Elder Abuse: Need for Educational Interventions to Create Public Awareness - Coursework Example

ELDER ABUSE: NEED FOR EDUCATIONAL INTERVENTIONS TO CREATE PUBLIC AWARENESS Paper written by Presented to in partial fulfillment of the requirements of [university and course name] date: 16th June 2008 ELDER ABUSE: NEED FOR EDUCATIONAL INTERVENTIONS TO CREATE PUBLIC AWARENESS SECTION I: INTRODUCTION The development of any health care system requires among other things, a creation of awareness among the masses regarding various health policies and issues, and in doing so, helping identify social health issues that pertain to it. Elder abuse is one such issue that has raised concerns over the years, and proper realization of the needs of this age group, the epidemiology as well as the demography is necessary to understand its prevalence in the UK. Health forums are a common medium through which various health professionals communicate to the public one to one regarding such issues. Therefore, the aim of the present study was to create awareness about elder abuse utilizing a health forum and then evaluating the success or the failure of the intervention by studying the effect, and the changes in the perception and knowledge of the participants due to the health forum. For most of the adult population that approaches old age, the changes are many, with very little support around them. With changes in the pace of the society, the culture of caring for the elders has significantly diminished, with only a few regions in the world practicing the same. For the most part, the elders are usually shifted to elder homes, where care is provided by various nursing and healthcare personnel. In doing so, they are marginalized as somewhat useless individuals of the society, who cannot contribute in the social stream. Some do stay at home, but the quality of life may not be optimal. Elder abuse is not a very obvious incident unless observed properly and the signs already known regarding it. For the most part, it is the various community services that observe such issues and therefore, identification of such cases among health care personnel should be an added part of their service (Neno and Neno, 2005, pp 42) Therefore, when identifying elder abuse, one must also look at some of the related technical terms that have been used in the past for it. Granny battering, elder mistreatment, old age abuse, granny bashing, are some of the names given to elder abuse. Many fall victim to such abuse due to inability to care for self . Therefore, patients or elders may be defined as abused individuals should they have some mental or physical disability, or are of advanced age or illness and are unable to care for themselves (Neno and Neno, 2005, pp 43) Other definitions state that elder abuse is the act of avoidance of provision of basic rights such as care, emotional or physical support etc. or deliberate mis-action towards such individuals (Neno and Neno, 2005, pp 43) SECTION II: THE IMPORTANCE OF THE ISSUE; THE HEALTH NEEDS ASSESSMENT AND ITS IMPORTANCE AS A HEALTH NEED The issue of elder abuse is on the rise globally and hence is the efforts to create awareness and prevent such cases from taking place. Many initiatives are indicative of the efforts being placed, such as an increase in the number of countries participating in the International Network for the Prevention of Elder Abuse. While this shows the efforts being placed to increase awareness regarding elder abuse, this also points out to an increase in the incidence of elder abuse throughout the world. The rising numbers of elderly population indicates that this percentage of people being abused will increase steadily, without any concrete measures to prevent it. (Mowlam et al, 2007, pp 11) It is however, not as easy to claim elder abuse and set about reprimanding or treating the issue. Elder abuse is a very complicated and multifaceted issue that requires careful exploration of factors that are leading to it. The abused individual himself, as well as the family, the history and the relationship patterns all influence the outcomes of abuse. Along side various social factors such as financial position and the dependency or independency states are also important adjuvant. Therefore, when studying the history of elder abuse, one must understand the exact backdrop based on which the situation has developed (Mowlam et al, 2007, pp 12) This categorized elder abuse into five major types of abuse, which is physical, psychological, financial, sexual abuse and neglect. (Neno and Neno, 2005, pp 44). Other failures to be considered as abuse include "isolation, abandonment, social exclusion, violation of human, legal and medical rights, and deprivation of choices, decisions, status, finances and respect" (Neno and Neno, 2005, pp 43). The biggest obstacle in the identification of the problem lies in the lack of conclusive researches in the area. In the UK for example, of the few, only one survey was found to study the abuse incidence among