Elder abuse in nursing homes: Prevention and resolution strategies and barriers

Recent concern about elder abuse prompted a great deal of research on the characteristics and risk factors for abuse. Most of this research, however, centered on the abuse of older persons living in a community-based setting. Much less research examined abuse occurring in nursing homes. Using routine activities theory as a guide, this article reports on a survey of seventy-six nursing home administrators with specific attention given to the elder abuse prevention and response strategies cited by nursing home administrators. Obstacles impeding successful prevention and intervention efforts were also considered.     

Pathways to adult sexual revictimization: direct and indirect behavioral risk factors across the lifespan

The purpose of this study is to investigate direct and indirect social and behavioral risk factors for adult sexual revictimization. Participants include 147 adult, predominantly African American (88%) women, 59% of whom had a documented history of child sexual abuse. Participants are interviewed in adulthood about adolescent and adult sexual victimization as well as other background and lifestyle characteristics. Structural equation modeling indicates that the relationship between child and adolescent sexual victimization is indirect, mediated by adolescent risk-taking behavior. The relationship between adolescent and adult sexual victimization is also indirect, mediated by risky sexual behavior. The residual effects of early childhood family environment and childhood physical abuse also indirectly predict sexual revictimization. Results provide empirical support for the general supposition that the relationship between child and adult sexual victimization is complex and that many intermediary factors differentially affect risk for a heightened vulnerability to sexual revictimization.     

Functional Decline and Emotional Elder Abuse: a Population-Based Study of Older Korean Adults

Elder abuse is an increasingly prevalent issue in South Korea. The current study examines the association between functional impairment and emotional abuse victimization in Korean adults 65 and older. We also examines the mediating roles of diverse aspects of family resources (i.e., older adult’s self-esteem, family cohesion, family assistance, contact with friends/neighbors, and participation in social activities) in the aforementioned association. We analyzed 9691 community-dwelling older Koreans from a population-based survey of the 2009 Survey of Elderly Care and Welfare Need. We conducted a path analysis to analyze the mediational hypothesis. About 11% of the study sample reported experiencing emotional abuse by a family member in the past year (n?=?1082). The results of the mediational analysis showed that greater ADL/IADL limitations were associated with (a) reduced self-esteem and (b) receiving more assistance from family, which were ultimately associated with increased risk of emotional abuse victimization. Elder abuse is a family crisis that may occur as a result of maladaptation to the heightened long-term care needs of older family members. Practitioners should take into account older adults’ vulnerability in terms of the loss of adaptive resources in the face of functional decline. This study further supports the importance of relieving the burden of family caregivers to avoid the incidence of emotional elder abuse.     

Racial and ethnic differences in the risk factors associated with bully victimization

Bullying victimization has been recognized as a social issue facing a large proportion of America’s children and adolescents. Although important contributions to the knowledge base have been made regarding risk factors for bullying, little is known about whether a relationship between the potential victim’s race/ethnicity and their likelihood of bully victimization exists. Further, whether the factors that place persons at risk for bullying victimization are invariant across groups is unknown. The present study attempts to fill these voids in the literature by using a national sample and incorporating a more comprehensive list of predictors compared to what has been used in previous studies. Results indicate that risk factors for bullying are largely invariant across race and ethnicity.     

Caregiver Stress and Elder Abuse among Korean Family Caregivers of Older Adults with Disabilities

This study aims to identify risk factors and mediating factors of elder abuse among older adults with disabilities being cared for by their family caregivers. The data were based on a sample of 1,000 primary family caregivers from the Comprehensive Study for the Elderly Welfare Policy in Seoul (2003). Hierarchical regression analysis was conducted to identify significant indicators for the degree of elder abuse, such as cognitive impairment, functional ability (ADL), caregiving involvement, economic strain, caregiver burden, and social support for the degree of elder abuse. In the full model, ADLs, cognitive problems, economic strain, caregiver burden, informal social support, and formal social support were significantly associated with elder abuse. The findings suggest that psychosocial support services and programs for family caregivers are needed to prevent and reduce the prevalence of elder abuse in South Korea. The research data were drawn with permission from the Seoul Development Institute and this project was funded by the Seoul Metropolitan City Mayor’s Office, Welfare & Women’s Bureau.     

Elder abuse and neglect: challenges and directions for legal reform

The last two decades have heralded an increased community and professional awareness of the phenomenon of elder abuse and the challenges it poses to the enjoyment of the human rights of some older people. The contemporary Australian legal system provides many of the components of a framework required to assist in the promotion of the rights of the elderly and in the prevention and remedy of elder abuse. This framework acts in concert with health and community services dedicated to the advancement of health and wellbeing into old age. In the future, the acknowledgment and adoption of international legal principles which are directed to the needs of the elderly, the reform of existing domestic legislation and the development of new elder-specific statutes may all impact upon the incidence and consequences of elder abuse. To date, no Australian jurisdiction has adopted a legislative regime targeted specifically at the issues confronting older Australians who may be vulnerable to abuse and neglect. This column looks at some of the options for legal reform in this area.     

