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Vulnerability, Policy, and Protection of the Elderly Population

Mary P. Davidson

College of Nursing, Auburn University

NURS 7350: Quality, Safety and Prevention Using Healthcare Technology

Dr. Stuart Pope

July 20, 2022

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VULNERABILITY, POLICY, AND PROTECTION OF THE ELDERLY POPULATION

Abstract

With the number of elderly individuals increasing globally, the occurrence of elder abuse

and neglect (EAN), including physical, sexual, emotional, phycological, financial abuse, and

neglect, is also increasing. With an increase in the number of elders globally, the prevention of

EAN is incredibly important. While there is current policy and methods in place to aid in the

treatment of EAN, the occurrence of EAN is still prevalent, and there are few prevention

strategies currently being utilized. The purpose of this paper is to explore the elderly as a

vulnerable population, to evaluate current policy and interventions in place to stop and prevent

EAN, and to identify strategy to address health inequality in the elderly population. A review of

current literature on the topic of EAN and current policy in place was completed and synthesized

to discover the effectiveness of current prevention and treatment practices. The literature states

current EAN resources can be useful when utilized appropriately, but overall can be inaccessible

to many populations, do not factor in health inequity, and do not adequately aid in the prevention

of EAN. Possible strategies to make EAN resources more accessible were also discovered, such

as by using interpreters, education and training, and technology. Literature also showed how

EAN can be prevented by increasing risk management practices, which could be done with

increased funding. While current literature provides methods to aid in the prevention and

treatment of EAN, more research is needed to discover the effectiveness of prevention and risk

management strategies.

Keywords: elder abuse and neglect, prevention, policy, treatment

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VULNERABILITY, POLICY, AND PROTECTION OF THE ELDERLY POPULATION

Vulnerability, Policy, and Protection of the Elderly Population

The average lifespan of the individual is increasing, with elderly populations, people 60

years or older, growing globally (Fast facts, 2021; Yunas et al., 2019). With an increase in elders,

there is also an increase in rates of elder abuse and neglect (EAN). Elders often suffer from

decreases in both physical and psychological functions, experiencing health issues such as

memory problems, complex chronic diseases, and mobility concerns (Bozzaro et al., 2018;

Mercier et al., 2020). As health issues arise, elders become increasingly dependent on caregivers

and often lose the ability to self-advocate, which makes elders extremely vulnerable and provides

the opportunity for EAN (Bozzaro et al., 2018). With an increase in the vulnerable elder

population, policy to protect elders from EAN has never been more needed or important. The

purpose of this paper is to explore the elderly as a vulnerable population, to evaluate current

policy and interventions in place to stop and prevent EAN, and to identify strategy to address

health inequality in the elderly population.

Documented Gaps and Health Conditions

Elder Abuse and Neglect

Due to increased vulnerability, elders are more susceptible to EAN. EAN includes

physical, sexual, emotional, phycological, and financial abuse as well as neglect (Fast facts,

2021). With EAN occurring in up to 27.5% of elders worldwide, EAN is an issue very prevalent

today (Yunas et al., 2019). EAN more often occurs in situations where the elderly individual has

physical disabilities, complex health concerns, or memory problems, such as cognitive

impairment or dementia. Elders often suffer from decreased physical and mental function and

must rely heavily on caregivers to complete daily tasks, such as eating, taking medication,

bathing, and toileting (Bozzaro et al., 2018; Elder abuse, 2020). With decreased function, have
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VULNERABILITY, POLICY, AND PROTECTION OF THE ELDERLY POPULATION

increased frailty and are more sensitive to environmental conditions. Decreased functions

increase dependency causing elders to be a vulnerable population and makes elders extremely

susceptible to elder abuse (Bozzaro et al., 2018). EAN not only includes singular or repeated acts

of harm, but also the lack of action when necessary, known as neglect (Yunas et al., 2019).

Neglect causes elders to have unmet needs for help with daily activities, to not have adequate

social or emotional support, and to be socially isolated (Mercier et al., 2020). EAN has been

shown to increase risks of mortality in elders as well as increases an elder’s likelihood to suffer

from depression, disability, stress, anxiety, and hospitalization (Yunas et al., 2019).

Gaps Between Disadvantaged Versus Privileged Groups

Poverty appears to be one of the largest factors affecting rates of EAN, with higher

occurrences of EAN being found in lower income households (Aslan & Erci, 2019). Elders with

lower incomes are more financially dependent on families, which causes an inability to escape

from abusive situations (Hernandez-Tejada et al., 2018). Elders with low incomes were also

found to have lower education levels, to suffer from more chronic illnesses, and to not know of

ways to seek help out of abusive situations (Aslan & Erci, 2019). While any elder is at risk for

EAN, underlying social inequalities play a large role in the occurrence of EAN.

