Elder Maltreatment: A Case Study and Australian Policy Analysis

This case study examines elder maltreatment through the lens of a specific case involving a 78-year-old man with Parkinson's disease and his 82-year-old wife, who is his caregiver. The study identifies the situation as interpersonal violence, focusing on the physical abuse suffered by the wife. It further analyzes the Elder Abuse Policy in Australia, discussing its aims to support and protect elderly individuals, the policy development process based on WHO guidelines, and the involvement of various stakeholders. The analysis covers situation assessment, stakeholder engagement, resource quantification, and the importance of monitoring and evaluation in effectively implementing policies to safeguard elderly individuals from abuse and neglect. This assignment highlights the need for better reporting, treatment, and prevention strategies for elder maltreatment within the Australian context.

Running head: ELDER MALTREATMENT
Elder maltreatment
Name of the Student
Name of the University
Author note

1ELDER MALTREATMENT
According to World Health Organization (WHO), violence is intentional use of power or
physical force, actual or threatened against another person or oneself, community or group
resulting in harm, injury, death, deprivation or maltreatment (Devries et al. 2013). Globally,
death due to violence is estimated to be 1.28 million increased from 1.13 million since 1990.
Among all the categories of violence, self-harm or suicide accounted for roughly 842,000,
405,000 interpersonal violence and 31,000 war or collective violence (Butchart and Mikton
2014). Elder abuse is another form of violence that is causing harm to older people and violation
of human rights. There is psychological, physical, emotional, financial and material abuse
resulting in neglect, harm, abandonment and loss of respect and dignity of older people (Dillon et
al. 2013). There is little information about the extent of elder maltreatment as older people are
scared to report to others. Therefore, the following essay involves the discussion of elder
maltreatment understood through the lens of elder abuse case study and policy analysis of Elder
Abuse Policy Australia.
In the given case study, a 78 year old man with Parkinson’s disease is being cared by his
82 year old wife who is weak and delicate. The wife fell and fractured wrist, however, she was
insisted to continue with her husband’s personal care. When the outpatient Physiotherapy (PT)
attended her fracture, PT saw bruises on her arms and face saying that she has fallen or ran into a
door. On insisting, eventually she admitted that her husband gets angry and often hit her. This
case study is elderly maltreatment and the chosen category of violence is interpersonal violence
(Moyer 2013). It is divided into categories like intimate partner violence and family between
partners and family members that take place in home. Interpersonal violence is one of the
commonest violence forms against women including sexual, physical, emotional and
psychological abuse and dominating behaviour by the intimate partner. In the given case study,

2ELDER MALTREATMENT
the wife is being physically violated by her husband despite of the fact that she is taking care of
him suffering from neuro-degenerative disorder. There is fear of retaliation, lack of economic
support and social support from family and friends are some of the barriers that the wife is facing
and eventually unable to leave her partner. The main risk factors involved in abuse of the wife in
the case study is impaired capability of the husband along with physical health issues. She is
subjected to physical abuse and violence by her intimate partner having a huge impact on her
health as a result of elderly maltreatment. According to WHO report, about 19-51% women are
physically harassed by their intimate partners and have serious health consequences. There are
immediate physical, behavioural and mental health consequences persisting long after the
violence (Devries et al. 2013).
Every one in ten individual of the age of above 60 years being older live at home
experience abuse and neglect where maximum cases remain hidden as reported by Centres for
Disease Control and Prevention (CDC) (Spivak et al. 2014). There are physical consequences of
elder maltreatment that are immediate including wounds, welts and injuries. In the given case
study, the woman is bruised on her face and arms and is subjected to persistent physical pain due
to broken wrist and soreness. She is aged and there is exacerbation of pre-existing health
condition due to this maltreatment affecting her health and mental status. There are
psychological effects due to this elder abuse affecting her mental health due to helplessness and
increased risk for anxiety and fear reactions that might have stopped her from revealing to the
PT.
The above discussion suggests that physical elderly maltreatment has a greater link to
adverse behavioural and mental health outcomes, but independently associated with morbidity
and premature mortality. According to Dong, Chen and Simon (2014) psychological abuse

3ELDER MALTREATMENT
estimates ranging from 27.9% to 62.3% is highly prevalent among elderly population and
physical abuse affecting 3.5% to 23.1%. In Australia, population based studies provided some
insights into extent of elderly women subjected to abuse. The research was conducted by
Australian Longitudinal Study of Women's Health (2014) to study the random sample of women
regarding older women abuse (Loxton et al. 2015). The findings suggested that around 8% are
vulnerable to physical abuse and neglect. This result depicts that elderly abuse is happening;
however there is lack of reporting and therefore, this policy provides responses to elderly
maltreatment. This policy is framed with an aim to support and promote elderly people for equal
participation in the society and protection of older people against advantage or misuse taken by
intimate partners, informal or formal supporters or representatives.
To safeguard the elderly maltreatment and provide elderly protective services, there
should be mandatory reporting of elder abuse and need for health policy research directions
dealing with this pervasive issue. There is need for effective strategies for detecting, treating and
preventing elder abuse increasing diversely in the elderly population. Health policy comprises of
plans, decisions, actions that need to be undertaken for the achievement of specific goals in
healthcare in elder abuse (Bodenheimer and Grumbach 2012). This health policy advancement
and collective advocacy would help to create a national infrastructure in Australia for the
protection of vulnerable elder population.
The health policy development comprising of strategies and plans is a dynamic and
complex process conducted by WHO framework comprising of key elements. According to
WHO (2014) report, for the protection and support to elderly people, national policy is important
that is dedicated to safeguard elder people for any type of violence and abuse (Dong et al. 2013).
The literature on elderly abuse suggests that national policy on elderly maltreatment can help in

