250 words
APA formatting
Resource attached.
95
6
As reviewed in Chapter 4, efforts are underway to increase the reporting
of elder abuse, under the belief that funneling victims into the system
will enable their receipt of services and interventions. As recommended by
the American Psychological Association (APA) “Guidelines for Psycholog-
ical Practice With Older Adults” (2014, pp. 37–38), this chapter is designed
to familiarize clinicians with elder abuse interventions, many of which are
relatively new. Clinicians will quickly observe that mental health inter-
ventions are essentially absent from the cache of interventions. To provide
some context for this section, a brief history of elder abuse interventions
is provided.
PERSPECTIVE ON SERVICES AND INTERVENTIONS
Historically, there have been two primary ways of responding in elder
abuse cases: (a) maintaining victim–offender relationship through
providing caregiver supports (e.g., respite care); and (b) separating
Elder Abuse Interventions
http://dx.doi.org/10.1037/0000056-006
Understanding Elder Abuse: A Clinician’s Guide, by S. L. Jackson
Copyright © 2018 by the American Psychological Association. All rights reserved.
Co
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
UNDERSTANDING ELDER ABUSE
96
victims from their offenders to obtain safety, through a change in liv-
ing arrangement, imposition of guardianship, or through offender
prosecution.
Respite Care to Maintain Victim–Offender Relationship
Family care remains the most prevalent method of eldercare, even for
those with severe disabilities such as Alzheimer’s disease (Doty, 2010;
see Larson & Kao, 2016, for a review). The caregiver stress model so
pervasive in the 1970s spurred the respite care industry as an inter-
vention for elder abuse. This intervention remains prominent today
(Ayalon, Lev, Green, & Nevo, 2016; Lindland, Fond, Haydon, & Kendall-
Taylor, 2015), even while support for the caregiver stress model is waning
(Jackson & Hafemeister, 2013d).
Separation of Victim and Offender
The other primary intervention has been to separate the victim from the
offender through various means. For example, one intervention designed
to safeguard incapacitated older adults is guardianship. However, safety
may be achieved for older adults with capacity by placement in a long-
term care facility. Although some modifications in living arrangements
are the result of safety concerns for older victims, an implicit underly-
ing purpose of changing the victim’s living arrangement is to separate
the older victim from the offender, especially when the two have been
cohabitating, a particularly common living situation among older vic-
tims of interpersonal violence (O’Keeffe et al., 2007). Not unsurprisingly,
Alon and Berg-Warman (2014) found that separating the older victim
from the offender resulted in a reduction in violence. However, separation
is not typically the desire of the older victim, especially in cases involving
family members (Harbison, Coughlan, Karabanow, & VanderPlaat, 2005;
Mariam, McClure, Robinson, & Yang, 2015).
Another approach designed in part to separate victims from their
abusers is prosecution. Prosecution has been the primary intervention
Co
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
ELDER ABUSE INTERVENTIONS
97
in elder abuse cases, although prosecution rates are astonishingly low
(Meirson, 2008), and prosecution may not be the most effective inter-
vention (Jackson, 2016a). Separation through prosecution may provide
but a temporary respite for the older person, as at some point the abusive
individual will be released and may return to the older person’s home, pre-
senting a renewed risk of abuse (Jackson & Hafemeister, 2014). Further-
more, relatively few older adults are interested in pursuing prosecution
(Jackson & Hafemeister, 2013c). This stance has spurred the development
of victimless prosecution. However, Kohn (2012) admonished clinicians to
listen to voices of victims in this matter.
CURRENT STATE OF ELDER ABUSE INTERVENTIONS
The field of elder abuse has placed very little effort into intervention devel-
opment (Du Mont, Kosa, Macdonald, Elliot, & Yaffe, 2015; Pillemer,
Connolly, Breckman, Spreng, & Lachs, 2015). Several reviews of elder abuse
interventions have been published (e.g., Moore & Browne, 2016; O’Donnell,
Phelan, & Fealy, 2015). Ayalon et al. (2016) recently reviewed the elder
abuse intervention literature and found only 24 studies, 19 of which con-
cerned caregiver interventions. Another review of the literature concluded
that interventions currently being used to protect and assist the victims of
elder abuse are relatively ineffective and sometimes even counterproductive
(Moore & Browne, 2016). For example, Davis and Medina-Ariza (2001)
field tested an elder abuse intervention program in New York City based
on a successful domestic violence intervention. One of the findings was
that households that received home visits (both in project and nonproject
dwellings) called the police more often than control households. However,
by 12 months the effect had disappeared. The researchers speculate that
elder abuse victims are often dependent on their abusers in multiple ways
and, compared with domestic violence victims, may have even less hope of
gaining independence from their abusers. This study was exceptional given
that many interventions fail to even evaluate their effectiveness, let alone
unintended negative effects (Pillemer, Mueller-Johnson, Mock, Suitor, &
Lachs, 2007).
Co
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
UNDERSTANDING ELDER ABUSE
98
ELDER ABUSE PROGRAMS AND INTERVENTIONS
TARGETING VICTIMS
There are a multitude of small programs across the country designed to
address elder abuse. None are large in scale, and few have been evaluated
to any extent. However, several programs warrant review here.
