Added value of elder abuse definitions: a review

Added value of elder abuse definitions: a review

Mysyuka, Yuliya; Westendorp, Rudi G.J.; Lindenberg, Jolanda

Citation

Mysyuka, Y., Westendorp, R. G. J., & Lindenberg, J. (2012). Added value of elder abuse definitions: a review. Retrieved from https://hdl.handle.net/1887/46805

Version: Not Applicable (or Unknown)

License: Leiden University Non-exclusive license Downloaded from: https://hdl.handle.net/1887/46805

Note: To cite this publication please use the final published version (if applicable).

ContentslistsavailableatSciVerseScienceDirect

Ageing Research Reviews

jo u r n al h om ep ag e :w w w . e l s e v i e r . c o m / l o c a t e / a r r

Review

Added value of elder abuse definitions: A review

YuliyaMysyuk^a,∗, RudiG.J.Westendorp^a,b,JolandaLindenberg^a

aLeydenAcademyonVitalityandAgeing,PoortgebouwLUMC,Rijnsburgerweg10,2333AALeiden,TheNetherlands

bLeidenUniversityMedicalCenter,POBox9600,2300RCLeiden,TheNetherlands

a r t i c l e i n f o

Articlehistory:

Received2January2012

Receivedinrevisedform28March2012 Accepted3April2012

Available online 25 April 2012

Keywords:

Elderabuse Definition Purpose

a b s t r a c t

Elderabusehasdevastatingconsequencesforolderpersonssuchasapoorqualityoflife,psychological distress,andlossofpropertyandsecurity.Itisalsoassociatedwithincreasedmortalityandmorbidity.

Elderabuseisaproblemthatmanifestsitselfinbothrichandpoorcountriesandatalllevelsofsociety.

Itistimelytodiscussoneofthebasicproblemsthathashamperedthestudy,detectionandintervention ofelderabuseasthevarietyofdefinitionsthatexistnowproduceadefinitionalchaosforresearchers, practitioners,andpolicymakers.

In this articlewe tracethe elements of“howtodefine elder abuse”and situate them intheir socio-historicalcontext.Wealsoanalyzethepurposesofthesedifferentdefinitionstoassesstheirappro- priatenessindifferentsettingsconcernedwithelderabuse.Ouranalysisshowsthatelderabusemirrors thesocietalarrangementswhichgaverisetothem.Italsohighlightsthatitisacomplexproblemthat isdifficulttodefine.Thecentralquestioniswhetherweneedacommondefinitionofelderabuseor differentdefinitionsthatcanbeusedindifferentsettings.Byevidenceofouranalysiswecanseethat thereisaneedforasufficientlybroadandflexibledefinitioninordertocoverdifferentbehaviorsthat canconstituteabuseandthevarioussettingsinwhichitmayoccur.Ontheotherhand,thedefinition needstobespecificandconcretetobeusefulinprofessionalcontexts.

Totakeafurtherstepforwardforbothresearchandpracticeofelderabuse,weproposetoconsistently adheretotheWHOdefinitionthatleadstheenquirertowardsabetterunderstandingoftheproblemand helpstodistinguishitfromotherphenomena;andtoasimplifieddefinitionforprofessionalpracticethat setsboundariestothephenomenaandisappropriateforeffectivepreventionandinterventionmeasures.

© 2012 Elsevier B.V. All rights reserved.

1. Introduction

Elderabuse remainedhiddenand taboountilquiterecently.

Afterchildabuseanddomesticviolencewerediscussedpubliclyin the1970s,elderabuseemergedasaformoffamilyviolence.During theearly1980smorepublicandprofessionalinterestwasgivento theissueofelderabuse(McCreadie,1996,2003;Pritchard,1995).

Whatexactlyconstitutedelderabuse,however,wasatthattime lessatthecenterofattention.Despitethefactthattheproblem ofelderabusehasgainedmorepublicattentionandquitesome researchwasconducted,globalstatisticsarestilllacking,inmany instanceshealthcareprofessionals stillignoreit,andeven now notenoughaction is takentoprotect theindividuals subjected toabuse.Moreovercasesareoftennotrecordedandunreported (Perel-Levin, 2008). Part of this underreporting is due to the complexity of and unequivocalityinherent in the phenomenon itself:abusecantakeplaceinawholerangeofsettings,including

∗ Correspondingauthor.Tel.:+31715240968.

