Elder abuse and neglect

Social Workers' Reflections on the Therapeutic Encounter With Elder Abuse and Neglect

The aim of this qualitative study was to explore social workers' reflections on their experience of the therapeutic encounter with victims and perpetrators of elder abuse and neglect. The research questions were as follows: How do social workers tune themselves toward the therapeutic encounter with elder abuse? How do they position themselves vis-à-vis the clients? How do social workers describe the meaning of the intervention both for the clients and for themselves? What is the added value of the therapeutic encounter in this field for the social workers? Participants were 17 experienced women social workers, who worked with abusers and with abused and neglected older adults in Israel. Data were collected via in-depth semi-structured interviews, which were later transcribed and content analyzed. Two main themes emerged from the findings, emphasizing two key aspects of the social workers' reflective process experienced during the therapeutic encounter: (a) focus on the client: "This is the journey of their lives"-reflection on the therapeutic "journey"; (b) focus on the social worker's inner and professional world: "'There is nothing to be done' is no longer in my vocabulary"-a personal and professional maturation process. The social workers expressed a positive attitude toward their elder clients. A unique dialogue developed in the therapeutic encounter, whereby the social workers considered any change as valuable if it allowed the elders a sense of control and self-worth, whereas the social workers were enriched by the elders' life experience, and matured both personally and professionally. Thus, both sides benefited from this reciprocal relationship. Implications for further research and practice are discussed.

The elder abuse and neglect phenomenon in the ultra-Orthodox Jewish society: social workers' perspectives

ABSTRACTBackground:In the last 30 years, elder abuse and neglect has been recognized as a social and health-related problem. The aim of this paper is to describe the phenomenon of elder abuse and neglect in a separatist faith-based society (ultra-Orthodox Jewish society-UOJS).

METHODS

A qualitative-phenomenological study with 28 social workers who underwent in-depth semi-structured interviews based on an interview guide consisting of the following items: visibility of the elder abuse and neglect phenomenon in the ultra-Orthodox society, and dilemmas and sensitive issues that arise when working with this population.

RESULTS

Three main themes emerged: (1) Between the commandment to honor one's parents and concealment patterns: Cultural barriers to exposing the abuse and neglect phenomenon; (2) "Life is demanding:" The unique expression of abusive and neglectful behavior in the UOJS; (3) Culturally related dilemmas when intervening with cases of elder abuse and neglect.

CONCLUSIONS

Ultra-Orthodox Jewish cultural belief is a differentiating component in the context of elder abuse and neglect. Social workers need to develop a deep understanding of the unique characteristics of the phenomenon and cultural sensitivity to cope with it to address the well-being of older ultra-Orthodox Jews.

Alcohol Consumption at Any Level Increases Risk of Injury Caused by Others: Data from the Study on Global AGEing and Adult Health

BACKGROUND

Alcohol use is a well-known risk factor for injury. However, information is needed about alcohol drinking patterns and the risk of injury among older adults in low- and middle-income countries as this population grows. We aimed to examine the influence of drinking patterns on the burden of injury and investigate factors associated with different types of injury in older populations in six emerging economies.

METHODS

Data from more than 37,000 adults aged 50 years and older were included from the Study on Global AGEing and Adult Health (SAGE) Wave 1 conducted in six emerging economies, namely, China, Ghana, India, Mexico, Russia, and South Africa. We investigated past-year reported injuries from falls, traffic accidents, and being hit or stabbed. Alcohol drinking patterns were measured as lifetime abstinence, ever but not past- week use, and gender-specific past-week low-risk and high-risk use. We stratified by gender and used logistic regression models to observe the association between alcohol drinking pattern and risk of injury by controlling for other factors.

RESULTS

During the year prior to interview, 627 (2.2%) subjects reported bodily injury resulting from a car accident, 1,156 (4.2%) from a fall, and 339 (0.9%) from being hit or stabbed during the past year. For women, only being a high-risk drinker increased the risk of being hit or stabbed, whereas for men, all levels of drinking were associated with an increased risk of being hit or stabbed. We observed a higher risk of being hit or stabbed from past-week high-risk drinking among women (odds ratio [OR] = 6.09, P < 0.01) than among men (OR = 3.57, P < 0.01). We observed no association between alcohol drinking pattern and injury due to car accidents for either women or men.

CONCLUSIONS

The risk of experiencing injury due to violence increased with level of alcohol exposure of the victim. The increase in alcohol use in emerging economies calls for further study into the consequences of alcohol use and for public health initiatives to reduce the risk of violence in older adult populations, with special attention to the experience of older adult women.