Victim Services Programs
The need for victim services in the context of elder abuse has been publicly
proclaimed (U.S. Senate Special Committee on Aging, 2015). Elder Care,
Inc., in Louisville, Kentucky, is an elder abuse victim service program
responding to the needs of victims of all forms of elder abuse. All police
reports where the victim is over the age of 60 are automatically electroni-
cally relayed to Elder Care. The victim advocate reaches out to the victim to
provide traditional victim services (e.g., court accompaniment, accessing
victim compensation, orders of protection, victim impact statements).
One unique way in which Elder Care responds to the needs of older adults
is by driving or transporting them to court to get an emergency protective
order and any follow-up hearings. However, if the older adult is physi-
cally unable to go to court for a protective order, a hearing over the phone
can be arranged. One advocate stays with the victim in their home while
another advocate is in the courtroom. Elder Care also employs a social
worker who ensures the older victim is linked with needed services in the
community. The program, however, has yet to be evaluated.
Elder Abuse Shelters
The use of domestic violence shelters for older victims has been problem-
atic in that they fail to meet the unique needs of older adults (Fisher, Zink,
Pabst, Regan, & Rinto, 2003). For example, medically and/or psychiatri-
cally dependent older adults are not able to function without assistance,
a service not offered by most shelters. However, The Harry & Jeanette
Weinberg Center for Elder Abuse Prevention developed wraparound
services for older victims that includes shelter within an established
Co
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
ELDER ABUSE INTERVENTIONS
99
long-term care facility, a model that is being replicated in other communi-
ties (Solomon & Reingold, 2012) but has yet to be evaluated.
Civil Legal Assistance Program
A notable shortcoming in our response to elder abuse has been the lack
of civil legal assistance to older adults. Pennsylvania, however, through
its Senior Law Center, provides civil legal assistance to older adults. The
National Association of Senior Legal Hotlines, of which Pennsylvania is a
member, provides assistance to seniors over the phone initially, and then
where appropriate, refers the older adult to assistance in their local area.
Maine Legal Services for the Elderly likewise provides civil legal assistance
to victims of elder abuse and is working tirelessly to remedy financial
exploitation cases. Los Angeles also has a notable program, Bet Tzedek
Legal Services, which provides free legal services to seniors and employs a
social worker to do a quick assessment of older callers and make referrals
if warranted (Morris, 2010).
Hospital-Based Elder Abuse Examiner Program
Building on the success of Sexual Assault Nurse Examiner (SANE) pro-
grams across the county, Canada has developed a program in which SANEs
are being trained to become Elder Abuse Nurse Examiners (EANEs) in
hospitals. A curriculum is being developed to ensure EANEs are able to
recognize elder abuse, understand the dynamics of elder abuse, and know
how and where to report suspected elder abuse (Du Mont et al., 2015).
High-Risk Victims
Persuading older victims to accept services has proven challenging in cer-
tain circumstances, for example, in cases in which there is long-standing
and repeated abuse (Dunlop, Rothman, Condon, Hebert, & Martinez,
2001; Reeves & Wysong, 2010). Recidivism is thought to be one indicator
of a high-risk victim. Therefore, efforts are underway to identify high-risk
Co
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
UNDERSTANDING ELDER ABUSE
100
victims (National Council on Crime and Delinquency, 2013; Sommerfeld,
Henderson, Snider, & Aarons, 2014). Once identified, more oversight and
resources targeting those individuals is provided (Terracina, Aamodt, &
Schillerstrom, 2015).
Eliciting Change in At-Risk Elders
As mentioned previously, one of the most cited risk factors for elder abuse
is social isolation (e.g., Acierno et al., 2010), and yet only one intervention
has incorporated isolation reduction (Mariam et al., 2015). Using a stages-
of-change framework, Eliciting Change in At-Risk Elders (ECARE) is an
intervention that aims to reduce or eliminate risk factors while empowering
victims through the use of trained outreach specialists—a model that has been
successfully used in other fields (DePrince, Labus, Belknap, Buckingham, &
Gover, 2012). When victims are reluctant to engage in services, staff actively
engage in alliance building. Once an alliance is developed, specialists guide
victims using motivational interviewing-type skills to assist older victims in
identifying needs, thinking through options, and taking steps toward change.
They then connect victims with sustainable services in the community that
enhance their safety. These interventions are time consuming and resource
intensive. For example, to meet the basic needs of at-risk older adults, out-
reach specialists may serve as an advocate between older adults and their
apartment managers, utility companies, and sometimes financial institu-
tions, as well as helping older adults access additional resources. Mariam
et al. (2015) found that a working alliance can be forged with intensely
ambivalent older adults (p. 28). The majority of participants (70.9%) made
some movement in their change stage.
