130-131).
Relationship factors - in the early theoretical models, the level of stress of caregivers was seen as a risk factor that linked elder abuse with care of an elderly relative. While the accepted image of abuse depicts a dependent victim and an overstressed caregiver, there is growing evidence that neither of these factors properly accounts for cases of abuse. Although researchers do not deny the component of stress, they tend now to look at it in a wider context in which the quality of the overall relationship is a causal factor. Today, the belief is that stress may be a contributing factor in cases of abuse but does not by itself account for the entire phenomenon.
Living arrangements, especially those with overcrowded conditions and a lack of privacy have been associated with conflict within families. Even though abuse can occur when the abuser and the older person suffering abuse live apart, the older person is more at risk when living with the caregiver (Krug, 2002, pp. 130-131).
Community and Societal factors - isolation of older people can be both a cause and a consequence of abuse. Many older people are secluded because of physical or mental issues. In addition the loss of friends and family members reduces the opportunities for social interaction.
Although there is little solid empirical evidence, societal factors are currently considered important as risk factors for elder abuse in both developing and industrialized countries. In the past the importance was generally placed on individual or interpersonal attributes as potential causal factors for elder abuse. Cultural norms and traditions such as ageism, sexism and a culture of violence are also now being recognized as playing an important underlying role (Krug, 2002, pp. 130-131).
Prevention
The consequences that physical and psychological violence has on the health of an older person are aggravated by the ageing process and diseases of old age. It becomes more difficult for an elderly person to leave an abusive relationship or to make correct decisions because of the physical and cognitive impairments that usually come with old age. In some instances, kinship obligations and the use of the extended family network to resolve difficulties may also lessen the ability of older people, particularly women, to escape from dangerous situations. Many times the abuser may be the abused person's only source of companionship. Due to these and other things preventing elder abuse presents a whole host of problems for practitioners. In most cases, the greatest dilemma is how to balance the older person's right to self-determination with the need to take action to end the abuse (Krug, 2002, pp. 134-138).
Countries that deliver services to abused, neglected or exploited older people have done so through the existing health and social services network. Such cases frequently involve medical, legal, ethical, psychological, financial, law enforcement and environmental issues. Rules and protocols have been developed to help case workers and special training is usually available to them. Care is often planned by consulting teams drawn from a wide range of disciplines. These services operate in close collaboration with task forces, usually representing statutory bodies and voluntary, private and charitable organizations, that offer consultation services, provide training, develop model legislation and identify weak points in the system (Krug, 2002, pp. 134-138).
In some Latin American and European countries, as well as in Australia, the medical profession has played a leading role in raising public awareness about elder abuse. In other countries, including Canada and the United States, physicians have lagged many years behind the social work and nursing professions. Few intervention programs for abused older people are present in hospital settings. Where they do exist, they are usually consultation teams who are on call in the event a suspected case of abuse is reported. Those involved in health care have an important role to play in programs that screen for and detect abuse (Krug, 2002, pp. 134-138).
Despite a growing interest in the problem, most countries have not introduced specific legislation on elder abuse. Particular parts of abuse are usually covered either by criminal law, or by laws dealing with civil rights, property rights, family violence or mental health. Specific legislation on the abuse of older people would imply a much stronger commitment to eradicating the problem. Even where such laws exist, cases of elder abuse have only rarely been prosecuted. This is principally because older people are usually reluctant -- or unable -- to press charges against family members, because older people are often regarded as being unreliable witnesses, or because of the inherently hidden nature of elder abuse. As long...
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