Elder Abuse Prevention: Emerging Trends and Promising Strategies

ELDER ABUSE PREVENTION: EMERGING TRENDS AND PROMISING STRATEGIES Lisa Nerenberg, MSW, MPH New York: Springer Publishing Company, 2007, 320 pp., $45.00 (hardcover) The time is right for publication of a sound, solid document about the definition and identification of elder abuse and the diverse means available to deal with this complex problem. And this book is exactly what's needed. A casual thinker might define the topic with ease, as simply a matter of battering or theft. Much to the contrary, the subject of elder abuse is multifaceted, the status of both the abused and the abusers often not clear, and the resources available to help solve the problem unfocused and inadequate. As the author recognizes, "Our field is still very much a work in progress. " (There are) "shifting paradigms and cross-currents of thought, values, and ideologies" (p. 15). Among the concerns that cause a lack of clarity are insufficient health and social service resources in countries with aging populations, and thus more men and women with disabilities combined with poverty. One result of the growing need for care is an insufficiency of trained workers, ageist attitudes, and increased family pressures. These pressures include crowding and lack of funds. The consequences may well result in what we in the Western world consider to be abuse. But there are other worlds. The author points out, for instance, that in "Mozambique, acts of violence against elderly women often stem from accusations of witchcraft connected with unexplained events . 'Mourning rites of passage' for widows in parts of Africa and South Asia can include cruel practices, sexual violence, forced marriages and eviction from their homes" (p. 15). In effect, actions that we in the United States define as abuse may well be considered standard practice elsewhere. Nerenberg has worked through this subject with care and offers appropriate questions related to definition: Are age and disability alone sufficient to define victims? Are perpetrators always intimates, or do we include strangers? How do we define "persons in positions of trust and confidence" or "strangers," recognizing that predators actively seek out victims and cultivate trust in order to steal? Who has the duty and responsibility to care for the older person? In abusive situations, do we include only overt acts, or also unintentional harmful lack of attention? (p. 218) The reader grasps the point that an easy understanding of complex subject matter does not apply to the broad subject of elder abuse. That noted, we can now proceed with the author's analysis of the most substantial concerns we all face here in the United States. PHYSICAL ABUSE A physical attack by an intimate may take place once, or such conduct by the perpetrator may be a multiyear behavior pattern. The field of elder abuse subdivides physical violence into subsets that include "elder domestic violence, elder homicide, elder suicide/homicide" (p. 27). Perpetrators may be elderly men and women, husbands, wives, partners, children, grandchildren, close acquaintances. FINANCIAL ABUSE We all recognize that, when there is money, there will be temptation. Money is taken from helpless older persons grossly or subtly. Thieves may be personal attendants, children, predatory lenders, addicted family members, scammers, phony sweethearts. Identity theft certainly occurs. "Cunning predators operating out of Canada, Africa or Europe are increasingly using the phone or Internet to gain their victims' trust and confidence, calling daily or multiple times a day, sending greeting cards, telling them bogus hard-luck stories accompanied by requests for money, and even making romantic overtures" (p. 25). ELDER SEXUAL ABUSE This definition usually focuses on sexual acts, violent or not, imposed on those not able to consent. Rape is an action that we define easily, but more subtle forms of sexual abuse include forcing the victim to watch pornography. …