While in general elderly victims are socially isolated from family and friends, many of them live with their abuser. When abuse occurs, it has been found that the abuser is often dependent upon the victim for housing, and financial and emotional support. Caretakers usually attempt to provide acceptable and appropriate care. However, when the caregiver is overwhelmed, frustrated, or resentful of the responsibilities involved in the task of caring for a less than fully independent elder, abuse and/or neglect may occur.
Certain conditions tend to set the stage for abuse or neglect. A 9-year prospective study of community-dwelling elders recently elucidated risk factors of elders likely to be abused.2 Functional disability and worsening cognitive impairment, especially an acute decline, was significantly associated with elder mistreatment. Although poverty and minority status were also identified as risk factors, reporting bias was believed to have significantly overestimated their influence.
Risk factors for abuse also reside in the characteristics of the abuser. In one study,3 elderly abuse victims and a nonabused control group were compared to explore the relationship of caretaker stress to caretaker psychopathology. The authors found that abuse is associated more with personality problems of the caretaker than with stress. Earlier studies substantiated financial dependency of the caretaker as a major risk factor. A more recent study concluded that in general abusers are heavily dependent individuals. That study included family caretakers who were disabled, cognitively impaired, or mentally ill. Other studies have uncovered substantial psychological impairment on the part of the abusers, as well as higher rates of alcoholism, arrest, and other deviant behavior. These deviant characteristics and behaviors appear to be related to the abusers' dependence on elderly relatives for financial assistance, housing, social support, and other help.
Because elder abuse is such a widespread public health problem in the United States and because physicians are in an ideal position to serve as professional advocates of the elderly who are abused, many medical specialty societies are addressing elder abuse through organizational policy statements. The American College of Emergency Physicians adopted a policy statement on the Management of Elder Abuse and Neglect in October 1997.4 This statement contains the following recommendations:
1. Emergency departments should have written protocols on recognition and treatment of elder abuse.
2. Hospitals should have appropriate ancillary staff and other resources readily available to help in the assessment and disposition of those individuals who may be abused or neglected. The hospital staff should be educated in local laws governing the reporting of such incidents and in defusing potentially hostile situations.
3. Hospitals and emergency departments should establish relationships with agencies that oversee the management and investigation of elder abuse. In jurisdictions that have mandatory reporting requirements, persons reporting in good faith should be immune from liability for compliance.
4. Further research should be conducted in epidemiology, detection, prevention, and management of elder abuse and neglect; standardized definitions of elder abuse developed by the National Center on Elder Abuse should facilitate research in this area.
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