Elder Abuse and Neglect: A Study of Adult Protective Service Workers in the United States
Ronald Dolon, EdD
Bernard Blakely, PhD
ABSTRACT The study analyzes data from a 1987 survey of 1,137 adult protective service workers in forty states and Washington, D.C. A four-page questionnaire was mailed to obtain information on the perceptions and practices of those practitioners in dealing with cases of elder abuse neglect. Data were collected on the incidence of elder abuse, neglect, self-neglect, and exploitation, the observed frequencies of hypothesized causes of elder abuse and neglect in actual cases, barriers to service, the effectiveness of various methods of intervention, the outcomes of elder abuse and neglect cases, and the perceived potential of community resources for reducing elder abuse and neglect.
During the past twenty years family violence has been a growing concern in the United States. In addition to the problems of child abuse and spouse abuse, researchers and practitioners have recently identified widespread instances of elder abuse and neglect. The exact rates of elder abuse and neglect are unknown. Steinmetz (1978) and the U.S. House Committee on Aging (1981) noted that between 500,000 to one million elderly are abused each year . More current estimates based on the work of Pillemer and Finkelhor (1987) suggest a range of between 701,000 and 1,093,560 cases of elder abuse in the United States annually.
In spite of the reported prevalence of elder abuse and neglect, it is not known how effective we are in combating these problems, what intervention methods and services are favored by practitioners, or which community resources are most helpful to practitioners. Neither do we know how frequently family conflict, substance abuse, or other hypothesized causes are operative in observed cases of abuse or neglect, or which factors are most likely to prevent victims from seeking assistance This paper examines:
- The frequency with which family conflict, dependency, substance abuse, and other contributing factors appear in cases of elder abuse and neglect
- The frequency with which fear, shame, and other factors are barriers to service for victims of elder abuse and neglect
- The perceived effectiveness of various methods of intervention in cases of elder abuse and neglect.
- The incidence of various outcomes in cases of elder abuse and neglect.
- The perceived potential of various community resources for reducing the incidence of elder abuse and neglect
Methodology
The study was designed to obtain survey data from adult protective service workers who were employed throughout the United States. In order to explain the purpose of the investigation, to obtain permission for the survey, and to identify the adult protective service workers, a letter was sent to 415 state directors of protective service programs and county welfare directors. Two hundred and forty-four directors agreed to participate and provided the names of adult protective service workers in their agencies. A four-page questionnaire was mailed to 1,490 adult protective service workers during the summer of 1987. Questionnaires were returned by 1,137 workers for a response rate of 76 percent. As a result, information was supplied by respondents from 40 states and Washington, D C.
To assure that respondents were utilizing consistent ideas as to what constitutes elder abuse and neglect, definitions were supplied on the questionnaire. The first definition referred to abuse as an act of physical or mental mistreatment which harms or threatens another person. The second definition described neglect as a pattern of conduct which deprives another person of the minimum amount of care which is necessary to maintain physical and mental health. Using the distinction between abuse and neglect, as defined above, this study examines whether there are differences in methods and outcomes in cases of abuse versus cases of neglect.
After respondents had been informed about the definitions which were to be used in the survey, they were asked to report the numbers of cases of elder abuse and elder neglect which they had encountered during the preceding year. In contrast to other studies which have attempted to estimate the total number of cases of abuse and neglect which occur each year, the purpose of these questionnaire items was to determine the amount of exposure which one group of practitioners, adult protective service workers, has to these problems.
Past researchers (Giordano & Giordano, 1984, Pedrick-Cornell & Gelles, 1982) have suggested the existence of a number of factors which contribute to elder abuse and neglect. Included in the survey were family conflict, physical dependency, inadequate support services, economic dependency, mental health problems, stress, substance abuse, substandard living conditions, and a lack of financial resources. Respondents were asked to report how frequently each factor was observed in cases of elder abuse and neglect. Rating categories ranged from “very often” to “never.”
The survey also provided a means of examining factors which prevent victims from obtaining needed services. Potential barriers to services which were contained in the questionnaire were victim’s fear, victim’s shame, and victim’s incompetence, lack of available services, waiting lists, and legal evidence Respondents were asked to determine how frequently each factor was a service obstacle in cases of elder abuse and neglect Forced-choice response categories ranged from “very often” to “never.”