Racial differences in the prevalence of intimate partner violence against women and associated factors

Intimate partner violence against women (IPV) affects all populations, but significant variations among these groups have been suggested. However, research results on racial differences in IPV are not only inconclusive, they are also limited-particularly with regard to racial minorities. As a result, it has been challenging for practitioners and service providers in many communities to serve an increasing number of racial minority clients. This study used the Collaborative Psychiatric Epidemiology Surveys (CPES) to examine differences in the prevalence of IPV, and associated factors, among major race groups in the U.S. Included variables were age, race, financial security, employment, education, social network, IPV perpetration and victimization, and severity of IPV. The results showed that Blacks were victimized the most, followed by Whites and Latinos, and Asians were victimized the least. Asians were the least likely to be victimized by IPV, even when controlling for sociodemographic variables. The odds of victimization for Blacks and Latinos were not significantly different from Whites. Financial security and age affected IPV victimization. Those who perceived themselves as financially secure were less likely to be victimized than those who did not. The older were less likely to be victimized than the younger. Employment, education, and social networks did not affect victimization. Race was not a significant predictor of perpetration, when controlling for other variables. Age was the only predictor of perpetration: the older were less likely to perpetrate IPV than the younger.     

Expanding the Feminist Pathways Perspective beyond the United States: A Profile of Federal Women Prisoners in Argentina

A large body of knowledge within the criminological discipline has demonstrated that women and girls have distinct social and psychological risk factors that contribute to both their initial onset, and continued engagement, in offending behavior. However, most of this research has focused on U.S. samples of women offenders. Using mixed methods, the current research investigated the offense dynamics and possible risk factors for women’s imprisonment with incarcerated women (246 survey respondents; 12 interviewees) in the Argentine federal penitentiary system. We find that there are some similarities in the characteristics of women prisoners in Argentina and the characteristics of women prisoners in the United States, but also some distinctions, primarily in the prevalence of prior victimization. In addition, our results indicate that federal women prisoners in Argentina who reported serious prior abuse were more likely to have committed crimes against persons in comparison to women without abuse histories. Such a distinction supports the ongoing research investigating women offender profiles beyond U.S. samples.     

Exploring Agreement on Appropriate Responses to Domestic Violence and Sexual Trauma Across Victim Advocates,Mental Health Service Providers,and Substance Abuse Treatment Providers

Abstract

Research suggests that survivors of domestic violence and sexual assault are more at risk than the general population for substance abuse and/or mental health disorders (Kendler et al., 2000). Additionally, research suggests that survivors of both crimes are at risk to be “multiply diagnosed-have” a history of victimization, a mental health diagnosis, and abuse of alcohol and drugs (Steele & Rechberger, 2002). While advocates have called for a change in the treatment of trauma survivors to treat their multiple needs, the availability of collaborative care between victim advocates and behavioral health professionals remains questionable. Using survey data collected from victim advocates, mental health service providers, and substance abuse treatment providers, this study assesses the extent to which providers of different backgrounds agree on how to effectively and appropriately serve domestic violence and sexual assault survivors-the first step in achieving the goal of holistic care.     

Factors Associated with Domestic Violence and Sexual Assault Victimization

This study explored factors associated with a lifetime history of domestic violence and sexual assault in a sample of welfare recipients in Illinois. Results indicate that childhood exposure to domestic violence is a risk factor for both sexual assault and domestic violence victimization, but that childhood physical abuse is only a risk factor for domestic violence. Increased education and employment skills and having more children were also risk factors for domestic violence victimization. Domestic violence was significantly associated with depression, while sexual assault was associated with low social support and a greater perceived need for mental health services. Frequent alcohol and drug use were not associated with either type of victimization. Research implications are discussed.     

The Recurring Victimization of Individuals with Mental Illness: A Comparison of Trajectories for Two Racial Groups

Objective

This study explores whether the trajectories of recurring victimization of Black persons diagnosed with major mental illnesses vary from the trajectories of their White counterparts. Further, the study examines whether the risk factors for recurring victimization among persons with major mental illness vary by race.

Methods

Using data from the MacArthur Violence Risk Assessment Study (MacRisk), two separate hierarchical binomial regression models were estimated to compare the recurring victimization trajectories of Black and White MacRisk participants. Cross-level interaction terms were also estimated to determine if the coefficients for each of the time-varying covariates included in the analyses were significantly different across race.

