Elder-Abuse Offenders: A Typology

Abstract

Who abuses-and why. A home health aide agency reports to the local adult protective services agency a case of suspected abuse. Seventythree-year-old Clara T resides with her husband, Tom. She has had a stroke, and experiences right-side paralysis, cannot walk, speaks with difficulty, and spends most of her day in a hospital bed set up in her dining room. Her home health aide reports having observed the following event: During one routine visit, Clara began to cry, stated that she did not feel well, and asked Tom to bring her a pain reliever. Tom gruffly responded by saying to Clara, Shut up! Instead, Clara's crying escalated. Tom picked up a pillow and approached his wife. He forcibly held the pillow over her face, angrily stating that when he tells her to shut up, that is what he expects her to do. Why does Tom T treat his wife in this manner? In fact, why does anyone abuse or neglect elderly individuals? Many believe that cases like the one above result from caregiver stress and constitute a problem best handled from a social-services perspective. Others view Mr. T's actions as criminal behavior requiring a response from law enforcement agencies. This article addresses some of the perplexing issues involved in understanding and responding to elder-- abuse offenders. It offers a typology of offenders to elucidate the dynamics operating when people mistreat the elderly. The typology was developed as a result of the author's experience conducting forensic investigations, delivering clinical evaluation and treatment services to victims and offenders involved in family and interpersonal violence, and providing casework consultation to adult protective services agencies and criminal-justice personnel. This model is offered as a theoretical tool to help social services professionals understand who abuses, and why-and to help them recognize and respond to incidents of elder abuse. Of course, human behavior is complex and is influenced by multiple factors. The typology attempts to conceptualize and communicate these factors that may cause elder maltreatment or allow it to occur. TYPES OF OFFENDERS Five types of offenders are postulated: (1) the overwhelmed, (2) the impaired, (3) the narcissistic, (4) the domineering, or bullying, and (5) the sadistic. Overwhelmed offenders. Overwhelmed offenders are well-intentioned; they enter into a caregiving position expecting to provide adequate care. For the most part, they are qualified or fit care providers in personality, intelligence, caregiving skills, and motivation. However, when the amount of care expected from these individuals exceeds that which they can comfortably provide, they lash out verbally or physically. Alternatively-or additionally-the quality of their care may degrade to the point of neglect. It is not unusual for people to become stressed and overwhelmed when the amount demanded of them exceeds their capabilities. Under these conditions, many are able to refrain from abusive or neglectful behavior. Overwhelmed offenders have failed to do this. Individuals vary in their ability to remain resilient and effectively cope when demands exceed capabilities. Some find it difficult to ask for help or set reasonable limits. Some feel they have nowhere to turn for assistance. Many factors cause care providers to become overwhelmingly stressed, including personal issues (unmet needs for sleep, food, or relaxation, or a conflict with a family member), care-recipient issues (elders who are impatient, critical, uncooperative or particularly challenging), and environmental issues (lack of necessary supplies, equipment, financial resources or personal assistance). When more than one of these factors are present, care providers may find it particularly challenging to remain effective. Overwhelmed offenders often recognize their abusive or neglectful behavior, and experience shame and remorse. Shame can cause the offender to hide the maltreatment and may inhibit him or her from seeking help to improve the situation. …

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