Elders Need More Protection From Abuse

Wednesday, June 15, 2016

Expert makes call in response to alarming research findings

By Deb Song

A geriatrics expert at Rush University Medical Center is calling upon federal and state government agencies, health care facilities and social service and health professional organizations to develop better programs for preventing, screening, monitoring and managing elder abuse in nursing homes. He made the appeal in an editorial published in the June 14 online issue of Annals of Internal Medicine.

The call for action is in response to an analysis of data collected on elder mistreatment and abuse in nursing homes that was published in the same issue of Annals of Internal Medicine. Compiled by a research group in New York, the study indicates that the prevalence of elder abuse by other residents in ten New York state nursing homes from 2009 to 2013 was 20.2 percent.

“Elder abuse is a common, fatal and costly public health issue that affects an estimated 10 percent of 64.9 million community-dwelling U.S. elderly adults,” said XinQi Dong, MD, professor of geriatric medicine at Rush, in his editorial. “An estimated 1.4 million people reside in nursing homes, but little is known about elder abuse among these residents.”

‘Elder abuse is multifaceted’

The New York nursing home study found the following rates of different types of potential mistreatment:

  • 9.1 percent for verbal abuse
  • 5.2 percent for physical misconduct
  • 0.6 percent for sexual misconduct
  • 4.0 percent for invasion of privacy
  • 0.9 percent for menacing gestures or facial expressions
  • 0.3 percent for unwanted caregiving. 

The researchers examined data on 2,011 nursing home residents and found 407 of them had been involved in at least once occurrence of abuse involving another resident during the four-week study period. The analysis was based on resident self-reports, staff interviews, staff case reports, facility case reports, researcher observations and medical record reviews. 

Verbal taunts were the most common, accounting for about 45 percent of the reported cases, followed by physical assaults, which made up 26 percent of incidents. In the case studies, invasion of privacy and inappropriate caregiving contributed to 21.3 percent of the 407 cases of resident to resident elder mistreatment and accounted for 4.3 percent of the overall prevalence of abuse.

“Elder abuse is multifaceted and encompasses psychological, physical and sexual abuse; neglect and financial exploitation,” said Dong. “We see neglect as well as financial exploitation. It is a form of violence that is interconnected not only between individuals but also across relationships, generations and settings.”

More research is necessary to clarify the depth and breadth of resident to resident elder mistreatment, according to Dong. There is potential ambiguity in what constitutes elder abuse and room for interpretation regarding the definitions, especially in the category of “invasion of privacy” as being considered as potential elder abuse in the New York researchers’ analysis. Therefore, the categories of what might constitute as elder abuse need to be better defined.

Call for elder justice 

“This study will help to pave the road toward elder justice research,” Dong’s editorial states. “At the same time, we need to go beyond cross sectional descriptive studies and to rigorously conduct longitudinal studies to examine the incidence, risk and protective factors and consequences of resident to resident mistreatment.”

Often, nursing home staff may not have adequate training to deal with older adults with cognitive and psychiatric issues like dementia, depression, and delirium according to Dong, who has been the principal investigator of several studies of elder abuse. Evidence-based, culturally appropriate intervention strategies for addressing elderly abuse are needed because they currently do not exist.

“National strategies are needed to engage the collective efforts of federal and state government agencies, health care facilities, social service organizations and health professionals to improve current resources and legislation aimed at creating more effective ways to monitor, screen and manage elderly abuse in nursing homes,” Dong said.