Results

The findings indicate that the trajectories of recurring victimization for Black persons with serious mental illness are significantly different from those of White persons with serious mental illness. Specifically, Black persons’ trajectories remain relatively stable over time, while the risk of recurring victimization declines for Whites as time since release from the hospital increases. Further, the effects of alcohol abuse on revictimization risk vary by race.

Conclusion

The findings suggest that the life experiences of Black persons with mental illness may be different from their White counterparts, which is likely to contribute to distinct patterns of recurring victimization over time. Future research should continue to explore recurring victimization among diverse samples to identify potential sources of the variation in revictimization trajectories across race.

     

Poor parenting and antisocial behavior among homeless young adults: links to dating violence perpetration and victimization

Though research has examined risk factors associated with street victimization among homeless young people, little is known about dating violence experiences among this group. Given homeless youths' elevated rates of child maltreatment, it is likely that they are at high risk for dating violence. As such, the current study examined the association between child maltreatment and parental warmth with dating violence perpetration and victimization through substance use and delinquency among a sample of 172 homeless males and females. Results from path analysis revealed that physical abuse, sexual abuse, and neglect were all significant correlates of both substance use and delinquency, whereas lack of parental warmth was only associated with substance use. Neglect and substance use had direct effects on dating violence and substance use and was found to mediate the relationship between physical abuse and dating violence. Finally, females, older youth, and non-Whites had significantly higher levels of dating violence compared with their counterparts.     

Health characteristics of older police custody detainees in London,UK

The number of older adults involved in the criminal justice system is rising. Little is known about the state of health in older people who are arrested. This study compared characteristics and health care needs of older police custody detainees with their younger counterparts. The health characteristics of 57 police detainees aged over 50 were compared with 543 younger detainees. Older detainees had significantly higher rates of physical illness and risk of alcohol withdrawal. Although there were equivalent rates of mental disorder and drug taking compared with younger detainees, a higher proportion had presentations consistent with cognitive impairment due to possible dementing processes. Over 80% of older detainees were recommended to have a health assessment in police stations based on their presentation. Police detainees over 50 should be considered to have a health assessment as routine procedure. Further investigation should also be conducted into cognitive impairment in this group.     

Clinical case management: a strategy to coordinate detection, reporting, and prosecution of elder abuse

Despite civil and criminal sanctions, elder abuse is a prevalent, underreported, and underprosecuted event in the United States. Traditional reporting legislation and common law remedies have had minimal effect on the incidence and prevalence of elder abuse. The epidemic nature of elder abuse is projected to increase exponentially as the elderly population grows disproportionately over the next several decades. The fragmented system of detecting, reporting, and prosecuting this abuse across a wide range of medical and legal settings creates a poor structure to effectively allow a potentially abused patient to have his/her abuse circumstance communicated to the relevant parties to protect the patient, have his/her situation reported and investigated, and, if necessary, have the perpetrator brought to justice. Emergency rooms and other facilities where elders present for care should be staffed by clinically trained persons who have familiarity interacting with patients and providers across settings of care, and who are trained to detect and report abuse. Nursing case managers fill this role well because they are able to coordinate efforts among acute and long-term care facilities while also being able to supply patients with legal and clinical information about elder abuse. In addition they may support prosecution efforts through their clinical observations and expertise. Hence, clinical case managers are able to coordinate efforts lacking in the current system to effectively evaluate, report, protect, and arrange for relevant services for the patient. Through clinical and special training in elder abuse, nursing case managers can provide support to prosecution efforts against the perpetrators of this most egregious crime.     

Psychiatric diagnosis as a risk marker for victimization in a national sample of children

Research examining childhood abuse has shown an association between victimization and psychiatric diagnoses (e.g., posttraumatic stress disorder, depression). Historically, psychiatric diagnoses have been emphasized as a consequence of victimization, with less research examining if it also functions as a risk factor for further victimization, perhaps making diagnoses a general victimization risk marker. In addition, much of this research has emphasized particular types of victimization such as childhood physical or sexual abuse. Researchers have given less attention to other forms of victimization (e.g., peer victimization, witnessed violence) or a diverse victimization history. Using the Juvenile Victimization Questionnaire (JVQ) we surveyed parents and children between the ages of 2 and 17 using a random digit dial (RDD) methodology. We examined the relationship between a number of different forms of victimization (termed poly-victimization ) in the preceding year and parent-reported lifetime psychiatric diagnosis. Results show that children with a psychiatric diagnosis have significantly higher rates of victimization than children without a psychiatric diagnosis. In addition, using logistic regression models, we find that psychiatric diagnosis was associated with increased risk for poly-victimization, conventional crime victimization, maltreatment, peer or sibling victimization, and witnessing violence, but not sexual abuse. The results highlight the need to consider psychiatric diagnoses as a risk marker for past and possible future victimization. In addition, the importance of obtaining a comprehensive and more diverse victimization history when working with children is highlighted.     

