Sample The Knowledge Of Health And Social Care Professionals About Elder Neglect

Running head: ELDER NEGLECT 1

The Knowledge of Health and Social Care about Elder Neglect

Name:

Instructor:

ELDER NEGLECT 2

Introduction

The mistreatment of the elderly has been widely depicted in ancient literature. However,

with the introduction of the concept in scientific literature in 1975 (Dong et al., 2009), abuse of

the elderly (AO) emerged as a pertinent research and public health issue (Rinker, 2009). By

1981, a US Congressional committee study established that up to 4% of the elderly demographic

had experienced varying degrees of abuse and neglect (Rinker, 2009). In the following years,

various initiatives such as the Annual World Elder Abuse Awareness Day had been implemented

to increase public awareness about senior abuse and neglect (Rinker, 2009). Elder abuse

encompasses various forms of abuse and mistreatment such as sexual abuse and self-neglect or

the latter’s more extreme variant, Diogenes syndrome (Dong et al., 2009). This paper will focus

exclusively on abuse to the extent that it relates to elder neglect.

Elderly neglect is a timely research and health issue due to the ageing of the global

population. By 2050, 20% of the global population is expected to be aged 60 years and above, up

from a global average of 605 million people (Oyetunde, Ojo, and Ojewale, 2013). Even more

alarmingly, 33% of global demographics are estimated to be made up of this age group by 2150

(Oyetunde, Ojo, and Ojewale, 2013). Furthermore, octogenarians are expected to make up 19%

of the “senior” age group by 2050, the fastest growing segment, while centenarians are

anticipated to increase fifteen fold over the same period.

The significance of this demographic shift is that it has also led rise of adding-related

diseases. Indeed, degenerative aging-related diseases such as cardiovascular diseases (ischemic

and coronary heart disease and stroke), neurodegenerative diseases (dementia, Alzheimer’s and

Parkinson’s disease), endocrine disorders (type 2 diabetes) and cancer have propelled the global

pandemic of non-communicable diseases (NCDs) (Oyetunde, Ojo, and Ojewale, 2013). Among

ELDER NEGLECT 3

the developing world’s elderly (≥60 years), NCDs account for twice the number of deaths when

compared to mortalities attributed to NCDs among those below 60 years (Bloom et al., 2011).

This epidemiological transition reflects the reality in the more industrialized nations: in the

developed world, non-communicable diseases and cardiovascular diseases already account for

the most number of deaths and morbidities (Niccoli and Partridge, 2012; Blokh and Stambler,

2015). Blok & Stambler (2015) and North & Sinclair (2012) demonstrate that age has the most

important influence on disease morbidity while Chaudhry et al. (2013) argue that as one’s age

increases, so too does the risk of hospitalization. It is during hospitalization or when professional

care is delivered for geriatric conditions that the risk for neglect and abuse develop (Oyetunde,

Ojo, and Ojewale, 2013).

Several of these geriatric disorders are chronic, requiring long-term custodial care, during

which the risk of neglect, exploitation and abuse by desensitized caregivers and other

perpetrators increases (Oyetunde, Ojo, and Ojewale, 2013). Indeed, long-term caregivers are at

greatest risk for desensitization from burnout and compassion fatigue from exposure to traumatic

emotional experience and the struggle of those suffering from ageing-related conditions (Day

and Anderson, 2011). Elder neglect has come to consume the interests of policymakers, health

care providers, social welfare professionals, and the public in general. As the elderly population

continues to expand, it is inevitable that elder abuse will remain a crucial public health policy

issue due to its economic, social and personal implications (Pillemer, Burnes, Riffin, and Lachs

2016).

In response, governments have implemented various policy initiatives to enhance care

and provide protection to the elderly that are in custodial or home care. In the U.K., national

standards such as the National Service Framework for Older People (2001) or the Fair Access to

ELDER NEGLECT 4

Care Services (2003) and legislations such as the Safeguarding Vulnerable Groups Act (2006)

provide the policy framework to support the elderly that are vulnerable to abuse or caregiver

neglect (Biggs, Mathorpe et al., 2009). These policy instruments and national campaigns such as

“Dignity in Care”, “No Secrets” and “In Safe Hands” emphasize the targeted approach of

protecting vulnerable adults (Biggs, Mathorpe et al., 2009).

This intensified international interest in research has raised questions on the scientific

research methods, definitions and theory underpinning elder mistreatment (Malmedal, Iversen,

and Kilvik, 2015). Presently, there are no universal definitions of what constitutes AO nor are

there standardized research methods that establish definitive prevalence rates (Malmedal,

Iversen, and Kilvik, 2015).

For instance, precisely defining “old age” is a challenge in itself (Phelan, 2015). Certain

researchers have deferred to the traditional and chronological state definition of old age, which,

once attained, entitles one to a pension (Phelan, 2015). For instance, in the United Kingdom, this

figure stands at 65 years of age. International organizations such as the World Health

Organization (WHO) have a threshold lower by five years. In response to demographic shifts,

other researchers divide the elderly demographic into the “young old” and “old old”, placing

boundaries between relative youth and “oldness” (Phelan, 2015; Sweiry and Willitts, 2012).

Interestingly, male individuals are categorized as “old” earlier than their female counterparts,

further blurring the line between what exactly constitutes old age (Sweiry and Willitts, 2012).

Regardless, this paper will focus on the U.K.-specific age group of 65 years old and above.