PRoviding Options To Elderly Clients Together (PROTECT)
The need for depression screening among older adults is gaining promi-
nence (Dong, Simon, Odwazny, & Gorbien, 2008; Roepke-Buehler, Simon,
& Dong, 2015). Under the theory that depressive symptoms hamper an
older adult’s ability to self-protect, Sirey et al. (2015) developed PRoviding
Co
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
ELDER ABUSE INTERVENTIONS
101
Options To Elderly Clients Together (PROTECT), an intervention designed
to identify elder abuse victims who are experiencing depression or anxiety
and then to offer them treatment designed to alleviate depressive symptoms
and enhance personal resources. PROTECT combines problem-solving
therapy with anxiety management techniques and offers education about
the effect of depressive and anxious symptoms in general, as well as the
potential impact of symptoms on taking steps to resolve the mistreatment.
Women (N = 68) were randomly placed in either an elder abuse resolu-
tion services combined with PROTECT or a mental health referral group.
Although mental health symptoms were not significantly different at the
16-week follow-up, those in the PROTECT group were more likely to
report having all or most of their needs met, were more satisfied with the
services they received, and had a greater sense of self-efficacy. However,
there was no difference between the two groups in perceived improvement
in the abusive situation.
GUARDIANSHIP AND CONSERVATORSHIP
Guardianship can be conceived of as a preemptive strike against elder
abuse or as an intervention to stop elder abuse that has already occurred.
States differ in their use of the terms guardian and conservator. As dis-
cussed previously, involuntary interventions such as court appointment
of a substitute decision maker (guardianship) are legally authorized in
most states if the client is exposed to a substantial risk of harm or if the
client lacks the capacity to make an informed decision to accept or reject
protective services (Moye & Braun, 2010). Guardianship is governed by
state law (for a review, see Demakis, 2013b) and requires a formal determi-
nation of decision-making capacity.1 A petition is submitted to the court,
and the judge makes a determination regarding capacity. Guardians may
be public programs; private nonprofit or for-profit agencies; individual
professional guardians; attorneys; and perhaps most frequently, family
1 For more information on guardianship state law, visit the website (http://www.americanbar.org/
groups/law_aging/resources/guardianship_law_practice.html) of the American Bar Association
Commission on Law and Aging, “Guardianship Law and Practice.”
Co
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
UNDERSTANDING ELDER ABUSE
102
members or friends (see Demakis, 2016, for guidance on interviewing
potential guardians and making recommendations to the court).
The prevalence of older adults under guardianship is unknown as most
states have incomplete guardianship data (Wood, 2006); the extent of the
misuse of guardianship is also unknown (U.S. Government Accountabil-
ity Office, 2010). Guardianship monitoring of some form—at least the
filing of reports and accountings with the court—is required in all states,
although improvements in monitoring have been recommended (Karp &
Wood, 2007). Guardianship should be used as a last resort, as it removes
fundamental rights (Kohn, 2010; Wright, 2010). However, guardianship
can be a necessary solution to elder abuse, offering vital protection for a
victim who lacks decision-making capacity. Recent trends are toward
limited guardianship in which a guardian has decision-making power
only in domains in which the older adult has diminished decision-making
capacity, which allows older adults to retain as much decision-making
power as possible (Moye, Butz, Marson, Wood, & the ABA-APA Capacity
Assessment of Older Adults Working Group, 2007).
INTERVENTIONS FOR ABUSIVE INDIVIDUALS
By statute, APS has had a singular focus on older victims to the exclusion of
abusive individuals. More recently, the field has acknowledged the impor-
tance of responding to the needs of abusers (Jackson, 2016a; Mosqueda,
Burnight, et al., 2016; Pillemer et al., 2015; Reeves & Wysong, 2010). The
exclusion of abusers from the elder abuse dialogue dis regards the role they
play in maintaining abusive relationships (Alon & Berg-Warman, 2014;
Henderson, Varble, & Buchanan, 2004). In addition, it has contributed to our
lack of empirical understanding of those who abuse older adults (Moore &
Browne, 2016). Possible interventions for abusers that have been identified
in the literature include counseling and treatment, creating barriers to the
victim’s finances, respite and assistance, education, criminal justice inter-
ventions, limited or no contact with the victim, alternative living arrange-
ments, supervised visitation, and vocational training to reduce financial
dependency (Breckman & Adelman, 1988; Wolf, 2001). However, no specific
program for elder abuse abusers (or its subtypes) has been developed.
Co
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
ELDER ABUSE INTERVENTIONS
103
CONCLUSION
The two predominant responses to elder abuse have been (a) maintaining
the victim–offender relationship by assisting caregivers and (b) separat-
ing the victim and offender. As this review reveals, the field is gradually
realizing the need to develop interventions that go beyond these dichot-
omous and limited responses. Elder abuse interventions generally, and
interventions focused on mental health specifically, are urgently needed
to meet the demand associated with increases in reporting. Clinicians can
make an extraordinary contribution to this field by developing mental
health interventions that not only assist older adults with recovery but
also promote their general well-being and ability to thrive.
Co
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
Review attached article.
250 words
APA formatting
· Examine two principal ways to responding to elder abuse.
· Analyze the details of two elder abuse programs of the four highlighted.
Order an Essay Now & Get These Features For Free:
Turnitin Report
Formatting
Title Page
Citation
Outline
