Risk factors of elder abuse in a community dwelling Spanish sample

Abstract

We analyzed the discriminative capacity of several risk factors for elder abuse and neglect, in order to identify what characteristics distinguish between caregivers with a high or low risk of abuse and neglect. Forty-five caregivers of relatives with dementia participated. The combination of caregiving impact, frequency of aggressive behaviors by care-recipients, stress related to provocative and aggressive behaviors, the frequency of provocative behaviors, interpersonal burden, autoefficiency expectations, quantity of help received and depression classify correctly as risk factors in 90.9% of the cases. This study permits us to identify what characteristics distinguish between caregivers with a high or low risk of abuse and neglect and caregivers.

Introduction

Elder abuse is a category of domestic violence together with child and gender abuse (Papadopoulos and La Fontaine, 2000), although elder abuse has been the last category that has caught the attention of researchers (Baker, 1975, Burston, 1975). This has been due to definitional problems (Kingston and Penhale, 1995; Papadopoulos and La Fontaine, 2000), and the different classifications developed by different authors. Although elder abuse is not a new phenomenon, it has remained as an invisible problem because of many reasons, particularly lack of awareness, lack of a universal definition and many barriers about this topic. Elder abuse is more frequent in situations where a trust relationship exists (for example, relatives, neighbors and friends) (Block and Sinnott, 1979, Lau and Kosberg, 1979, Papadopoulos and La Fontaine, 2000, Cohen et al., 2006), and specifically, elder abuse is more frequent in the family setting. In particular children, adults and spouses are, with more frequency, probably responsible for elder abuse (NCEA, 1998, Schiamberg and Gans, 2000).

In general terms, the prevalence of elder abuse in community dwelling elderly persons is between 1 and 10%, according to different studies (Block and Sinnott, 1979, Hwalek and Sengstock, 1986, Hudson, 1986, Pillemer and Finkelhor, 1989, Neale et al., 1991, Ogg and Bennett, 1992, Podnieks, 1992, Penhale, 1993, Comijs et al., 1998, Schofield et al., 2002), even though this percentage must be considered only a rough estimate, because the majority of cases are not reported and/or detected. In recent years different studies suggest that negligence is the most frequent type of elder abuse (see for example, NCEA, 1998).

Several risk factors exist that are related with elder abuse (Wolf, 1998). Elder abuse is not the consequence of only one factor but it is the result of combination of personal, family, social and cultural factors (Kosberg, 1988, Schiamberg and Gans, 2000). This investigation is focused on elder abuse by family caregivers. Within this approach, the associated risk factors have been grouped depending on whether they belong to the elder, the caregiver or the context of the caregiving situation.

Firstly, among factors associated with elders, gender can be emphasized, although contradictory results exist, that is, some researchers point out that to be a woman is a risk factor (Penhale, 1993) and others point out that be man is a risk factor (Pillemer and Finkelhor, 1989). Another risk factor would be age, so that older people are at greater risk (National Centre on Elder Abuse, 1998); marital status, so that married people are more at risk (Schiamberg and Gans, 2000); some personality traits, such as blaming oneself for the situation (Quinn and Tomita, 1997, Schiamberg and Gans, 2000), or a person who shows excessive loyalty to the person responsible for abuse (Kosberg, 1988), or resignation (Schiamberg and Gans, 2000). Further factors include the presence of provocative and/or aggressive behaviors, especially those present in persons with dementia (Kosberg, 1988); presence of cognitive impairment (dementia, Alzheimer's disease) (Kosberg and Nahmiash, 1996); poor health, although contradictory results have been found with respect to this factor. Some studies indicate that older people in good health can be abused, whereas others have found the opposite (Kosberg and Nahmiash, 1996); communication problems (Kosberg, 1988) and dependency (physical, economic and so forth), although with respect to this factor opposing results have also been found (Glendenning, 1993, Kosberg, 1988, Pillemer and Finkelhor, 1989) and so it is not possible to assume a direct relationship between dependency and abuse (Pillemer and Suitor, 1988).

Secondly, among factors associated with informal caregivers, gender can be stressed, so women, who assume the caregiving of their older relatives with greater frequency, have a higher risk of being responsible for abuse (Kosberg, 1988, Henderson et al., 2002). Moreover, other researchers point out that gender is related with the type of abuse (Pillemer and Wolf, 1986, Penhale, 1993) (men-physical abuse, women-negligence); the role of inexperience (lack of knowledge and suitable training) in the caregiving of older people (Henderson et al., 2002), or psychological disorders (depression, anxiety and dementia) are also held to be relevant. Although it was found that the presence of these disorders themselves do not increase the probability of elder abuse (Tomita, 1990), it was found that the presence of these disorders can prevent suitable interactions between caregiver and older person (Kosberg, 1988, Quinn and Tomita, 1997). Additionally, a number of personality traits may be involved as some caregivers may blame the older people for the situation and do not have sufficient patience or do not understand the elder's needs (Quinn and Tomita, 1997), and so forth. Some caregivers may have substance abuse problems such as alcohol and/or misuse other drugs, which can mean they are not able to provide suitable care (Godkin et al., 1989); the presence of negative feelings such as anger and hostility, as a consequence of some characteristics of the caregiving situation (Adelman et al., 1998) may also be relevant here.

A further risk factor is that the caregiver is stressed, although contradictory results have been found with respect to the relationship between this variable and elder abuse. Although some authors found this relationship (Hudson, 1986), others point out (Anetzberger, 2000, Papadopoulos and La Fontaine, 2000) that, although many caregivers report high stress levels, only a minority of them abuse their relatives. In addition, another factor is the perception of burden related to caregiving, although again contradictory results have been found (Steinmetz, 1990, Gordon and Brill, 2001) so, even if the majority of caregivers may state that they are overburdened, not all abuse their relatives; a further factor is financial dependence or being dependent for accommodation on the elder (Henderson et al., 2002).

Finally, among risk factors associated with the caregiving situation, the factors that increase the risk of abuse are, the amount of help (formal and informal) received, so caregivers who receive less help and support have more risk of abuse (Wolf and Pillemer, 1989, Kosberg and Nahmiash, 1996). In addition, the lack of informal and/or formal contacts, that is, social isolation, of the caregiver (Kosberg, 1988, Schiamberg and Gans, 2000) or for the elder (Homer and Gilleard, 1990) also increase the probability of abuse. Furthermore, the decline of intergenerational ties; economic difficulties (Kosberg, 1988); that caregiver and elder live together (Kosberg, 1988); the previous history of the relationship (Homer and Gilleard, 1990) may all have an effect here. The current quality (Glendenning, 1993) of the relationship between caregiver and elder is also a factor, so the poorer the quality of the relationship, the greater the risk. Additionally, in overcrowded situations, where the household is shared with too many people causing lack of space and intimacy (Kosberg and Cairl, 1986) the risk of abuse may be increased.

Following this examination of risk factors, an exploratory study about the risk of elder abuse by family caregivers was carried out. The aim of this study is to analyze the discriminative capacity of several risk factors for elder abuse and neglect, that is, to identify what characteristics distinguish between caregivers with a high risk of abuse and neglect and caregivers with low risk.