ELDER NEGLECT 5

Figure 1: Perception of the end of youth and start of old age, organized by mean age and gender (Adapted

from (Sweiry and Willitts, 2012))

Figure 2: Perception of the end of youth, organized by survey year and survey respondent’s age bracket

(Adapted from (Sweiry and Willitts, 2012))

ELDER NEGLECT 6

Figure 3: Relationship between survey respondents ‘age bands and the perception of the end of

youth and when old age starts (Adapted from (Sweiry and Willitts, 2012))

Research Objectives

The preceding portion of this paper has briefly outlined the demographic challenges that

have precipitated the heightened research focus on elderly neglect. The following portions will

enumerate and explain the challenges health care providers in detecting and reporting abuse of

elderly persons (AO) and the perceptions and attitudes of these same professionals in handling

the elderly patient. An understanding of gaps in knowledge and attitudes is essential because, as

elderly patients demand greater health services and community care, inefficient interventions and

countermeasures to neglect and mistreatment will only worsen the situation of the vulnerable

adult patient.

In agreement with this background, this author aims to answer the following research questions:

i. What is the prevalence of elder neglect, particularly in the health care setting?

ii. What are the definitions of AO by health and social care professionals?

ELDER NEGLECT 7

iii. What is the extent of the knowledge and attitudes of these professionals about elder

neglect?

iv. What factors influence their knowledge of this issue?

Methodology

This author selected to conduct a systematic literature review of secondary research

obtained from peer-reviewed journals. Scientific literature published in English in 2009 or after

from digital databases such as Social Care Online, Applied Social Sciences Index and Abstracts,

ASSIA, Scopus, Zetoc and ScinceDirect were reviewed. The literature search was conducted

using the following search terms, in combination and otherwise:

i. “the knowledge”, “the attitude”, and “the perception”; These terms are associated with

the experiences and views of health/social care personnel as they provide care to

older clients

ii. “health care” and “social care”: These terms encompass the care provided to the elderly

in institutional and community settings by professionals

iii. “elder neglect”, “elderly neglect”, and “older people neglecting”: These terms cover acts

of mistreatment towards elderly patients. Notably, these terms were so constructed as

to avoid selecting literature that discussed and explored self-neglect as opposed to

neglect perpetrated by others

This search strategy yielded thirty seven (37) papers. The rationale for selecting the

parameters of the inclusion criteria was, firstly, to identify material with scientific credibility (i.e.

peer-reviewed and with original analysis). Secondly, the selection was intended to generate

literature with an element of recency. This criterion was necessary to avoid reviewing material

ELDER NEGLECT 8

that is debunked or further clarified in late years. Thirdly, the literature was intended to focus

exclusively on research conducted on elder neglect within social and health care settings,

avoiding the increasingly vast material available on, for instance, self-neglect. The inclusion

criteria were as follows:

i. Primary or original research into the perceptions of, knowledge in, and attitudes about

elderly neglect among health and social care professionals

ii. Published in 2009 or later

iii. Published in a peer-reviewed scientific journal and

iv. Qualitative or quantitative research exclusively conducted about elder neglect

Studies were excluded if they:

i. Duplicated data from other sources

ii. Reported on lifetime abuse instead of elder abuse

iii. Reported abuse for respondents less than 60 years of age

iv. Reported on general issues of elder neglect as opposed to health/social care professionals’

attitudes

v. Provided prevalence data, but did not include a description of perpetrator attitudes

Out of the 37 articles, eight (8) articles were selected as they met the selection criteria for

original research, recency, credibility, and desirable scope of research. Of the 29 articles that

were excluded, 17 were eliminated on the basis of their titles, abstracts, and reference lists while

the remaining 12 were excluded primarily due to data and research duplication and inability to

obtain full access.

ELDER NEGLECT 9

Definitions of Elder Neglect

Development of a succinct definition for elder or senior neglect has been problematic,

with various researchers suggesting and legislative jurisdictions enforcing different meanings an

interpretations (Killick et al., 2015). Indeed, a plethora of terms currently exist to describe this

phenomenon: “granny battering”, elder mistreatment, elder exploitation, senior abuse, abuse of

older persons (AO), inadequate care of the elderly, “missed care” and even “granny abuse”

(Malmedal, 2013). The World Health Organization (WHO) recognizes the following

interpretation of elder abuse: ‘a single, or repeated act, or lack of appropriate action, occurring within

any relationship where there is an expectation of trust which causes harm or distress to an older person’

(Galpin, 2010). In the United Kingdom (U.K.), the meaning of “adult abuse”- the preferred term- is

expanded into ‘a single or repeated acts. It may be physical, verbal or psychological, it may be an act of

neglect or failure to act, or it may occur when a vulnerable person is persuaded to enter into a financial or

sexual transaction to which he or she has not consented, or cannot give consent’, which is also similar to

the meaning in the majority of US States (Malmedal, 2013; Galpin, 2010).

Elder abuse is categorized into five typologies: physical abuse; sexual abuse;

emotional/psychological abuse; financial exploitation; neglect; and two other types, self-neglect and

abandonment (Rinker, 2009). Neglect is the intentional refusal or failure of a caregiver to provide the

essential care and services necessary to a vulnerable adult (Rinker, 2009). Self-neglect, on the other hand,

is characterized by the self-endangering behavior of an elderly adult, who may or may not be mentally or

physically incapacitate (Rinker, 2009).