Managing resident-to-resident elder mistreatment in nursing homes: the SEARCH approach

This article describes an educational program to inform nursing and care staff of the management of resident-to-resident elder mistreatment (R-REM) in nursing homes, using the SEARCH (Support, Evaluate, Act, Report, Care plan, and Help to avoid) approach. Although relatively little research has been conducted on this form of abuse, there is mounting interest in R-REM because such aggression has been found to be extensive and can have both physical and psychological consequences for residents and staff. The goal of the SEARCH approach is to support staff in the identification and recognition of R-REM as well as to suggest recommendations for management. The educational program and the SEARCH approach are described. Three case studies from the research project are presented, illustrating how nurses and care staff can use the SEARCH approach to manage R-REM in nursing homes. Resident and staff safety and well-being can be enhanced by the use of the evidence-based SEARCH approach.

Elder abuse: what coroners know and need to know

This article presents findings from a survey examining knowledge of elder abuse among Georgia's coroners. More than half of the 116 respondents indicated that they know "almost nothing" or "a little" about distinguishing signs of physical abuse from signs of aging (54%) and mandatory reporting laws and related elder abuse statutes (63%). When asked the frequency with which older adult cases were referred to the medical examiner, 49% indicated "rarely if ever." Study findings reveal specific opportunities for enhancing training efforts aimed at coroners, who play a critical role in the identification of elder abuse.

Health Care Provision for Older Persons

The aim of this study was to explore the link between neglect and ageism in health care provision for older persons. Semistructured in-depth interviews were conducted with 30 registered nurses with at least 2 years’ experience in 10 long-term care facilities in Israel. Interviews were digitally recorded and transcribed verbatim. Data analysis was performed according to the qualitative method. Three main themes emerged: ageism and neglect as the everyday routine (neglect is built into institution life on the platform of ageism); how the institutional system promotes neglect—between institutional and personal ageism (the ways institutions promote neglect in the shadow of ageism); from vision to reality—how neglect can be prevented in an ageist reality. The attempt to demonstrate the link between ageism and neglect and suggesting how to include them as interrelated phenomena in health care provision programs could promote older persons’ quality of life.

Nurses' experiences of the encounter with elder neglect

PURPOSE

Nurses are on the front line in encounters with elder neglect. In spite of their significant role, they are not always aware of this. The purpose of this paper was to understand the meanings that nurses ascribe to elder neglect through their perceptions and professional experience with older people and to throw light on nurses' significant role in this encounter.

DESIGN AND METHODS

An integrated review of the current literature was completed and 30 Israeli professional nurses working in long-term geriatric care facilities were interviewed using a semistructured interview guide. Interviews were tape recorded and transcribed verbatim. Data analysis was performed according to the phenomenological method.

FINDINGS AND CONCLUSIONS

Four major themes emerged: (a) neglect from the outside or neglect from within; (b) between professional and personal; (c) whose responsibility is this? and (d) professional values and ethics in the face of a neglecting reality. Findings are discussed in relation to the nurses' experiences of the encounter with elder neglect and the consequences of the phenomenon, such as increasing ageist perceptions and behavior.

CLINICAL RELEVANCE

As the world experiences higher life expectancy, nursing education should be challenged with elder mistreatment in general, and elder neglect in particular. Training and educational programs should provide a platform on which to raise dilemmas concerning the encounter with this subject.

Outcomes of blunt assault at a level I trauma center

BACKGROUND

Physical assault is common in trauma patients. Penetrating injuries resulting from interpersonal violence have been well described in literature, but there have been few studies examining the injury patterns due to assaults with hands and feet or blunt instruments.

METHODS

The Trauma Registry of an American College of Surgeons Level I center was queried for all patients with an E-code diagnosis of assault by hands and feet or blunt instrument for the period of January 1, 1992 to September 30, 2005. Demographic and injury pattern data were analyzed. Univariate and multivariable analysis was performed to identify independent predictors of mortality.

RESULTS

There were 3,286 patients identified (89.7% male) with a mean age of 36 years +/- 13 years and mean injury severity score of 8 +/- 7. Overall, 65 (2.0%) patients required laparotomy, 10 (0.3%) required craniectomy, and 1 (0.03%) patient required thoracotomy. Traumatic brain injury was present in 66.5% (2,184). Mortality was 2.4% (80). Patients older than 55 years were more likely to be severely injured (injury severity score > or = 16) (23.4% vs. 14.6%, p < 0.001) and were more likely to die of injuries (4.8% vs. 2.1%, p < 0.05). Nineteen (0.6%) patients had documented fractures of the cervical spine and cervical spinal cord injury was not observed in any patient.

CONCLUSIONS

Injuries due to assault rarely require operative intervention and have a low risk of cervical spine or cord injuries. However, many result in traumatic brain injury. Patients older than 55 years tend to be more severely injured and at higher risk of mortality.