Motivation and emotion/Book/2018/Elder abuse impacts on emotion

Overview


Elder abuse is unfortunately an increasingly common phenomenon; at home, in the work place and even more common in nursing homes. Until recently, there has been a lack of awareness and knowledge on the subject; only recently has more focus and research been moved onto trying to understand and prevent the phenomenon. There is a vast array of evidence and research which demonstrates the correlation between elder abuse and the impacts it has on emotion; and is an intriguing issue into understanding what motivates the person to commit such acts. The aim of this chapter is to describe the effects that elder abuse has on emotion, with relation to theories and research and also to discuss limitations of current research and its possible implications on the population.

What is elder abuse?
There are numerous official definitions of elder abuse across a vast range of proffessions. One widely used definition is by the World Health Organisation, that states that elder abuse can be defined as "single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person" (Yadollah, Tengku aizan, & Rahimah, 2013). For another definition, see wikipedias definition of elder abuse.

Elder abuse can be defined into four types; physical abuse, psychological abuse, financial abuse, or neglect (Wolf, 2001). Within these sub-types, the abuse can also be categorised as intentional, or unintentional; abuse or neglect. Intentional abuse is defined as a conscious attempt to inflict suffering on a person whereas unintentional abuse is defined as abuse or neglect due to inadequate knowledge or training, or laziness of the person (Wolf, 2001).

Another frequently ignored, but one of the most common; three times more common than any other form of elder abuse; is elder abuse from the elderly person themselves, in the form of self-neglect. Elder self-neglect is a controversial topic as some may argue it is not a form of elder abuse, but others do, so it will be discussed nonetheless. Elder self-neglect can be defined as when vulnerable elders fail or refuse to address their own basic physical, emotional, or social needs (Hildebrand, Taylor & Bradway, 2013). Elder self neglect can allegedly increase premature death 16 fold; and there are 1.2 million cases of elder self-neglect in America each year (Hildebrand et al., 2013).

Prevalence
The known prevalence of elder abuse is very limited and most likely quite inaccurate, due to under reporting of those involved, for a variety of reasons. However, it is estimated that only 1 in every 14 cases of elder abuse are reported to social services (Dong et al, 2011). However, some data is available on the prevalence of individual aspects of elder abuse; revealing that emotional, verbal and financial abuse are the most common, with a small 2% being physical and a larger 20.8% being verbal abuse in Hong Kong (Yan and So-Cum Tang, 2001). Another study conducted in Amsterdam also supported these findings (Comijs et al, 2015). Worldwide prevalences are also scarce and under reported. However, a systematic review by Yunus, Hairi and Choo (2017) found that the prevalence of elder abuse worldwide ranged from 3.2% to 27.5%, whereas the prevalence in developing nations was reported to be from 13.5% to 28.8%.

Figure 5. One year prevalence of elder abuse (in percentages)

What is emotion?
Emotion is any conscious experience characterised by intense mental activity and a certain degree of pleasure or displeasure. Some emotions are biologically rooted, whilst some are learnt through experience, modelling or culture. There is no one ultimate definition for emotion, as it is multifactorial. Emotion is often involved and confused with moods and/or psychological disorders. For a more detailed definition, see emotion.



Theories of elder abuse
There is little research or knowledge as to what motivates elder abuse. A suggestion for the future of motivational and emotional research would be to undertake more research into what motivates one to commit acts of abuse onto an elderly victim. In this way, more research can be done into ways to prevent the phenomena. Elder abuse theories come from many perspectives; psychological, sociological and biological and no one theory has been proven to be the cause. See Figure 4 for a list of some of these theories. Figure 4. List of some of the more popular elder abuse theories

Risk factors for elder abuse
There has however, been significantly more exploration into potential risk factors for elder abuse. Several risk factors have been identified through analyses including, but not limited too; cognitive impairment, behavioural problems, dementia (Comijs et al., 2015), psychological problems, dependency on the caregiver, poor physical health, low income, previous abuse, family conflicts, low social support and ethnicity; as well as caregiver risk factors including; caregiver burden or stress, and psychological problems (Johannesen & Loguidice, 2013).