the elderly. This survey in 1992, consisting of 2,000 individuals, questioned about the presence of abuse and the kind of abuse that these elderly people suffered from. The results of the survey showed that almost five percent of the participants had faced verbal abuse, whereas two percent each had suffered from physical and financial abuse respectively. (Neno and Neno, 2005, pp 44) A more quantitative finding is more likely to be found in nursing homes and settings, who identify and report such cases of abuse. The recent trends show an alarming increase in the prevalence of elder abuse, and much of it may be on frequent basis . Creating awareness among the masses therefore is the first step in stopping and preventing elder abuse, which in many cases may be unintentional. Public awareness programs and health promotion activities are usually some of the most efficient methods where practitioners can come in one to one contact with the public and create awareness on various issues. With the help of various UK preventing and health promotion strategies, the issue of elder abuse is finally taking its own voice and generating more interest than before. SECTION III: METHODOLOGY USED IN THE EDUCATIONAL INTERVENTION FOR ELDER ABUSE METHODOLOGY Elder abuse, should be considered as a social issue that warrants attention not only from the health professionals but from people from all walks of life. Current reports now use the term abuse for many types of harm that is aimed at an elderly person. Perpetration by a family member is also now a part of definition of abuse. The identification of the problem is not the only aim in this issue, rather, the reporting and the consequent reprimanding is also a part of this whole program. (Mowlam et al, 2007, pp 11) The project was therefore a preventive as well as an educative one, where the participants, that is those who visited the forum were made aware about the various factors of elder abuse and their proper identification. This area should be given the status of a primary issue, since there is very little awareness among the public regarding the issue. What little information we have is from the small number of studies that have been carried out, making it a need of normative basis. (Wills, 2007) The first problem in this issue therefore is to identify the target audience in order to achieve correct demographics regarding elder abuse. From the various previous studies, it has been established that the main contributors to elder abuse are the family members themselves, and a small proportion of other health care providers such as carers, or sometimes the nursing staff. In most of the surveys, there has been a lack of information regarding the role of residential conditions, which may contribute to this form of abuse. However, for simplicity sake, the researchers of this intervention assumed that the target audience should be families and offspring, and Hertford shire residents ageing from 20 to 40 years were selected. The aim of the intervention was therefore, to create awareness among the public regarding elder abuse, how it is carried out, and in doing so gathering demographics about the rates of elder abuse in Hertford shire, which has been reported to have a large percentage of elderly citizens within the community (ONS, 1991) An educational approach was considered as the best form of medium in the intervention, where most of the factors pertaining to learning such as cognitive and behavioral learning, auditory, visual and kinetic methods would confer the best education to the masses regarding the issue. Utilizing such an intervention was anticipated to generate more interest, and more retention of the facts than other forms of raising awareness. However, since this was an educational intervention, where the public was self-motivated to learn about the issue, the rates of success were expected to be affected. Those who would be self motivated to learn more may have some cursory knowledge of the issue already and may want to improve on what they know. However, many of the people would not be able to gain knowledge about the issue should they choose to avoid or ignore it. Therefore, while educational intervention may only be applicable to those who are interested in learning about the topic. Among these still, very few may be motivated enough to consider implementing the knowledge into practical terms. Self-motivation therefore is the key factor in such educational interventions (Dunn and Griggs, 1998) In short, the aim of the intervention was to create an educational opportunity for the public where by awareness regarding elder abuse was provided. The intervention aimed to provide following results at the end a four-minute presentation prepared. identifying the term elder abuse and who is vulnerable to it. the five types of abuse who to contact in case of abuse. The process of creating the table clinic was carried out in various steps. The first and foremost was the division of work among the participants. This