Research and Evidence in SW Practice

Research and Evidence in Social Work Practice

February 16, 2014
Research Methods and Data Practice Evaluation 3020
Wayne State University School of Social Work
Chelsey Pasha
Ec5994

Research and Evidence in SW Practice

Part 1: Introduction of Population

As we move from generation to generation the baby boomers, one of the most populated
generations today are beginning to reach senior status, and are thinking about retirement, which
seems to begin later than age sixty-five. It is reported that the aging population represents
approximately 40 million or 12.9 percent of the population (Dong, 2012). By the year 2030,
there will be about 72.1 million older people in the United States, which is more than twice the
number in 2000 (Dong, 2012). They are starting to rely on Medicare for health care assistance,
as well as assistant living and skilled nursing facilities. This generation consists of our grand
parents and great grand parents who will need to rely on our assistance when to come to assisting
with their health care needs.
Imagine your grandmother or grandfather has reached a stage where they no longer can
care for themselves. A skilled nursing facility may be the only option that your grandparents
have. In your mind you believe everything will be okay because you know that your
grandparents will be in a safe environment with people who genuinely care about the well being
of your love ones. A month later after having placed your family member in an assisted living
facility you learn that grandparent has a bruise above their eye, and they keep mentioning that
they want to go home. What would your reaction be? What are your thoughts?
Elder abuse is an arising problem within the gerontology community. There are four
common categories of elder abuse according to Sjostrom, physical abuse, neglect, psychological
abuse, and financial abuse. According to the World Health Organization ten percent of elders in
the United States experience abuse each year, and in multiple forms (Dong, 2012). Elder abuse
leads to chronic health care problems and ultimately death. Adult Protective Services reports that

Research and Evidence in SW Practice

each year in the United States there are a handful of elder abuse cases reported as well as a
handful that go unnoticed. Recent research on elder abuse is beginning to take a look at abuse
culturally focusing on race as the basis of the study, as well as minority communities and the
home. Researchers are also beginning to take a look into health care facilities, health care
professionals more specifically the Nursing aides who assist the elderly on a daily basis. Physical
abuse includes kicking, pushing, hitting, punching, slapping, and anything that would physically
harm a senior (Sjostrom, 2004).
Working in a skilled nursing facility has opened my eyes to some of the aforementioned
problems that happen on a daily basis. I have been employed with a nursing facility for almost
two years now and every senior in there I respect and adore. Often I think about how most of the
seniors where I work has little or no family contact. Holidays, birthdays, are insignificant
because they simply dont have family or someone special to share those special days with. They
rely and depend on everyone from dietary to nursing to take care of them. Putting them in harms
way or neglecting them will always be unacceptable. My first month on the job was intense, and
very hard for me emotionally. A nursing assistant was fired for abuse. They suspected that she
had been hitting some of the residents, and when they investigated a little deeper they learned
she had in fact harmed some of the residents when she would get frustrated. My initial reaction
was that of happiness when announced she had been let her go. I was glad that she was gone and
could no longer hurt any other resident, but she is one of thousands who get away with abuse
everyday.
Its often easy to get frustrated especially with seniors, because they dont comprehend
like we think they should, however others forget that most seniors who live in a skilled nursing
facility are not there by choice. They often are battling a form of dementia, which impairs their

Research and Evidence in SW Practice

state of thinking. They simply cant understand what is going on nor do they comprehend
sometimes where they are so they become combative. As health care professionals the first
response to combative behavior should not be to become combative. Its not just physical abuse
but verbal abuse that I have also witnessed. I love working with seniors and I wouldnt trade my
job for anything at this moment.
Part II: Article Summary and Intervention Methods