4ELDER MALTREATMENT
better reporting and treatment of elderly maltreatment (Dong, Simon and Evans 2013). Various
policies are formulated in context to elder maltreatment including characterization and
prevention. In Australia, the understanding of social dynamics (socio-economic features and
demographics) influences elder maltreatment and its prevention. Despite of paucity in evidence
on elder abuse prevalence, around 2% to 10% Australians experience elder maltreatment and
percentage of neglect is high (Lacey 2014). It is of great concern that elder maltreatment problem
will be reaching unprecedented proportions as the population ages by 2050 by the age of 65
years (). For this, WHO policy guidelines provide blueprint for the conduction of policy process.
In the given case study, there is need for proper action for safeguarding the wife from elder
maltreatment and further physical or mental abuse and neglect.
Elder Abuse Policy in Australia was developed with a purpose to identify cases of
elderly maltreatment and taking appropriate actions in safeguarding them. The policy is also
developed to maintain dignity and protect security and safety of the elderly people and
achievement of standardized and integrated approach for the management of elderly abuse. In the
given case study, the wife seemed to be scared of reporting abuse due to fear of retaliation,
therefore, the policy statement addresses the suspected cases of elder maltreatment for
safeguarding and preventing further abuse and neglect (Dow and Joosten 2012). The policy
outlines that addressing older people abuse is human rights and they have right to self
determination irrespective of their age. From the policy perspective, state, Commonwealth and
territory have the responsibility to protect the aging population in Australia and provide services
that provide them good quality of life.
Six steps are involved in the development of policy as per WHO guidelines. After the
assessment of the situation and raising awareness, it is important to identify the leadership and

5ELDER MALTREATMENT
fostering of political commitment for the initiation of policy development process. The first step
is the engagement of stakeholders. The effective implementation of an elder abuse policy can be
done through negotiation and inclusive participation between stakeholders along with co-
operation from government and non-governmental organizations (NGOs) in safeguarding elders
from abuse. In this step, the stakeholders through meaningful engagement and broad consultation
work in collaboration for the meaningful policy development dialogue. This is important to build
consensus based on the current elder abuse situation in Australia and various goals, values and
overall directions of the policy formation guiding elder abuse policy guidelines (Althaus,
Bridgman and Davis 2012). The stakeholders include; government and state officials comprising
of Ministry in Department of Health, NGOs, community sectors, political parties, councils,
committees, local governments and monitoring agencies having centres against violence and
statistics bureau. Academics comprising of universities, research institutes and think tanks.
NGOs, advocacy groups like victim care groups, community groups, volunteer groups and
sponsors like foundations and clubs. Private for profit entities can also be included in the
stakeholders like media outlets, professional gatekeepers like trade unions and labour
associations. The analysis is required in this step is examination of remit of each stakeholders
understanding the relationship between them. There is need for collaboration between them and
helping each other bringing together towards the common goal of prevention of elderly abuse.
Situation analysis and priority setting is the second step involved in situation analysis
assessing the current situation of elder abuse in Australia for aiding in designing and integrate
elements of elder abuse prevention policy into existing legislation or policies. This strong
situational analysis would describe the demography, statistics and collection of facts of elderly
population subjected to elder abuse. Situational analysis is important as it serves the stage for

6ELDER MALTREATMENT
priority setting need to be addressed in the policy making through inclusive and broad policy
dialogue (Dong 2013).
The third step is the bringing together of the stakeholders as disconnected efforts in
planning and national processes, lack of communication among stakeholders can lead to
fragmented policy implementation. There should be balance and coherence between them for the
comprehensive and adequate situation analysis and priority analysis. Funding is an important
factor for analysis as it can lead to competition for the available resources (Australian Public
Service Commission 2012).
The next step is to ensure that the policy values and vision are taken into operation. For
this, effective planning is important at every level ensuring alignment between expectations and
needs of the people and analysis of national priorities. There is also need to link the operational
and strategic plans at the local and sub-national levels describing how the national policies on
elder abuse can be translated to broad targets and national activities within “off-budget” and “on-
budget” resources. In this step, national health goals and strategies need to be translated by
stakeholders into feasible plans and appropriate approaches based on the local circumstances
(Lawrence and Weber 2014).
The next step is the quantification of resources and budget planning. The priorities need
to be translated into resource planning through quantification of needed inputs in regards to
equipment, people and infrastructure. This step also determines the budgetary implications being
an iterative process. Before proceeding with budgeting phase, the costing is important in
planning for the implementation of the policy. The policy makers need to make sound decisions
for the available resources being a strategic process. This requires a negotiation consensus

