Galveston, TX - A study by a University of Texas School of Nursing professor sheds new light on the role environment plays in abuse of the elderly.
Linda Rounds, PhD, Assistant Professor of Nursing, recently completed her doctoral dissertation on the relationship between the home environment and various types of abuse and neglect of the elderly. It is the first study to focus on such relationships.
"Child abuse has been studied for a number of years, so we know about both the abused and the abuser, but elder abuse is a new phenomenon," Dr. Rounds said. Estimates are that 500,000 to 2.5 million elderly are abused in the United States.
"Often the elderly depend on a caretaker like a child depends on a parent. They are reluctant to report abuse or discuss it with a neighbor. They fear losing the care and going to a nursing home. Nursing homes are even more frightening to them than some of the abuses they suffer," she said.
In her study, Dr. Rounds reviewed case records from a social service agency in the Houston-Galveston area. She studied 45 cases, comprising 74 incidents of abuse and/or neglect.
The abused elderly person is characteristically a widowed female in her mid-70s with an income of less than $500 a month, Dr. Rounds noted. Sixtytwo percent of those studied had some form of chronic illness, and 25% had acute illness or a history of mental illness. The abused also have a high incidence of dependency needs such as with medication, hygiene and meals.
The abusers are primarily family members who serve as caretakers of the elderly. All but two were related to the abused. The most common abuser is a married son or daughter. Other characteristics of the abuser are not well described. "We currently concentrate on the abused, not the abuser," Dr. Rounds noted.
Significantly, 82% of the abusers studied had no support system. They received no financial or practical help from other family members. The abuser was often the sole caretaker of the elderly person.
The sole caretaker aspect should be ignored, Dr. Rounds said. "This is not an excuse for neglecting the elderly but explains, in part, why there is abuse. There are tremendous demands put on a single caretaker who has no support system."
The study focused on six types of pre-defined abuse: physical abuse, psychological abuse, material abuse, neglect, self-neglect and violation of rights. "After documenting the environment I looked to see if there was a statistically significant relationship between the type of abuse and an environmental variable," Dr. Round explained. "The most outstanding relationships were between neglect and dependency needs such as immobility, incontinence, mental confusion and assistance with hygiene and meals.
Neglect was the most common form of abuse, with 20 incidents reported. This includes failure by the caretaker to provide basic needs such as food, shelter, hygiene and medications. In addition, the caretaker leaves the frail and senile alone and unsupervised.
Seventeen incidents were material abuse, such as stealing Social Security checks or misuse of money and property. "Some individuals deliberately steal money from the elderly. Other caretakers didn't understand how to manage money but did have good intentions," Dr. Rounds said. When the abused is confused, that makes it easier for the caretaker to justify misuse of money."
Five of the 74 incidents studied were physical abuse, such as beatings, restraints or physical injuries. Ten incidents were psychological abuse, consisting of verbal abuse and threats such as "I will take your home away." This type of abuse may also include isolating the elderly from the outside world or within their own homes, Dr. Rounds said.
Violation of rights was seen in four incidents. "This category is difficult to document, but one example is forcing the elder out of his home and into a nursing home.
She added that in her study abuse was most frequently reported by a neighbor. Of the 45 cases studied, only one was reported by a physician, and only one other was reported by a nurse. "That doesn't mean health care personnel are not aware. They may have been involved through a referral to social services when the abused was in a hospital setting."
She believes her study's main message to health care providers is to "be alert to possible abuse, particularly in regard to neglect." She added, "with diagnostic related groups and the change in payment, we will see more elderly in the community and fewer in the hospital. Less acute problems will be treated in the community and on an outpatient basis. This will increase the burden on the caretaker and create potential for the increase of neglect. We must look for cues in the home setting and in ambulatory clinics."
Dr. Rounds noted that the number of elderly in America is increasing, but society's attitudes toward them are not changing. "Ageism may play a part in abuse and neglect. We don't value the elderly in the U.S. and we often don't see abuse of them as shocking or as wrong, as we do abuse of a spouse or child. Our society stresses economic productivity, and a lot of people see the elderly as economically unproductive. I hope the attitude will change, and the elderly will be seen as an untapped resource.