Implications of psychological and emotional well-being
Elder abuse results in many implications upon the person receiving it. A meta analysis conducted by Dong, et al (2013) focused on the psychological and emotional implications associated with elder abuse in population-based studies; which was measured by either perceived psychological distress or clinical diagnosis. Measured outcomes included depression, somatisation, perceived happiness, loneliness, anxiety, post-traumatic stress disorder, perceived stress, suicidal ideation and attempts, low self-esteem, paranoia and psychiatric disorders. Depression, anxiety and post-traumatic disorder were reported as the most reported psychological consequences of elder abuse; especially in older female cohorts. Compared to those who weren't subjected to any from of abuse, abused elders were more likely to report a higher level of psychological distress. Also revealed was that elder abuse that was reported to social services agencies was associated with the lowest reported levels psychological well-being. These findings have also been replicated in a study by Pillemer and Prescott (1988) whose participants whom suffered from elder abuse were significantly more reportedly sad or depressed than non-victims of abuse. Additionally, case studies examined by Dong et al (2013) also portrayed that depression and dementia were significantly common among neglected elders who attended doctors surgeries and clinics. Further, a questionnaire study on 335 Chinese elders conducted by Yan and So-Cum Tang (2001) revealed that participants who reported higher rates of abuse scored significantly higher on overall psychological and emotional distress scales; those participants were also significantly more dependent on their caregivers than non-abused participants, suggesting that elder abuse may result in a decrease in independence, or a key motivation concept known as learned helplessness; thus supporting the ideas behind Social Exchange Theory; that increased dependency on the caregiver can result in abuse.

More negative emotions have been found to be implications of elder abuse in elderly participants in Amsterdam. Comijs et al., (2015) conducted a study to explore the prevalence rates, risk factors and consequences of elder abuse in an elderly randomly selected sample of participants who were involved in the Amsterdam Study of the Elderly (n=1797). Participants ages ranged from 69 to 89, with a significant proportion being in the older age brackets. Measures were taken through face interviews, consisting of open-ended questions with a main focus on four types of elder abuse; financial, verbal, physical and neglect. Results revealed a significant proportion of participants reporting frequent emotions of anger, fear, disappointment or grief, immediately of closely after the abusive incident occurred. Interestingly, 11 of 43 of those subjected to physical or extreme verbal abuse reported responding aggressively themselves. A major strength of this study would be its generalisability to the elderly population because of the study's large sample size. However, as a significant proportion of the participants were in the older age brackets, a suggestion would be to accumulate an equal range of ages across participants for improved external validity. Further, it would be beneficial to the reliability of the study to conduct a similar study in the future using other survey measures such as dichotomous (yes or no) or multiple choice questions, as it is an easier, more efficient way of interpreting research data. Open-ended questions, like those used in this study are a great way of obtaining large, qualitative amounts of data; but are hard to categorise and manipulate when interpreting the data. To further support the findings of the links between negative emotions and elder abuse, Yunus et al. (2017) also found significant relationships between elderly mistreatment and stress, anxious symptoms and depressive symptoms. Noteworthy in these results, is that all variables were not properly controlled for. Outcomes of this research could have been influenced by other factors including gender, cognitive impairments, substance use, ethnicity and income.

While many studies have revealed the psychological and physical impact of elder abuse, like the ones above, many do not focus solely on the emotional adversities the phenomenon can create. One impressive study conducted by Park (2014) explored the psycho-social impacts of elder mistreatment and also found negative emotional, physical and psychological outcomes. Ten elderly participants in New Zealand whom had been subjected to mistreatment or abuse by a family member, were assessed via in-depth interview (a case study method of measurement); and data obtained analysed through coding techniques and concept mapping. Findings revealed that all the participants had an increased risk of psycho-social and socio-emotional discomforts or distress. The emotional impacts the abuse had on the participants included emotional distress, low self-esteem, fear (Lee, Kaplan & Perez-stable, 2014), demoralisation, humiliation, depression, loneliness and unhappiness. Remarkable ethical validity was present in the study by Park (2014), with the comfort of the participants as a priority evident through multiple companies of ethical approval being used, anonymity and several small sessions of collecting data, so that the participant would feel at ease with the interviewer. While case studies are a qualitative way of obtaining data, they are very hard to analyse. A suggestion for further similar research would be to conduct a similar, or the same study using more effective analytical research methods, and more participants so that the findings can have greater external validity.

