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That Caregiver Stress Is Not the Primary Cause of Elder Abuse

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That Caregiver Stress Is Not the Primary Cause of Elder Abuse GENERATIONS – Journal of the American Society on Aging By Bonnie Brandl and Jane A. Raymond Policy Implications of Recognizing that Caregiver Stress Is Not the Primary Cause of Elder Abuse Studies show the causes of elder abuse to be wide-ranging—and not necessarily an outcome of caregiver stress. Seeing caregiver stress as a primary cause of abuse has unintended and detrimental consequences that affect the efforts to end this widespread problem. ach year, millions of older adults are abused, of elder abuse? And what are the unintended Eneglected, or financially exploited (Lifespan consequences of focusing on stressed caregivers of Greater Rochester et al., 2011; Acierno et al., to prevent and alleviate elder abuse? 2010). In 2009, an estimated $450 billion was spent on providing care for older individuals The Dynamics Of Elder Abuse: Historical (Feinberg et al., 2011). Burdened caregivers who Perspective and Evolving Analysis do not have adequate support and resources While early elder abuse research was linked to often experience stress. Would preventing caregiver stress, later analysis of the methodolo- caregiver stress eliminate or reduce elder abuse? gies identified several limitations that potentially skewed the findings. When studies were first done, there An historical perspective were no good baseline data or In chapter six of Elder Abuse: Conflict in the definitions for elder abuse. Family, Hudson (1986) examined research on elder abuse from 1979 to 1985. In her review of Early elder abuse research suggested that seventeen studies, she documented twelve that caregiver stress was the primary cause of elder list caregiver stress or claim stress as a cause of abuse. According to this model, “the elderly elder abuse. Some of the cites from the chapter victim is viewed as very dependent on the include the following: caregiver, usually an adult daughter, who • “Most (75 percent) abusers were experiencing becomes frustrated, angry and sometimes some form of stress” (O’Malley, 1979). abusive or neglectful because of the continuous • “Abuse was cyclical and precipitated by stress” caretaking needs of the infirm parent” (Wolf, (McLaughlin, Nickell, and Gill, 1980). 2000). But is caregiver stress the primary cause • “The elder was a source of stress to the abuser, Copyright © 2012 American Society on Aging; all rights reserved. This article may not be duplicated, reprinted or distributed in any form without written permission from the publisher: American Society on Aging, 71 Stevenson St., Suite 1450, San Francisco, CA 94105-2938; e-mail: [email protected]. For information about ASA’s publications visit www.asaging.org/publications. For information about ASA membership visit www.asaging.org/join. 32 | Fall 2012 • Vol. 36 .No. 3 Pages 32–39 Elder Abuse and the Elder Justice Movement in America who was experiencing a variety of stressors” of the caregiver is often based on previous family (Boydston and McNairn, 1981). history, the amount of care required, and the • “These families were under stress 80 percent perceptions of the partner or family member of the time, with the elderly person being the about caregiving (Brintnall-Peterson, 2012). scapegoat for the caregivers’ frustrations” “Family members often undertake caregiving (Chen et al., 1981). willingly, and many find it a source of deep • “Abusers…. 67 percent were under stress” satisfaction and meaning” (Feinberg et al., 2011). (Department of Aging, 1981). Rather than focusing on what they may be • “The most frequently reported cause of elder missing, they concentrate on the gains that may abuse was frustration of the caregiver due to occur, such as in richer relationships or en- change in lifestyle and burden of the elder” hanced skills. According to Feinberg and col- (Levenberg et al., 1983). leagues, “Those who take on this unpaid role After reviewing these studies, Hudson risk the stress, physical strain, competing concluded that elder abuse researchers in the demands, and financial hardship of caregiving, early 1980s faced significant challenges: they and thus are vulnerable themselves.” were studying a problem that was rarely dis- Most stressed caregivers do not hurt or harm cussed and poorly understood. There were no older individuals. Although popular, the situ- baseline data for or common definitions of elder ational model does not explain why some abuse. Sample sizes were often small, and still stressed caregivers never harm or exploit older the results were frequently generalized. Most adults. More often, caregivers experience research consisted of retrospective studies that caregiver distress, which perhaps more aptly used convenience samples and were dependent