ELDER NEGLECT 10

Table 1: A summary of common definitions (Adapted from (Malmedal, 2013))

ELDER NEGLECT 11

Figure 4: Definitions of the various typologies of elder abuse (Adapted from (Biggs, Mathorpe et al.,

2009))

However, by framing the discussion of the definition to include only intentional abuse,

researchers are imposed in their investigation of elder care that, though not willfully neglectful, is

inadequate due to poor training of or ignorance by well-meaning health/social care staff and other

caregivers (Malmedal, 2013). Indeed, this situation more closely mirrors the definition that the health care

professional would be most familiar with. Admittedly, whether intentional or unintentional, and in line

with WHO’s definition, it still results in a negative impact (harm) (Malmedal, 2013). Nonetheless, this

author defers to the following definition, which is perhaps the most operational definition for the health

ELDER NEGLECT 12

care setting: “the failure of an individual responsible for caretaking to respond adequately to established

needs for care” (Malmedal, 2013).

Figure 5: Inadequate care (Adapted from (Malmedal, 2013))

Vulnerability

A vulnerable adult is one that is incapable of protecting himself/herself from exploitation,

neglect, or abuse due to development disability or a physical or mental impairment (Podnieks et

al., 2010). In this paper’s context, this impairment is anticipated to have been occasioned by

advanced or advancing age.

Experiences of abuse and mistreatment are pervasive within the elderly demographic

(Mansell et al., 2009). Remarkably, news of mistreatment of the old is not as sensational as, say,

child abuse and the issue has often attracted apathetic government intervention, disregarding the

special needs of the elderly for protection from and rehabilitation after abuse (Galpin, 2010). It is

sometimes not difficult to convincingly argue that the rights of the elderly have been relegated

behind those of other vulnerable groups such as children.

ELDER NEGLECT 13

Among the old, females are the most likely (3.8%) to be at the receiving end of

mistreatment than men (1.1%) (Biggs, Mathorpe et al., 2009) due to the triple blow of ageism,

female stereotypes, and institutionalized employment discrimination. For instance, despite the

concerted efforts to protect young women from the agony of domestic violence, older female

victims do not have access to policy relief and are seldom recognized (Galpin, 2010).

In addition to gender, other factors that predispose the elderly individual to mistreatment

and abuse include: living arrangement and housing tenure (renting vs. owner-occupier), poor

health status (disability, dementia, and depression), low social contact (divorce, marital

separation, widowed), ethnicity, past and present occupation, and past inequalities in education

and employment (Galpin, 2010; Biggs, Mathorpe et al., 2009; Mansell et al., 2009).

Table 2: 1-year prevalence of different types of abuse, by age and gender (Adapted from (Biggs,

Mathorpe et al., 2009))

ELDER NEGLECT 14

Prevalence of Elder Neglect

For several reasons, the global prevalence of elder abuse cannot be definitively stated

(Malmedal, Iversen and Kilvik, 2015; Gutman and Yon, 2014). Firstly, research in this field is

still nascent and where research is available, there are disagreements on the definitions and

research methodologies to use (Gutman and Yon, 2014). For instance, while there are five major

typologies agreed to in literature- psychological/emotional, financial, sexual, and physical abuse

and neglect- there are disagreements on any other measures (Gutman and Yon, 2014; McDonald,

2011). Furthermore, there is poor public awareness about senior neglect and health care

professionals are not sufficiently well trained to detect abuse and under-report any such

detections. For these reasons, there are a variety of prevalence figures for this phenomenon. It is

critical to understanding global prevalence research so as to put U.K. national figures in

perspective.

Gutman and Yon (2014) cite a prevalence of between 3-10%, while Malmedal, Iversen,

and Kilvik (2015) report a prevalence of 0.3% of UK residents aged 65 years and above for

sexual abuse, 0.6.% in the USA and 1.2% and 2.2% among similarly aged men and women

respectively in Sweden. In a 1-year prevalence calculation study synthesized from twenty (20)

peer-reviewed journal articles, Pillemer, Burnes, Riffin, and Lachs (2016) reported the following.

Nigeria had the largest prevalence rate of physical abuse at 14.6%, while Canada and the United

States reported the lowest at 0.5% and 1.4% respectively. India (4.3%) and China (4.9%) had

higher incidences than Europe at 1.67%. Nigeria had the lowest prevalence of elder sexual abuse

(0.04%), lower than the US (0.5%) and Europe (1%) (Pillemer, Burnes, Riffin, and Lachs 2016).

Nigeria (13.1%) and Israel (6.4%) had the highest incidence of financial exploitation/abuse, far

higher than Mexico (2.6%), US (4.5 percent) and Europe (3.9%). Using a substantive threshold

ELDER NEGLECT 15

criteria that required occurrence of ≥10 incidents in the past 12 months (from the same

perpetrator) and elder perception of harm/seriousness, India (10.8%) reported the highest

emotional/psychological abuse rates while Canada (1.4%) and Europe (2.9%) registered rates

lower than the mean, 3.3% (Pillemer, Burnes, Riffin, and Lachs 2016). Once again, India

registered the highest prevalence rates of neglect (4.3%) against a mean of 3.1%. Europe had the

lowest neglect prevalence at 0.5%, better than the United States’ 1.1% prevalence (Pillemer,

Burnes, Riffin, and Lachs 2016).

