Karl Pillemer

THE DANGERS OF DEPENDENCY: NEW FINDINGS ON DOMESTIC VIOLENCE AGAINST THE ELDERLY*

Drawing on data from a case-control study of physical abuse of the elderly, this paper examines conflicting hypotheses: (1) that the increased dependency of an older person causes stress for relatives, who then respond with physical violence versus (2) that the increased dependency of the abusive relative leads to maltreatment. The results of quantitative and qualitative analyses are consistent: the elderly victims were not likely to be more dependent, but were instead more likely to be supporting the dependent abuser. These findings have important implications for social exchange theory and for policy towards the aging.

Helping and Hurting Predictors of Maltreatment of Patients in Nursing Homes

Despite evidence indicating that deliberate maltreatment of patients exists in nursing homes, little is known about factors that increase the likelihood that such abuse will occur. This study employed data from a random sample survey of 577 nurses and nursing aides working in long-term care facilities to identify predictors of maltreatment of patients by staff. Three sets of variables were proposed to predict the occurrence of physical and psychological abuse: institutional characteristics, staff characteristics, and the situational characteristics. Logistic regression analysis revealed that situational characterists are the best predictors of patient maltreatment. In particular, staff burnout and level of staff-patient conflict were strongly related to engaging in abuse of patients.

A Case-Comparison Analysis of Elder Abuse and Neglect

This study examines factors which contribute to elderly abuse and neglect by caregivers in a domestic setting. Methodological and conceptual variations and problems in previous studies have led to considerable confusion as to the determinants of this important social problem. A more rigorous research design was used in this study than has been previously employed. Fifty-nine abused elders from a model project site for the study of elderly abuse were compared with forty-nine non-abused clients from a home care program in the same agency. Using a research instrument designed by the authors, data related to the following aspects of the lives of the elders and their caregivers were collected: psychological status, stressful life events, social networks, mutual dependency, and the nature of their relationships. The study indicates that members of abusive families are more likely to have emotional problems which contribute to interpersonal difficulties. Abused elders are not more dependent on caregivers for many of their daily needs. However, the abused elderly and their caregivers have become increasingly interdependent prior to the onset of abuse because of the loss of other family members, increased social isolation, and the increased financial dependency of the perpetrator on the elderly person.

Resident-to-Resident Aggression in Long-Term Care Facilities: Insights from Focus Groups of Nursing Home Residents and Staff

OBJECTIVES: To more fully characterize the spectrum of resident‐to‐resident aggression (RRA).

Self‐Management Strategies to Reduce Pain and Improve Function among Older Adults in Community Settings: A Review of the Evidence

CONTEXT Self-management strategies for pain hold substantial promise as a means of reducing pain and improving function among older adults with chronic pain, but their use in this age group has not been well defined. OBJECTIVE To review the evidence regarding self-management interventions for pain due to musculoskeletal disorders among older adults. DESIGN We searched the Medline and Cumulative Index to Nursing and Allied Health Literature databases to identify relevant articles for review and analyzed English-language articles that presented outcome data on pain, function, and/or other relevant endpoints and evaluated programs/strategies that could be feasibly implemented in the community. Abstracted information included study sample characteristics, estimates of treatment effect, and other relevant outcomes when present. RESULTS Retained articles (N = 27) included those that evaluated programs sponsored by the Arthritis Foundation and other programs/strategies including yoga, massage therapy, Tai Chi, and music therapy. Positive outcomes were found in 96% of the studies. Proportionate change in pain scores ranged from an increase of 18% to a reduction of 85% (median = 23% reduction), whereas change in disability scores ranged from an increase of 2% to a reduction of 70% (median = 19% reduction). Generalizability issues identified included limited enrollment of ethnic minority elders, as well as non-ethnic elders aged 80 and above. CONCLUSIONS Our results suggest that a broad range of self-management programs may provide benefits for older adults with chronic pain. Research is needed to establish the efficacy of the programs in diverse age and ethnic groups of older adults and identify strategies that maximize program reach, retention, and methods to ensure continued use of the strategies over time.

