The major theoretical approaches to conceptualizing counseling are the social constructionist perspectives . These refer to the emergence of a phenomenon relative to social contexts ( Loseke , 2017) . Specifically, in the context of abuse and neglect, these con d itions arise due to complex social and psychological practices that reflect broader social arrangements ( Eisikovits et al., 2013). In the same breath, the naturalist theory is an essential guiding concept with regard to the motivation toward service to humanity . This is especially in professions that involve serving and helping those in need since i t emph a si z es social construction of reality, its negotiation and interpretation ( Slife & Richardson , 2014) . The other theoretical approach that attempts to explain the type of response elicited as well as the nature and type of outcomes is a conceptual framework that delineates the effects of elder abuse based on meaning. Meaning, in this case , is used to refer to the manner in which older people perceive their experience of being mistreated. The basis of this theory is that the meaning attributed by older adults to an experience of being abused or mistreated is influenced by beliefs, norms, nature of mistreatment, and the relationship between the victim and the perpetrator . The long-term health impacts of elder abuse are postulated to exert an effect through four principle pathways , namely, behavioural, social, cognitive, and emotional.
Elderly A buse and N eglect
The population of seniors is on the rise globally . T his is not isolated to developed countries, but rather, the trend is similar in the middle and low - income countrie s . With the ballooning population levels, it is expected that the magnitude and severity of EAN will increase correspondingly, with a resultant negative impact on public health (Dong, 2016) . The prevalence of EAN worldwide is estimated at between 3.2% and 27.5% . I n developing countries , the levels are on the upper end of this spectrum n otwithstanding the fact that these figures may be grossly underestimated (Yunus et al., 2017; Stankunas et al., 2016; Corbi et al., 2015 ; Cooper et al., 2008; Collins et al., 2000 ) . A widely accepted and commonly used definition of EAN in the face of cross - cultural as well as geographical differences, is “ a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person ” ( Davis, 2016; World Health Organization [ WHO ] , n.d. ; Centers for Disease Control and Prevention [ CDC ] , 2017). This perspective of EAN is heavily influenced by work in highly developed western country settings . However, what might constitute EAN in other culturally different and less affluent settings is markedly different . F or instance, failure of kinship obligations is regarded as abuse in certain cultures (Yunus et al., 2017). E lderly abuse and neglect h as been categorized into physical, verbal , psychological, sexual, financial, neglect, and most recently , social ab use (Davis, 2016).
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Numerous adverse impacts of abuse on the elderly have been highlighted in the literature . These include a higher risk of mortality ; disability ; depression syndromes ; frequent or extended hospitalization ; higher probability of being committed to nursing homes ; and metabolic syndrome . Others include sleep disturbance ; pain pathology ; gastrointestinal disturbance ; suicidal tendencies ; as well as stress and anxiety. However, these relationships are rarely straightforward . Instead, they a re often subject to confounding, mediation and moderation . T he case of the relationship between mortality and depression is a good illustratio n of this confounding. The other confounders include sociodemographic factors such as age, gender, or ethnicity; health-related variables such as cognition and comorbidities; psychosocial factors such as depression; substance use; and the moderating effect of gender o n pain, allergy, anxiety, suicidal tendency, and sleep. The consequences of abuse on health can be categorised as physical, behavioural, psychological and social (Davis, 2016; Lachs & Pillemer , 2015 ) . Often, notwithstanding the nature of abuse, physical and mental health is affected as well as decreased quality of life.
Abuse can be categorized as physical, emotional or psychological, sexual, neglect, financial and social. Physical abuse refers to the use of physical force that has the potential of resulting in physical injury or distress, as well as the threat of physical force ( Collins et al., 2000; Davies, n.d. ). The signs of physical abuse include fearfulness of particular people ; bruising ; skin tears or wounds ; scratches ; and behavioural changes especially tendencies to wards aggression or violence . Others are the refusal to be cared for by certain staff ; increased reports of falls ; inconsistencies between injuries and history ; and a lag between injury and seeking help. Psychological abuse caus es the victim to be fearful, intimidated, powerless, guilty , worthless, isolated, shameful or disrespected. The indicators that this type of abuse has occurred are numerous. They include signs of fear in the presence of certain people ; keeping to oneself ; changes in the behavior to people ; an upsurge in complaints of poor health ; and a negative self-perception . They also include depression ; failure to complain ; failure to report ; and inconsistencies regarding a self-reported state of mind. Sexual abuse is the threat of sexual contact or actual sexual contact with an older adult without their consent . I t includes taking advantage of a power imbalance , the use of a threat in a professional or trusting relationship between a perpetrator and an elderly person to gain consent or taking advantage of the older person ’ s inability to give consent due to cognitive impairment. Some of the indicators that this type of abuse may have occurred are complaints of pain or itching in the genital area ; signs of fearfulness with certain people ; refu s al of care by certain persons amongst the caregiver s and lacerations . They also include bruising on upper arms ; confirmation of sexually transmitted diseases (STDs); blood - stained underwear or pads ; increased anxiety with personal hygiene such as showering or ablutions ; and signs of emotional and physical abuse.
