Counselors' Role in Preventing Abuse of Older Adults: Clinical, Ethical, and Legal Considerations

Mistreatment of older adults is commonplace. These individuals are subjected to abuse, financial exploitation, and neglect. The authors present an overview of the literature concerning mistreatment, with an emphasis on clinical, ethical, and legal considerations. Methods are proposed for prevention, including counselor education, advocacy, and counseling opportunities. ********** According to the 2004 Survey of Adult Protective Services (APS), 565,747 vulnerable adults were mistreated in their homes and in institutionalized settings (see National Center on Elder Abuse [NCEA], 2006). If this rate remains stable, by the year 2050, approximately 2 million older adult individuals will be abused annually (Welfel, Danzinger, & Santoro, 2000). Of the 565,747 mistreatment cases identified by APS, 5,797 were of a sexual nature, although underreporting is likely because of state-specific restrictions regarding investigations at certain care facilities (Ramsey-Klawsnik et al., 2007). The majority of individuals over the age of 60 who experience abuse in the United States are Caucasian (77.1%), followed by African Americans (21.2%), and American Indian/Alaskan Natives (.6%; NCEA, 2006). On average, there are approximately 8.3 reports of abuse per 1,000 people over the age of 60, with reports ranging from .40 per 1,000 in Oregon to 24.5 per 1,000 in Connecticut (Ramsey-Klawsnik et al., 2007). These statistics are particularly disturbing because it has been found that older adults who are abused are 3 times more likely to die at an earlier age than are older adults who are not abused (Black, 2008). According to the ACA Code of Ethics (American Counseling Association [ACA], 2005; Standard A.4.a.), "counselors act to avoid harming their clients, trainees, and research participants and to minimize or to remedy unavoidable or unanticipated harm." However, in our view, in the spirit of "do no harm," with older adults, counselors have a duty to protect clients from potential or substantiated harm. To fulfill this duty, there is a need for greater emphasis on preventative methods to reduce the incidences of abuse perpetrated against older adult clients. The purpose of this article is to examine the current literature on the mistreatment of older individuals and propose preventative measures to reduce the occurrence of abuse. More specifically, we highlight potential abuse symptoms and forms of abuse, perpetrator characteristics, and nursing home and other accommodation considerations. Preventative measures for counselors are presented at the end of each section. We also discuss ethical and legal considerations as well as future research directions. ABUSE OF OLDER ADULTS: SYMPTOMS AND FORMS Awareness of the various symptoms and forms of elder abuse can allow the counselor to assist a victim. The APS identified three different forms of mistreatment of vulnerable adults: abuse, financial exploitation, and neglect (APS, 2006a). Abuse is defined as the intentional infliction of harm onto a person that can be perpetrated either sexually, physically, verbally, or emotionally (APS, 2006a). The second form of mistreatment of vulnerable adults discussed by the APS is financial exploitation, which is the process of illegally using a vulnerable adult for monetary gain without that individual's informed consent. The last of the three forms of mistreatment is neglect, which is the failure of the vulnerable adult to care for themselves (self-neglect) or the failure of the caregiver to provide proper care (APS, 2006a). The first form of maltreatment addressed by the APS is abuse, which occurs in a variety of forms. The majority of those experiencing abuse are female and "tend to be highly impaired due to advanced age and have frequent cognitive, physical, and communication limitations" (Ramsey-Klawsnik et al., 2007, p. 337). The individual is seen as someone akin to a child, in the sense that the older adult is unable to, or simply will not, tell another person about the acts that have been committed against her or him (Jeary, 2005). …