Nine intervention techniques were included in the questionnaire that examined the effectiveness of methods used to deal with elder abuse and neglect. The techniques were home visits, family crisis intervention, legal intervention, instruction on self-care, changing victim’s living situation, individual victim counseling, advocacy, planning and arranging for appropriate services and case monitoring. Rating categories ranged from “very effective” to “not effective “
As a means of examining the disposition of cases of elder abuse and neglect, respondents were asked to indicate the frequencies with which eight different outcomes were observed. The outcomes were “client safe and stable,” “client enters hospital,” “criminal prosecution of perpetrator of abuse or neglect,” “client enters long-term care facility,” “client refuses assessment,” “client referred elsewhere,” “client refuses access,” and “access refused by perpetrators of abuse or neglect “ Rating categories ranged from “very often” to “never”.
Finally, information was provided about the perceived potential of fourteen community services for reducing elder abuse and neglect. The list of community services which was included on the questionnaire was adapted from a study sponsored by the Illinois Department of Aging (Crouse, Harris & Poertner, 1981). The services which were evaluated by respondents were social services, family counseling, meals on wheels, home health aides, agency homemakers, visiting nurses, daycare, transportation, telecare, sitters, legal counsel, foster care, and respite care. Categories for rating the potential of resources for reducing abuse and neglect ranged from “excellent” to “inadequate” or “not available.”
The first step in analysis was to examine the amount of exposure to elder abuse and neglect cases which was reported by respondents and the manner in which these cases were distributed among adult protective service workers. The remaining phases of analysis focused on similarities and differences in the ratings which were supplied in cases of abuse and neglect. The general plan of analysis can be illustrated by considering barriers to services in cases of abuse and neglect. First, average ratings for fear, shame, incompetence, and the other three factors which were included on the questionnaire were used to establish a rank order which pertained to the frequency with which each barrier was observed in cases of abuse, and second, in cases of neglect. Two-tailed t-tests were then used to identify instances in which the average rating for a given factor in cases of abuse differed significantly (p ≤ .001) from the average rating it received in cases of neglect.
Findings
From the 1,137 questionnaires which were returned by respondents, 1,072 individuals reported that they had come into contact with at least one case of elder abuse or neglect during the preceding year. Altogether, these respondents indicated that they had observed 12,590 cases of elder abuse and 19,541 cases of elder neglect. These results provide support for the idea that elder abuse and neglect are widespread problems, but fall very short of recent estimates of the national incidence of cases of elder abuse and neglect even if allowances are made for the agencies and individuals who did participate in the investigation. To the extent that such estimates are accurate, it appears that the vast majority of cases of elder abuse and neglect do not come to the attention of adult protective service workers.
The data further show that elder abuse and neglect are not the only mistreatment or deprivation problems which practitioners encounter. Additional questions were used to determine the numbers of cases of self-neglect and exploitation which respondents had observed. The respondents reported 29,835 self-neglect cases and 10,106 exploitation cases. While other factors in addition to problem frequency must be weighed in determining allocations of agency resources, the likelihood that a given problem will be encountered by caseworkers must also be taken into account. On the basis of frequency, it would appear that exploitation cases would deserve nearly as much attention in staff training and other forms of staff support as abuse and that self-neglect cases would be given the highest priority by agencies which employ adult protective service workers.
A majority of the respondents observed between one and ten cases of abuse, neglect, and exploitation, respectively, during the preceding year. With regard to self-neglect, approximately 42% of those reporting indicated that they had observed between one and ten cases of this form of deprivation. Thus, workers commonly deal with ten cases or fewer than ten cases per year of each of the four types of problems. Given the small numbers of observed cases, many agencies with tight budgets may have difficulty in providing the necessary training to thoroughly familiarize workers with the particular needs and methods of treatment of abused, neglected, or exploited elders.
The veiled suggestion that workers might benefit from additional training is not confined to the judgments of the researchers. More than 45% of the respondents expressed agreement with a statement that services for victims of elder abuse and neglect could be improved by providing more training opportunities for practitioners. Another 45.3% of the respondents strongly agreed with the statement. Although more than 90% of the respondents possess college degrees and a majority have been on the job for more than five years. Apparently many of these individuals feel that specialized training is needed to improve performance in saving victims.