Neglect refers to the failure to provide care which is necessary for an older adul t' s physical and mental health, welfare, and safety. The presence of ongoing neglect may be shown by pressure sores, malnutrition, dehydration, inadequate personal care, dental problems, poor continence care, constipation, and abandonment. Financial abuse include s the use of an older person ’ s finances and assets illegally or irresponsibly . F or instance, it can take place through the disappearance of personal effects and belongings or changes in financial and legal documents like wills and power of attorney . S igns that this may be occurring include fearfulness and agitation with certain people . It may also be shown by financial hardship that is inconsistent with income and which did not exist previously. Social abuse may result from the isolation of the older person from family or social networks and loss of contact with family and friends . I ndicators of ongoing social abuse include an increased tendency of being critical of friends and family and making excuses to avoid socializ ing or hav ing visitors (Davies, 2016).
Negative Impacts on the P atient
In the study by Yunus et al. (2017) , mortality emerged as one the major consequences of elder abuse and neglect . P remature mortality was found to be a highly probable outcome of EAN in this study following data abstraction and quality appraisal . H owever, data was sour c ed predominantly from the developed countries of the United States ( U . S ) and Australia, and with a sex bias skewed towards women. This finding has been corroborated by the study conducted by Corbi et al. (2015). I n this study , despite the racially diverse sample, the sample composition was biase d toward whites and elderly persons of English origin, hence the lack of accurate representation. It was also determined in the same study that most of the studies assessed emphasized the psychological and emotional domain of health than physical health and function. Furthermore, most of the studies were of the cross-sectional type, hence precluding the attribution of causality or temporal order . Further, the significant outcomes tended to consist of psychological correlates such as depression a n d similar stat e s such as poor mental health, negative emotional states, and psychological distress.
On the other hand, consequences such as sleeping problems, harboring suicidal tendencies, urinary incontinence, metabolic syndrome, and allergies were supported by few studies. Nonetheless, the several studies reviewed in the article approached the analysis of the data by separating abuse subtypes and analyzing the relationship of each to outcomes of health separately . H owever, comparisons of results with those that did the reverse should be made with care. The other effects that have not been adequately addressed include a decline of quality of life (QoL) ; deterioration of cognitive abilities ; impairment of physical function such as gait speed and hand grip ; social and behavioural disorders ; sexually transmitted diseases ; and diseases of the reproductive system which are often the results of sexual abuse.
Caregiver F actors that P redispose to A buse
Mistreatment and neglect are not only associated with the failure of family members to provide care but can also be due to inappropriate behavior of caregivers, nurses and other professionals toward the elderly (Dong, 2016; Lachs & Pillemer , 2015 ) . In this regard, Corbi et al. (2015) sought to examine the role of nursing in the abuse of the elderly with a particular focus on possible types of mistreatment, motivations and preventive interventions . The scholars determined that a tiny part of the information available dealt with abuse of the elderly by the nursing fraternity. The abuse perpetrated in care facilities was mostly attributed to low - skilled professionals ; the presence of high levels of stress in private life ; a low tolerance threshold by the staff concerned ; high incidences of burn-out ; negative attitudes toward elderly amongst the nursing staff concerned ; and the inadequate attempt at compliance with the applicable regulations and best practices.
