Abstract
Old age is one of the most critical stages of human development. Older adults are among the most vulnerable groups in the world, and they face multiple challenges, such as social and biological needs. As people get older, the elderly population will require more support in their daily jobs and activities, which will create more pressure for their families and caregivers. Failure of families and caregivers to care for the elderly and the different social conditions, such as poor living conditions and financial constraints, may significantly contribute to elder abuse. Elder abuse is the intentional or unintentional behavior towards the elderly in emotional, physical or psychological forms. This paper provides an overview of the contributing factors to elder abuse and neglect as well as the ethical issues and ethical considerations facing elder abuse in the healthcare industry.
Introduction
Abuse is one of the most challenging issues in developed and developing nations across the globe. Currently, elder abuse is one of the most covert types of mistreatment that comprises issues such as justice, health, human rights, and ethics. People involved in elder abuse often portray ageism or demonstrate negative attitudes and assumptions toward the elderly leading to abuse. Evidence shows that at least 1 in 6 elderly adults experiences abuse, but only 1 out of 24 cases are reported (Phelan, 2020).
Elder abuse and the complex combination of ethical considerations that are associated with it present society and the entire healthcare field with some huge challenges. The current level of awareness and the management of these issues leaves so many questions and offers an uncertain outlook for the near future. Besides, the lack of training opportunities and requirements, ongoing debates and discussions, as well as published research exploring ethical considerations of elder abuse not only insufficiently serves the current population of the elderly population, their caregivers, and healthcare providers but also puts the entire field of healthcare in the poor state to manage the changing and burgeoning cohort of the elderly in the coming years.
Since the awareness of elder abuse is affected by the knowledge, preparedness, and expertise of caregivers, nurses and caregivers act as the first line of defense in identifying and reporting mistreatments and providing support to the elderly population. Abuse of the elderly is a violation of their freedom and human rights that can cause serious loss of independence, dignity, and respect and also negatively affect some ethical principles such as competency, autonomy, beneficence, etc. Elder abuse interventions are often accompanied by ambiguity, and ethical challenges since the inadequacy or lack thereof of professional principles can lead to legal, personal, and ethical challenges. However, it is complex for healthcare professionals to perform successful interventions for elderly people willing to stay in abusive situations. Besides, this phenomenon increases the challenges for caregivers and nurses when legal commitments do not concur with ethical principles (Phelan, 2020).
This paper seeks to explore the ethical considerations of elder abuse, including comprehensive information on the main ethical issues at hand for professionals in the healthcare field, as well as an array of recommendations to enhance our current management of the ethical considerations surrounding this significant issue of elder abuse.
What is elder abuse?
According to the World Health Organization (WHO), elder abuse refers to the single or repeated acts or lack of appropriate actions happening within any relationship where trust is expected and which causes harm and distress to the elderly people (Yon et al., 2019). Elder abuse is inclusive of emotional, physical, psychological, financial, and sexual abuse, as well as neglect. Physical abuse can include slapping, shoving, restraining using chains and ropes, and even serious beatings. When people use adequate force to inflict unnecessary injury or pain on the elderly, it is considered abusive. Physical abuse is also inclusive of the inappropriate utilization of physical restraints, medications, and any form of physical punishment.
Verbal, psychological, and emotional abuse can also incorporate silent treatment, name-calling, intimidation, and threatening elderly individuals. Such acts tend to cause fear, emotional pain and distress, and mental anguish in the victims. Emotional and verbal abuse can be inclusive of swearing, yelling, insulting, and disrespecting the victims, while psychological abuse may include coercion and threats that creates a power differential between the elderly and the caregivers or family members.
Sexual abuse can include sexual exhibition and even rape. It can be inclusive of forcing the elderly into pornography, inappropriate touching and photographing, forced sexual contact, and unwanted sexual behavior. It can also include sodomy, rape, and coerced nudity. Financial abuse is inflicted on the elderly, including embezzlement of funds, fraud, forgery, and general misuse of the victim’s money.