Social Inequalities of Health Disparities

Research shows social inequalities highly influence EAN rates. Lower education levels is

found to be correlated with increased incidence of EAN (Mercier et al., 2020). Research shows

when the education level of an elder increased, occurrence of abuse decreased. Elders with only

a primary level education or less were 2.43 times more likely to suffer from EAN than an elder

with a higher level of education (Aslan & Erci, 2019). Education can help encourage positive

health behaviors in individuals, and elders with lower education levels might not be able to
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VULNERABILITY, POLICY, AND PROTECTION OF THE ELDERLY POPULATION

efficiently communicate or report any abuse occurring (Aslan & Erci, 2019). Illiteracy was also

found to be positively related with elder abuse, with illiterate elderly individuals being more

likely to experience increased rates of physical abuse, sexual abuse, and neglect (Aslan & Erci,

2019). Genders plays a role in EAN as well, with women being more likely to experience EAN

than men (Aslan & Erci, 2019; Hernandez-Tejada et al., 2018). Race influences EAN as well

with non-Caucasian individuals being twice as likely to suffer from EAN than Caucasian

individuals (Hernandez-Tejada et al., 2018). EAN was found to be more prevalent in divorced or

widowed elder and in elders who were separated from families (Aslan & Erci, 2019). Another

positive relationship was discovered between the ages and number of children an elder has and

the increased occurrence rate of EAN (Aslan & Erci, 2019). A positive relationship was also

found between EAN occurrence and the number and ages of children of the elder (Aslan & Erci,

2019). Elders’ environments affect EAN occurrence, with high income countries having an EAN

rate of 7.6% to 10% and low to middle income countries have an EAN rate of 15.7% (Mercier et

al., 2020). While efforts are being made against EAN, the systems currently in place to stop and

prevent EAN are not effective, efficient, or equitable to all elders due to lack in prevention

abilities and inaccessibility.

Policies and Interventions to Reduce Health Inequalities

Adult Protective Services

Adult Protective Services (APS) is a government agency available to adults 65 years of

age or older suffering from EAN. APS is responsible for investigating any reported case of abuse

or neglect to decide if actual abuse occurring, and if so, step in to aid the victim. If the victim is

eligible, APS can provide financial assistance for living expenses, social services, health

services, legal aid, and recommendations for further services in the community (Texas
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VULNERABILITY, POLICY, AND PROTECTION OF THE ELDERLY POPULATION

Department of Family Protective Services, 2022). APS can provide protective services, but only

investigates off reports of potential abuse (Halphen et al., 2021).

Elder Justice Act

The Elder Justice Act is the first piece of federal legislation allocating funds to aid in the

fight against EAN. The Elder Justice Act aims to use public health services and social services to

help report, stop, and treat EAN. The Elder Justice Act authorized funding and grants to support

services such as APS, Long-Term Care Ombudsman programs, Medicare/Medicaid certified

long-term care facilities. National leadership was also created through the Elder Just Act by the

formation of the Elder Justice Coordinating Counsel and Advisory Board (Federal laws, 2022).

National Adult Maltreatment Reporting System

The prevalence of EAN in the U.S. is monitored by the National Adult Maltreatment

Reporting System (NARMS), which is a data reporting system used to track and better

understand EAN. Data for NARMS is provided by APS and collects information about EAN

regarding reports and investigations, clients and victims, and perpetrators. NARMS uses the

collected data to further understand EAN, examine trends, improve resources, and find gaps in

policy. The goal of NARMS is to better understand the phenomena of EAN so EAN can be better

prevented and treated (McGee & Urban, 2021).

Model and Strategies to Address Health Inequalities

When examining current policy in place to protect the elderly, the main issue arising is

the lack in prevention capabilities. Policy currently in place, such as APS and the EJA, focuses

on how to report, stop, and treat EAN, but policy lacks preventative measures or risk assessments

to stop EAN from occurring. Current research shows increasing risk management practices, such

as increasing home safety measures and educating health professionals on risks of EAN, shows
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VULNERABILITY, POLICY, AND PROTECTION OF THE ELDERLY POPULATION

positive outcomes in decreasing EAN occurrence, but risk management practices are rarely

utilized due to lack of necessary funding and resources (Dyer et al., 2021; Storey et al., 2022).