The most predictive of all factors for abuse and mistreatment by caregivers is the increasing levels of stress among nursing staff . This is likely to arise from the increase in the number of older adults requiring care in hospital s and homes ( Dong, 2016; Corbi et al., 2015). I ncidence of abuse is proportional to the number of institutionalized patients in home, lo n g - term care hospitals and nursing homes. Caregivers may be predisposed to abuse or neglect due to lack of psychological support when faced with stress owing to demand of the job or personal problems (Collins et al., 2000) . Actors that potentiate abuse and neglect on the part of the caregiver are depression, stress, reduced functional capacity, fatigue and limited time with the patient. The negative attitude among hea l th professionals is due to inadequate time with the patient, lack of compassion, unprofessional conduct and stress. There are conditions that predispose to this behavior such as alcohol and drug use by nurses to relieve stress ; an increasing number of elderly and dementia patients ; as well as patient aggression (Parmar et al., 2014).
Risk F actors, C haracteristics and E nvironments that I nfluence O ccurrence
The risk of abuse of the older adult is related to various characteristics . These include characteristics related to the individual old person ; characteristics of the family ; organizational and cultural issues of residential care settings ; quality of social networks ; access to community amenities and ageism. Adult abuse and neglect occur across socio - economic status, gender, and ethnicity. It may take place in the older person ’ s home perpetrated by family members or caregivers ; in residential care facilities ; and to some extent , in public spaces. The perpetrators may be paid care workers, aged care workers, other professionals, unpaid carers or other family members. Abuse by strangers or opportunistic perpetrators is rare in comparison to the other forms mentioned. The risk for abuse of older people is correlated with age ; power imbalance in a relationship ; level of need ; trust in the perpetrators ; the expectation to be treated with dignity ; alcohol and drug dependency ; the continuum of domestic violence ; cognitive or mental disability ; and ageism (Friedman et al., 2017; Rosen, 2014 ; Davies, n.d. ).
The more advanced in age a victim is , the higher the probability of an event of abuse or neglect occurring ( Lachs & Pillemer , 2015 . The existence of a power imbalance between the aged person and a family member, caregiver or any other professional or service provider increases the probability that abuse or neglect will be reported (Davis, 2016) . The level of need and the corresponding individual burden experienced by the perpetrator has a direct correlation to whether abuse will occur. Trust in the perpetrators of abuse , t he perception of being safe in the care of a perpetrator , and the expectation to be treated with dignity are some of the predisposing factors of abuse against older people. Alcohol or drug dependency that impairs the perpetrator ’s ability to behave in a respectable way towards an elderly person is one of the risk factors for the occurrence of abuse. Others are d omestic abuse that extends through family or marriage ; cognitive or mental impairment that make it impossible to stop acts of domestic violence ; and ageism. These factors create an atmosphere of diminished respect for the older person ’ s rights to make their own decisions, be independent , and be safe . Subsequently, they have the effect of devaluing and disempowering the older people.
The most frequent type s of abuse are psychological and financial . H owever, data on elder abuse is still inconsistent due to the fact that abuse is still poorly defined, under - recognized and the mechanisms for reporting are poorly defined (Corbi et al., 2015 ; Davis, n.d. ). Additional risks for abuse of the elderly include disability and dependency . M oreover, the elderly suffer anxiety and depression due to low income, social isolation, mental and physical disability, poor familial or social support . Since the most common type s of abuse ha ve been identified as financial exploitation and psychological abuse, evidence of financial exploitation and abuse could be use d as a surrogate of impending physical and psychological abuse.
Biblical Perspectives o n Crisis Counseling
Giving counselling to the victims of elder abuse cannot be overstated. This is because it aids in helping the affected individual to confront the deed so as to live a healthy life. For instance, chronic crises can result in stress and trauma which could subsequently lead to the development of mental illnesses. In this regard, it is important for counsellors to be both knowledgeable and skilled. This calls for the need to understand the spiritual needs of their clients ( MacArthur & Mack , 2013; Parker 2011; Tan, 2011). In this pursuit, understanding and differentiating the characteristics of Bible-based therapy is requisite ( Slife & Richardson , 2014) . By using the Bible as the basis for crisis management and counseling, an abused older adult is more likely to be helped back to normal functioning. He or she is also likely to cope better with the ordeal. Moreover, a relationship is re-established between God and the client. In this case, the counsellor has to remind the accused that God, through his son Jesus, is the source of strength, love and guidance ( MacArthur & Mack , 2013). The client also has to understand that despite the increasing number of crises in the world, God is always there to offer solace.
