Elder Abuse and Neglect in Residential Settings: Different National Backgrounds And Similar Responses.

Glendenning F, Kingston P, eds. Binghamton, NY 13904, Haworth Maltreatment & Trauma Press, 1999, paperback, 173 pp, ISBN: 0-7890-0807-6, $24.95.

This book's purpose is to provide information that may be used to help develop policies and mechanisms throughout the world to protect elderly people who are frail. The editors have compiled 10 articles plus an index. Each article is followed by an extensive reference list.

Several themes recur in the articles. The definition of abuse is broadened from the traditional definition of physical or verbal abuse to any treatment of a person that negatively affects his or her quality of life. Another theme is the difference in definition between institutionalized abuse and individual abuse. In the former, facility characteristics, such as poor record keeping, inadequate physical facilities, an authoritarian routine, and staff dissension, can contribute to abuse. In individual abuse, individual characteristics, such as the low self-esteem of the caregiver and a difficult workload, can contribute to incidents of neglect or abuse. The cultural attitudes toward individuals who are dependent and the perception that a residential setting is the place of last resort for elderly people contribute to societal indifference toward these problems.

Some of the articles address specific factors that can contribute to poor quality of life, including poor nutrition, misuse of medications, unfit managers of homes, and gender considerations. In the last factor, most abuse is committed by female caregivers toward female residents, because they form the majority in residential facilities.

Several articles discuss the incidence of abuse in individual countries. For example, a survey of nursing staff in Sweden found self-reported knowledge of, or participation in, abuse by a small number of caregivers. A study from Israel concludes that, although abuse in the traditional sense is confined to rare occurrences in unlicensed homes, abuse, when defined as violation of residents' rights, is seen in many facilities.

The final article, about elder abuse in institutions in South Africa, is of particular interest. The need to integrate a multicultural society and to allocate scarce resources in a more equal manner presents a great challenge. Residential facilities are currently segregated by racial groups, and the vast majority are for elderly residents who are white. In addition, limited government resources are being channeled toward other pressing needs, and there are no laws protecting the elderly against abuse. Cultural differences can lead to resentment and abusive situations, particularly verbal and financial abuse of residents. Legislation, the development of ombudsman programs, education and training of staff, and an increased awareness of cultural differences within the general population are all critical needs in South Africa.

The remedies suggested in this final article echo the recommendations of most of the authors in this book: increasing each society's general awareness of the issues as well as providing specific training for caregivers.

Although this book is intended to provide perspectives from a variety of countries, 6 of the 10 articles are written by authors from the United Kingdom. The report from the United States covers the specific topic of poor nutrition. The editors' stated purpose would have been better met if a greater variety of countries had been represented. However, this book remains a good resource for persons who want a variety of perspectives on abuse and neglect of the elderly in residential settings.

Elizabeth Green, PT Presbyterian Hospital Charlotte, NC

Ms Green is a rehabilitation manager in an acute care hospital and in a long-term care facility.