Abuse of the elderly-the hidden agenda. II. Future research and remediation.

A schema for future research and efforts to remediate abuse of the elderly is presented. In the community at large, increased exposure of and education pertaining to the elderly are needed in order to intensify the public/community presence and reduce prejudices. In the medical community, improvements are needed in the extent of geriatric training, the ethics of pronouncement of death, the reliability of clinical documents, and the reporting of suspected cases of abuse. In the legal community, there is need for laws prohibiting abuse and neglect, and providing opportunity for recovery of minimum damages, with covering of attorney's fees and court costs. It is proposed that the administrative process be altered so as to provide either a financial penalty for abuse and neglect, or a reward for providing superior care.

Abuse of the elderly--the hidden agenda. I. The caretakers and the categories of abuse.

An overview of the problem of abuse of the elderly is presented in an effort to guide future research. Categories of caretakers for the aged include formal (i.e., institutional settings) and informal (e.g., family, neighbors, sitters). Data are presented from a task force report on the status of nursing homes in the State of Texas. Categories of abuse are discussed under four divisions: physical, psychologic, material, and fiscal. Deliberate physical abuse by formal caretakers was the least common; physical neglect was far more common, e.g., the development of decubitus ulcers, inadequate nutrition, improper medication, and vermin infestation. Psychologic abuse was most frequent in the area of benign neglect, with patients regarded as "going to die anyway." A tendency toward infantilization by formal caretakers was observed. Material abuse included primarily theft, chiefly of personal items rather than medication items. Fiscal abuse included embezzlement of patients' trust funds, improper charges for service, failure to notify the State of the death or departure of a patient, abuse for drugs, and artificial upgrading of Medicaid recipients' classifications. Possible causes of abuse are reviewed.