Elder abuse prevention: emerging trends and promising strategies

Preface

Acknowledgments

1. Eight Trends Shaping Practice

1. Increasingly Frail Elders Living at Home

2. Shifting Paradigms: From Protection to Empowerment

3. Heightened Understanding of Victims

4. The Circle Widens: The Burgeoning Abuse Prevention Network

5. The Changing Role of APS

6. The "Criminalization" of Elder Abuse

7. Focus on Forensics

8. Going Global: International Initiatives to Prevent Elder Abuse

2. Defining Elder Abuse: The Controversies

Controversies in Defining Elder Abuse

The Disability Requirement

The "Special Relationship" Requirement

Intentionality

Focusing on Conduct or Its Impact

Frequency and Severity

What the Experts Say

Challenges in Defining Specific Forms of Abuse

Financial Abuse

Physical Abuse

Elder Sexual Abuse

Emotional Abuse

Neglect

Self-Neglect

Abandonment

Other

3. Service Models from Which We Have Drawn

Introduction

The Adult Protective Services (APS) Model

The Domestic Violence Prevention Model

The Public Health Model

The Victim Advocacy Model

The Restorative Justice Model

Neutralization Theor

The Family Caregiver Support Model

The Family Preservation Model

4. Factors Influencing Intervention Needs

Victim Considerations

Victims' Mental Capacity and Ability to Consent

Victim Risk Factors

Victims' Resources and Support Systems

Perpetrator Considerations

Perpetrator Characteristics that Affect Service Needs

Perpetrators' Reasons or Motives for Abusing

Abusers' Willingness and Ability to Change

Abusers' Access and Level of Threat to Victims and Their Assets

Urgency of the Situation

Ethical Considerations

Autonomy and Self-Determination

Least Restrictive Alternatives

Other Ethical Principles

Competing and Conflicting Principles

Cultural Factors Affecting Service Needs

Cultural Factors Affecting Risk

Attitudes about Abuse

Obstacles to Accessing Services

Cultural Considerations Affecting Practice

5. Preventing and Treating Elder Abuse

Assessing Victims' Service Needs

Services and Interventions for Victims

Maximizing Independence

Resolving Crises

Emergency Services

Ensuring Victim Safety

Healing, Empowerment, and Support

Preserving, Protecting, and Recovering Assets

Ensuring Justice

Interventions for Perpetrators and Those at Risk for Abusing

Counseling for Perpetrators

Domestic Violence Treatment

Programs for Caregivers

6. What Agencies, The Justice System, and Communities Can Do

What Agencies Can Do

General

Agency-Specific Practices

APS Programs

Domestic Violence Programs

Health Care Facilities

Providers of Home Health Care

Legal Service Providers

Dementia Care Programs

What the Justice System Can Do

Law Enforcement

Prosecutors' Offices

Victim Assistance Programs

Forensics Centers

Elder Justice Centers

Improving Court Access

Elder Courts

Self-Help Clinics

Guardianship Monitoring

What Communities Can Do

Multidisciplinary Teams

Coalitions and Councils

Volunteer Programs

What Community Institutions Can Do

Financial Institutions

Academic Institutions

Churches

7. What States and Tribes Are Doing

What States Are Doing

Ensuring that Professionals Report and Respond Appropriately

Ensuring Justice

Ensuring a Comprehensive, Coordinated Service Response

Protecting Elders with Diminished Capacity and Those at Risk for Undue Influence

Special Challenges

What Tribes Are Doing

Improving Coordination

Ensuring Justice

Training Professionals

Meeting the Demand for Services

8. Community Outreach

Goals of Outreach

The Impact of Outreach

Local, State, National, Tribal, and International Campaigns

Local Outreach Campaigns

State Outreach Campaigns

National Outreach Campaigns

Tribal Outreach Campaigns

An International Campaign

9. Responding to Challenges

Defining Abuse

Responding to a Multicultural Society

Defining Capacity for Specific Tasks

Service Needs

Meeting the Challenge of "Consumer Choice"

Research Challenges and Needs

Evaluating the Impact of Services

Assessing the Impact of Abuse Definitions on Practice

The Economic Costs of Elder Abuse

Shedding Light on "Help-Seeking"

Predicting Helpers' Risk of Abusing

Professional Training Needs

Challenges to Coordination and Collaboration

Ethical Challenges

10. Moving Forward

Guiding Principles

A Holistic Response

A Continuum of Service Options

Addressing Cultural Differences

A Public Health Perspective

Long-Term Services

An Approach: Case Management

An Agenda

Promoting Research

Training

Filling Service Gaps

Advocacy

References