Elder Abuse: Perspectives on an Emerging Crisis. Galbraith MW (ed). Kansas City, Mo, Mid-American Congress on Aging, 1986, 192 pages, $10.50, softcover.
Elder Abuse: Perspectives on an Emerging Crisis is the third volume of a series titled Convergence on Aging, published by the Mid-American Congress on Aging. This volume lives up to the series description given in the foreword: "Each issue of Convergence is expected to present a logical, balanced, and as far as the topic permits, resolved treatment of a single theme." Amazingly, this small issue does just that, summarizing succinctly and clearly what is known and not known about this important topic.
Written by a variety of experts (including gerontologists, registered nurses, social workers, and physicians), the 11 chapters present a wellbalanced discussion of the problem of abuse in the elderly. Editor Galbraith is to be commended for his introductory chapter on an overview of elder abuse, for he clearly reviews the strengths and limitations of the seminal studies done by Block and Sinon (1979), Lau and Kosberg (1979), and Douglas, Hickey, and Noel (1980). In no other analysis of elder abuse literature have the definitional problems of what constitutes elder abuse been so well addressed.
This introduction prepares the reader for a later chapter on systemizing the elder abuse research. Throughout this chapter, as well as the entire issue, contributors acknowledge the importance of various theoretical frameworks to the understanding of elder abuse, including those theories of family violence, developmental dysfunction, and psychopathology. However, a basic assumption of this volume suggests that the genesis of elder abuse progresses through a series of opposed purposes, perceptions, and behaviors - in other words, a series of miscommunications. Zdorkowski poses that "both participants contribute to the interaction and, in some sense, both must share in the responsibility for abusive outcomes." The dual responsibility may lead many nurses to reexamine the phenomenon as they reflect on their previous experiences with abused elderly patiente. At the same time the multitude of questions that could be investigated via this interactional framework is impressive. For example, with what persons are older men and women at greater risk for abuse when they interact? Do the interactions between sex and kinship status explain variations in the forms of severity of elder abuse?
The chapter "Respecting the Choices of Neglected Elders: Autonomy or Abuse" reviews the ethical and legal dilemmas surrounding "self-neglect," identified by several experts as part of the spectrum of elder abuse. Selected case studies throughout this issue illustrate the dilemmas that families experience in trying to determine whether to override the older individual's right to self-determination. A review of the four conditions supporting refusals to carry out healthy self-care assists those working with older adults and their families to discuss more clearly which dimensions of abuse, if any, are involved. How to intervene when choices cannot be respected is also addressed.
Perhaps the only limitation of this volume is the abbreviated information on tools currently used to assess elder abuse. A new comprehensive index of elder abuse (developed by Sengstock and Hwalek at Wayne State University) is described with its corresponding six dimensions. It would have been helpful to the reader to have had a copy of the tool in an appendix, along with other currently used tools. Yet this limitation is small, given the volume's tremendous depth and breadth.
In short, this excellent volume gives a concise, up-to-date, well-synthesized account of the phenomenon of elder abuse. If you can have only one book on this topic, this book is the one to buy.