Crisis R esponse
The general global population is aging due to the lengthening of the life expectancy . This means that more seniors will require home-based care as well as nursing home facilities. Due to this , the quality of nursing care should be improved. There should be awareness creation and recognition among health professionals and elderly alike on what constitutes abuse and neglect as well as the recognition of suspect abuse cases ( Baker et al., 2016) . There is a need for best practices in policy regulations concerning the identification and reporting of abuse by nurses and other healthcare professionals ( Lachs & Pillemer , 2015) . In most developed nations such as the U . S and Italy, elder abuse is considered a sentinel event that involves death or serious physical injury or risk that necessitates or signals the need for an investigation, response and other s evere action. Indicators of preparedness to tackle this issue includes awareness among healthcare workers of the obligation to report cases of abuse or neglect. However, there still exists an unsuitable environment and lack of awareness of the communication of suspected cases of abuse and neglect resulting in frustration amongst healthcare professionals. The role of the nurse is key in recognizing and reporting abuse . H owever, there exists difficulty in recognition of abuse and neglect . As a result, nurses require appropriate training.
There i s a difference between perception and objective evidence of abuse . Thus, there is a need for medical expertise for detection of and reporting of abuse cases ( Baker et al., 2016) . In this pursuit, c linical evaluation and protocols are key. Understanding the major risk factors for elder abuse is important for prevention . O n the other hand , lack of standards or guiding criteria makes it difficult to manage abuse and neglect. There are diverse variables that determine the probability of abuse and neglect . However, inadequate supervision by caregiver or medical staff of the elderly is the most significant cause of escalation of abuse and neglect. This is especially so for the elderly with a disability, dementia, cognitive disorientation or those on psychotropic medication. In order to ensure early warning , it is mandatory to hav e a surveillance system in place by the nursing staff so as to provide information on the safety of patients . T he ability of this system to identify potential risks is also critical . Despite the willingness of healthcare professionals to increase their knowledge about abuse, there is the tendency among health care providers and social workers to underestimate the presence of abuse of older people even after receiving training on recognition of abuse and neglect.
Crisis R esponse M aterials and R esources
Several preventive measure s have been proposed to reduce the occurrence of elder abuse . H owever, the number of studies that have sought to evaluate the effectiveness of these strategies is limited . The most popular measures that can be adopted include information campaigns to impart knowledge and promote awareness of elderly abuse ; educational and vocational training aimed at health professionals and social workers who are frequently in contact with the elderly ; and focusing on the role of caregivers in the evaluation and management of suspected cases . Others are legal information concerning the protection of the elderly and the review of issues about ethical reporting. Face - to - face training increases the retention of knowledge compared to written or distance learning. There are other resources for the management of abuse and neglect among the elderly . T hese include identification of potential victims ; educational programs for caregivers and nurses to prevent abuse , manage fragile patients as well as report and recognize cases of abuse. The use of phone hotlines dedicated to the support of family members as well as caregivers can be adopted . Emergency shelters that provide temporary housing security, video surveillance systems in nursing homes and hospitals prevention as well as for providing evidence of abuse in criminal trials are necessary . However, the use of video surveillance should be within the law and should respect the privacy of the patients and employees.
Conclusion
T he sample composition of some of the studies exploring EAN is extremely unrepresentative w ith most of th e elderly persons sampled being whites, of English origin, from developed countries and mostly female. Due to this, t here is the need to mount research studies in the middle and low - income regions as well as among non - western populations. Likewise, these studies should boast a b alance with regard to the sexes i n order to determine the replicability of these findings in the current settings. In most of the studies carried out in this area, the analysis mostly did not involve a disaggregation of the subtypes of EAN to determine the effects of each category of abuse on the risk of death. As a consequence, future studies should focus on treating the subtypes of EAN separately in order to provide new and deeper insights into understanding the dynamics of abuse and premature mortality. In the same breath, there is need to replicate existing studies on morbidity outcomes with longitudinal, prospective designs in order to help explain the mechanisms of premature mortality. Further , due to the fact that different types of abuse have different health effects, making distinctions between the subtypes of abuse as morbidity outcomes are being assessed has the potential for enabling not only better interpretation of data but also deeper insights and usefulness of data. Simultaneously, investigations of dose and response relationships with respect to severity of abuse and the resultant health impacts need to be investigated if attribution of causality is to be strengthened. Similarly, investigations into the frequency of use of healthcare services arising from effects of abuse are necessary to establish the nature of this relationship. It is also imperative that studies into the development of tools for screening and recognition of abuse in an objective manner be carried out in the future to enable the development of early warning tool s.