Table 1 provides information about the frequencies with which nine contributing factors were observed by respondents in cases of elder abuse and neglect. The most commonly observed factor in cases of elder abuse was family conflict. Average ratings for stress and physical dependency indicated that these factors were also “often” observed (x > 2.00, x 1.00, x < 2.00) .The most surprising ratings appear at the bottom of the list Lack of financial resources, substandard living conditions, and substance abuse were the least commonly observed factors in elder abuse. While the average scores for these three factors indicate that they are sometimes present, the low ranks accorded to these factors suggest that stereotypes of poverty, overcrowded living conditions, and abuse of alcohol may not be typical characteristics of elder abuse cases.
When attention is shifted to elder neglect, seven of the nine factors had average scores which fell between the “very often” and “often” categories (x > 3.00, x < 2.00). In descending order, the four most frequently observed factors were physical dependency, inadequate support systems, lack of financial resources, and substandard living conditions. Mental health problems, economic dependency, and family conflict occupied the next three positions in the rank order for neglect. The least commonly observed factors were stress and substance abuse.
Case | FactorFrequency with Abuse | Frequency with Neglect | t | Probability | DF | ||||
---|---|---|---|---|---|---|---|---|---|
X | SD | Rank | X | SD | Rank | ||||
Family conflict | 2.246 | .80 | 1 | 2.024 | .76 | 7 | 9.22 | .000* | 1041 |
Stress | 2.235 | .81 | 2 | 1.984 | .81 | 8 | 10.93 | .000* | 1041 |
Physical dependency | 2.180 | .80 | 3 | 2.348 | .75 | 1 | 6.95 | .000* | 1032 |
Mental Health problems | 1.964 | .78 | 4 | 2.110 | .75 | 5 | 6.69 | .000* | 1042 |
Inadequate support services | 1.944 | .86 | 5 | 2.278 | .81 | 2 | 14.49 | .000* | 1036 |
Economic dependency victim | 1.856 | .84 | 6 | 2.037 | .80 | 6 | 7.83 | .000* | 1042 |
Lack of financial resources | 1.799 | .84 | 7 | 2.168 | .77 | 3 | 16.05 | .000* | 1047 |
Substandard living conditions | 1.683 | .83 | 8 | 2.167 | .77 | 4 | 18.76 | .000* | 1047 |
Substance abuse | 1.572 | .90 | 9 | 1.510 | .86 | 9 | .86 | .389 | 104 |
ª Categories included: Very often = 3; Often = 2; Seldom = 1; Never = 0
*Significant at or beyond the .001 level of probability
The six top ranking factors in cases of elder neglect are generally consistent with images of dependency, impairments, and limited resources. The placement of family conflict and stress in the seventh and eighth positions of the rank order, however, raises an interesting issue. How can an elder be deprived of the care which is necessary to maintain physical and mental health without generating family conflict and stress? Perhaps a partial answer lies in the contrasting perspectives of victims, family members, and protective service workers. Both victims and family members may view deprivation as a normative condition. On the other hand, adult protective service workers are likely to define conditions of deprivation as abnormal, threatening circumstances which require intervention and remedy.
T-tests showed that eight of the nine differences in average ratings of factors for elder abuse and neglect were statistically significant (p ≤ .001). Only the difference in average ratings for substance abuse in ninth position in both rank orders failed to attain statistical significance. The results of the statistical tests as well as the movements which were observed in positions within the two rank orders suggest somewhat drastic changes in the roles played by at least five of the factors that were examined. Perceptions of the frequencies with which family conflict, stress, inadequate support systems, lack of financial resources, and substandard living conditions appear in cases of elder abuse and elder neglect were subject to considerable variation. Judging from the reports of practitioners, it appears that these factors may figure more or less prominently in the etiology of elder problems depending on whether the end result is abuse or neglect.
Table 2 reports findings on the frequencies with which six factors were observed as barriers to services in cases of elder abuse and neglect. In cases of abuse, three factors had average ratings between the “very often” and “often” categories (x > 2.00, x > 3.00). These were fear, competency, and shame. The remaining three factors had average ratings which fell between the “often” and “seldom” categories (x > 1.00, x < 2.00).