Current policy is also inequitable to the inaccessibility of the available resources. Even in

situations where resources are available to an elder, most resources require access to healthcare

to discover abuse or rely on others to report abuse on behalf of the elderly. If financially unable

to access healthcare or in social isolation, the elder is unlikely to be able to self-report or have a

bystander report on the elder’s behalf.

Use of Interpreters

EAN resources are less accessible to elders living in rural communities and among

diverse populations, especially populations who do not speak English. One fifth of people living

in American do not speak English, which makes many EAN resources unattainable. Memory and

function issues elders often have, such as dementia, mental illness, delirium, and sensory

impairment, causes further complication and can often results in misunderstanding with an elder

who cannot speak English. The use of interpreters and having EAN resources available in other

languages is a way to make resources more accessible (Dyer et al., 2021).

Use of Education and Training

EAN resources can also be more attainable through further education and training of

healthcare professionals and the utilization of technology. Education and training can be

improved through making education material accessible to health professionals in rural areas by

providing the education material through multiple formats, such as primary research, journal

articles, and curriculum on how to prevent and treat EAN. Experts can also teach EAN

prevention and treatment training to community members, healthcare workers, city personnel,

and federal personnel by traveling to rural communities to provide training (Dyer et al., 2021).
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Use of Technology

The use of technology can bring resources directly into patient’s homes using video and

phone interviews with APS and physicians (Dyer et al., 2021). Through the utilization of

telecommunication, APS and healthcare services can be brought to diverse and rural elders who

otherwise might not be able to receive care. Through video calls, APS can complete assessments

of both the client and the home while in the presence of a physician. Other technologies allow for

elders to be monitored remotely through various available apps. Physicians and family members

can, in real time, watch and look after elders and prevent the occurrence of EAN. Utilization of

technology also allows for other agencies to get involved remotely, such as law enforcement and

medical examiners, which brings the option of interdisciplinary collaboration into the elder’s

home as well (Dyer et al., 2021).

Conclusion

With the elderly population growing, the prevention and treatment of EAN has never

been more important. While strides have been made in the attempt to create policy and agencies

to stop EAN, more work must be done in the prevention of EAN. Increasing risk management

practices is a way to screen for possible EAN and stop EAN before the abuse begins. Resource

accessibility is also in issue in EAN, with elders relying on bystanders health professionals to

report abuse. Current resources often do no account for health inequities, which causes the

resources to not be used by certain populations of elders. Through using interpreters, education

and training, and technology, resources can be more attainable for all elders. EAN can also be

prevented through increasing funding available to risk management strategies to help screen for

potential EAN before the abuse occurs. While work is being done to improve EAN prevention

methods, more research is needed on ways to prevent and treat EAN.

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VULNERABILITY, POLICY, AND PROTECTION OF THE ELDERLY POPULATION

Summary

The occurrence of elder abuse and neglect (EAN) is increasing as the elderly population

grows, and the need for treatment and prevention of EAN is growing as well. The purpose of this

paper is to explore the elderly as a vulnerable population, to evaluate current policy and

interventions in place to stop and prevent EAN, and to identify strategy to address health

inequality in the elderly population. A review of current literature on the topic of EAN and

current policy in place was completed and synthesized to discover the effectiveness of current

prevention and treatment practices, while also searching for strategies to improve prevention and

treatment methods for EAN. When looking at EAN occurrence, documented gaps and social

inequities are prevalent. EAN occurrence is higher in elders in poverty, as well as in elders who

have lower education levels, who are divorced and separated from families, who are women,

who are non-Caucasian, and who live in low-income countries. There are current policy and

agencies in place to stop EAN, such as APS, the Elder Justice Act, and the National Adult

Maltreatment Reporting System. While such agencies are effective when used appropriately,

such agencies are often inaccessible to all populations and are not effective in the actual

prevention of EAN but rather can only be used to stop EAN once the abuse has already occurred.

Many agencies are also dependent on the reporting of abuse by bystanders or healthcare

professionals. Current literature shows EAN resources can be made more accessible by using

interpreters, education and training, and technology. Literature also showed how EAN can be

prevented by increasing risk management practices, which could be done with increased funding.

While current literature provides methods to aid in the prevention and treatment of EAN, more

research is needed to discover the effectiveness of prevention and risk management strategies.
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VULNERABILITY, POLICY, AND PROTECTION OF THE ELDERLY POPULATION

References

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Bozzaro, C., Boldt, J., & Schweda, M. (2018). Are older people a vulnerable group?

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Centers for Disease Control and Prevention. (2021, June 2). Fast facts: Preventing elder abuse.

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