Family and caregivers may also neglect the elderly ranging from not providing appropriate attention to willingly refusing to meet the elderly’s emotional, physical, and social needs. Neglect can also include failure to provide the victims with basic needs such as water, food, shelter, clothing, medications, etc. Family members who are responsible for paying bills for the elderly may also refuse to pay or properly manage the victims’ finances.
Although abuse appears in many guises, the net effect is almost the same. Abuse tends to create potentially dangerous events and feelings of worthlessness and isolates elderly people from people who can actually help them.
Causes of Elder Abuse
There is no clear explanation for elder abuse and neglect. Elder abuse is a very complicated phenomenon that can arise from numerous causes, such as stress within the family, as well as cultural and societal issues. Family stressors that may add to elder abuse are inclusive of discord stemming from history or trends of violent interactions within the family, lifestyle accommodations and adjustments to living in different households, and social isolation (Lin, 2018). Additionally, marital and intergenerational violence may continue into old age and become triggers for elder abuse. In some cases, elder abuse is just a continuation of abuse that was ongoing in the family over a couple of years. For instance, if a woman was in an abusive marriage for most of her life, she is unlikely to report abuse in old age and in poor health. In some cases, the financial constraints of living in multigenerational households or living in overcrowded areas may cause stress and trigger elder abuse. Such situations can be worsened by a lack of financial resources by adult children.
Moreover, even though most caregivers offer care and support to the old relatives, the caregiving act creates stress that affects both the caregivers and the receivers of care which may cause harmful caregiving behaviors that increase the risk for elderly abuse. The personal problems faced by the caregiver, such as mental or emotional stress, caregiver stress, addiction to drugs, loss of employment, etc., can lead to abuse by a frail elder individual (Lin, 2018). Besides, some old adults also abuse their caregivers, especially if they have dementia. Caregivers who lack appropriate training and awareness about how to care for old adults are susceptible to anger and frustration that can lead to a variety of abusive behaviors.
The Ethical Dilemma
Professional healthcare workers experience different ethical dilemmas and conflicts in their duties of attending to the elderly population. These challenges may be due to the elders’ encounters with abuse on a couple of occasions. The main ethical dilemma emerges in a situation where a healthcare worker is attempting to attend to a victim of abuse who actually refuses to be assisted. Strands of literature demonstrate that there is a very high probability of resistance of attendance who was once an abuse victim (Russo et al., 2019). Such situations create dilemmas for healthcare workers since such refusal builds conflict among ethical principles. These principles are inclusive of autonomy, beneficence, paternalism, and ambiguity in the determination of the capacity of decision-making. These conflicts between principles also have a significant impact on the role of nursing, especially on the implementation of the responsibilities of healthcare workers.
In most situations, elderly adults may argue with healthcare workers interfering with their freedom in their effort to provide assistance. In such cases, the ability of healthcare workers to provide their services is compromised. Typically, the resistance character breeds a cold and uncomfortable environment between the two. Therefore, healthcare professionals are hands tied towards learning the previous abuse of elderly people. This infringes on the reporting process as well as adult protective services. For any successful reporting, the consent of the elderly person is required, and thus any refusal to cooperate by the elderly clients creates more ethical dilemmas.
The dilemma lies in reporting a case of abuse to the relevant authority and also respecting the individual’s freedom of choice and determination (Heisler, 2019). There are various impacts of such a dilemma in the healthcare field. The first problem is that the ethical dilemma compromises the delivery of healthcare services. Besides, the efficiency of health services is reduced, and in many events, the healthcare worker may find themselves under blame in case the health status of the victim deteriorates.
Consequences for Elder Abuse
Elder abuse can have multiple emotional and physical impacts on elderly adults. Most abuse victims suffer from physical injuries such as scratches, minor cuts, bruises, and welts, and serious injuries that can cause long-term disabilities. These may comprise broken bones, head injuries, soreness, and constant physical pain. Physical injuries may be fatal, lead to premature death, and probably worsen existing health problems. Besides, elder abuse may have detrimental effects on the victims’ emotional health by causing fear and anxiety and may also create issues with trust and being wary around other people (Storey, 2020).
