While elder abuse is not a new phenomenon, it is a relatively new field of information and study that impacts a wide range of medical, legal, individual, institutional, and ethical issues. A National Institute of Justice study indicates that nearly 11 percent of the 5.7 million individuals in the United States who are over the age of 60 encountered some form of elder abuse in the previous year. In terms of financial exploitation alone, the elderly population reportedly loses a staggering $2 billion each year. The ability to address elder abuse, neglect, and exploitation at the state and national levels is a daunting yet critical challenge that must be met.
The Older Americans Act (OAA) was established in 1965 on the heels of the civil rights era and as part of President Lyndon B. Johnson’s Great Society reforms. The OAA was the first federal legislation to address the need for services and resources for older adults. This act was particularly helpful in allowing the federal government’s Administration on Aging to provide and manage state-agency grants to assist with elder abuse information, awareness, prevention, research, and policy leadership. Federal guidelines for defining elder abuse were the result of a 1987 amendment to the OAA, although a clear-cut standardized definition among the states is still in progress. The OAA expired in fiscal year 2011, but advocates have been working toward reauthorization of the act. Among the priorities for the reauthorization are economic security, the empowerment and protection of older adults, job training and services through the Senior Community Service Employment Program (SCSEP), support for senior centers, use of evidence-based health initiatives, and recognition of the need for more research and development.
More recently, in 2010, and enacted as part of the Patient Protection and Affordable Care Act (PRACA, commonly known as Obamacare), the Elder Justice Act (EJA) was formally established to coordinate national efforts for combating elder abuse in all its forms. The EJA earmarked nearly $195 million annually over four years for both national and state coordination of elder abuse prevention activities. Over $16 million was directed toward state adult protective services, which are at the forefront of fighting elder abuse, neglect, and exploitation. The EJA also established the Federal Elder Justice Coordinating Council and an Advisory Board on Elder Abuse, Neglect, and Exploitation as part of the mandated EJA coordination efforts. The newly formed council and advisory board bring together key experts from leading agencies in a multidisciplinary approach for addressing elder abuse nationwide. Elder justice, then—as defined within the 2010 Elder Justice Act—brings much needed attention to the rights of the elderly to be free from all forms of abuse.
Senator Herb Kohl, an initiator of legislation aimed at helping the elderly, introduced the End Abuse in Later Life Act as part of the 2012 Violence Against Women Reauthorization Act. The provisions in this more recent legislative effort would provide grant funds overseen by the Department of Justice for a wide range of training opportunities for law enforcement personnel, prosecutors, population-specific state-based agencies, and victim advocate groups.
Elder Abuse Defined
While the OAA provided some guidelines for defining elder abuse, definitions can still vary from state to state. According to the National Center on Elder Abuse, there are seven major categories for types of elder abuse: physical, emotional, sexual, exploitation, neglect, abandonment, and self-neglect. Elder abuse typically is perpetrated by someone the victim trusts and usually occurs in domestic or institutional settings. All elderly persons are potentially at risk of abuse, neglect, or exploitation, but particularly those older individuals who have physical or mental impairments.
Ethical issues seem to take on greater significance with the elderly population because older individuals are more vulnerable than most other adults. Question of ethics and the elderly seem to surface in two broad yet significant areas: how the older population wants to be treated and how the older population actually is treated.
Medical professionals, attorneys, social workers, individual and institutional caregivers, advocates, and family members are the most common groups that either come in contact with, or are entrusted with, advising and caring for the aging population as they face a variety of physical, mental, emotional, and financial issues. Not surprisingly, these are also the individuals, professionals, and organizations that are faced with ethical considerations when dealing with the elderly as their clinician, caregiver, evaluator, negotiator, or advocate.
Several common areas harbor the potential for ethical concerns, including circumstances that involve a present or future potential for conflict of interest, issues pertaining to confidentiality, and scenarios involving decision-making autonomy and competency. Conflict of interest circumstances can involve spouses, family members of different generations, guardians or conservators, or caregivers (individuals or businesses).