E-mailaddress:mysyuk@leydenacademy.nl(Y.Mysyuk).

hospitals,nursinghomes,residentialcarehomes,daycentersand eventheperson’sown home,perhapstheone placewherethe olderpersonmightfeelsafest(Abbey,2009;AnselloandO’Neill, 2010; Arai, 2006). Family members, adultchildren, or spouses areimplicatedin90%ofthecasesofelderabuse.Otherabusers includecareprofessionalssuchashealthorsocialworkers,friends, orneighbors.Sometimestheabusersdonotrecognizewhatthey aredoing asa formof abuse;they, and at timestheirvictims, do not know what constitutes abuse and what not, different organizations and professionals still use different terminology, adheretodifferentdefinitionsandthusperceiveabusedifferently.

This causessignificant issues for research as it makes it more difficulttocomparetheoutcomesofvariousreportsastheresult oftheinconsistenciesinthedefinitionsofelderabuse(Pillemer andWolf,1986;PillemerandPrescott,1989;Newton,2010).

Lackofagreementaboutthedefinitionanditsparametershas made theassessment of prevalence and incidence problematic fromanempirical perspective (Harbisonand Morrow, 1998).It makesitespeciallydifficulttodeterminetheextentoftheprob- lemof elderabuse. Prevalencerates of elderabuse of between 4 and 6% were found in Canada, Great Britain, Finland and a 1568-1637/$–seefrontmatter © 2012 Elsevier B.V. All rights reserved.

http://dx.doi.org/10.1016/j.arr.2012.04.001

prevalencerateof betweenoneand tenpercentwasestimated intheUSA(Griffin,1994; Pillemerand Finkelhor,1988).Inthe Netherlandsoneprevalencestudyonelderabuseshoweda5.6%

prevalencerate(Comijsetal.,1998,2000;Comijs,1999).Inade- quateknowledgeandtraininginhowtodetectabuseandalackof staffawarenessofwhatconstitutesabusecanleadtounderreport- ingofcasesofabuse,underestimationandimpreciseprevalence rates(Anetzberger,2004;Griffin,1994;Kivelaetal.,1992;Oggand Bennett,1992;Podnieks,1992).Someprevalencestudiesinclude onlyoneformofelderabuse,suchassolelyphysicalabuseandoth- ersmorethanone,forexample,physicalandpsychologicalabuse.

Asaresult,prevalenceratesareinconsistentandincomparable.On topofthis,thestudiesinvolvedprovidedifferentinterpretationsof elderabuse,thismakesitconfusingtoanalyzeandunderstandthe phenomenoninacomparativewayanditalsohasanimpactonfur- therresearch,andthusforthedevelopmentofpolicies,prevention andinterventionprogrammes.

Asafirststeptowardsfurtherdevelopingthefieldofelderabuse inacomparativeway,thisarticlereviewsdefinitionsofelderabuse takingintoaccountdifferentaspectsofthesedefinitionsandeffects theycanhaveonresearchandprofessionalpractice.Thepurpose ofthisanalysisistocometoanunderstandingofthedevelopment ofresearchandpracticeinelderabuse.Byenablingcomparative understandingithopestocontributetoacomprehensiveapproach towardselderabuse.

2. Methods

2.1. Identificationofstudies

Studies were identified by searches of 11 databases (PsycINFO, PubMed, EMBASE, Web of Science, CINAHL, Aca- demic Search Premier, ScienceDirect, Wiley, LWW, HighWire, Taylor&Francis/Informa). The search strategy consisted of the AND combination oftwo concepts: “elderabuse”, “definitions”.

For these concepts,allrelevant keyword variationswere used;

not only keyword variations in the controlled vocabularies of thevariousdatabases;butthefreetextwordvariationsofthese concepts as well (such as: elder neglect; elder mistreatment;

terminology;concepts; ontologies). Searches were restrictedto paperspublishedinEnglish.Thebibliographiesofrelevantoriginal andreviewarticleswerescreenedaimedtoincludeallpublished studiesthatprovideinformationaboutthephenomenonofelder abuse; definitions of elder abuse; problems in defining elder abuse;thedevelopmentofdefinitions;comparisonandanalysisof differentdefinitions.Thetitlesandabstractsofallarticlesidenti- fiedbythesearchwerescreenedandpotentiallyrelevantarticles were retrieved and assessed. Additional relevant articles were identified through Pubmed; Google Scholar and other relevant searchengines.Relevantbooksand chaptersof thebookswere alsoincludedtothereview.

