A framework for polyvictimization in later life

This article provides a context and overview for what is known about polyvictimization in later life. Drawing from previous literature, the article includes a definition of the phenomenon, as well as theoretical constructs by which it may be understood. We place other forms of polyvictimization within the context of elder abuse, recognize frameworks for conceptualizing polyvictimization in later life, and distinguish between polyvictimization at younger ages and polyvictimization in later life. The paper concludes with implications of the framework for research, practice, and policy.

A Qualitative Approach to Increasing HIV Prevention in Primary Care Settings for Older Adults: Perspectives From Primary Care Providers

The purpose of this research was to explore primary care providers' willingness and ability to increase HIV prevention efforts among older adults and to gain recommendations for improving HIV prevention in primary care settings. Data were collected through 24 semistructured interviews with primary care providers. The results of the study reveal that the majority of providers find it necessary to increase HIV prevention efforts in primary care settings and are willing to do so; however, they cannot do so without assistance. Providers suggested strategies to increase HIV prevention in primary care, for instance, expanding the use of electronic reminders to include HIV prevention and increasing collaboration among providers of different specialties. As a result of the interviews, additional recommendations for increasing HIV prevention have been identified. These findings will aid in improving the quality of care provided to individuals older than 50 in primary care settings.

Sexual Abuse of Vulnerable Young and Old Women

Aggregated data from 125 substantiated Adult Protective Services cases of sexually abused women were collected during a 5-year period. Women older than 59 years represented 63% of the cases. Regardless of age, the most common types of abuse involved sexualized kissing and fondling and unwelcome sexual interest in the women’s body. Most identified perpetrators were older males. Family members were most likely to abuse women living in the community, whereas women living in facilities usually experienced abuse by another resident. Perpetrators were prosecuted and convicted in six cases. About 12% of the women continued to be at risk of further sexual abuse.

Living the Life of Another: The Need for Public Guardians of Last Resort

Self-report surveys were sent to preidentified representatives of Adult Protective Services, sheriff's offices, community services boards, state training centers, and state hospitals to assess the need for public guardianship. The agencies estimated the need for a total of 2,881 surrogate decision makers (including powers of attorney and payees) and, in particular, 1,425 guardianships. Events most likely to precipitate guardianship included third-party behavior, mental illness or personal behavior, and cognitive impairments or limitations. Virginia's trajectory of the establishment of explicit public guardianship is highly instructive for states and localities seeking to establish or refine public guardianship statutes. As a result of information obtained from the needs assessment and a companion evaluation of two demonstration projects, the Virginia Public Guardian and Conservator Program became law in 1998.

Resuscitation Policy Concerning Older Adults: Ethical Considerations of Paternalism Versus Autonomy

The heated national debate concerning health care must include a discussion of a patient's wishes and the implications of his or her right to determine individual medical treatment decisions, especially at the end of life. This article is an examination of physician paternalism versus patient autonomy concerning do-not-resuscitate (DNR) orders within the context of utilitarian ethical theory. The author proposes effective compromise between the two; consideration of decision making on a case-by-case basis; enhanced education for all actors concerning cardiopulminary resucitation (CPR), DNR, and advanced directives; and consensus reached through democratic debate regarding the allocation of health care resources.

The Sexual Victimization of Older Women Living in Nursing Homes

This study examined 64 cases of sexual victimization of women ages 65+ (mean = 81) living in facilities that were investigated by APS and regulatory agencies in five states over a six-month period. Typically, abuse involved molestation (53%) and unwelcome sexual interest in the body (20%). Abilities and needs of women in substantiated and unsubstantiated cases were comparable. Resident perpetrators were more likely to be substantiated than staff or any other perpetrator (p = 0.008). Our results underscore the need to evaluate differences associated with gender, age, and residence, and to train on reporting and intervention by disciplines serving victims.

Primary Care Providers' HIV Prevention Practices Among Older Adults

PURPOSE

To explore primary care providers' HIV prevention practices for older adults. Primary care providers' perceptions and awareness were explored to understand factors that affect their provision of HIV prevention materials and HIV screening for older adults.

DESIGN AND METHOD

Data were collected through 24 semistructured interviews with primary care providers (i.e., physicians, physician assistants, and nurse practitioners) who see patients older than 50 years.

RESULTS

Results reveal facilitators and barriers of HIV prevention for older adults among primary care providers and understanding of providers' HIV prevention practices and behaviors. Individual, patient, institutional, and societal factors influenced HIV prevention practices among participants, for example, provider training and work experience, lack of time, discomfort in discussing HIV/AIDS with older adults, stigma, and ageism were contributing factors. Furthermore, factors specific to primary and secondary HIV prevention were identified, for instance, the presence of sexually transmitted infections influenced providers' secondary prevention practices.