Factor | Barriers to Victims of Abuse | Barriers to Victims of Neglect | t | Probability | DF | ||||
---|---|---|---|---|---|---|---|---|---|
X | SD | Rank | X | SD | Rank | ||||
Victim’s fear | 2.477 | .71 | 1 | 2.188 | .82 | 2 | 16.02 | .000* | 1065 |
Victim’s competency | 2.208 | .74 | 2 | 2.393 | .69 | 1 | 9.99 | .000* | 1065 |
Victim’s shame | 2.012 | .85 | 3 | 1.878 | .85 | 3 | 6.57 | .000* | 1061 |
Legal evidence | 1.824 | .91 | 4 | 1.620 | .92 | 5 | 9.66 | .000* | 1057 |
Lack of available service | 1.735 | .87 | 5 | 1.799 | .87 | 4 | 4.19 | .000* | 1067 |
Waiting list | 1.288 | 1.04 | 6 | 1.452 | 1.07 | 6 | 8.86 | .000* | 1056 |
Lack of financial resources | 1.799 | .84 | 7 | 2.168 | .77 | 3 | 16.05 | .000* | 1047 |
Substandard living conditions | 1.683 | .83 | 8 | 2.167 | .77 | 4 | 18.76 | .000* | 1047 |
Substance abuse | 1.572 | .90 | 9 | 1.510 | .86 | 9 | .86 | .389 | 104 |
ª Categories included: Very often = 3; Often = 2; Seldom = 1; Never = 0
*Significant at or beyond the .001 level of probability
These were legal evidence, lack of available services, and waiting lists. According to these ratings, psychological and/or physiological conditions of victims are the factors which most commonly appear as barriers to services. The relatively low rank which was observed in the case of legal evidence may be due not only to the infrequency of its appearance but also to the fact that adult protective service workers may seek therapeutic remedies rather than those which involve prosecution of perpetrators. Lack of available services and waiting lists were ranked in the two lowest positions in cases of abuse. The low ranks which these last two factors received may be attributed to the fact that there are comparatively few instances in which services are unavailable or in which waiting lists result in delays in service delivery. However, it appears equally plausible that adult protective service workers are used to working around problems which involve limited services and delays in providing services.
Rankings in cases of neglect resemble those which were obtained in cases of abuse. In cases of neglect the top three positions in the rank order also involve psychological and/or physiological conditions on the part of victims, and the bottom three positions are again occupied by lack of available services, legal evidence, and waiting lists. Two of the six factors occupied exactly the same positions in the rank orders for abuse and neglect, and each of the remaining four factors varied a single step in its placement in the rank order for neglect from the position it occupied in the rank order for abuse. T-tests showed that the differences in average ratings for abuse and neglect for all six factors were statistically significant. However, since the structures of the two rank orders are highly similar, and a large sample was employed in the investigation, the substantive significance of the observed differences is open to some question.
Comparison of the perceived effectiveness of nine methods of intervention in cases of elder abuse and neglect, is shown in Table 3. Changing the living situations of victims, planning and arranging for appropriate services, and making home visits were considered on the average to be more than “effective” methods (x > 3.00) of dealing with cases of both elder abuse and neglect. Five of the remaining intervention methods received average ratings which fell between “effective” and “somewhat effective” (x < 3.00, x > 2 00) in treating elder abuse and neglect The only method which was perceived to be less than “somewhat effective” in working with elder abuse and neglect was instruction on self-care. As might be surmised, those intervention techniques which involved the courts, advocacy roles, or individualized approaches were considered to be the least effective forms of treatment.