References
Baker, P. R., Francis, D. P., Hairi, N. N., Othman, S., & Choo, W. Y. (2016). Interventions for preventing abuse in the elderly. Cochrane Database of Systematic Reviews . doi: 10.1002/14651858.CD010321.pub2
CDC (2017). Elder Abuse P revention . Retrieved from https://www.cdc.gov/features/elderabuse/index.html
Collins, K. A., Bennett, A. T., & Hanzlick, R. (2000). Elder abuse and neglect. Archives of internal medicine , 160 (11), 1567-1569. doi: 10.1001/archinte.160.11.1567
Cooper, C., Selwood, A., & Livingston, G. (2008). The prevalence of elder abuse and neglect: a systematic review. Age and ageing , 37 (2), 151-160. doi: https://doi.org/10.1093/ageing/afm194
Corbi, G., Grattagliano, I., Ivshina, E., Ferrara, N., Cipriano, A. S., & Campobasso, C. P. (2015). Elderly abuse: risk factors and nursing role. Internal and emergency medicine , 10 (3), 297-303. doi: 10.1007/s11739-014-1126-z
Davis, J. (2016). Elder Abuse. Australian Nursing and Midwifery Journal, 24 (3), 28-29. Retrieved from http://ezproxy.liberty.edu/login?url=https://search-proquest-com.ezproxy.liberty.edu/docview/1815955131?accountid=12085
Davis, J. (n.d.). Elder Abuse. MedicAlert Foundation.
Dong, X. (2016). Elder Abuse in Nursing Homes: How Do We Advance the Field of Elder Justice?. Annals of internal medicine , 165 (4), 288-289. doi: 10.7326/m16-1161
Eisikovits, Z., Koren, C., & Band-Winterstein, T. (2013). The social construction of social problems: the case of elder abuse and neglect. International psychogeriatrics , 25 (8), 1291-1298. doi: 1 0.1017/S1041610213000495
Friedman, L. S., Avila, S., Rizvi, T., Partida, R., & Friedman, D. (2017). Physical abuse of elderly adults: victim characteristics and determinants of revictimization. Journal of the American Geriatrics Society , 65 (7), 1420-1426. doi: 10.1111/jgs.14794
Lachs, M. S., & Pillemer, K. A. (2015). Elder abuse. New England Journal of Medicine , 373 (20), 1947-1956.
Loseke, D. (2017). Thinking about social problems: An introduction to constructionist perspectives . Routledge.
MacArthur, J. F., & Mack, W. A. (2017). Counseling: How to Counsel Biblically . Thomas Nelson.
Parker, S. (2011). Spirituality in counseling: A faith development perspective. Journal of Counseling & Development , 89 (1), 112-119.
Parmar, J., Jette, N., Brémault-Phillips, S., & Holroyd-Leduc, J. (2014). Supporting people who care for older family members. Canadian Medical Association Journal , 186 (7), 487-488. doi: 10.1503/cmaj.131831
Rosen, A. (2014). Where mental health and elder abuse intersect. Generations , 38 (3), 75-79.
Slife, B. D., & Richardson, F. C. (2014). Naturalism, psychology, and religious experience: An introduction to the special section on psychology and transcendence. Pastoral Psychology , 63 (3), 319-322.
Stankunas, M., Avery, M., Lindert, J., Kalediene, R., Edwards, I., Di Rosa, M., ... & Soares, J. J. (2016). Abuse in the Elderly—Cost Driver in a Health Care System?. Population health management , 19 (3), 224-225. doi: 10.1089/pop.2015.0178
Tan, S. Y. (2011). Counseling and psychotherapy: A Christian perspective . Baker Academic.
WHO (n.d.). Elder Abuse. Retrieved from http://www.who.int/ageing/projects/elder_abuse/en/
Yunus, R. M., Hairi, N. N., & Choo, W. Y. (2017). Consequences of Elder Abuse and Neglect: A Systematic Review of Observational Studies. Trauma, Violence, & Abuse . doi: 10.1177/1524838017692798