IMPLICATIONS

HIV disease, while preventable, is increasing among older adults. These findings inform future research and interventions aimed at increasing HIV prevention practices in primary care settings for patients older than 50.

Elder abuse and neglect: a survey of clergy awareness, knowledge, and intervention preferences

This article explores the research question: What is the perceived level of elder abuse and neglect awareness and knowledge among Protestant clergy members in Kentucky? Of the 300 clergy contacted, 160 participated, for a response rate of 53.3%. Pearson Chi-Square analyses were used to determine statistical significance, and phi coefficient correlations examined the strength of the associations between variables. Findings indicate that approximately 44% of clergy members in this study report some "awareness" of elder abuse and neglect. However, 56% of clergy respondents do not know that Kentucky is an "any person" mandatory reporting state. Specifically, participating clergy appear poorly informed about legal requirements for reporting elder abuse and neglect and perceive types of abuse differently. Untrained clergy with little formal training indicate a willingness to provide therapy to victims despite reporting that they do not feel qualified to do so.

WorldView Environmental Scan on Elder Abuse

In response to a growing and worldwide recognition of elder abuse, the WorldView Environmental Scan on Elder Abuse was undertaken. It represented an attempt to collect both information on the nature of the problem of elder abuse and responses to it from a global perspective. The first of its kind, the Scan gathered information about elder abuse as well as on related legislation and policy, services and programs, educational resources and needs, training, and past and ongoing research. A total of 53 countries responded to the survey questionnaire, with 362 respondents representing the six world regions designated by the World Health Organization. Findings revealed that factors contributing to elder abuse include changing social and economic structures, isolation of victims, inadequate knowledge of laws and services, intergenerational conflict, and poverty. Barriers to seeking resources to intervene and protect older adults include the culture of the country, language issues, literacy, stigma, lack of mobility, lack of funding, and insufficient familiarity with and access to the internet. The data serve as a catalyst to take action, both globally and nationally, while emphasizing the changes necessary to protect the rights and dignity of older adults.

Kentucky's Local Elder Abuse Coordinating Councils: a model for other states

In 1998 Kentucky's Local Coordinating Councils on Elder Abuse (LCCEAs) were established to intervene in cases of elder abuse in local communities. As of 2008 there were 39 LCCEAs in the state, covering 112 of Kentucky's 120 counties. This study was an attempt to understand a concerted statewide multidisciplinary team (MDT) effort related to elder abuse. Survey questions examined the roles, processes, varieties, and accomplishments of these councils. Nearly half of the councils have been in existence for less than 3 years. Councils provided a range of services from expert consultation to service provided for keeping members up to date about services, programs, and legislation. Roles for the councils included identifying service gaps and systemic problems and advocating for change. Half the councils conducted case reviews, and of those, most examined all types of cases. Lack of funding was a major problem for all councils. Funding came from a patchwork of sources, which suggested that it was inadequate and unreliable. The LCCEAs appear to function largely as community educators. To ensure the long-term viability of the LCCEAs and to better integrate and unify their efforts, LCCEAs need committed staffs, constant funding, clear vision and goals, and uniform and consistent outcome measures.

An Adult Protective Services' view of collaboration with Mental Health Services

Mental Health Services (MHS) meet mental health needs of older adults through active, outpatient, community-based care. Adult Protective Services (APS) are involved with needs of older adults who have mental disability and mental illness. Adult Protective Services and MHS staff may to work together when they respond to the needs of victims and adults at risk for abuse, neglect, self-neglect, and exploitation. The purpose of this study was to understand effective APS-MHS collaborations (e.g., leadership, organizational culture, administration, and resources in predicting success). A survey that was sent to members of the National Adult Protective Services Association (NAPSA) revealed that both APS and MHS have strong commitments to protecting clients' rights and autonomy, but there appear to be differences between the two with regard to implementation, apparent in cases involving clients with diminished mental capacity who are at imminent risk, but who refuse help. Strengths of APS-MHS collaborations included improved communication and better service for at-risk clients.

The Bridge From Then to Now: Tibetan Elders Living in Diaspora

This study presents how older Tibetan refugees have adapted to changing social and economic conditions in India. Participant observation and open-ended interview questions were used to explore life experiences of 14 older Tibetans living in India who participated in this study. Findings revealed that, after having to abandon familiar environments, these participants underwent harsh times in India but have adapted well. They have secured meaningful lives for themselves. Availability of children and institutional resources has proved beneficial at old age. Participants with children perceived that they were well cared for, which added to their satisfaction with present circumstances. However, those without children did not have any source of support and were dissatisfied. Religious activity was important for these participants. The ability to freely practice religion contributed to their satisfaction in exile. These findings are instructive for the treatment and acceptance of refugees throughout the world by contributing to the field of refugee aging and adaptation.

