Terms such as "elder abuse" and "elder neglect" are often used to refer to what others may be doing that creates problems for the elder. In some cases what is done for the older person creates some problem (abuse/exploitation). In other situations the problem is created by what was not done (neglect). At times what is done is intentional, that is, another person setting out to do physical or emotional harm to the older person. In other situations, what is done to or not done for an elder may create some harmful situation or condition even though the other party never intended a harmful outcome. It can be difficult, at times, to ascertain a person's intent towards an elder.
ELDER ABUSE: The following may help to clarify variations in the definitions of what constitutes its different forms.
PHYSICAL MISTREATMENT: Abuse involving acts of violence that may result in pain, injury, impairment, or disease (e.g., pushing, striking, slapping or pinching, force-feeding, incorrect positioning, improper use of restraints and medications, and sexual coercion or assault.)
PSYCHOLOGICAL MISTREATMENT: Abuse involving conduct that causes mental anguish in an older person such as verbal insults, harassment, or intimidation, threats of punishment or deprivation, treating the older person like an infant, lack of a safe environment, and isolating the older person from family, friends, or activities.
FINANCIAL OR MATERIAL MISTREATMENT: Abuse involving misuse of the person's income or resources for financial or personal gain of a caretaker or advisor, such as denying the person a home, stealing money or possessions, coercing the person into signing contracts, assigning durable power of attorney to someone, purchasing goods, or making a will.
Psychiatric symptoms seen in elder abuse of all types include:
ELDER NEGLECT: As opposed to abuse, neglect involves failure to use available funds and resources necessary to sustain or restore the health and well-being of an individual (e.g., person is suffering from substandard care at home despite adequate resources, withholding information about personal resources, and pressure to transfer assets to a family member).
ELDER SELF-NEGLECT: Caseworkers (a generic term applicable to those staff who provide adult protective services) actually work with a higher proportion of elder self-neglect cases than any other of the case categories subsumed under elder mistreatment. Nationwide, 50% or more of the cases annually referred for possible adult protective services intervention are elder self-neglect. Not all state statutes include the category of self-neglect, and when included there is variation in the definition.
The National Association of Adult Protective Services Administrators (NAAPSA) has encouraged the adoption of the following definition.
Self-neglect is the result of an adult's (usually defined as 18 or older) inability, due to physical and/or mental impairments or a diminished capacity, to perform essential self-care tasks including: providing essential food, clothing, shelter, and medical care; obtaining goods and services necessary to maintain physical health, mental health, emotional well-being, and general safety; and/or managing financial affairs (NAAPSA, 1990).
A basic distinction to keep in mind between self-neglect and other types of elder mistreatment is that the primary sources of risk are not being created by another person. In both case categories, however, priority is given to the elder's safety and his/her legal rights for autonomy. Problems of self-care may be no more or less life-threatening than the conditions that result from the actions of other people. And because of this, cases are given equal attention based on the potential vulnerability and risk levels of the elderly client.
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