7ELDER MALTREATMENT
between stakeholders for the costing planning (Wampler and Hartz-Karp 2012). The actual
expenditure need to match with policy priorities and for achieving it, stakeholders in elder abuse
policy should put in realistic inputs that is based on national strategy and policy planning.
Monitoring and evaluation is the last step in policy making. For effective outcomes,
more focused and increased investment is required in the monitoring and evaluation process on
how the plans, strategies and policies need to be implemented. This step requires assessment of
progress, performance as per the agreed benchmarks, indicators and scope for improvement
within monitoring and evaluation framework. This step also allows scope for continuous
improvement, learning and improvement in planning process with timely corrections
contributing to proper documentation of policy reform. Better documentation and support from
networks can help to guide and drive better implementation of elder abuse policy, plans and
strategies in Australia (Tsui, Hearn and Young 2014).
From the above discussion, it can be concluded that elderly abuse is at alarming stage in
Australia. Violence is divided into various categories like self-directed, collective, non-physical,
interpersonal violence, targeted or everyday violence. The elderly maltreatment falls under the
category of interpersonal violence as per WHO guidelines. Policy considerations are important to
prevent elderly population from abuse with better reporting and safeguarding them from further
health and violence. WHO provides guidelines for the step wise formulation of policy
development. Elder abuse policy in Australia is developed with a purpose for identifying elder
abuse cases and provides appropriate action against it. This policy development in conjunction
with concerned stakeholders can help to develop elder abuse policy against elderly maltreatment
addressing the issue that have devastating physical and mental consequences for elderly
population.

8ELDER MALTREATMENT
References
Althaus, C., Bridgman, P. and Davis, G., 2012. The Australian policy handbook. Allen & Unwin.
Australian Public Service Commission, 2012. Tackling wicked problems: A public policy
perspective.
Bodenheimer, T. and Grumbach, K., 2012. Understanding health policy. McGraw Hill
Professional.
Butchart, A. and Mikton, C., 2014. Global status report on violence prevention, 2014.
Devries, K.M., Mak, J.Y., Garcia-Moreno, C., Petzold, M., Child, J.C., Falder, G., Lim, S.,
Bacchus, L.J., Engell, R.E., Rosenfeld, L. and Pallitto, C., 2013. The global prevalence of
intimate partner violence against women. Science, 340(6140), pp.1527-1528.
Dillon, G., Hussain, R., Loxton, D. and Rahman, S., 2013. Mental and physical health and
intimate partner violence against women: A review of the literature. International journal of
family medicine, 2013.
Dong, X., 2013. Elder abuse: Research, practice, and health policy. The 2012 GSA Maxwell
Pollack award lecture. The Gerontologist, 54(2), pp.153-162.
Dong, X., Chen, R. and Simon, M.A., 2014. Elder abuse and dementia: a review of the research
and health policy. Health Affairs, 33(4), pp.642-649.
Dong, X., Chen, R., Chang, E.S. and Simon, M., 2013. Elder abuse and psychological well-
being: A systematic review and implications for research and policy-A mini
review. Gerontology, 59(2), pp.132-142.

9ELDER MALTREATMENT
Dong, X., Simon, M. and Evans, D., 2013. Elder self-neglect is associated with increased risk for
elder abuse in a community-dwelling population: Findings from the Chicago Health and Aging
Project. Journal of aging and health, 25(1), pp.80-96.
Dow, B. and Joosten, M., 2012. Understanding elder abuse: a social rights
perspective. International psychogeriatrics, 24(6), pp.853-855.
Lacey, W., 2014. Neglectful to the Point of Cruelty; Elder Abuse and the Rights of Older
Persons in Australia. Sydney L. Rev., 36, p.99.
Lawrence, A.T. and Weber, J., 2014. Business and society: Stakeholders, ethics, public policy.
Tata McGraw-Hill Education.
Loxton, D., Powers, J., Anderson, A.E., Townsend, N., Harris, M.L., Tuckerman, R., Pease, S.,
Mishra, G. and Byles, J., 2015. Online and offline recruitment of young women for a
longitudinal health survey: findings from the Australian Longitudinal Study on Women’s Health
1989-95 cohort. Journal of medical Internet research, 17(5).
Moyer, V.A., 2013. Screening for intimate partner violence and abuse of elderly and vulnerable
adults: US preventive services task force recommendation statement. Annals of internal
medicine, 158(6), pp.478-486.
Spivak, H.R., Jenkins, E., VanAudenhove, K., Lee, D., Kelly, M. and Iskander, J., 2014. CDC
grand rounds: A public health approach to prevention of intimate partner violence. Morbidity and
Mortality Weekly Report, 63(2), pp.38-41.
Tsui, J., Hearn, S. and Young, J., 2014. Monitoring and evaluation of policy influence and
advocacy. London: ODI Working paper, 395.

10ELDER MALTREATMENT
Wampler, B. and Hartz-Karp, J., 2012. Participatory budgeting: Diffusion and outcomes across
the world. Journal of public deliberation, 8(2).