Within the context of the elder neglect in the United Kingdom, three (3) crucial terms are

used, that is (Biggs, Mathorpe et al., 2009):

I. “Mistreatment”, encompassing all typologies of abuse and, critically, neglect as well. In

this sense, neglect is operationally defined as the “repeated deprivation of assistance

needed by the older person for important activities of daily living” (Biggs, Mathorpe

et al., 2009). As in the previous section detailing global prevalence, threshold criteria

are deployed to define these terms. For instance, neglect is taken to have occurred if

at least 10 incidents have been perpetrated against a vulnerable adult over a 12 month

period

II. “Abuse”, in reference to all typologies of abuse but excluding the concept of neglect, and

finally

III. “Interpersonal abuse” which relates to abuse at the sexual, phsycial and psychological

levels.

As already indicated, this paper will focus on mistreatment in as much as it relates to neglect

due to its caregiver component. Ina national survey of 2,100 respondents (65 years and older)

from all four countries of the United Kingdom, Biggs, Mathorpe et al. (2009) report the

ELDER NEGLECT 16

following. Firstly, the difference in prevalence rates between England, Wales, Scotland, and

Northern Ireland were not statistically significant, coming in at 2.6%, 3.1%, 3.0%, and 2.0%

respectively. Of interest is that neglect (1.1%) was the most prevalent typology of mistreatment

in all four countries compared to sexual (0.4%), financial (0.7%), physical (0.4%), and

psychological abuse (0.4%). In proving that types of mistreatment often occur in combination,

6% of respondents experienced at least two unlike types of mistreatment. The national average

stood at 2.6% for a 12-month recall period, a total in excess of 230,000 UK citizens. This rate is

generally in line with literature cited in the preceding section on global incidence of elder

neglect.

Secondly, once the perpetrator definition was expanded from trusted caregivers such as

family and care workers to neighbors and personal acquaintances, the average national

prevalence rate increased to 4.0% (>340,000 of those aged 66 years and above) (Biggs,

Mathorpe et al., 2009). Once again, Biggs, Mathorpe et al. (2009) demonstrate, as has already

been done previously by this author, that definitions can affect prevalence data. Furthermore, in

addition to reporting higher levels of mistreatment compared to men (3.8% vs. 1.1%), women

also experienced more neglect as they grew older than their male counterparts. Importantly,

sexual abuse among women decreased with age, unlike the case in men.

Thirdly, 70% of respondents that had experienced one form of mistreatment or the other

reported the incident. For instance, men aged ≥85 years reported financial abuse 6x more than

men between 66 and 84 years of age (0.4%). (Biggs, Mathorpe et al., 2009).

ELDER NEGLECT 17

Table 3: Summary of select findings: 1-year prevalence of elder abuse in the United Kingdom,

2009 (Adapted from (Biggs, Mathorpe et al., 2009))

Perpetrator Characteristics

The majority of abuse that is committed by perpetrators of whom there is a reasonable

expectation of trust (Biggs, Mathorpe et al., 2009). Perpetrators are usually identified by the

setting in which the abuse happened. They could be spouses, family members, friends, and

acquaintances in community settings and caregivers in institutional settings. Where there were

multiple perpetrators, approximately half (51%) of all mistreatment incidents were committed by

spouses, quarter (24%) by children to the older person, almost half (49%) by another relative, 5

percent by a friend and 13% by a caregiver (Biggs, Mathorpe et al., 2009). In financial abuse

incidents, 56% of perpetrators were men and 44% were women, but the majority of interpersonal

abuse was committed by men (80%) (Biggs, Mathorpe et al., 2009).

ELDER NEGLECT 18

Table 4: Perpetrator-victim relationship, by type of abuse (Adapted from (Biggs, Mathorpe et al., 2009))

Impact of Elderly Neglect

Elder abuse evokes several reactions from its victims. (Malmedal, Iversen, and Kilvik,

2015) document suicide ideation and note that 55% (11) of older patients in an institution where

they had been sexually assaulted by fellow patients or health care staff died in the twelve months

that followed. In a survey of 2,100 people, (Biggs, Mathorpe et al., 2009) report that 77% reacted

emotionally and 49% had a confrontational response. 33% of respondents perceived that the

abuse had had a very serious effect, while 43% conceded that they felt the effects were serious.

Furthermore, 70% of respondents took some form of action. Of this 70%, 30% resorted to

seeking help from a health or social care professional.

Reporting of Elderly Abuse

Still, 30% of those that suffered abuse and mistreatment did not report the incident

(Biggs, Mathorpe et al., 2009). Victims fail to report this abuse due to fear of victimization,

abandonment, and retaliation, a sense of helplessness, embarrassment, feeling of shame, self-

ELDER NEGLECT 19

blame and desire to avoid breaking up the familial or friendship bonds (Anderson, 2015;

Anthony, Lehning, Austin and Peck, 2009).

In some jurisdictions, such as the United States, health care professionals and social

workers are obligated by law to report incidents of elder neglect, just as much as they are

required to report incidents of child abuse (Daly, Schmeidel and Jogerst, 2012; Schmeidel, Daly

et al., 2012). However, review of medical research literature provides reporting compliance of

between 2% (among physicians), 18% (social workers) and 26% (nurses) (Daly, Schmeidel, and

Jogerst, 2012). (Schmeidel, Daly et al., 2012) reports that as many as 60% of gerontologists

never ask their patients about abuse. Meanwhile, Alana (Anderson, 2015) notes that, on average,

physicians have the lowest reporting rates compared to home care workers, community

members, and social workers.