The role of culture in elder abuse
Cultural norms significantly affect family relationships and their everyday functioning. They dictate family members roles and responsibilities, how members treat each other, how decisions are made and who makes them, how resources are distributed among one another, and how to resolve certain problems. Culture also significantly influences how families cope with stress, and how they react to it. Cultural differences of elder abuse is a little investigated subject, and needs further attention in future research. However, in the little investigation that has been undertaken, some differences have become apparent, including perceptions of elder abuse and what classifies as elder abuse, and cultural differences in self-neglect. One such instance is that in a cross-cultural questionnaire study of elder self-neglect, numerous differences in several aspects of elder abuse were evident; contributing to the emotional aspects of elder abuse (Filippo, et al., 2007). Firstly, cultural differences were identified in medical specialist visits. White people were twice as likely to visit a specialist compared to African Americans. In some cultures, it is seen as neglectful to not attend a medical professional when unwell; however some cultures may not value this the same. Further, in all questions in the study, Asian Americans were significantly less frequent in attributing behaviours to elder-self neglect; suggesting their culture regards some behaviours and situations differently, that others may identify as neglectful or abusive. White cultures were found to identify having no health insurance and low income as a significant risk factor to elder abuse; while Asian American participants did not. Lastly; overall in this study, significant differences in perceptions of self-neglect and abuse were found in 45% of the items on the questionnaire, leading to the conclusion that culture does influence elder abuse. These findings, and many others, bring to attention that cultural differences in attitudes, acceptable and unacceptable behaviours, respect for the elderly and other cultural values may contribute to the emotional aspects of abused elders. What we may find abusive, and makes us sad; others may not; they may not be bothered by the incident, as it is regarded as normal in their culture. This evidence supports Anetzberger (2012) theory of elder abuse, and helps explain some of her reasoning in more detail.

Links with mortality and disability
Additionally, Dong et al, (2011) conducted a study on 113 participants who were subjected to elder abuse, to determine the relationship between elder abuse and mortality, which was assessed using the National Death Index. Participants were measured on levels of depression, social engagement and social networks; which revealed much predicted results. Those victims who scored higher levels of depressive symptoms had a significantly higher risk of mortality associated with elder abuse. Further, those whom scored in the lowest and middle levels of social networking and social engagement, also had an increased risk of mortality associated with elder abuse. To support these findings, (Schofield, Powers & Loxton, 2013) also concluded in a 12 year longitudinal study that elder abuse and its emotional effects were correlated with increased risk of mortality, but also disability; along with results confirmed by the works of Yunus et al. (2017).

Criticisms
While these results are very convincing, one must acknowledge that a significant portion of these results are self-reported levels of emotional and psychological distress; which are less reliable than those assessed via other means of analysis, due to many forms of bias. While this must be acknowledged, there is a clear correlation between elder abuse and emotion displayed by these results. Another controversial critique to note among all these findings, is the relevance that the theory by Anetzberger (2012) is applicable. While many of these studies display results depicting highly negative emotional consequences of abuse, this could be because of the way the individual has perceived it. The abuse inflicted on the person could actually not be classified that way by onlookers, but by the person receiving the abuse it is. Further, many incidents of abuse may not have been reported or resulted in negative emotions due to the beliefs and norms of the elderly person; in that they do not recognise or believe what they may have been subjected to is abuse.

Conclusion
How does this information help improve and understand our motivational and emotional lives? By understanding relevant theories of what motivates elder abuse, we can develop more strategies and research to help prevent the incidents from occurring in the first place. By doing so, improving the well-being of thousands of elderly people physically, emotionally, psychologically and financially; thus extending the person's lifespan and enhancing their quality of life. However, it may be difficult to address self-neglect issues, and this area of abuse needs to attract more focus in future research. Further, chapters like this can help to raise awareness of the phenomena and in turn bring more people who have been subjected to abuse, to the surface. In turn, getting help and improving their overall wellbeing.

In conclusion, all evidence of the effects of elder abuse reveal negative emotional aspects, along with negative psychological, financial and physical implications. There are many theories of elder abuse, but no such theories have really proven why it occurs because of the reasons given. One suggestion for future professionals is to tackle the question of "why does this particular theory of elder abuse actually cause abuse"? If the reasons as to why and how elder abuse occurs are uncovered, then we can put more research into stopping the phenomenon from occurring; thus, improving elderly individuals emotional lives.