was then followed by a thorough research on the topic of elder abuse with specific context to the UK and prevalence of abuse in UK. The research was carried out on various mediums including journals, books, and electronic medium. These resources were then studied and verified for there authentication and completeness. The selected resources were then thoroughly reviewed and the key areas were identified. Based on the studies carried out already in the past on elder abuse, the objectives of the intervention were identified. The method of intervention was then decided, along with the various tools that would be used in the presentation. Meanwhile, the stall was arranged into specific areas, where by the persons would be received and then carried through the presentation with ease. A questionnaire was devised which would be carried out in one part of the stall, along with an area of discussion regarding elder abuse, and finally the dissemination of the knowledge via various information tools such as bags, posters, wristbands etc. The time constraints did not allow for inclusion of various charity sources, which would have added more substance to the presentation. The identification of the key areas, which would be discussed in the presentation, was carried out. The four areas mentioned above were selected as some of the basic and essential issues in gaining awareness about elder abuse. The stall was strategically made so as to allow all forms of communication and learning aids to work and also allow all learning models to be applicable. Therefore, along side a discussion panel was included visual aids such as posters, leaflets and information bags. The main method of communication decided was the discussion panel, and a four minute presentation was made to be given to the listener. The presentation consisted of discussion of four areas mentioned above with the help of power point presentation, and a following anonymous questionnaire to assess the effect of the presentation on the listeners knowledge. No visual presentations of people were included to show elder abuse, for ethical reasons. However, real scenarios with pseudonames were included to provide impact to the presentation. The aim was therefore to provide the maximum of information in the minimum of time by utilizing all types of educational tools. SECTION IV: RESULTS AND FINDINGS The questionnaire used included many key areas regarding elder abuse. The listeners were asked if they already were aware of elder abuse, and if they are aware of various types of abuse, the location of abuse, being able to identify abuse, and the status of the abused as independent or dependant. The following statistics were found from the questionnaires. Questionnaire results Under 19 12 Already aware abuse occurred:   Questions answered   20 - 30 63 Yes 95     31 - 40 15 No 5 Yes 96 41 - 60 10     No 4     Able to name two types of abuse       Student nurses 90     Is abuse easily identified   Students 10 Yes 84         No 16 Yes 17 Stall Raiting       No 83     Thought abuse occurred:       5 10     Are abused dependent?   7 13 Nursing home 22     9 29 Own home 78 Yes 97 10 48     No 3     Knowledge of contact numbers   Yes 78 No 22 The success of the educational intervention was assessed and was found to be successful in creating and improving awareness in more than 50% of the participants. Elder abuse awareness along with at least two types of abuse was identified by 84% of the individuals. 97% agreed that dependency is the key factor that is related to abuse and contributes to it. And 78% were aware of the various help agencies and their contact numbers for identification and reporting of abused individuals. The questionnaire however, did have some weaknesses in the number of questions. The initial number of questions was more, however, due to time constraints, this number was reduced. The pattern of the questionnaire could have been improved, as small font size was used, and instead a larger font size would have been appropriate. There were not many questions regarding the frequency and severity of abuse as seen by the participants. The failure to include older age groups and in gaining their personal perspective may have been a valuable tool to assess the percentage and prevalence of elder abuse in the population. However, as mentioned, the target audience specifically was chosen between ages 20 and 40, who may be the biggest contributors or preventions of elder abuse. The overall effectiveness of the intervention was found to be high, where participants understood the various factors that constituted elder abuse and the need to create awareness in this area. The intervention was a short term one, which meant that the long-term effects of the presentation and clinic could not be assessed. In order to assess the long-term effects, other researches will be required, with more supplements to the primary research. The demographics should be reviewed and studied for changes in the incidences and frequency of elder