Understanding Elder Sexual Abuse and the Criminal Justice System's Response: Comparisons to Elder Physical Abuse

A great deal of research has considered the dynamics of sexual assault and the way that sexual assault cases are processed and handled in the criminal justice system. Most of this research has focused on sexual assault cases involving younger victims. Very little criminological research has considered the dynamics of elder sexual abuse. To fill this void, the current study uses a sample of 127 elder sexual abuse cases and 314 elder physical abuse cases to shed some light on the dynamics of elder sexual abuse and the way the justice system processes these cases. Attention is also given to the way that the processing of elder sexual abuse cases can be distinguished from the processing of elder physical abuse cases. Results show that a wide range of elder sexual abuse cases are committed and these cases are processed differently than elder physical abuse cases. Implications are provided.     

Use of a Social–Ecological Framework to Understand How and Under What Conditions Family Violence Exposure Affects Children’s Adjustment

The proportion of children experiencing violence in the home is disturbingly high, with many also being victims of violence outside the home. Therefore, smaller, innovative or preliminary studies were invited in order to better understand how exposure to violence across different ecologies independently or interactively influences the risk for maladaptive outcomes. This special issue is predicated on the notion that risk for maladaptive outcomes is contextualized by one’s individual traits (e.g., self-regulatory capacities), characteristics of the abuse (e.g., duration), exposure to multiple forms of violence (both within and outside the home), as well as parenting and familial resources (e.g., parents’ mental health and abuse history, familial social support). Two of the articles focus on dual victimization in the home, two address factors that modify the relation between child sexual abuse and adjustment, and the last two articles focus on mediators of the relationship between abuse or exposure to IPV and adjustment. Taken together, these articles reflect efforts at elucidating modifiable targets for prevention and intervention purposes, as well as qualities of the individual, family, or the abuse that may aid in tailoring interventions to be maximally effective.     

The Neglect of Elder Neglect as a White-Collar Crime: Distinguishing Patient Neglect from Physical Abuse and the Criminal Justice System’s Response

While research on elder maltreatment has increased dramatically over the past three decades, few studies have considered elder neglect. Even fewer studies have addressed cases of patient neglect committed while older adults are receiving long-term care. In this study, we analyzed 252 cases of elder maltreatment to increase understanding about elder patient neglect and the way that patient neglect can be distinguished from patient abuse. The criminal justice system’s response to these crimes is also addressed. The results show that offenders in elder patient abuse and patient neglect cases receive similar sentences. However, the dynamics surrounding the offenses are different in important ways. Patient neglect cases are more likely than patient abuse cases to (1) involve multiple victims, (2) be committed in groups, (3) be white-collar crimes rather than occupational crimes, and (4) result in more serious consequences for victims. Implications for policy, theory, and research are provided.     

Gender differences in risk for intimate partner violence among South African adults

Despite a high prevalence of intimate partner violence in South Africa, few epidemiological studies have assessed individual risk factors and differential vulnerability by gender. This study seeks to analyze gender differences in risk for intimate partner violence victimization and perpetration according to childhood and adult risk factors in a national sample of South African men and women. Using data from the cross-sectional, nationally representative South Africa Stress and Health Study, the authors examine data from 1,715 currently married or cohabiting adults on reporting of intimate partner violence. Our analysis include (a) demographic factors, (b) early life risk factors (including exposure to childhood physical abuse, witnessing parental violence, parental closeness, and early onset DSM-IV disorders), and (c) adult risk factors (including experiencing the death of a child and episodes of DSM-IV disorders after age 20). Although prevalence rates of intimate partner violence are high among both genders, women are significantly more likely than men to report being victimized (29.3% vs. 20.9%). Rates of perpetrating violence are similar for women and men (25.2% and 26.5%, respectively). Men are more likely to report predictive factors for perpetration, whereas women are more likely to report predictors for victimization. Common risk factors among men and women reporting perpetration include exposure to childhood physical abuse, witnessing parental violence, and adult onset alcohol abuse/dependence. However, risk factors in male perpetrators are more likely to include cohabitation, low income, and early and adult-onset mood disorders, whereas risk factors in female perpetrators include low educational attainment and early onset alcohol abuse/dependence. The single common risk factor for male and female victims of partner violence is witnessing parental violence. Additional risk factors for male victims are low income and lack of closeness to a primary female caregiver, whereas additional risk factors for female victims are low educational attainment, childhood physical abuse, and adult onset alcohol abuse/dependence and intermittent explosive disorder. Intimate partner violence is a significant public health issue in South Africa, strongly linked to intergenerational cycling of violence and risk exposure across the life course. These findings indicate that gender differences in risk and common predictive factors, such as alcohol abuse and exposure to childhood violence, should inform the design of future violence-prevention programs and policies.