There are many studies being done to research elder abuse more thoroughly. The first
article to compare, which is titled: Culture Diversity and Elder Abuse: Implications for Research,
Education, and Policy by Xin Qi Dong, studies the effects of abuse in the elderly from a cultural
view. Studies recently provided more information on a cultural basis looking at African
Americans, Hispanics, Asians, Pacific Islander and Native Americans. More recently the studies
have included Latino, Korean, and Chinese populations. According to Dong, in 2010
approximately 20 percent of people ages 65 and older were minorities. The largest number
represents the African American community, which made up 8.4 percent of the aging community.
6.9 percent were Hispanic and 3.5 percent were Asian or Pacific Islander and one percent were
American Indian (Dong, 2012). It is imperative according to the National Research Council to
urge health care professionals as well as social services agencies to explore cultural issues that
specifically relate to elder abuse. In doing so the study will bring forth more evidence and a
better understanding of elder abuse as a whole. Dong goes onto mention in the article more
cultural explorations are needed in order to get a better study of what is going on (Dong, 2012).
According to the article there are many challenges that exist when studying minority
communities. A community based participatory research approach could become the best way to

Research and Evidence in SW Practice

gather information when studying the abuse of elders in minority communities (Dong, 2012).
Dong stresses the importance of educating health care professionals, law enforcement, social
services agencies, and Adult Protective Services. Providing education now will prevent higher
incidents of elder abuse in the future.
Dongs article focuses on studying the root of elder abuse by breaking it down according
to subcultures. In my opinion the article was an excellent source of information. When studying
the aging community it is important to focus on race, primarily because of the ratio in terms of
minority groups in a nursing home setting are small. In most cases, African Americans choose to
take care of their sick and elderly family as well as other minority groups who tend to follow the
same trend. It is rare that you find a high rate of a minority group in an assistant living or skilled
nursing facility. Dong addresses the aging population throughout the article focusing on
implementation of policies and acts that will protect our seniors from abuse in the future as many
of them began to age into nursing facilities. Focusing on race by community and the different
environments in which these seniors live in will also tell what type of abuse they are dealing with
(Dong 2012). Cultural and ethical issues were addressed in the article, which made the
information more credible.
The second article titled: A Comparison of Three Measures of Elder Abuse by Diana
Meeks-Sjostrom focuses on the indications of abuse. The IOA according to Sjostrom is a twentytwo-item assessment tool for abuse and non-abuse cases. A health care professional uses the
assessment most times after a home visit has taken place (Sjostrom, 2004). Sjostrom also
mentions the Elder Abuse and Neglect Assessment or EAI, which is made up of forty-four scale
sheet used in clinical settings by health care professionals. The EIA assessment more specifically
checks for neglect and abandonment in the elderly. Sjostrom mentions that research suggest that

Research and Evidence in SW Practice

professionals do not specifically identify most incidents of elder abuse (Sjostrom, 2004). She
talks about the types of abuse elders face naming neglect as the most common form. Neglect
makes up sixty to seventy percent of all mistreatment cases (Sjostrom, 2004). Neglect can lead to
more severe forms such as physical and psychological abuse. The elder abuse assessments have
shown high accuracy rates in clinical and home settings in the past and she (Sjostrom)
thoroughly believes that it will work in the future. Sjostrom list these methods as the best way to
assess abuse, but mentions that there could be a better way to assess long-term care as well
(Sjostrom, 2004).
The article itself was lengthy and repetitive, however it did produce a lot of information
regarding abuse and the forms of abuse. Sjostrom listed the measures of elder abuse in her article
naming different measures as assessment tools. In todays world the EIA and the IOA assessment
may not be as efficient to thoroughly check for abuse due to the fact that so many baby boomers
will each have a story that will be different over the next decade. The article did not address
cultural issues, however ethical issues were addressed but in small detail.
The last article titled: Caregiver Factors contributing to psychological elder abuse
behavior in long-term care facilities: a structural equation model approach by J. Wang focuses on
caregivers as one of the main causes of elder abuse. Wang takes into account the education of the
caregivers, the numbers of hours worked each day and the number of days worked each week as
a contributing factor to psychological and physical abuse among the elderly (Wang, 2009). Wang
also suggest that experience plays the largest role in the abuse. Asking questions like how many
years does the caregiver have working with the elderly? In most cases Wang attributes abuse
among caregivers against the elderly when they are fully dependent on someone. In 2001, a