abuse. Briefly stated more and extensive research in this area is still required in order to impact a decrease in the frequency of elder abuse. SECTION V: CONCLUSION In the UK the prevalence elder abuse amounts to 2.6% of people who are above 66 years of age (Keefe et al, 2007, pp 8). This includes abuse from the family members of the care takers only. The incidence rate increases should other people such as the neighbors are also included, which amounts to 4.0% of elders being abused. The number of people victims of elder abuse in the UK alone amounts to 227, 000 people, which is expected to rise with time. The most frequent type of abuse was in the form of neglect, followed by financial abuse, psychological abuse, physical abuse and lastly sexual abuse (Keefe et al, 2007, pp 9). Mistreatment was found to be more common among females than in males, where as men were more likely to experience financial abuse. The socioeconomic position was also a significant factor leading to such abuse. Other factors that contribute to abuse include mistreatment due to marital status, living arrangements and health status respectively. Mostly the closest members are the ones involved in the mistreatment, such as spouse, family members or care providers (Keefe et al, 2007, pp 9). Another significant factor pointed out by Pritchard is the "taboo" that is attached to abuse caused on males. He claims that men are unable to be identified as suffering from abuse because of the taboo related to it, and therefore, treatment, alleviation and healing of such cannot be carried out. (Pritchard, 2007, pp 109, 110) Other people who have been abused may not discuss these issues due to shame or embarrassment (House of Commons, 2003, pp 7). Factors that contribute to abuse include social isolation, i.e. those who had lesser social contacts than others were more likely to be abused. A poor relation between the abused and the abuser is a very important contributor. History of family violence, dependance on the abuser in any way, mental health history or other addictions in the patient is also very important contributors in elderly abuse. Mostly, this results in abuse in the home settings, but other settings, including office settings must not be excluded (House of Commons, 2003, pp 19). The study of Cooper et al in 2006 concluded that "Severity of cognitive impairment, depression, and delusions predicted screening positive for abuse in older adults, but having a known psychiatric diagnosis did not, indicating that screening for psychiatric morbidity might be rational strategies to combat elder abuse. People in Italy and Germany were most likely to screen positive for indicators of abuse, and the authors suggest that this might relate to higher levels of dependency in the participants looked after at home in these countries as a result of cultural and service provision differences" (Cooper et al, 2006, pp 489, 492 and 496). The treatment and prevention of elder abuse therefore, requires more researches and more awareness in all levels of society. The need for a multidisciplinary approach is essential to ensure a productive outcome for this problem (House of Commons, 2003,pp 17). Educational interventions such as the one carried out are an effective manner to introduce and increase awareness in this area, and to improve outcomes for patients suffering from elder abuse. REFERENCING Cooper C, Katona C, Finne-Soveri H, Topinkova E, Carpenter I and Livingston G, 2006. Indicators of Elder Abuse: A Crossnational Comparison of Psychiatric Morbidity and Other Determinants in the adHoc Study. American Journal of Geriatric Psychiatry, 14(6) pp 489-497 Dunn, R & Griggs A. (1998). Learning Styles and The Nursing profession. New York: NLN Press House of Comnmons Health Committee, Elder Abuse. Second Report of the Session 2003-04, Volume 1. Site last accessed on June 10th, 2008 from http://www.publications.parliament.uk/pa/cm200304/cmselect/cmhealth/111/111.pdf. Madeleine OKeefe, Amy Hills, Melanie Doyle, Claudine McCreadie, Schaun Scholes, Rebecca Constantine, Anthea Tinker, Jill Manthorpe, Simon Biggs, Bob Erens, 2007. UK Study of Abuse and Neglect of Older People: Prevalence Study Report. Site last accessed on June 19th, 2008 from http://www.comicrelief.com/docs/elder-abuse/ComicRelief-ElderAbuse-Full.pdf. Alice Mowlam, Rosalind Tennant, Josie Dixon and Claudine McCreadie, 2007. UK Study of Abuse and Neglect of Older People: Qualitative Findings. Prepared for Comic Relief and Department of Health. Neno R and Neno M, 2005. Identifying Abuse in Older People. Nursing Standard. 20, 3, 43-47. Office of National Statistics (1991) Hertfordshire residents by age: 1991 census. Retrieved March 4,2008, from http://www.statistics.gov.uk/StatBase/xsdataset.asp?vlnk=1938&Pos=&ColRank=1&Rank=272 Jacki Pritchard, 2007. Identifying and Working with Older Male Victims of Abuse in England. Journal of Elder Abuse and Neglect, 19(1/2), 2007, pp 109-227 Wills, J. (2007). Promoting Health. Oxford: Blackwell. Read More