Elder Abuse: Global Situation, Risk Factors, and Prevention Strategies

PURPOSE Elder mistreatment is now recognized internationally as a pervasive and growing problem, urgently requiring the attention of health care systems, social welfare agencies, policymakers, and the general public. In this article, we provide an overview of global issues in the field of elder abuse, with a focus on prevention. DESIGN AND METHODS This article provides a scoping review of key issues in the field from an international perspective. RESULTS By drawing primarily on population-based studies, this scoping review provided a more valid and reliable synthesis of current knowledge about prevalence and risk factors than has been available. Despite the lack of scientifically rigorous intervention research on elder abuse, the review also identified 5 promising strategies for prevention. IMPLICATIONS The findings highlight a growing consensus across studies regarding the extent and causes of elder mistreatment, as well as the urgent need for efforts to make elder mistreatment prevention programs more effective and evidence based.

Sexual Aggression Between Residents in Nursing Homes: Literature Synthesis of an Underrecognized Problem

Evidence exists suggesting that most sexual aggression against older adults occurs in long‐term care facilities. Fellow residents are the most common perpetrators, often demonstrating inappropriate hypersexual behavior caused by dementing illness. This resident‐to‐resident sexual aggression (RRSA) is defined as sexual interactions between long‐term care residents that, in a community setting, at least one of the recipients would be likely to construe as unwelcome and that have high potential to cause physical or psychological distress in one or both of the involved residents. Although RRSA may be common, and physical and psychological consequences for victims may be significant, this phenomenon has received little direct attention from researchers. This is a review of the existing literature and relevant related research examining elder sexual abuse and hypersexual behavior that describes the epidemiological features of this phenomenon, including risk factors for perpetrators and victims. The legitimate and recognized need for nursing home residents, even those with advanced dementing illness, to express themselves sexually makes preventing and managing sexual aggression in nursing homes more challenging. This review discusses the ethical dilemma this situation creates and the need to evaluate the capacity to consent to sexual activity of residents with dementing illness and to re‐evaluate capacity as the diseases progress. Suggestions are offered for managing incidents of RRSA and for future research, including the importance of designing effective interventions.

Environmental Volunteering and Health Outcomes over a 20-Year Period

PURPOSE This study tested the hypothesis that volunteering in environmental organizations in midlife is associated with greater physical activity and improved mental and physical health over a 20-year period. DESIGN AND METHODS The study used data from two waves (1974 and 1994) of the Alameda County Study, a longitudinal study of health and mortality that has followed a cohort of 6,928 adults since 1965. Using logistic and multiple regression models, we examined the prospective association between environmental and other volunteerism and three outcomes (physical activity, self-reported health, and depression), with 1974 volunteerism predicting 1994 outcomes, controlling for a number of relevant covariates. RESULTS Midlife environmental volunteering was significantly associated with physical activity, self-reported health, and depressive symptoms. IMPLICATIONS This population-based study offers the first epidemiological evidence for a significant positive relationship between environmental volunteering and health and well-being outcomes. Further research, including intervention studies, is needed to confirm and shed additional light on these initial findings.

Peer Support for Alzheimer’s Caregivers Is it Enough to Make a Difference?

This study tested a social support enhancement intervention for caregivers to relatives with Alzheimer’s disease. Theory and empirical research on life-course transitions and social support suggest that support from an experientially similar peer (i.e., a person who has undergone the same stressful transition) will lead to positive outcomes among caregivers. The intervention differed from previous programs for caregivers by isolating social support enhancement as the intervention mechanism, without simultaneously providing education, counseling, or direct services. Using a randomized, control-group design, no main effects were found. At the level of interactions, a modest buffering effect was found for persons in more stressful caregiving situations. However, the overall pattern of the results suggests that social support alone is not a sufficient intervention to improve the experience of caregivers. Implications for future research and planning of interventions are discussed.

Conflict Between Nursing Home Staff and Residents’ Families Does It Increase Burnout?

Objective: In this study, the authors examine the influence of conflict between nursing home staff and family members of residents on staff burnout. Method: Data were collected from interviews with a representative sample of 655 nursing home nurses and nursing assistants. Hypotheses were tested using structural equation modeling. Results: Results indicate that conflict with family members increases staff burnout and decreases staff satisfaction. Staff and family conflict increases when staff members feel they do not have enough time to complete required tasks. Level of conflict decreases when staff perceive that family members have care expectations that are similar to their own. Interestingly, staff who have personal experience as family caregivers are more likely to report conflict with family members of residents, a result that necessitates further study. Discussion: Staff burnout and dissatisfaction affects both individuals and organizations. Policy that addresses staff and family interaction can have an important place in the design and delivery of long-term care.