A multitude of conflicts can arise between the interests of these entities and the desires of the elder. Confidentiality issues can occur simply because of the amount of private information about the elder that must be shared. The information cannot be disseminated unnecessarily, carelessly, or in a manner that can bring harm to the elderly person. As well, reporting elder abuse may be mandatory or voluntary in states and raises questions about immunity and anonymity for the reporters of the abuse, neglect, or exploitation. Decision-making autonomy and competency in medical, business, and personal arenas can come into question for older people who may or may not be able to reason clearly, fully understand, adequately express themselves, or who may simply want the right to refuse intervention regardless of perceived dangers.
A less common, but not necessarily less important, area of ethical concerns have to do with themes of beneficence (the doing of good) and nonmaleficence (doing no harm). There are a number of ways that family members, professionals, and organizations can “do good” when it comes to assisting and caring for the elderly. However, problems can occur if the acts of doing good become the justification for overriding the elder’s wishes and ignoring the older person’s autonomy. Likewise, the key players in the lives of the elderly may also face subtle yet complicated cost-benefit decisions impacting the older person. A decision that might work very well on paper may not manifest as well in real time, thereby leading to a potentially ethical dilemma.
Lastly, ethical issues may come into question because elder abuse can be a family-systems issue, a potentially criminal issue, and even a cultural issue. Some elder maltreatment can be dealt with through local state social service or family-oriented agencies; other forms of elder mistreatment must be dealt with through potential criminal prosecution and the involvement of the courts. In either case, both the victim and the abuser may find themselves involved with a larger, more complex network of systems and organizations and varying regulations and requirements for reporting and dealing with the problem of elder abuse. In some cases, the reporting requirements might dissuade either the victim or the potential reporter from bringing the case to the attention of the appropriate authorities.
Ethical issues surrounding broken trust, loss of confidentiality, reduced decision-making power, and loss of freedom during an investigation can plague both the victim or the reporter as they wrestle with seeking help from either family system or legal-system resources. Similarly, the reluctance of some cultures to turn to government officials for help in what may be viewed as merely a family matter can raise ethical concerns for both the victim and the reporter in elder abuse cases. Likewise, some local family-system or legal-system agencies may not be prepared to deal with culturally sensitive perceptions of elder abuse and, as a result, may not have culturally relevant responses and services. This interplay of familial, legal, and cultural goals and values can create ethical dilemmas for some elder abuse victims, the advocates, and the systems involved.
- American Psychological Association. “Elder Abuse.” http://www.apa.org/pi/prevent-violence/resources/elder-abuse.aspx (Accessed February 2013).
- Dresser, Rebecca. “Ethical and Policy Issues in Research on Elder Abuse and Neglect.” In National Research Council (U.S.) Panel to Review Risk and Prevalence of Elder Abuse and Neglect. Richard J. Bonnie and Robert B. Wallace, eds. Washington, DC: National Academies Press,
- Elder Justice Coalition. “Elder Abuse and the Elder Justice Act: Fact Sheet.” http://www.elder justicecoalition.com (Accessed March 2013).
- National Center on Elder Abuse. Department of Health and Human Services. http://www.ncea.aoa.gov/faq/index.aspx (Accessed February 2013).
- National Council on Aging. “NCOA 2011 Reauthorization Priorities.” http://www.ncoa.org/public-policy-action/older-americans-act (Accessed February 2013).
- O’Shaughnessy, Carol V. “The Elder Justice Act: Addressing Elder Abuse, Neglect, and Exploitation.” National Health Policy Forum. (November 30, 2010). https://www.nhpf.org/ uploads/announcements/Basics_ElderJustice_11-30-10.pdf (Accessed February 2013).
- Pham, Sherisse. “Government Report Finds Elder Abuse on the Rise.” New York Times (March 3, 2011). http://newoldage.blogs.nytimes.com/2011/03/03/government-report-finds-elder-abuse-on-the-rise (Accessed March 2013).
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