According to Woolf (1998), other factors that can contribute to the abuse of elderly persons, either in care facilities or in the home environment include external stress and intra-individual dynamics or personal problems. In terms of the former, a family members financial problems, job stress, or other issues may impact upon their ability to properly care for their elders in need. In terms of intra-individual dynamics, caregiving professionals could be the victims of their own circumstances, which may put them at risk of becoming abusive towards elders. The NCEA (2005) cites alcoholism, drug addiction, or emotional disorders as high-risk factors in this regard.

THE NATURE of ELDER ABUSE

According to the NCEA (2005), elder abuse in nursing homes can manifest itself in various ways, of which physical abuse is only one category. One of the problems related to abuse is the general public conception that it usually manifests only in terms of physical abuse, where elders are being physically harmed in some way. It is therefore critical to raise public awareness of the problem in terms of other forms of abuse, including verbal, emotional, or sexual abuse, as well as neglect and exploitation. Neglect can take the form of either physical or medical neglect, whereas exploitation generally involves the elder's personal property.

McNamee and Murphy (2006) emphasize that there are various complicating factors in detecting abuse. The reason for this is not only a basic lack of awareness among the public or concern within caregiving facilities. An additional reason is the nature of the various conditions that could lead to injury or death for elders. The authors for example note that caregivers, Adult Protective Services agencies and doctors must rely on forensic markers to detect abuse. The problem is however that these professionals are not trained to distinguish between neglect and injury as a result of illness or the aging process.

Indeed, some abuse symptoms may be mirrored in the effects of these diseases and conditions. This means that, should abuse be present, this is not necessarily detectable. A further problem is that police officers also often lack the necessary training to investigate and prosecute cases of elder abuse. The issue is therefore surrounded not only by direct problems, but also by a number of more distantly related factors that make it difficult to either detect, prosecute, or prevent abuse.

McNamee and Murphy (2006) cite research to suggest that bruising tends to be one of the most common and obvious indicators for abuse. The authors state that, while research on patterns of bruising related to child abuse is plentiful, the lack of similar data for the elderly population is significant. Perhaps this is indicative of the nature of the problem in terms of society and its concern for the elderly.

According to the authors, a futher body of research focusing on elderly deaths in caregiving institutions, revealed some markers that professionals could use in investigating possible abuse cases. These markers relate closely to the risk factors for abuse in institutions, as mentioned above, and include 1) the physical condition/quality of care; 2) facility characteristics; 3) inconsistencies, and 4) staff behaviors.

Physical markers for abuse may for example include untreated injuries, fractures, sores, lack of oral care, poor hygiene, and lack of cleanliness. Unusual bruising and family statements regarding the lack of physical care can also be used as markers. Facility characteristics may include unchanged linen, strong odors, unemptied trash cans, or other general forms of unhygienic conditions. Inconsistencies may include discrepancies between medical records, staff statements, and investigator observations. Staff behaviors that could raise suspicion include lack of knowledge or concern about residents, evasiveness, and an unwillingness to release medical records.

In addition to the basic lack of knowledge, expertise, and concern for elder abuse in the United States, is the general attitude towards deaths in nursing homes. According to McNamee and Murphy (2006), the general belief even among professionals who work with the elderly on a daily basis is that deaths as a result of elder abuse are rare. Hence, many cases where such abuse might have been suspected, are simply ignored. In addition, there tends to be an attitude of ageism among medical examiners and coroners. This results in a belief among these professionals that nursing home deaths is a waste of time and resources, as the elderly are already on the verge of dying. Hence there is a lack of concern with determining the true cause of death in elderly patients.

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Some causes of abuse are also attributed to cultural differences or differing definitions of abuse, and therefore remain unchecked and uninvestigated.
In Western society today, there is also a general disregard for the elderly as disposable. They are therefore either intentionally or unintentionally, considered to be undeserving of dignity or support. If an elderly person is abused within the home environment, persons outside the home who suspect this often feel that it is a private family matter and that it is not appropriate to intervene.

Finally, religious and ethical belief systems in some cultures could result in the mistreatment of female family members, particularly if such family members are older. The strength of these beliefs is such that often not only the abuser, but also the victim, believe that no harm is being done. This keeps the victim lock in the situation without realizing it.

Another limiting factor in detecting abuse is the stereotypical profile of the abuser and the abused. According to the University of Illinois Extension (2010), and several other authors, the typical victim of elder abuse tends to be white female in her mid-70s or older, widowed, and living on a limited income. Generally, the abuser lives with the abused persons and in family situations is generally the spouse or adult child. For a variety of reasons, elderly victims tend to not report abuse. These reasons include fear of retaliation, shame resulting from the situation, or fear of leaving the home for the purpose of submitting a report. Abusers usually depend upon the elder for housing, financial or emotional support.

The problem with such typifying reports is that, once a typical pattern is broken, it tends to be disregarded. Less attention is for example given to situations where elder abuse takes place when neither abuser nor abused follow the typical profile of either.

It must however also be stated that there is no single excuse that might be forwarded for any type of abuse. Because it is usually the vulnerable and defenceless who suffer, abuse is one of the most tragic crimes. Compounding the tragedy is the situation of the abuser, who is often driven to such actions by personal circumstances and problems. In civilized society, however, a respect for all life should be promoted. Elder abuse can therefore not be allowed to continue; society should be required to restore the respect and high regard it once held for its aged population.

In addition to providing reasons for and the descriptions of the nature of elder abuse, many authors therefore also provide suggestions for possible solutions.

ELDER ABUSE: THE REMEDY

To prevent elder abuse, various sectors of society can play a significant role. Indeed, individuals, professionals and institutions can work together towards the aim of preventing elder abuse and stopping it where it is occurring. The NCEA (2005, Jul.) is for example raising awareness by means of publication. Some documents focus on risk factors that could lead to elder abuse, and mitigating these factors in order to prevent abuse before it occurs.

The NCEA's reports focus on preventing abuse in caregiving facilities. The culture and management of a facility may for example be a risk factor, where certain behaviors and attitudes are for example considered to be acceptable within the culture of the workplace. This could typically occur where the staff is generally homogeneous in terms of culture or commonly held beliefs. In this light, the authors suggest a collaborative effort in order to prevent abuse. According to the NCEA (2005, Jul), it is vitally important to construct a team of representatives who will collaborate to prevent abuse. The team's actions and collaboration should furthermore be fully transparent to the rest of the staff in order to provide every individual with the power of prevention.

The authors also suggest collaboration on a wider scale. Nursing facilities for example have the responsibility of quality care and life for those residing with them. As such, all staff members at such facilities should take responsibility to report abuse should this happen. Staff members should also be aware of this responsibility as a deterrent for crimes of this nature.

Facilities should then also work in collaboration with licensing and certification agencies. These agencies enforce state and federal laws on a formal level. Evaluators have the task of regularly inspecting care homes in order to ensure that facilities are adequate to…