Intervention Method | Effectiveness with Abuse | Effectiveness with Neglect | t | Probability | DF | ||||
---|---|---|---|---|---|---|---|---|---|
X | SD | Rank | X | SD | Rank | ||||
Changing living situation of victim | 3.114 | .88 | 1 | 3.041 | .88 | 3 | 3.72 | .000* | 1045 |
Planning and arranging for appropriate services | 3.042 | .78 | 2 | 3.223 | .75 | 1 | 10.76 | .000* | 1052 |
Home Visit | 3.029 | .82 | 3 | 3.160 | .81 | 2 | 6.85 | .000* | 1065 |
Case monitoring | 2.925 | .80 | 4 | 2.982 | .80 | 4 | 4.02 | .000* | 1052 |
Family Crisis intervention | 2.696 | .85 | 5 | 2.632 | .86 | 5 | 3.59 | .000* | 974 |
Legal intervention | 2.598 | .96 | 6 | 2.405 | .97 | 7 | 8.26 | .000* | 1002 |
Advocacy | 2.563 | .990 | 7 | 2.552 | .92 | 6 | .69 | .493 | 989 |
Individual counseling for victim | 2.199 | .84 | 8 | 2.128 | .85 | 8 | 3.70 | .000* | 990 |
Instruction of self-care | 1.783 | .74 | 9 | 2.034 | .84 | 9 | 10.97 | .000* | 920 |
ª Categories included: Very often = 3; Often = 2; Seldom = 1; Never = 0
*Significant at or beyond the .001 level of probability
One of the unanticipated results in the table was the fact that changing the living situations of victims was the most highly rated treatment in cases of abuse. In extreme cases, changing the living situation of victims may be the only realistic solution which is available to practitioners. However, evidence suggests that extreme forms of abuse do not commonly occur (Pillemer & Finkelhor, 1987). In the average case of abuse which comes to the attention of protective service workers, it might be thought that providing appropriate services, conducting home visits, case monitoring, and family crisis intervention would constitute preferred remedies. In fact, these latter approaches may be the ones which are most frequently prescribed in cases of abuse. The problem with these techniques, considered singularly or in combination, may be in their lack of permanence. The judgments of the respondents appear to suggest that the most certain way of assuring that maltreatment does not re-occur is to remove the victim from the environment which spawned abusive behavior in the first place.
T-tests produced eight statistically significant differences in average ratings for methods of intervention in cases of elder abuse and elder neglect. However, once again the rankings in cases of abuse tended to resemble the rankings in cases of neglect. Positional changes of at least two steps were observed in the two rank orders only in the case of changing the living situation of victims. One step changes occurred with planning and arranging for services, home visits, legal intervention, and advocacy. The remaining four variables occupied exactly the same positions in the rank orders for abuse and for neglect Some of the observed differences in ratings may point to real differences in perceptions in abuse cases as opposed to neglect cases. For example, it would appear that instruction on self-care does little to assist a victim of abuse The same intervention method would appear to be somewhat more effective in cases of neglect, as the ratings differential indicates. In other cases, more information is needed to meaningfully interpret small but statistically significant differences in the observed ratings.
Table 4 focused on the outcomes which were reported by respondents in cases of abuse and neglect. Inspection of the table shows that the rank orders of outcomes are nearly identical for abuse and neglect. In each case the most frequently reported outcome is that the client is safe and stable. However, it should be further noted that the safety and stability of victims are not perceived on the average to occur “often” (x > 2.00) in either abuse cases or neglect cases. “Client enters long term care facilities” and “client enters hospital” are the next most commonly observed outcomes in both rank orders “Client refuses access” is ranked in fourth position in the rank order for abuse and in fifth position in the rank order for neglect. “Client referred elsewhere” appears in fifth position in the rank order for abuse and in fourth position in the rank order for neglect. The least common outcomes in both rank orders were “perpetrator refuses access,” “client refuses assessment,” and “criminal prosecution.” Of these last three outcomes, only criminal prosecution was rated as a comparatively rare occurrence (x < 1 00) Consequently, the ratings suggest that prosecution is much less likely than termination of services because clients or perpetrators refuse access or because clients refuse assessment.
If the first three outcomes which are listed in the table are interpreted as favorable outcomes, t-tests suggest slightly higher probabilities of achieving positive results in cases of neglect than in cases of abuse. By the same token, the t-test performed on ratings of “perpetrator refuses access” suggests a slightly higher probability of obtaining this negative result in cases of abuse than in cases of neglect. Other statistically significant differences in average ratings for abuse and neglect were observed in conjunction with client referrals and criminal prosecution.
