ATrain Education

 

Continuing Education for Health Professionals

IA: Abuse of Dependent Adults

Module 3

Adults with Disabilities and Abuse

Older adults are not the only population vulnerable to abuse from caretakers. Anyone over age 18 whose physical and/or mental condition makes them dependent on others for care or protection is at risk for abuse. Americans with Disabilities 2010, a report published in 2012 by the U.S. Census Bureau (most recent available data), notes that approximately 56.7 million non-institutionalized Americans of all ages live with disabilities in the communicative, mental, and/or physical domains. Of that total, 51.5 million are adults (Brault, 2012). Representative conditions in each domain are shown below:

Communicative

  • blindness or difficulty seeing
  • deafness or difficulty hearing
  • difficulty having speech understood

Mental

  • learning, intellectual, or developmental disability
  • Alzheimer’s disease, senility, or dementia
  • other mental or emotional condition that seriously interferes with everyday activities

Physical

  • use a wheelchair, can, crutches, or walker
  • difficulty walking a quarter mile, climbing a flight of stairs, lifting an object weighing 10 pounds, grasping objects, getting in or out of bed
  • disease or medical condition (eg, arthritis, cancer, cerebral palsy, heart trouble, missing or deformed limbs, back or head injuries, stroke, etc.) that contributes to a limitation of activity (Brault, 2012)

The prevalence of disability increases with age, from 11% of people ages 25 to 44, to 35% of those 65 to 69, and 70.5% of those 80 and over (Brault, 2012). According to the State Data Center of Iowa, in 2014, 353,430 Iowans had some kind of disability, and 112,390 of them were age 65 and older. That represents 31.8% of people 65 and older, the highest percentage of any age group in the state (IowaSDC, 2016).

A Cornell University study for Iowa in 2015 looked at the topic using slightly different categories, but reflected similar numbers and percentages. It identified the percentage of males and females with disabilities as nearly the same at 11.8% of females and 12% of males. The study found that 22.6% of people ages 65 to 74 and 46.4% of people 75 and older had some type of disability (Erickson, 2016).

People with disabilities are 4 to 10 times more likely to become victims of violence, abuse, or neglect than people without disabilities. Women with disabilities report greater numbers of perpetrators and longer time periods of individual episodes than women without disabilities (IDA, 2016).

Those who abuse people with disabilities may justify the abuse by considering the victim as somehow less than human, sometimes referring to them as “damaged merchandise,” “feeling no pain,” “a disabled menace,” or “helpless.” These attitudes may be shared by others who are aware of the abuse but do not report it (IDA, 2016).

Dehumanizing or demeaning attitudes about people with disabilities persist in society as well as among healthcare workers. Such attitudes may be especially problematic when dealing with sexual abuse because the victims may be seen as only seeking attention, as asexual or hypersexual, and/or as not credible witnesses.

There is a common misperception that having a disability protects a person from victimization, when in fact the opposite is true. People with disabilities are more vulnerable to abuse than non-disabled people. Certain difficulties or behaviors further increase the vulnerability of those with disabilities, including:

  • Difficulty with learning, communication, social adjustment
  • Difficulty with anger management, which prompts others to respond negatively
  • Cognitive problems such as perception, remembering or understanding risky situations
  • Spastic body movements, slow physical responses, speech impairments
  • Alcohol and drug abuse, in an effort to “fit in” (IDA, 2016)

Forms of Abuse and Where They Occur

Dependent adult abuse of people with disabilities usually occurs in isolated locations where victims have little or no control of their environment. As with elder abuse, private homes and institutional settings also provide opportunities for abuse.

Iowa acknowledges the following as categories of dependent adult abuse when they are a result of the willful, negligent acts or omission of a caretaker:

  • Physical abuse
  • Sexual abuse
  • Sexual exploitation
  • Financial exploitation
  • Denial of critical care
  • Self denial of critical care (IDA, 2016)

Victims and Perpetrators

Depending on the type and extent of their dependency, victims of abuse may be unable to work or may be underemployed, which limits their choice of caregivers and housing. Limited income may force them to live in high-crime areas.

Men, as intimate partners or as healthcare workers, are more likely to abuse disabled dependent adults than women are. Family members may victimize relatives, and staff members and other residents of a facility, or community-based personal care attendants may also be abusers (IDA, 2016).

Although dependent adults of both sexes are vulnerable to abuse, the most likely victim is a woman of advanced age (75 or older) who is isolated and dependent on someone else for care or protection. Alcohol abuse may also be an issue for some individuals, particularly in cases of self-neglect, and the effects of heavy alcohol use on memory and other cognitive functions are more evident in women than in men (Lopes et al., 2010). Alcohol also interacts with many prescription drugs used by older adults.

Dependent adults may also suffer abuse because of intergenerational conflict that intensifies with the increased dependency of the parent. Victims often blame themselves for making the abuser angry, rather than acknowledging that the abuser is at fault.

The presence of one or more of these characteristics does not indicate that abuse is occurring. Instead, they help explain why abuse may occur.

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