reflects the harmful effects, burden, and other on voluntary responses (Hudson, 1986). symptoms of tension that challenge some Also, older victims often did not want to be caregivers (Brintnall-Peterson, 2012). Common interviewed about abusive incidents they symptoms of caregiver distress include engaging perceived as shameful or embarrassing; most in behaviors that are not in the best interest of studies gathered information from professionals the caregiver, such as overeating; self-medication and abusers—not the victims themselves. Yet and substance abuse; and experiencing depres- results derived from abusers’ perspectives need sion, anxiety disorders, social isolation, or to be interpreted with caution since abusers are chronic medical or mental health problems known to lie, minimize the abuse, and justify (Hoffman and Mendez-Luck, 2011). their behavior (Hudson, 1986; Bancroft, 2002; Stark, 2007). Therefore, Hudson concluded that Why Does Elder Abuse Exist and Persist? “stress could easily mask the discovery of other Elder abuse presents in various forms such as significant contributing or causative factors. physical, sexual and emotional abuse, neglect, Stress does seem to be an intensifier of potential and financial exploitation. Offenders can be mistreatment, but it is not a clear predictor, since spouses or partners, family members, care- most families providing eldercare experience givers, and other persons in positions of trust or stress and yet do not mistreat their elders” authority. Given the complexity of these cases, (Hudson, 1986). no single intervention, response, or policy initiative is going to solely address the problem. Evolving analysis: providing care—satisfying Anetzberger (2005) has observed that with for some, stressful for others “a problem as complex as elder abuse, it is Caregivers are as diverse as the older adults in unlikely that any single theoretical perspective their care. The perceived and actual stress level could explain all forms and situations.” Most Copyright © 2012 American Society on Aging; all rights reserved. This article may not be duplicated, reprinted or distributed in any form without written permission from the publisher: American Society on Aging, 71 Stevenson St., Suite 1450, San Francisco, CA 94105-2938; e-mail: [email protected]. For information about ASA’s publications visit www.asaging.org/publications. For information about ASA membership visit www.asaging.org/join. Fall 2012 • Vol. 36 .No. 3 | 33 GENERATIONS – Journal of the American Society on Aging Pages 32–39 researchers and practitioners have moved away (NCJRS, 2010; Lundy and Grossman, 2004; from a single causation theory (NCJRS, 2010; Lachs and Pillemer, 2004; Wolf and Pillemer, Ramsey-Klawsnik, 2000; Sklar, 2000). Ramsey- 1997). Often the victim and abuser are living Klawsnik suggests that a small percentage of together, but the older individual is providing abusers are overwhelmed or impaired caregiv- financial resources for food, clothing, and ers; some caregivers have medical or mental housing and taking care of the home. In some health conditions that make it difficult or cases, the caregiver was the victim of the care impossible to provide adequate care. In these recipient’s abusive behavior—reinforcing that situations, the older adult may experience abuse the adult who is often defined as “vulnerable or neglect, but the harm is due to the inability of or at risk” may not be the victim. the caregiver to provide adequate care without Penhale (2003) suggests that “the general assistance. The remaining offenders are narcis- concept of ‘elder abuse’ should be more closely sistic, domineering, or bullying and sadistic examined and that more emphasis should be (Ramsey-Klawsnik, 2000). given to the nature of power within relation- ships.” In some cases, Some studies suggest the abuser is dependent on the elder abuse is intimate- partner violence or victim in some way—perhaps financially or emotionally. domestic violence, with all the classic Several studies and articles have debunked dynamics, well into old age (Fisher and Regan, the popular notion that elder abuse is primarily 2006; Zink et al., 2005; Zink et al., 2006; Lundy caused by caregiver stress (Acierno et al., 2010; and Grossman, 2004). Other studies have sug- Fischer and Regan, 2006). Vinton’s 1991 litera- gested that the dynamics of elder abuse are ture review found that “there appears to be similar to the power and control dynamics consensus in the areas of spouse and elder experienced by younger battered women abuse that life stressors alone cannot account (Harris, 1996). Similar to the experiences of for violence.” Reis and Nahmiash (1998) found younger battered women, often an offender is that “the caregiver stress theory of abuse is using a pattern of coercive tactics to gain and not supported by the findings of this study.
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