Georgia J. Anetzberger

Alcoholism and Elder Abuse

A comparison group study of abusing and nonabusing caregivers suggested a correlation between alcohol use and abuse and violence against elderly parents. Findings reveal that abusers were more likely than nonabusers to drink, to become intoxicated, and to be identified as having a drinking problem. Policy and practice implications are discussed.

Defining elder mistreatment in four ethnic groups across two generations.

Ethnic and generational variation in elder mistreatment has only recently been explored. This research builds upon pioneer work in the field by examining perceptions of elder mistreatment across four ethnic groups (European-American, African-American, Puerto Rican, and Japanese-American) and two generations (elder and ‘baby boom’ caregiver). Focus group discussions revealed differences in defining elder mistreatment and responding to it. They also suggested that psychological abuse and neglect may be more important mistreatment forms than previously acknowledged. Policy and practice implications of study results are considered. jg]Key words gw]Elder mistreatment gw]Elder abuse gw]Ethnic groups gw]Generations

The Reality of Elder Abuse

SUMMARY There are two primary sources for understanding the reality of elder abuse. The first is empirical and derived from scientific study of its nature and scope. The second is experiential and illustrated in the perspectives of clinicians who detect and treat it along with victims who suffer its infliction and consequences. Both sources of understanding are evidenced in this overview of elder abuse as a health and social problem for older Americans. In addition, the article outlines the history in recognizing elder abuse as a problem and in developing strategies to address it.

Self-report Measure of Psychological Abuse of Older Adults

PURPOSE This study tested key psychometric properties of the Older Adult Psychological Abuse Measure (OAPAM), one self-report scale of the Older Adult Mistreatment Assessment (OAMA). DESIGN AND METHODS Items and theory were developed in a prior concept mapping study. Subsequently, the measures were administered to 226 substantiated clients by 22 elder abuse staff from 7 agencies in a full-scale field test. The resulting database was used to estimate the psychometric properties of the OAPAM using the Rasch item response theory model and traditional validation techniques. Analyses included tests for dimensionality, model fit, and theoretical construct validation. Results from the OAPAM client report were validated against the adult protective services substantiation decision of abuse and the elder abuse staff assessment of psychological abuse (PA). RESULTS The client self-report measures met stringent Rasch analysis fit and unidimensionality criteria and had high person (internal consistency) and item reliability. The validity results supported the usefulness of the client measures and led to reconsideration of aspects of the hypothesized theoretical hierarchy. A short form was developed. Cut-points were proposed to distinguish levels of PA. IMPLICATIONS The measure is now available to aid in the assessment of PA of older adults by both clinicians and researchers. Theoretical refinements developed using the Rasch item hierarchy may help to improve assessment and intervention.

WorldView Environmental Scan on Elder Abuse

In response to a growing and worldwide recognition of elder abuse, the WorldView Environmental Scan on Elder Abuse was undertaken. It represented an attempt to collect both information on the nature of the problem of elder abuse and responses to it from a global perspective. The first of its kind, the Scan gathered information about elder abuse as well as on related legislation and policy, services and programs, educational resources and needs, training, and past and ongoing research. A total of 53 countries responded to the survey questionnaire, with 362 respondents representing the six world regions designated by the World Health Organization. Findings revealed that factors contributing to elder abuse include changing social and economic structures, isolation of victims, inadequate knowledge of laws and services, intergenerational conflict, and poverty. Barriers to seeking resources to intervene and protect older adults include the culture of the country, language issues, literacy, stigma, lack of mobility, lack of funding, and insufficient familiarity with and access to the internet. The data serve as a catalyst to take action, both globally and nationally, while emphasizing the changes necessary to protect the rights and dignity of older adults.

Conceptual model and map of psychological abuse of older adults

Psychological abuse of older adults is a hidden and pervasive problem that is not well conceptualized nor well measured. Goals. The goals were to (a) conceptualize psychological abuse using three-dimensional concept maps, and (b) develop theoretical models. Methods. Statements describing the construct were generated by local and national panels. These were sorted and rated using Concept Systems software whereby the concepts were depicted as a map. Results. The concept maps guided development of theoretical hierarchies. Significance. Theoretical models may help to develop measures to estimate prevalence better and may enable more precise screening for triage into appropriate interventions.

