Literature ReviewJestina SajiElder AbuseMount Saint Vincent UniversityGraduate Preparatory ProgramEEAP 0900-01MS. Lisa CrowellMarch 25, 20191. INTRODUCTIONAbuse of elders can take many forms. There are many different types of abuse that happens to older people. Sadly, abuse occurs far too often. Relatives, friends, caregivers and professionals can all be responsible for the abuse of elders and the vulnerable. Older people who experience abuse are unable to care for themselves or need assistance with their care. Elder abuse means a knowing, intentional, or negligent act to vulnerable adults. This paper will focus on elder abuse, and the types of abuses faced by seniors. Further, this paper will focus on the safety measures to prevent abuse and neglect towards the elders. Furthermore, this paper will point on where all the places the abuses happen.DEFINITION Elder abuse means the single or multiple acts of harming an older person that cause them to break their reliability by leading them into suffering or pain.Aims and ObjectivesThe overall aim of the review of the literature was to connect, combine and analyze on abuse of older people through qualitative research approach including in-depth interviews with a purposive sample of older adults reaching 65 years of age who experienced abuses like physical, sexual, emotional, financial, and neglect. 1. Different forms of abusePhysical abuseThe abuse which involves physical discomfort, pain, injury, assault. It also includes behaviors like slapping, burning, punching, beating, giving overdosage of drugs, restrain and feeding inappropriately (The Working Group of Elder Abuse, 2002).Sexual abuseThe abuse is described as without the consent of the person forcefully getting contacted with the person. It can be all types of sexual assault like rape, coerced nudity and sexually explicit photography (The Working Group of Elder Abuse, 2002).Emotional or psychological abuseWhen the older person diminishes the identity, self-respect, self-esteem it is said to be as emotional abuse. For instance calling by name, threatening, ignoring, isolating and excluding from the meaningful events (The Working Group of Elder Abuse, 2002).Financial abuseIt is also known as material or property abuse. For example stealing of money, misusing power of attorney, forcefully making the older adults sell their properties (The Working Group of Elder Abuse, 2002).NeglectWhen the caregiver or the family member fails to meet the needs of the older adults they feel isolate or alone this is known as neglect such as denial of food, water, shelter, clothing, or the medical treatment (The Working Group of Elder Abuse, 2002).2. Possible causative factorsThe mental health problems were blamed to be a reason behind the abusive behaviors.According, to a Canadian study conducted in Ireland in a long term care center, included face to face interview among 42 older adults states that the mental health problems were the main cause of abuse which was common with stress, substance abuse and which ultimately lead to the situational and emotional factors harming the health of one partner with spousal abuse (podnieks, 1992). The same idea was found in the study of Pritchard (2001). Cultural factors like a set of beliefs, morals, values, language and law play a vital role among elders abuse. Additionally, in the study of Schaffer (1999) highlighted that the role of cultural factors in elder abuse in Australia states that, the vulnerability of abuses takes place due to limited facilities available to older people for transportation, support cares. Peri et al. (2008) similarly reported with the same idea with older adults living in rural community dwellings had no access which results in abuse and neglect. Unfortunately, there are a majorities of factors which lead to abuse, and sometimes mental health disorders act as serious issue behind the act such as dementia.2.1 Dementia as a risk factor The abuse among older people with dementia indicates dementia itself as the risk factor for elder abuse. The case-control study conducted among the 142 people in the US came with the result that the majority of people who are prone to get abuse are high when compared with those of the one who is not (Dyler et al.2000). The caregiver abuse is commonly seen as the major factor in elderly abuse with dementia in people with thinking and reasoning impairment. The studies show that the surging in the cognitive impairment makes the seniors with dementia more prone to the abuse (Pot et al, 1995 cited in Lee and Kolomer, 2005; Cooper et al.2008a). Further, these studies was associated with the findings of the study conducted in Japan among older people with dementia (Kishimoto et al 2013). Similarly, several other studies have highlighted sexual abuse in elders with cognitive impairment. Even though the study finds gaps in the research regarding risk factors there should be further research on this to form a final verdict. 3. Impacts of Abuse on the older personThere are negative impacts of abuse on the older person resulting from health implication to the social implications.3.1 Heath ImplicationsThe qualitative data based on an interview in nursing homes was conducted among the 18 older female women who were victims of abuse in Canada they shared their experience of physical abuse, depression, and anxiety. But, the common consequences of the abuse were reported an emotional effect on the health (Lanzenbatt et al.2010). The same idea was highlighted by (Podnieks 1992) in his study the outcome of abuses often results in mental health disorders.3.2 Social implicationsLoneliness and isolation were the two kinds of factors that affected the older adults in the society living in nursing homes as well as in residential. Older adults who are victims of abuse have shared that often the victims find isolated at homes and institutionalized settings (Pritchard 2000). Again the study was conducted by Pritchard in 2001 with 12 men and they were interviewed and they were physically and emotionally isolated by their family members even though they were staying with them but they were experiencing lack of care and often finds difficult to have social contact with people and the society.3. Coping with abuseThe coping strategy which the older adults deal with were resilience, drugs and religious belief. There were many studies conducted by the researchers about the coping strategy which the elders developed after the abuse.3.1 ResilienceOlder adults as a survival tool used resiliency throughout their life as a part of the abuse. The study conducted by the abuse experienced victims has gained a will power to deal with the scenario (Lanzentte et al. 2010). The same idea was in the study of older women victims of domestic violence they just tackle the situation with the mindset of “let it go” and move on with it (Scott et al. 2004). Some of the senior women who experienced the abuse they remained quiet for the sake of their growing children. Buchabinder and Winterstein (2003) claimed, through his study that most women bare the abuse for the welfare and future of their children, but simultaneously others point out them as unwise. It’s always necessary to share the abusive experience by the elders which they are facing in the day today life to avoid further attacks. 