Recommendations
Issues associated with the interventions for abused elderly adults inevitably raise ethical, health, and legal concerns for healthcare workers. Healthcare professionals have a duty to uphold the best interests of their clients and to protect their rights when acting on their behalf. Therefore, healthcare workers are responsible for being aware of the client’s history and interests and the professional code of ethics, as well as the adult protection laws within their state or jurisdiction. They are also responsible for knowing the potential for elder abuse or neglect, designing treatment plans, and reporting as required to the appropriate agencies. During assessments of cases of elder abuse, it is vital to evaluate the client’s current issues, level of risk, the goals that may have the greatest priority, and the effect of healthcare interventions on the client.
The plans of interventions should be designed while taking into consideration how the workers’ preconceptions and personal values may affect their clinical judgment. Since each case of abuse presents unique challenges to healthcare professionals, they have a duty to comprehend their roles and responsibilities to the client. In addition, due to the sensitive nature of this issue, healthcare practitioners should be well-versed in ethical, legal, and clinical considerations to make professional and informed decisions for their clients.
Healthcare professionals have a duty to describe the available alternatives to the elders so that they may choose the best options that reflect their culture, beliefs, community, and philosophy of life. In most cases, there should be a close follow-up of elder abuse cases in addition to referrals and collaborative work with other agencies. Healthcare workers should also be able to involve the communities, families, experts, and agencies to address the contributing factors to elder abuse.
Furthermore, the issue of elder abuse is a social issue that demands the collaboration of different disciplines and communities. Efforts focused on increasing awareness of the issue and building attention to care and coordination with social, health, legal, and human services will likely reduce elder abuse and neglect (Ries & Mansfield, 2018). The improvement of community policing policies and other community-oriented strategies will also emphasize the need for collaboration between different professionals and community members to best handle elder abuse cases.
A multi-disciplinary approach to elder abuse helps the victims by improving their choice and autonomy, enhancing access to community services and supports, providing continuity of care, and mitigating injury or loss by raising the probability that the elderly adults will receive the help they need. For health care practitioners working with older clients suffering abuse and neglect, it is their challenge to balance their duty to safeguard vulnerable elderly adults with their right to confidentiality and self-determination. Like most ethical dilemmas, the objective will mainly be to respectfully come to an informed decision that will cause the least harm to the vulnerable clients.
Conclusion
The impacts of elder abuse are detrimental to the physical, emotional, and psychological health of the victims. Lack of knowledge and awareness about this menace and the fact that the victims resist reporting abuse only reduces the chances of properly solving it. Better knowledge and comprehension of the aging phenomenon and particularly the complex issues that accompany it is the best initiative. The rights and dignity of the elderly must be protected by implementing the interventions mentioned above and taking into consideration the special laws for the protection of the elderly.
References
Heisler, C. J. (2019). ETHICAL DILEMMAS, VULNERABLE ELDERS, AND ELDER ABUSE. Innovation in Aging, 3(Suppl 1), S238.
Lin, M. C. (2018). Elder abuse and neglect: Examining caregiver characteristics and perceptions of their elderly care receiver’s under-accommodative behavior. Journal of Family Communication, 18(4), 252-269.
Phelan, A. (2020). Advances in Elder Abuse Research. Springer International Publishing.
Ries, N. M., & Mansfield, E. (2018). Elder abuse: The role of general practitioners in community-based screening and multi-disciplinary action. Australian journal of general practice, 47(4), 235-338.
Russo, A., Reginelli, A., Pignatiello, M., Cioce, F., Mazzei, G., Fabozzi, O., … & Giovine, S. (2019, February). Imaging of violence against the elderly and women. In Seminars in Ultrasound, CT and MRI (Vol. 40, No. 1, pp. 18-24). WB Saunders.
Storey, J. E. (2020). Risk factors for elder abuse and neglect: A review of the literature. Aggression and violent behavior, 50, 101339.
Yon, Y., Ramiro-Gonzalez, M., Milton, C. R., Huber, M., & Sethi, D. (2019). The prevalence of elder abuse in institutional settings: a systematic review and meta-analysis. European journal of public health, 29(1), 58-67.
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