Health care providers fail to report abuse for several reasons: fear of triggering an

escalation in abuse; failure to screen diligently for abuse due to lack of time, resources or

specific diagnostic/detection guidelines; reluctance to be involved in criminal or civil

proceedings; fear of liability; fear of jeopardizing rapport and trust with the patient; lack of faith

in the adequacy of the reporting and intervention system; reluctance to cede practitioner

autonomy; and ignorance in or lack of familiarity with the protocol to detect and the bureaucratic

process of reporting (Anderson, 2015; Daly, Schmeidel and Jogerst, 2012; Schmeidel, Daly et

al., 2012; Killick and Taylor, 2012). Indeed, clinicians are most likely to under-report than over-

report (Killick and Taylor, 2012). When decisionally competent, the client’s wish to avoid action

or investigation significantly affects the practitioner’s ability report abuse (Killick and Taylor,

2012). However, unlike in Great Britain, mandatory reporting in Northern Ireland has led to

higher rates of reporting (over-reporting) in line with the ‘mandated reporter’ effect (Killick and

ELDER NEGLECT 20

Taylor, 2012). Paradoxically, mandatory reporting leads to loss of patient-physician rapport and

thereby, lesser patient trust, in addition to loss of physician control (Killick and Taylor, 2012).

In light of this, (Schmeidel, Daly et al., 2012) details how practitioners relegate elder

abuse reporting in favor of immediately critical pathologies such as heart disease: in their study,

the researchers document practitioners conceding that they have limited time bandwidth and

have to prioritize and elder abuse is not necessarily a significant priority. Social care providers,

nurses, and physicians shifted responsibility regarding whose duty it was to identify, ascertain,

and report neglect: nurses felt that reporting abuse was beyond their licensure; physicians felt

that nurses were in a good position to identify abuse due to their close proximity to the patients;

and social workers were reluctant to ask patients about abuse due to fear of alienating clinicians

(Schmeidel, Daly et al., 2012).

Ageism in the General Population

Ageism is a term that encompasses the prejudicial attitudes towards older people and,

despite introduction into the researcher’s vocabulary in 1969, is still under-studied compared

with other forms of discrimination such as gender, ethnic, and social discrimination (Abrams,

Eilola, and Swift, 2009). In a survey-based study, Abrams, Eilola and Swift (Abrams, Eilola, and

Swift, 2009) assessed the attitudes of sample of the general UK population and established that

age is a significant predictor of attitudes towards the elderly. 26% of respondents reported

experiencing age-related discrimination. Indeed, age stereotypes informed the perception

formation of respondents: almost all (94%) of the respondents conceded that individuals above

70 years of age experienced age-related discrimination. In another related study, 80% of

ELDER NEGLECT 21

respondents reported that age-related discrimination is very or fairly serious and that 34% had

experienced age prejudice over the recall period (past 12 months) (Sweiry and Willitts, 2012).

Moreover, individuals in this age bracket were assessed to have lower competence

compared to those less than 30 years of age. At the same time, younger respondents felt they had

little in common with those above 70 and positively related with those under 30: less than 33%

of young respondents (under 30) had older friends (70 and above) (Abrams, Eilola, and Swift,

2009). This social distance severely affects intergenerational contact and further perpetuates age

stereotypes.

Table 5: Mean rating of the frequency of age prejudice in the past 12 months, by socio-demographics

(Adapted from (Sweiry and Willitts, 2012))

ELDER NEGLECT 22

Ageism: Perceptions and Attitudes of Health and Social Care Professionals

In a landmark study of prevalence of institutional elder mistreament, 10% of respondents (n=577)

self-reported physical abuse in the preceding 12 months compared to 36% who reported to have observed

the same by others (Malmedal, 2013). 40% admitted to have committed psychological abuse while 81%

claimed to have observed psychological mistreatment by others (Malmedal, 2013). Nevertheless, this

tendency to notice neglectful behavior by other practitioners is not novel: Reader and Gillespie (Reader

and Gillespie, 2013) report similar discrepancies in nursing staff perception of patient neglect. In another

publication, 8% of complaints to the USA Ombudsman Reporting System (n=4,000) related to nursing

home abuse (Malmedal, 2013). Another recent study established that 4.2% of patients committed into

long-term care had been subject to physical abuse, 13% to emotional abuse, 0.6% to sexual abuse, 16.2%

to neglect and 9.2% to financial exploitation (Post, Page, et al., 2010). Furthermore, the survey

established that each patient was 51.4% likely to have experienced multiple types of abuse (Post, Page, et

al., 2010). It seems irreconcilable that medical personnel entrusted with the care of vulnerable adult

patients would mistreat, neglect, and abuse them.

ELDER NEGLECT 23

Indeed, nurses and other hospital care providers (HCPs) have a generally positive attitude to

caring for elderly patients and do not deny their patients’ special care needs (Oyetunde, Ojo, and Ojewale,

2013). In fact, over 95 percent of survey respondents (n=400) acknowledged elder abuse was not rare

(Rinker, 2009). Ironically, only 49.75% of the respondents deny having come into contact with victims of

senior abuse in the preceding 12 months, hinting at possible inadequate screening or under-reporting

(Rinker, 2009).

