Elder Abuse and Neglect

Elder Abuse and Neglect

Clin Geriatr Med 21 (2005) xi – xiii Preface Elder Abuse and Neglect Martin J. Gorbien, MD, FACP Guest Editor The phrase demographic imperative is...

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Clin Geriatr Med 21 (2005) xi – xiii

Preface

Elder Abuse and Neglect

Martin J. Gorbien, MD, FACP Guest Editor

The phrase demographic imperative is used frequently when discussing any topic relevant to the growing population of older adults. It is at the core of the burgeoning fields of geriatric medicine and gerontology. The number of people 85 and older will be seven times higher in 2050 than it was in 1980. In 2030, 20% of the population will be elderly. Experts in the field of aging urge governmental officials to allow the demographic imperative to appropriately effect public policy. This simple phrase takes on special meaning when we begin to discuss elder abuse and neglect. In the United States, the growing population of frail, vulnerable citizens throughout the community and in institutions has resulted in a daunting task of keeping this population safe and free from harm while respecting their autonomy. Many who have chosen careers working on behalf of this population were drawn to it because of the challenge of unmet needs of elders. Age-related syndromes that result in frailty, functional decline, or psychiatric illness increase the risk of abuse, neglect, and self-neglect. We have been limited by a paucity of data and sound scientific research on this subject. A review of this field’s brief history reveals progress in the study of elder abuse and response in legislation and programming. Legislation dealing with this form of domestic violence may vary significantly from state to state. More recently, there have been substantive changes at the national level to standardize our approach to the study of elder mistreatment. Ideally, an improved approach will lead to better programs devoted to the prevention and response to elder abuse and neglect. 0749-0690/05/$ – see front matter D 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.cger.2005.01.001 geriatric.theclinics.com

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Our best estimates indicate that between 1 and 2 million Americans over the age of 65 are mistreated each year [1]. Every report on the topic of abuse or neglect cautions us of the underrepresentation of its prevalence. The vexing discussion of self-neglect appropriately reminds us of how little we know about a subject even more difficult to define, identify, and remedy. The demographic imperative suggests that all of these problems will grow along with the population. The concept of unmet needs of this growing, at-risk older population remains at the center of the societal challenge. The National Research Council’s 2003 compendium provides a comprehensive summary of the history of the study of elder mistreatment, current data, and future research needs [2]. It is an important work and serves as an excellent resource for students and professionals interested in this subject. The extensive, interdisciplinary panel of experts reflects the importance of contributions from a vast array of fields. bThe test of a people is how it behaves towards the old.Q This famous quote by Abraham Joshua Heschel describes the importance of this critical, modernday issue with clarity, elegance, and power. Elder abuse and neglect as well as self-neglect are public health issues. With the privilege of caring for any marginalized population comes the challenge of meeting their vast needs and protecting their interests. This issue of the Clinics in Geriatric Medicine provides an update on a wide range of issues in the area of elder abuse and neglect intended to give clinicians and others a compendium of current information on this broad subject. The scope of elder mistreatment is great. The categories of mistreatment are diverse. Physical, sexual, financial, and emotional abuse can be very different entities despite their common root in domestic violence. The special relationship between dementia and elder mistreatment is fascinating and frightening given future projections for dementia cases in the United States. Team care will become even more essential. Physicians, nurses, and social workers will note that we need to call upon a diverse group of professionals to examine and respond to elder mistreatment in the comprehensive manner that it deserves. Health care professionals will succeed in their efforts on behalf of elder mistreatment by developing collaborative programs with representatives from law enforcement, financial, governmental, and legal entities. We are grateful to the authors for their scholarly treatment of topics that underscore the need for support for an interdisciplinary approach to vulnerable older adults. It is with deep gratitude and great reverence that we acknowledge the pioneering and enduring work of the late Dr. Rosalie Wolf. Martin J. Gorbien, MD, FACP Section of Geriatric Medicine Rush University Medical Center 710 S. Paulina Street Chicago, IL 60612, USA E-mail address: [email protected]

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References [1] Pillemer K, Finkelhor D. The prevalence of elder abuse: a random sample survey. The Gerontologist 1988;28(1):51–7. [2] National Research Council. In: Bonnie RJ, Wallace RB, editors. Elder mistreatment: abuse, neglect and exploitation in an aging America. Panel to Review Risk and Prevalence of Elder Abuse and Neglect. Committee on National Statistics and Committee on Law and Justice, Division of Behavioral and Social Sciences and Education. Washington, DC7 The National Acadamies Press; 2003.