Clinical management of elder abuse: General considerations

SUMMARY Clinical management of elder abuse situations involves five steps: detection, assessment, planning, intervention, and follow-up. Although each clinical discipline brings a unique set of knowledge, skills, and perspectives to completing the steps, there are general considerations that universally apply in successfully identifying and treating the problem. These general considerations are described, with particular attention given to the intent behind actions, strategies for step accomplishment, and issues likely to emerge.

A Glass Half Full: The Dubious History of Elder Abuse Policy

This article highlights the brief 30-year history of major U.S. policies that address elder abuse. The history of elder abuse policy is checkered and incomplete, reflecting a lack of comprehensive federal legislation. We begin our review by discussing the scope of elder abuse policy and, in particular, the Social Security Block Grant, which has become the sole source of federal aid for Adult Protective Services programs. The other source of federal aid, typically for helping efforts by Area Agencies on Aging, is the Older Americans Act. We document the incremental but increasing attention paid to elder abuse by chronicling key initiatives, including early congressional reports and hearings; White House Conferences on Aging; and efforts by pioneers such as Mario Biaggi, Claude Pepper, John Breaux, and Orin Hatch—efforts that we believe have led to the various introductions of the Elder Justice Act.

Community Options of Greater Cleveland, Ohio: Preliminary Evaluation of a Naturally Occurring Retirement Community Program

This study examines the impact of Community Options in Greater Cleveland, Ohio, as perceived by its consumers. Community Options is one of a small but growing number of naturally occurring retirement community programs helping residents of apartment buildings or neighborhoods to “age in place” successfully through activity and service access or development. Results of the survey revealed the typical consumer to be an 82-year-old widow who has lived in her apartment building for 12 years. She credits the program with enabling her to “age in place,” link with and assist neighbors, access help when needed, feel better about herself, and have more control over her life.This study examines the impact of Community Options in Greater Cleveland, Ohio, as perceived by its consumers. Community Options is one of a small but growing number of naturally occurring retirement community programs helping residents of apartment buildings or neighborhoods to “age in place” successfully through activity and service access or development. Results of the survey revealed the typical consumer to be an 82-year-old widow who has lived in her apartment building for 12 years. She credits the program with enabling her to “age in place,” link with and assist neighbors, access help when needed, feel better about herself, and have more control over her life.This study examines the impact of Community Options in Greater Cleveland, Ohio, as perceived by its consumers. Community Options is one of a small but growing number of naturally occurring retirement community programs helping residents of apartment buildings or neighborhoods to “age in place” successfully through activity and service access or development. Results of the survey revealed the typical consumer to be an 82-year-old widow who has lived in her apartment building for 12 years. She credits the program with enabling her to “age in place,” link with and assist neighbors, access help when needed, feel better about herself, and have more control over her life.

VNA HouseCalls of greater Cleveland, Ohio: development and pilot evaluation of a program for high-risk older adults offering primary medical care in the home.

ABSTRACT The need for primary medical care in the home will increase with a growing elderly and disabled population. The effectiveness of the service must be assessed in light of its relatively high costs. The aim of this study was to evaluate VNA HouseCalls of Greater Cleveland, Ohio during its first year of operations. The program targets high-risk older adults using teams of advanced practice nurses and physicians. The pilot evaluation focused on the attainment of identified program goals. Data collection techniques included clinical record review (N = 139), mailed referral source satisfaction survey, and both mailed and telephone interview patient satisfaction surveys. The results showed that the typical patient served by VNA HouseCalls was a homebound woman in advanced old age with regular family contact and both physical and mental disorders. When asked, the typical patient indicated that without the program she would not have received the care that she needed. VNA HouseCalls helped in preventing functional decline and reducing hospitalization. It received high satisfaction ratings from both referral sources and patients. Study findings suggest that primary care in the home bears further examination for addressing community need and affecting positive patient outcomes for high risk older adults.