3.2 Dependency on DrugsPeople from all walk can experience a problem with drug use when the person becomes the routine victims of the abuse they eventually became the user of drugs and other sedatives. According to (Lanzenbatt et al.2010) the interview conducted at northern neither land often found the older victims of abuse usually become addicts of codeine and paracetamol by exploiting the prescriptions and non-prescriptions as well as tend to develop over usage of alcohol and even develop with smoking habits to cope with the situation. To, overcome this scenario usually the victims found their shelters among the social support groups and super natural powers (religion based) to tend back to the normal life from the abusive experiences.3.3 Role of ReligionThe elderly victims of abuse found great relief through spiritual activities like engaging in church activities to overcome abusive experiences. The older adults found their physical and psychological strength with the bond in religion. Pritchard (2000) reported that for the abusive sufferer the religion can be their comfort zone to overcome the bad experience they faced and can adopt a new environment for a better life. Moreover, in the study of Hightower et al. (2006, p.223) concluded that the feeling of isolation and loneliness was reduced among the abusive older women as the churches functioned as the larger area like a family to reduce abuse.4. Approaches and Preventive measures for elderly abuse The preventive measures for the elders against the abuses should be like awareness programs, education, and social support groups. Mostly, the elders are prone to get abused by the professional from the field of service care providers like doctors, nurses, clergy, police and household help. According to Walsh et al. (2007) states that to reduce the abuse in older adult’s education to the public an essential tool to reduce the ageist beliefs. Further, awareness programs for the public and among the health care professionals. There are different types of models used by the researches for older adults against the abuse.4.1 Adult protective service modelThe study conducted at the United States by Heisler (2001, p.52) claims that there are interventional measures against the elderly abuse in the jurisdiction system by giving justice to the abused person and keeping the offenders for the legal ethics and governance. The system is developing across the country for the welfare of the elders as the jurisdictions provide with specialized laws for criminals, sudden response to the elder abuse victims and even several programs are been conducted like victim-witness assistance program. On the other hand, the study conducted by Nerenberg (2008) claims that when the older citizens are taking the help of the court they should be alert as there could also be a negative impact on elders. But, the limitation of the study there is a gap in, this model which remains as an exceptional outcome and all victims may not seek the help of court due to fear and even financial status.4.2 Victim AdvocacyThe victim advocacy helps the older adults in providing their rights and help them to make decisions and act as a backbone to attain the rights. For instance: The Aged Rights Advocacy Service (ARAS) in South Australia. These groups work with older adults with some of the welfare care services using aged care facilities and act as the representatives of the services. When the older adults become the victims of the abuse the service act as the safeguard for them was they can have their voice of rights, dignity, respect, and decision making with the support of the representatives. They also provide with the legal support, police assistance, and guardianship. This protective measures act as an intervention towards all sorts of abuses like financial abuse, physiological, social, and psychological abuse and equally distributes the rights and policies to the older adults. Moreover, special preference were given to women with all sorts of safeguard measures (Cripps 2001).4.3 The Public Health ModelThe government should protect and pay attention on the public by educating and by doing surveillance and screening programmes. Kurrle (2004 & 2006) and Kurrle and Naughtin (2008) have noted in the study conducted in Australia among the abuse of older people. These advices medical practitioners to screen older adults. The same idea was conducted by Reis (2000) in Canada in his study by his research through several tools were used to assess the abuse of elders through the effective indicators and formed in a conclusion that a screening tool should be used among the professionals and medical practitioners to know about the problems faced in a typical abuse and where there is a lack in the social support. For example, there was an incident resulted were there was abuse to the care recipient and there was no adequate social support. Too aware about this it includes the education towards the public, political and social communities to deliver the accessibilities to be equally distributed among the elders with all rights. 4.4 Elder Friendly Society These approaches were famous in North America. Research has found that this type of eco-friendly projects reduces the isolation and loneliness among older adults with a reduction in the abuse of risk (EFC Reports 2009). This project aims to enhance the welfare and quality of older adults by encouraging them to be an active part of society. The strength of this project, is the government of South Australia has made this scheme accessible to the urban and rural communities. During the evaluation of these project the positive outcomes for older people were more concentrated (EFC Reports accessed 2009). The limitation of the study when we go through the research is that eco-friendly society is not applicable everywhere and some gaps are present in the research and that has to be fulfilled.RecommendationsThe recommendations are aimed to ensure a better standard of living to older adults by strengthening them in coping with mistreatment and abuse. It will be very much helpful for the older adults by considering them to have Freephone or telephone listening and counseling service specifically to respond to meet the needs of the older people. Furthermore, in the remote rural areas, the community transportation facility should be made accessible. So, that they can maintain social contacts, hobbies and, interest.ConclusionThis overall review provides the older people experience of mistreatment and abuse. This study demonstrates the adverse effects of the abuse and the implication of abuse on their health and society. It also focuses on the preventive measures to the abuse through various models. The abuse of older people need interdisciplinary understanding and a coordinated multiple service system responses to the victim. Since, some interventional strategy is needed for the older people as they fail to recognize the abuse when it is being perpetrated on them, by improving their knowledge, about the abuse that occurs with families and in health care centers that is by the caregivers. With better knowledge older people are more likely to become empowered in recognize the abuse and to cope with it. Empowering the older people enhance to be more self-reliant and confident to deal with the abuse and even gain strength to seek help. ReferencesBuchbinder, E., & Winterstein, T. (2003). “Like a wounded bird”: older battered women’s life experiences with intimate violence. Journal of Elder Abuse & Neglect, 15(2), 23–44. https://doi.org/10.1300/J084v15n02_02Cripps, D. (2001). Rights focused advocacy and elder abuse. 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