Research and Evidence in SW Practice

study was conducted regarding residential settings, and the most common forms of abuse during
that time verbal and psychological (Wang, 2009).
Wang believes that cross sectional studies are the best way to gain research in elder
abuse. He believes that the best way to really gather this type of data is to go from community to
community and ask questions to seniors who live with a caregiver (Wang, 2009). Wang believes
that the best approach for long-term care is to make sure that the each area of elder abuse is
covered. The article touches mostly on the measures of studies performed (Wang, 2009).
The articles information, which is relevant to the study, creates a wide range of
information to look at, however it should be more in depth. Wang touches on information useful
to identifying elder abuse. He lists ethical and some cultural issues as well.
Interventions that are best for this population are definitely education, which is the most
important method in my opinion. Educating health care professionals starting with nursing
assistants to nurses will decrease elder abuse and neglect especially in the nursing home setting.
Educating caregivers of the elderly who live in a residential setting is also vital to stop abuse.
Often time lack of knowledge of how to handle the elderly when they are at their most venerable
state leads to frustration, which leads to abuse. Educating health care officials on how to
recognize the signs of abuse and mistreatment in the elderly is also important. The quicker
someone is able to detect a problem the less likely it is to happen again. Education is key in all
aspects of health care, the more training the better the care.
Dong mentioned in the first article how important it is to break down and study elder
abuse by culture. Pointing out what types of abuse are happening on a cultural scale will identify
why it is happening, and what settings abuse are more likely to take place. These two
intervention methods in my opinion would be the best way to try and alleviate elder abuse.

Research and Evidence in SW Practice

Education and culture are two important factors because you are trying to find out who is being
abused and how to stop it from happening. Although elder abuse is an issue that gets very little
attention it is still important to think of ways to help our seniors, because abuse is simply abuse
no matter what age you are.

Part 3: Importance of Evidence Based Practice

Studying elder abuse is important, and the more information that can be gathered will be
beneficial for implementing legislature that will prosecute and ban health care professionals from
abuse of the elderly. According to Dong, there are two acts currently pending within legislature
that would change the field of elder abuse. The Elder Abuse Victims Act will provide services
and protection to the elderly on a national level. The second act pending in legislation is the
Older Americans Act or OAA, which provides protection of older adults and their rights (Dong,
2012). It is important that these acts become effective in the long run for seniors.
Listening to older adults who have been abused and possibly using their issues for case
studies would be pivotal for researchers who are studying the effects of elder abuse. It would
allow researchers to get a clearer understanding elder abuse. The disavantages would be far less
great because of the population that is being studied. At this time I cant identify any
disadvantages of studying elder abuse in an evidence-based practice.
The elderly or seniors as we prefer to call them depend on us whether its for health care
issues or just a kind word. I think its crucial that we look to our health care professionals to
provide us with answers if we suspect abuse. Educating society about this particular population
and the effects abuse has on them will in my opinion open more eyes to what is truly happening

Research and Evidence in SW Practice

around the world. I always tell people to never discredit the elderly because if it were your mom
or dad you would want someone to empathize with your situation.

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10

References

Dong, X. Q. (2012). Culture diversity and elder abuse: implications for research, education, and
policy. 36(3),
Meeks-Sjostrom, D. (2004). A comparison of three measures of elder abuse. Journal of Nursing
Scholarship, 36(3), 247-50. Retrieved from
http://search.proquest.com.proxy.lib.wayne.edu/docview/236397165?accountid=14925
Wang, J., Lin, M., Tseng, H., & Chang, W. (2009). Caregiver factors contributing to
psychological elder abuse behavior in long-term care facilities: A structural equation
model approach. International Psychogeriatrics, 21(2), 314-20.
doi:http://dx.doi.org/10.1017/S1041610208008211