Outcomes | Frequency with Abuse | Frequency with Neglect | t | Probability | DF | ||||
---|---|---|---|---|---|---|---|---|---|
X | SD | Rank | X | SD | Rank | ||||
Client safe and stable | 1.879 | .72 | 1 | 1.991 | .69 | 1 | 6.38 | .000* | 994 |
Client enters long-term care facilities | 1.678 | .78 | 2 | 1.842 | .73 | 2 | 8.18 | .000* | 1057 |
Client enters hospital | 1.575 | .75 | 3 | 1.643 | .74 | 3 | 3.72 | .000* | 1058 |
Client refuses access | 1.457 | .82 | 4 | 1.457 | .81 | 4 | 0.00 | 1.000 | 1055 |
Client referred elsewhere | 1.456 | .80 | 5 | 1.410 | .80 | 5 | 3.53 | .000* | 1048 |
Perpetrator refuses access | 1.350 | .89 | 6 | 1.212 | .86 | 6 | 8.33 | .000* | 1025 |
Client refuses assessment | 1.307 | .76 | 7 | 1.305 | .76 | 7 | .12 | .904 | 1058 |
Criminal prosecution | .676 | .65 | 8 | .509 | .60 | 8 | 11.75 | .000* | 1045 |
Instruction of self-care | 1.783 | .74 | 9 | 2.034 | .84 | 9 | 10.97 | .000* | 920 |
ª Categories included: Very often = 3; Often = 2; Seldom = 1; Never = 0
*Significant at or beyond the .001 level of probability
The overall response pattern in Table 4 does not indicate that we are highly successful in treating cases of elder abuse and neglect. Even though a positive outcome, “client safe and stable,” was the most frequently reported outcome in both abuse and neglect cases, the numerical values of these averages suggested that this ideal was not routinely realized. In fact, 26.2% of the respondents reported that this outcome is “seldom” achieved in abuse cases and another 2.4% of those reporting indicated that it is “never” the case that abused clients end up in safe and stable situations. Slightly smaller percentages provided skeptical responses about positive outcomes in cases of neglect. At the same time, from 31.2%-41.5% of the respondents indicated that “often” or “very often” clients refuse access or assessment or perpetrators refuse access in cases of abuse and neglect Given the extent of such problems, it does not seem surprising that 32.5% of the respondents voiced agreement with a statement that “elder abuse and neglect are generally sources of frustration for me,” or that another 17.1% of the respondents strongly agreed with the statement.
Table 5 contains ratings of the perceived potential of 14 community resources for reducing abuse and neglects. The ratings in the table show that social services, home health aides, agency home makers, and visiting nurses are considered to be the four resources that have the greatest potential for reducing abuse. Day care, foster care, respite care, and police protection appear in the fifth through the eighth positions in the rank order for abuse. The final six positions are allocated to meals-on-wheels, sitters, family counseling, legal services, transportation, and telecare.
Outcomes | Frequency with Abuse | Frequency with Neglect | t | Probability | DF | ||||
---|---|---|---|---|---|---|---|---|---|
X | SD | Rank | X | SD | Rank | ||||
Client safe and stable | 1.879 | .72 | 1 | 1.991 | .69 | 1 | 6.38 | .000* | 994 |
Client enters long-term care facilities | 1.678 | .78 | 2 | 1.842 | .73 | 2 | 8.18 | .000* | 1057 |
Client enters hospital | 1.575 | .75 | 3 | 1.643 | .74 | 3 | 3.72 | .000* | 1058 |
Client refuses access | 1.457 | .82 | 4 | 1.457 | .81 | 4 | 0.00 | 1.000 | 1055 |
Client referred elsewhere | 1.456 | .80 | 5 | 1.410 | .80 | 5 | 3.53 | .000* | 1048 |
Perpetrator refuses access | 1.350 | .89 | 6 | 1.212 | .86 | 6 | 8.33 | .000* | 1025 |
Client refuses assessment | 1.307 | .76 | 7 | 1.305 | .76 | 7 | .12 | .904 | 1058 |
Criminal prosecution | .676 | .65 | 8 | .509 | .60 | 8 | 11.75 | .000* | 1045 |
Instruction of self-care | 1.783 | .74 | 9 | 2.034 | .84 | 9 | 10.97 | .000* | 920 |
ª Categories included: Very often = 3; Often = 2; Seldom = 1; Never = 0
*Significant at or beyond the .001 level of probability
Eleven statistically significant differences were observed in average ratings for abuse and neglect cases. Six positional changes of two or more steps were found among these significant differences. Meals-on-wheels was considered to have much higher potential for reducing neglect than for reducing abuse. Police protection, social services, and legal services were reported as having higher potential impacts in cases of abuse than in cases of neglect. Finally, transportation and telecare occupied higher positions in the rank order for neglect than they occupied in the rank order for abuse. Examination of the degrees of freedom in the table reveals another aspect of the perceived potential of community resources for reducing elder abuse and neglect. Degrees of freedom vary from a low of 318 in the case of telecare to a high of 1,061 in the case of social services. The observed variations in degrees of freedom resulted largely from variations in the number of reports that services were not locally available. For example, from 392 to 686 individuals indicated that day care, foster care, sitters, and telecare were not available for use in abuse or neglect cases. Thus, it appears that many practitioners are constrained to carry out their professional roles without access to some of the resources that are available for combatting elder abuse and neglect.
