are in regards to child abuse or spousal abuse.  Elder abuse and neglect is another hidden form of abuse that has more recently come to the public’s attention.[1]  The elderly are often stereotyped as a class of individuals who because of their frailty invites criminality.[2]  This type of stereotype expresses victim-blaming. As with any other type of crime, this characterization of the victim fails to explain the true causation of the action.

          Before one can discuss possible reasons for elder abuse, you must first look at what exactly is the definition of abuse and neglect and what are the differences between the two concepts.  Next we will discuss how to identify abuse and neglect and how professionals such as doctors and caregivers must report any signs of abuse.  Finally this paper will discuss some possible reasons for elder abuse and why elderly individuals are often reluctant to report such abuse when it is occurring.

Concept of abuse and neglect         

          According to the Oxford English Dictionary, abuse is defined as the misuse, perversion; unjust or corrupt practice; reviling; insulting or unkind speech. Neglect is defined as a form of abuse that consists of a failure to fulfill care-taking and protective responsibilities, which leads to injury or distress.[3]  Generally abuse may be considered acts of commission whereas neglect may be considered as acts of omission.[4]  However, the term abuse typically encompasses both abuse and neglect.  The term active abuse generally refers to what is defined as abuse whereas the term passive abuse refers to what is defined as neglect.  Often when one form of abuse is present, other forms typically accompany it.

Identification of abuse and caregiver responsibilities

Every state in the U.S. have laws that address abuse and most have mandatory reporting laws requiring caregivers and health professional to report any signs of potential abuse.  These laws are very similar to laws that require the mandatory reporting of child abuse. In most states, reporting elder abuse legally supersedes a physician’s commitment to patient confidentiality.[9] An example of these types of laws in South Dakota can be found at SDCL 22-46. 

SDCL 22-46-1 defines abuse as “physical harm, bodily injury, or attempt to cause physical harm or injury, or the infliction of fear of imminent physical harm or bodily injury on a disabled adult.”  It further defines neglect as “harm to a disabled adult’s health or welfare, without reasonable medical justification, caused by the conduct of a person responsible for the adult’s health or welfare, within the means available for the disabled adult, including the failure to provide adequate food, clothing, shelter or medical care.  If a disabled adult is under treatment solely by spiritual means, the court may, upon good cause shown, order that medical treatment be provided for that disabled adult.”  SDCL 22-46-1 further defines a disabled adult “as a person 18 years or older who suffers from a condition of mental retardation, infirmities of aging as manifested by organic brain damage, advanced age or other physical dysfunctioning to the extent that the person is unable to protect himself or provide for his own care.”  SDCL 22-46-2 states that any person who abuses or neglects a disabled adult is guilty of a class 6 felony.  SDCL 22-46-6 allows for immunity from liability for reporting abuse or neglect of disabled adults.  This is to help insure that caregivers report signs of abuse and neglect without fear that they themselves would be blamed for their observations and concerns.

Most states consider mandatory reporters to be the following:  Physicians, physician assistants, medical interns, dentists, nurses, family counselors, social workers, policemen, firefighters, EMTs, psychologists, coroners, physical therapists, occupational therapists, osteopaths, podiatrists, executive directors of licensed home health agencies, managers of assisted living.  These individuals must report to their state agencies.  Failure to do so may result in fines.

Physicians are a crucial link in discovering and identifying potential elder abuse.  During examinations they are required to look for potential abuse and if any thing unusual is discovered, they are required to report their findings to the authorities.  Visual examinations are only the first step in diagnosing abuse; communication with the potential victim is also crucial.  The victims are often reluctant to freely give information so physicians must ask a series of questions in order to unearth possible answers.  Some possible questions doctors may ask are:[14]

1.            Physical abuse questions

a.     Are you afraid of anyone at home?

b.     Have you been kicked or shoved?

c.      Have you ever been tied down or locked in a room?

d.     Have you ever been force-fed?

e.     Has anyone touched you in a sexual way without permission? 

2.            Psychological abuse questions

b.     Have you been threatened with punishment or institutionalization?

c.      Have you received the silent treatment?

3.            Financial/Personal rights abuse questions

a.     Is money being stolen from you or used inappropriately?

b.     Are you given adequate information about your finances?

d.     Does you caregiver spend your money on themselves?

b.     Have you been left alone for long periods of time?

c.      Is your home safe?

5.            Follow up questions if abuse is identified

b.     How many times has it happened?

c.      Why do you think it happens?

d.     When do you think it will happen again?

e.     Is the abuser present?  Do you know their name?

f.       Do you feel it is safe to return home?