Shinan-Altman and Cohen (Shinan-Altman and Cohen, 2009) provide another possible

explanation: nursing staff at nursing homes have a high prevalence of attitudes that condone abusive

behaviors, which in turn endanger the welfare of their elderly clients. These attitudes are precipitated by

several factors, notably: role conflict and ambiguity due to poor coordination, lack of proper skills, lack of

autonomy, and undefined roles; and burnout, from working extra hours due to wage pressure or client

demands (Shinan-Altman and Cohen, 2009). The higher the burnout and work stressors, the lower the

sense of job dissatisfaction and personal achievement among nursing staff. In turn, these factors lead to

depersonalization, psychological distancing, ageism, and provision of lower quality of care to elderly

people (Shinan-Altman and Cohen, 2009). In this regard, it is essential to provide competitive salaries,

invest in personnel training programs and grant non-physician staff greater autonomy in their HCP teams.

Increasing the knowledge of health care providers about the needs of older patients may also counter

ageist attitudes and stem the entrenchment of negative attitudes that condone abuse and neglect (Allan

and Johnson, 2009).

ELDER NEGLECT 24

Table 6: Nursing attitude towards elder care (Adapted from (Oyetunde, Ojo, and Ojewale, 2013))

Figure 7: The relationship between work stressors, work burnout, self-perceived work autonomy, and

attitudes condoning senior abuse (Adapted from (Shinan-Altman and Cohen, 2009))

Recent research into patient neglect- the failure of a designated care giver to meet the

needs of a dependent so as to ensure minimal quantity of work performed (Reader and Gillespie,

2013) - recognizes two aspects: procedure neglect and caring neglect. The concept of patient

neglect fits into the larger narrative of “patient abuse”, which is the willful attempt by a HCP to

inflict harm on a patient (Reader and Gillespie, 2013). Whereas laziness to change a patient’s

linen is considered patient neglect, withholding food is considered patient abuse. Another

important distinction must be made between a medical error due to, for example, lack of training,

ELDER NEGLECT 25

poor care because of bona fide mistakes and neglect such as avoiding to shampoo a patient.

These distinctions have been made elsewhere in this paper.

Procedure neglect is the purposeful failure to meet professional medical standards in the

provision of care such as failure to feed an incapacitated patient. On the other hand, caring

neglect is the provision of care below threshold or protocolized treatment that, although does not

cause immediate harm, depicts staff as unconcerned about the patient’s welfare. An instance of

caring neglect is the callous dismissal of complaints of pain. Family members and patients report

higher prevalence rates for caring neglect than HCPs (Reader and Gillespie, 2013). To illustrate

this divergence in perceptions about patient neglect, (Reader and Gillespie, 2013) points at

previous research in the area: in one quoted study, 73% of elderly patients reported caring

neglect during their hospitalization and, in another, 21% of a patient’s relatives perceived neglect

such as failure to provide food or failure to reposition a patient in the bed to avoid bed sores.

The most common proximal causes, as already highlighted in a previous study, are high

workloads, lack of training, burnout, and conflict within the multidisciplinary HCP teams

(Reader and Gillespie, 2013). Distal causes include organizational gaps in resource allocation,

coordination, and strategic mis-alignment with patient needs and objectives.

ELDER NEGLECT 26

Figure 8: Model of patient neglect (Adapted from (Reader and Gillespie, 2013))

These factors play a large role in entrenching acceptance and expectation of senior abuse

(Pillemer, Burnes, Riffin, and Lachs 2016). Furthermore, the normalization of the attitude that

elderly patients are burdensome, coupled with the lack of intergenerational contact between the

younger and able-bodied HCPs and their patients, has precipitated a situation of apathy

(Pillemer, Burnes, Riffin, and Lachs 2016). When perceptions are cross-culturally reviewed,

notable variations can be unearthed (Bowes, Avan, and Macintosh, 2012). For instance, gender-

based violence is normalized in the Korean context while violence is structurally embedded in

the local Chinese value systems (Bowes, Avan, and Macintosh, 2012). A culturally-sensitive

analysis of perceptions is critical in further establishing HCPs attitudes.

Self-efficacy among Hospital Care Providers (HCPs) providing care to elderly patients

Self-efficacy is the confidence in one’s own ability to produce a desired effect (Anderson,

2015). Within the context of providing care to elderly patients, self-efficacy of HCPs would refer

ELDER NEGLECT 27

to the confidence to meaningfully impact the quality of care (Anderson, 2015). Abilities such as

screening competence, knowledge of reporting protocols, and an ability to identify and overcome

obstacles, gained through observational learning, are critical to bolstering self-efficacy scores

among these professionals and their commitment to improving care quality (Anderson, 2015).

Concluding Arguments

The ongoing global shift in demographics due to modern medicine has, unfortunately, led

to the violent emergence of the theme of elder neglect and abuse or, as it is referred to in health

care settings where the elderly are increasingly becoming institutionalized, patient neglect.

Hospital care providers (HCPs) are the chief perpetrators of patient abuse and neglect, despite

their legal and ethical contract with their clients. Risk factors that have led to this turn of events

include ageism, high workloads and low time bandwidth, low self-efficacy and a normalization

and expectation of elder mistreatment. For instance, due to the prevalent notion that the elderly

are asexual, sexual abuse may not be taken as seriously as it taken happens in child abuse

contexts. AO must be viewed in the larger scope of human rights: geriatric rights are no less

important than those of any other demographic. In fact, due to their vulnerability, policy should

aggressively protect the elderly patient.