Land of the free, home of the brave: voting accommodations for older adults

Voting is a fundamental right for all United States citizens, one that usually continues for elderly people as long as they are alive. As adults age, certain issues regarding voting warrant deeper consideration than in previous years, especially those presenting as a result of impaired sight, hearing difficulty, dementia, or other special needs. What will happen to millions of men and women who have taken the right to vote for granted, but who gradually become immobile or physically impaired? What are states doing to help secure the enfranchisement of an increasing number of older adult voters? The purpose of this article is to address these issues by focusing on the following questions: What has been the historical nature of polling place accommodations for elderly people? What are states doing in terms of accommodating older voters at the polls while ensuring the integrity of the voting process? What effect has recent Help America Vote Act legislation had with regard to polling place accommodations? Our results indicate that accommodations for older voters are being made but are not yet at a level required to serve a rapidly aging population.

Mentoring in gerontology doctoral education: the role of elders in mentoring gerontologists

This study examined elder mentors' and students' roles, functions, and satisfaction with the Elder Mentorship program at the Graduate Center for Gerontology, University of Kentucky. The Elder Mentorship program matches gerontology doctoral students with older adults in the community. Parallel surveys were constructed to evaluate the program from the perspectives of elder mentors and student mentees. Data were analyzed using descriptive frequency analyses, with open-ended questions analyzed thematically. Results show that students and elder mentors were mostly satisfied with their experiences. Elder mentors perceived their participation more positively than did student mentees. Future programs utilizing the elder mentorship model may benefit from matching students and elder mentors in terms of shared interests.

Medicaid Waiver Personal Care Services: Results of a Statewide Survey

Through a statewide telephone survey of 819 beneficiaries (or their proxies), we collected data regarding client and aide demographics, as well as clients' satisfaction, outcomes, perspectives on staff performance, and complaints associated with home-based personal care services provided under the Virginia Medicaid Elderly and Disabled (E&D) waiver. Most respondents indicated that services improved their lives, and they were generally satisfied. Opportunities for improvement exist, however, especially related to the amount of time spent with the client, the need for training, and communication issues. Ongoing use of client/family caregiver surveys is warranted to allow continued monitoring of service provision.

Sexual abuse of vulnerable young and old men

During a 4-year period, aggregated data from Adult Protective Services case files in Virginia revealed 17 cases of sexually abused young, middle-age, and old men. The most common types of sexual abuse across age groups involved instances of sexualized kissing and fondling and unwelcome sexual interest in the individual men's bodies. The majority of alleged perpetrators were male; they typically were similar in age to the men and resided in the same residential facility. In none of the cases was the alleged perpetrator prosecuted. Only two of the men continued to be at risk of further sexual abuse by the alleged perpetrator. Implications of these data for future research and practice include a need for studies that focus on differences between male and female victims, especially concerning investigations and interventions, and for training on reporting and intervention for facilities and agencies and organizations working with victims and alleged perpetrators.

Elder abuse and neglect

In the past 10 years, reports of the abuse of older adults have risen by 30%. Supported by a growing body of work, research, practitioner and policy communities are poised to confront the problem. This article represents a review of the elder abuse and neglect literature published since 2001. Literature on elder abuse and neglect tends to be grouped in the following categories: definitional issues; screening and assessment instruments; the scope of elder abuse and neglect; sexual abuse; risk factors; outcomes; studies of Adult Protective Services; multidisciplinary teams; interventions by medical, criminal justice and policy communities; long-term care facilities; and theoretical perspectives. The authors suggest that studies of elder abuse and neglect move beyond descriptive studies and include more nuanced statistical methods and mixed methods approaches, further explore the promising research design of crosslinking a variety of databases, include a theoretical underpinning and work toward more theorizing, explore incidence and prevalence approaches to eventually capture elder abuse and neglect on a national level, and focus on outcomes of interventions (e.g., education, agency/entity).

Assuring Quality Care: Exploring Strategies of Medicaid E&D Waiver Providers

Implementing quality assurance (QA) programs in unregulated non-institutional settings remains a challenge for home- and community-based service providers. A sample of 65 Elderly and Disabled (E&D) Waiver providers were presented with eight problem scenarios commonly found in homecare services. Each of the respondents was able to identify strategies they would use to recognize and address each problem. Findings suggest providers currently use multiple mechanisms as part of their overall QA program. Discussion focuses on the strengths of using multiple approaches and on increasing provider awareness of complementary QA strategies and reducing the reliance on staff report as a major QA strategy.