2.2. Inclusionandexclusioncriteria

Thestudieswhichprovidedinformationaboutthephenomenon ofelderabuse,definitionsofelderabuse,problemsindefiningelder abuse,thedevelopmentof definitions,comparison andanalysis ofdifferentdefinitionsoranyinformation wereincludedinthe review.

Thearticlesthatdidnotcontainnecessaryandrelevantinfor- mationwereexcludedfromthereview.

2.3. Resultsofthesearch

ThePsycINFOyielded113hits,thePubMedyielded77hitsfrom which52wereunique(notfoundinotherdatabases),theMEDLINE

yielded80hits(0unique),theEmbaseyielded35(12unique),the WebofScienceyielded56hits(17unique),theCINAHLyielded 84hits(36unique),theAcademicSearchPremieryielded42hits (0unique),theScienceDirectyielded4hits(1unique),theWiley- Blackwellyielded12hits(0unique),theLWWyielded96hits(76 unique),theTaylor&Francisyielded38 hits(19unique)and the COCHRANEyielded0hits.

Screeningoftitlesandabstractsidentifiedpotentiallyrelevant papers;thenthepapers wasthoroughlystudiedand12 studies whichmettheinclusioncriteriaareaddressedinthisreview.

Otherrelevant studieswhich wereidentifiedfromreference lists,authorsandadditionalsearchengineswerealsoincludedin thereview(seeFig.1).

Informationobtainedduringthesymposium“Elder abusein context”(Leiden,2011),interviews,exchangesandmeetingswith professionals,experts,olderpeoplealsocontributedtothisreview.

2.4. Classificationofdefinitions

Toexploredefinitionsofelderabuse,wewillfirstdiscusswhat kindsofdefinitionsarecommonlydistinguishedandwhichpur- posestheyserve,asacomparativestartingpointforouranalysisof elderabusedefinitions.Thiswillbethefirststartingpointforour analyticalframeworkforthesedefinitions.

Inalonghistoryofdefinitions,manystrandshavebecometan- gled together,sothat “definition”hasimplicitly cometomean manydifferentthingstomanypeople,ofteninwaysthatareincon- sistent(Cregan,2005).Asafirststep,Robinson(1950)distinguished twotypesofdefinitions:lexical(oralsodictionary)andstipulative.

Lexicaldefinitionsareusedwhenweneedtoexplaintheexist- ingmeaningofanoldwordorterm;thatis,aword/termthatis alreadyinuseinthecommunity,butunfamiliartothepersonwant- ingtheexplanation.Lexicaldefinitionsseektopinpointwhatwas meantbysomewordtosomeoneatsomepointintime(Belnap, 1993).

Ifonemightwishtoexplainaproposedmeaningforanewword, stipulativedefinitionswillbeused.Thepurposeistospecifythat acertaintermwillbeusedonlytomeanacertainprecisething withinagivencontext (Belnap,1993;Ierodiakonou,1993).This maybeabroadeningornarrowingofanexistingsenseofaterm;

acompletelynewusageofanexistingterm;ormayinvolvethe creationofatotallynewterm.Itisaspecificationofhowtheauthor intendstousetheterminthefuturewithinaparticularworkor context,andbindstheauthortomakinggoodonthatintention (Zaltaetal.,2009).

However,besidesthetwotypesthatRobinson(Gulpa,2008) distinguished,therearealsomanycasesnotexhibitingeitherone ofthesetypes,includingperhapsmostdistinctivelyphilosophical definitions;inthesecasesonewantsbothtorelyonanold,existing meaningandtoattachanew,proposedmeaning,theytrytoexplain thecircumstancesofelderabusewithoutnecessarilybeingafull sum-upoftheconditionsthatmakeitcountaselderabuse.Forthis purposeathirdtypeofdefinition,herecalledexplicatory,isused inwhichanalysesorexplicationsexpounded.

Thethreebroadlydistinguishedtypesofdefinitions–lexical, stipulativeandexplicatory–discussedabovecanbeidentifiedin definitionsofelderabuseaswell.Thesetypeswillbeusedasa conceptualframeworktoanalyzeelderabusedefinitions inthis review.