Mandatory reporting may have only worsened the situation due to reluctance by HCPs to

ask their clients about abuse for fear of jeopardizing their welfare, confidentiality, and goodwill.

While non-HCP neglect can be resolved though formation of a therapeutic alliance with other

stakeholders such as relatives and social case workers, patient neglect requires more systematic

intervention such as re-training of staff and better resource allocation.

ELDER NEGLECT 28

Research into abuse of elderly persons is still evolving. There is still a lack of definitive

information on the typologies of elder abuse (EA), their costs and impact on individuals and the

society in general, and ameliorating countermeasures. Far more research has been undertaken in

child abuse and perpetrator patho-psychology than has been in EA. Longitudinal research into

EA perpetrator psychology, victim reactions, and predisposing factors is required. Aging-related

studies such as those commissioned to understand economic burden of retirees could prove

valuable to this end. Along this vein, there is near total scientific silence of systematic literature

reviews of interventions, particularly in the framework of evidence-based practice. A clearer

understanding of the impact of cultural diversity on perceptions is still lacking, an obstacle that

can be overcome via cross-national and minority studies in developed and developing countries

alike.

An emphasis in renewed geriatric training is critical in resolving the impending crisis of

EA. Competence among HCPs is crucial in, firstly, confronting this phenomenon at the source

(during visits and consultations) and, secondly, in preventing abuse and rehabilitating victims.

HCPs are willing to provide better care and report strong suspicions of abuse, but are currently

encumbered by regulatory inadequacy, bureaucratic strangling, and low self-efficacy. This

requires a renewed focus on policy that: i) Provides financial incentives for continuous education

(CE) geriatric training; ii) Compensates physicians for the time spent investigating and reporting

elder abuse; iii) Simplifying reporting structures; iv) Encourages whistle blowing that is followed

immediately by time-bound investigation of claims. Nursing staff providing care to the elderly

should work closely with social care workers as part of a multidisciplinary care team that is

patient-focused without bureaucratic separation. Integration of these various stakeholders could

prove to be both a short- and long-term countermeasure against low self-efficacy among HCPs.

ELDER NEGLECT 29

These issues should form the basis for an ongoing conversation of evidence-based reform

in geriatric medicine. This conversation will require concerted and collaborative effort by

legislative, social welfare, HCPs, and community stakeholders in resolving abuse of this

vulnerable demographic.

ELDER NEGLECT 30

References

1. Abrams, D., Eilola, T., and Swift, H. (2009). Attitudes to age in Britain 2004-2008.

DWP Research Report No 599: HMSO. Available at:

http://research.dwp.gov.uk/asd/asd5/rports2009-2010/rrep599.pdf

2. Anderson, A. Nurses’ Self-Efficacy For Managing Elder Abuse. The University of Texas

at Tyler, Dissertation, 2015

3. Allan, L.J., & James A. Johnson. (2009). Undergraduate Attitudes Toward the Elderly:

The Role of Knowledge, Contact and Aging Anxiety. Educational Gerontology, 35:1, 1-

14, DOI: 10.1080/03601270802299780

4. Bowes, A., Ghizala Avan, and Sherry Bien Macintosh. Cultural Diversity and the

Mistreatment of Older People in Black and Minority Ethnic Communities: Some

Implications for Service Provision. Journal of Elder Abuse & Neglect, 24:251–274, 2012

5. Amy N. Schmeidel, Jeanette M. Daly, et al. Healthcare Professionals’ Perspectives on

Barriers to ElderAbuse Detection and Reporting in Primary Care Settings. J Elder Abuse

Negl. 2012 ; 24(1): 17–36. doi:10.1080/08946566.2011.608044.

6. Anthony, E., Lehning, A., Austin, M., & Peck, M. (2009). Assessing elder mistreatment:

instrument development and implications for adult protective services. Journal of

Gerontological Social Work, 52, 815-836. doi:10.1080/01634370902918597

7. Biggs S, Manthorpe J, Tinker A, et al. Mistreatment of older people in the United

Kingdom: findings from the first national prevalence study. Journal of Elder Abuse &

Neglect 2009;21:1-14.

ELDER NEGLECT 31

8. Blokh, D., & Stambler, I. (2015). Information Theoretical Analysis of Aging as a Risk

Factor for Heart Disease. Aging and Disease, 6(3), 196–207.

http://doi.org/10.14336/AD.2014.0623

9. Bloom, D.E., et al. (2011). The Global Economic Burden of Noncommunicable Diseases.

Geneva: World Economic Forum.

10. Chaudhry, S. I., et al. (2013). Risk Factors for Hospitalization Among Older Persons

Newly Diagnosed with Heart Failure: The Cardiovascular Health Study. Journal of the

American College of Cardiology, 61(6), 635–642.

http://doi.org/10.1016/j.jacc.2012.11.027

11. Daly, J. M., Schmeidel Klein, A. N., & Jogerst, G. J. (2012). Critical Care Nurses’

Perspectives on Elder Abuse. Nursing in Critical Care, 17(4), 172–179.

http://doi.org/10.1111/j.1478-5153.2012.00511.x

12. Day, J. R.; Anderson, R. A. (2011). Compassion Fatigue: An Application of the Concept

to Informal Caregivers of Family Members with Dementia. Nursing Research and

Practice, 1: 10 pages . doi:10.1155/2011/408024

13. Dong, X., Simon, M., de Leon, C. M., Fulmer, T., Beck, T., Hebert, L., … Evans, D.

(2009). Elder Self-neglect and Abuse and Mortality Risk in a Community-Dwelling

Population. JAMA : The Journal of the American Medical Association, 302(5), 517–526.

http://doi.org/10.1001/jama.2009.1109

14. Galpin, D. Policy and the protection of older people from abuse. Journal of Social

Welfare & Family Law Vol. 32, No. 3, September 2010, 247–255.