IMPLICATIONS
The current investigation focused upon perceptions and judgments of professionals who are charged with important roles in the delivery of services to elderly victims of abuse and neglect. The study might be described as practitioner-oriented research in that an attempt was made to examine the incidence of observed cases of elder abuse and neglect in worker caseloads, problems which workers encountered in dealing with cases of elder abuse and neglect, the effectiveness of available intervention techniques, outcomes of cases of elder abuse and neglect, and other issues of relevance to worker-client relationships.
Utilization of a practitioner-oriented perspective documented the existence of feelings of frustration among workers in coping with cases of elder abuse and neglect and a widespread belief that additional training is needed to improve the quality of services which are provided to victims of elder abuse and neglect. Expressions of interest on the part of adult protective service workers in increased training opportunities present several challenges to agency administrators. First, a majority of the workers who responded to the survey reported that they had come into contact with ten cases or fewer than ten cases of abuse, neglect, and exploitation in the preceding year. Given the relatively small number of cases involved, agencies may find it difficult to justify expenditures on training and other forms of staff support in these problem areas. Even if budgetary constraints can be overcome, questions remain as to the types of training which are likely to benefit workers who serve victims of elder abuse and neglect.
The responses to the survey contained numerous suggestions with regard to potential topics for additional research as well as for staff training. For example, examination of barriers to service showed that workers must frequently overcome problems of fear, shame, and incompetence on the part of victims of elder abuse and neglect. At the present time, the process of overcoming such problems is poorly understood. The research literature does not disclose which strategies are generally available and how common they are in eliminating psychological and physiological obstacles to treatment. To the extent that research can provide answers to such questions, the resulting knowledge can be used to enhance worker performance.
Examination of factors which contribute to elder abuse and neglect showed that family conflict and stress were more likely to be observed in cases of abuse than in cases of neglect. A possible explanation is that deprivation may be considered to be a normative condition by victims of neglect and their families. Assuming that such situations represent empirical realities, how do workers assist their clients in redefining the conditions of victims? Once again, it appears that research is needed to determine what techniques are currently being utilized and how well they work. Unanswered questions also surfaced during analysis of the other major areas on which the survey focused. Little is known about mechanisms that can be utilized to improve the effectiveness of community resources in combating elder abuse and neglect, how workers manage when services are available at the local level, or what factors differentiate between favorable and unfavorable outcomes in cases of abuse and neglect. Practitioner-oriented research can provide enlightenment on such issues and help in shaping future policies and practices regarding the discovery and treatment of elder abuse and neglect.
REFERENCES
Clark, B.C. (1984). Geriatric abuse—Out of the closet. Journal of the Tennessee Medical Association, August, 471, 472.
Crouse, J., Harris, B., & Poertner, 1. (1981). Abuse and neglect of the elderly in
Illinois: Incidence and characteristics, legislation and policy recommendations. Springfield, Illinois: Illinois Department on Aging.
Giordano, N.H., & Giordano, J.A. (1984). Elder abuse: A review of the literature. Social Work, 232-236.
Pedrick-Cornell, C , & Gelles, R J (1982) Elder abuse The status of current knowledge. Family Relations, 31, 457-465
Pillemer, K., & Finkeihor, D, (1988). The prevalence of elder abuse: A random sample survey The Gerontologist, 28, 5 1-57
Steinmetz, S K (1978) Battered parents. Society, 5, 54-55
U.S. Congress Select Committee on Aging. (1981). Elder abuse: The hidden problem. Washington, D.C.: U.S. Government Printing Office.