Theincongruitybetweendifferentinterpretationsanddefini- tionsof elderabusealsohastheirimpactontheunderstanding oftheconsequencesofthephenomenon.Toexplaintheimpactof elderabuse,weneedtohaveaclearideaofwhatthatphenomenon entails.Cleardefinitionsserveseveralimportantpurposes:

References Identified 632 DatabasesSearched

PubMed=77 PsycINFO =113 MEDLINE=80 EMBASE =35 COCHRANE=0 Web of Science=56 ScienceDirect=4

Academic Search Premier=42 CINAHL =84

LWW=96

Wiley-Blackwell=12 Taylor&Francis=33

Duplicates Removed 306

Titles/Abstracts Screened 326

Excluded 250

Full Text Retrieval 76

Other Sources 38 (identified from reference lists, other search engines)

Full Text Screened 64

Excluded 22

Meeting Study Selection Criteria 42

Fig.1. Literaturesearchresultsflowchart.

• Aspointerstowardsthesocialprobleminquestionwhichguide towardsaclearerunderstandingoftheissue.

• Definitionshelptofocusonthesocialproblemunderstudyand differentiateitfromotherphenomena.

• Clear and consistent definitions are necessary for permitting effective intervention and prevention strategies (Biggs et al., 1995).

Thethreepurposescanbeidentifiedinelderabusedefinitions aswellandthatisthesecondtoolinouranalysisofelderabuse definitions.Theoverviewofouranalyticalframeworkcomprising thedifferenttypesofdefinitionsandthepurposesthattheyserve isshowninTable1.

Table1

Typesofdefinitionsandtheirpurposes.

Typeof definition

Semantics Purpose

Lexical Existingmeaningofanold word/term

Betterunderstandingof phenomenon;focusonthe problemunderstudy Stipulative Proposedmeaningforanew

word

Effectivepreventionand interventionstrategies Explicatory Bothexistingandproposed

meaning

Betterunderstandingof phenomenon,explainingcasual mechanisms

3. Results

3.1. Thedevelopmentofelderabusedefinitions

Despitethattherecognitionofelderabuseprovokedquitealot ofdebate,therewaslittleattempttoplacethephenomenoninsome formofconceptualframeworkforsometime.Thereisnocommon visionondefinitionsofelderabuse.Inthisarticletheevolvement ofdefinitionsofelderabuseinhistoricalperspectivewillbeana- lyzed.Acriticalanalysisisinsightfulbecauseitcanenlightenour understandinginelderabuseandenableastep-forwardinthecon- ceptualizationandunderstandingoftheproblem.

Thedefinitionsofelderabusechangedanddevelopedconsider- ablyovertime:from“grannybattering”,“grannybashing”to“elder mistreatment”and“elderabuse”(1970–2000s).Someofthemwere rathersimilarandhadsharedintentions,otheronesintroduced new and different elements. An overview can be found in Fig.2.

3.2. Femalesandphysicalassault

Inthe1970sthefocusofearlydefinitionsofelderabusewason physicalassaultofolderwomenwiththeuseoftheterms“granny battering”,“grannybashing”and“grannybatteringsyndrome”.Part oftheexplanationfortheattentionforelderabuseatthatexact pointintimecanbelinkedtolargerdevelopmentsinsociety.The IndustrialRevolutionsetthestageforreshapingthestatusolder personsoccupyinoursocietyandtheirassociatedvalues.Through

Elder abuse ¹ (O’Malley et al.)

Definitions Properties

-“Systematic physical abuse of an elderly person by a relative” (p. 23)

Granny battering ² (Bakker; Burston)

Elder mistreatment ¹ (Beachler)

Battered elder syndrome ² (Block & Sinnott)

Granny battering ² (Eastman)

Old age abuse ¹ (Eastman)

Elder mistreatment ¹ (Comijs)

Elder abuse ¹ (WHO)

Elder mistreatment ³ (Bonnie & Wallace)

General developments

Females and physical abuse

Risk factors and wideningof

actions

Widening of victims

Wideningof perpetrators

Wideningof context -Importance of the quality of

relationships - Females

- Acts or lack of actions -Personal or professional settings -“Ill treatment” of older people

-Parallel with “baby battering’

-Physical assault - Family crisis -Stressed caring daughter -Vulnerable women -Ageist negative assumptions