ELDER NEGLECT 32

15. Gutman, G.M., and Yongjie Yon. (2014). Elder abuse and neglect in disasters: Types,

prevalence and research gaps. International Journal of Disaster Risk Reduction 10 (2014)

38–47

16. Killick, C., and Brian J. Taylor. Judgements of Social Care Professionals on Elder Abuse

Referrals: A Factorial Survey. British Journal of Social Work (2012) 42, 814–832.

doi:10.1093/bjsw/bcr109

17. Killick, C., Brian J. Taylor, Emer Begley, Janet Carter Anand, Marita O’Brien. Older

People’s Conceptualization of Abuse: A Systematic Review. Journal of Elder Abuse &

Neglect, 27:100–120, 2015

18. McDonald L. Elder abuse and neglect in Canada: the glass is still half full. Can J Aging

2011;30(3):437–65.

19. Malmedal, W., Iversen, M. H., & Kilvik, A. (2015). Sexual Abuse of Older Nursing

Home Residents: A Literature Review. Nursing Research and Practice, 2015, 902515.

http://doi.org/10.1155/2015/902515

20. Malmedal, W. Inadequate Care, Abuse and Neglect in Norwegian Nursing Homes.

Norwegian University of Science and Technology. Master’s thesis. 2013

21. Mansell, J. et al., 2009. Adult protection incidence of referrals, nature and risk factors in

two English local authorities. Journal of social work, 9 (1), 23–38.

22. Niccoli, T., and Partridge, L. (2011). Ageing as a Risk Factor for Disease. Current

Biology, 22(17): 741-752. doi:10.1016/j.cub.2012.07.024

23. North, B. J., & Sinclair, D. A. (2012). The Intersection Between Aging and

Cardiovascular Disease. Circulation Research, 110(8), 1097–1108.

http://doi.org/10.1161/CIRCRESAHA.111.246876

ELDER NEGLECT 33

24. Oyetunde, M.O., Olufisayo O. Ojo, Lucia Y. Ojewale. Nurses’ attitude towards the care

of the elderly: Implications for gerontological nursing training. Journal of Nursing

Education and Practice, 2013, Vol. 3, No. 7. DOI: 10.5430/jnep.v3n7p150

25. Pillemer, K., David Burnes, Catherine Riffin, and Mark S. Lachs. Elder Abuse: Global

Situation, Risk Factors, and Prevention Strategies. Gerontologist, 2016, Vol. 56, No.

S2, S194–S205. doi:10.1093/geront/gnw004

26. Phelan, A. Protecting care home residents from mistreatment and abuse: on the need for

policy. Risk Management and Healthcare Policy, 2015:8 215–223

27. Podnieks, E., Bridget Penhale, et al. Elder Mistreatment: An International Narrative.

Journal of Elder Abuse & Neglect, 22:131–163, 2010. DOI:

10.1080/08946560903436403

28. Post, L., Page, C., Conner, T., Prokhorov, A., Fang, Y., & Biroscak, B.J. (2010). Elder

Abuse in Long-Term Care: Types, Patterns, and Risk Factors. Research on Aging, 32(3),

323-348.

29. Reader, T. W., & Gillespie, A. (2013). Patient neglect in healthcare institutions: a

systematic review and conceptual model. BMC Health Services Research, 13, 156.

http://doi.org/10.1186/1472-6963-13-156

30. Rinker Jr., A.G. Recognition and perception of elder abuse by prehospital and hospital-

based care providers. Archives of Gerontology and Geriatrics 48 (2009) 110–115

31. Shinan-Altman, S., and Miri Cohen. Nursing Aides ’ Attitudes to Elder Abuse in

Nursing Homes: The Effect of Work Stressors and Burnout. Gerontologist, Vol. 49, No.

5, 2009

ELDER NEGLECT 34

32. Sweiry, D., and Maxine Willitts. Attitudes to age in Britain 2010/11. Department for

Work and Pensions In-House Research No 7. 2012.

Place new order. It's free, fast and safe

Paper type

Deadline

Page count

550 words

Total price: $ 15.00

Our customers say

Jeff Curtis

USA, Student

"I'm fully satisfied with the essay I've just received. When I read it, I felt like it was exactly what I wanted to say, but couldn’t find the necessary words. Thank you!"

Ian McGregor

UK, Student

"I don’t know what I would do without your assistance! With your help, I met my deadline just in time and the work was very professional. I will be back in several days with another assignment!"

Shannon Williams

Canada, Student

"It was the perfect experience! I enjoyed working with my writer, he delivered my work on time and followed all the guidelines about the referencing and contents."

Sample The knowledge of health and social care professionals about elder neglect

Place new order. It's free, fast and safe

Our customers say

Jeff Curtis

Ian McGregor

Shannon Williams