- Dependence of older person -Intention of harm by caregiver - Deprivation by caretaker of service - Relationship caregiver-caretaker -Physical pain, mental

anguish

1975-1977

- Dependency, developmental disorders, crisis, environmental conditions

-“Labeling”: syndrome, disease -Powerless and sick older people

-Physical, psychological and economic

-Care-giving relative -Applies to older people, not just grannies

-A new term “maltreatment”

-Narrowing the settings

-Physical, psychological, material damage

- Focus on trust relationship -Excludes random acts of violence or

criminal behavior

-Reduces specificity but increases the territory covered by the problem

-Excludes cases of self-neglect, and victimization of elders by strangers -Ambiguous terms “harm”, “trust relationship”

-Intentional actions

-Vulnerable elder-caregiver

1979-1982

1984

2002-2003 1998

Rationale Forms Circumstances

-Physical, emotional, financial

Fig.2. Developmentofelderabusedefinitions,¹lexical²stipulative,³combination.

thisrevolution,mengenerallygainedpositionintheuppertiersof societalhierarchy,predominantlycontrollingdecision-makingand resources.Havingpowertocontrolresourcesputthemintovisi- blerolesinsociety,maintainingthestatusquo.Thoseindividuals lackingpowerandvisibility, suchaswomenandchildren,were lessvalued. Thiswasreflected inthesocial movementoffemi- nismthatdevelopedinresponse.Theattentionforfemales(weak, powerless,vulnerable)indefinitionsofelderabusecanbeseenas mirroringthesedevelopments.Atthesametimewecanidentify anongoing,increasedincidencerateofabuse,notonlyofwomen andchildren,butalsooftheelderly(withthespecialaccenton elderlywomen)generallyconsideredthemostinvisibleandleast valuedofall(BaronandWelty,1996).Theterm“granny batter- ing”wasusedintheUKasaneuphemismfor theill-treatment ofolderpeople(Baker,1975).Theterminologyofchildabusewas adopted,anddoctorsconcernedwiththeelderlysaw“babybatter- ing”tohaveitsparallelsfortheirolderpatients(Burston,1975).

InBaker’s(1975)article,thetermincludedtheriskstoolderpeo- ple’shealthandwell-being,aswellasovermedicationandgeneral misuseofdrugs,andphysicalabuse.The“grannybatteringsyn- drome”wasquicklyadoptedasamodelforsocialandhealthcare workers,featuringastressedorburnt-outdaughtercaringforher physicallydisabledandslightlyconfusedmother(Eastman,1982;

Cloke,1983;Schlesinger,1984).

Besidesthefocusonvulnerablefemales,anotherfocusthatcan beidentifiedinthesedefinitionswastheoneonphysicalassault.

Caseexampleswerecitedtosuggestthatthoseatriskwereliving inthreegenerationsfamilies:“thedomesticsituationmaywellbe linkedtoapressurecooker”(Burston,1977).Theterm“grannybat- tering”itselfrevealedtheoftenageistassumptionsthatlaybehind itslabeling,whereelderlyvictimsareseenaspassiverecipientsof careandthereforeaburdentotheirfamily.

InalaterdefinitionofelderabusebyO’Malleyetal.(1979,p.

13)attentionwasagaingiventophysicalabuse.Theydefineditas:

“thewillfulinflictionofphysicalpain,injuryordebilitatingmental anguish,unreasonableconfinementordeprivationbyacaretaker ofserviceswhicharenecessarytothemaintenanceofmentaland physicalhealth”.Thisdefinitionbroadenedthecontextofphysical abuseincomparisontopreviousdefinitions.Theabusewasalso consideredasintentionofharm.Therelationshipbetweencare- giverandcaretakerwasintroduced.Inspiteofthesenewelements, thisdefinitionstilldescribeselderabusequitenarrowly;thetermi- nologyusedinthedefinitionisdifficult,andnotfullyunambiguous.

Itcanbeconsideredalexicaldefinition;elementsrequiredefini- tionbythemselves.Itappliesthelabelof abuseonlyifthereis therelationship“caregiver”–“care-receiver/caretaker”and when thecaregiverintendstodoharm.It alsoassumesthattheolder personisdependent. Thisassumptioneffectivelyexcludesinde- pendentelderlywho,asweknowfromprevalencestudies(Griffin, 1994; Pillemerand Finkelhor, 1988;Anetzberger, 2004;Griffin, 1994;Kivelaetal.,1992;OggandBennett,1992;Podnieks,1992), mayalsobethevictimofabuse.