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Example research essay topic: Abuse And Neglect Elder Abuse - 1,834 words

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... times more than one data form was received for the same maltreated elder, describing either the same or different abusive incidents. It was necessary to identify such duplicates and count each person only once for purposes of this study. Out of a total of 1, 699 APS and sentinel reports, study staff identified 93 sets of genuine duplicates, resulting in 1, 606 unduplicated reports (1, 466 APS and 140 sentinel). Duplicate cases reported both to APS and sentinel agencies were removed from the sentinel data file, so that duplicated instances of abuse and neglect were counted as reports to APS.

Duplicate sentinel reports were assigned to the sentinel agency that first sent in the form. Obtaining National Estimates from the Study Data The samples of agencies and sentinels who participated in the NEAIS were selected using scientific probability sampling methods to obtain a nationally representative sample. As a result, it is possible to make valid projections from the NEAIS data, to make national estimates of the numbers of elders who have been abused and neglected, and to describe their characteristics. This estimation of national and subgroup totals and proportions is achieved by applying sample weights to each of the cases in the study. The weight applied to each elder abuse report can be thought of as indicating the number of cases nationally that are represented by the individual case in the study.

By aggregating these sample weights for the relevant study cases, national and subgroup estimates are obtained, both of total numbers of elders, and their characteristics. This methodology is routinely applied in national samples to measure social and economic issues. The Current Population Survey, which (among other things) produces the official U. S. monthly national estimates of unemployment and employment, is one well-known example. Another is the Health Interview Survey, which produces periodic national estimates for a wide range of health measures.

There were a number of steps involved in the process of developing weights for the NEAIS data. These are described in Chapter 3 of the full report, and in Appendix L. l 'P 218 37356 ' Interpreting Results in the Presence of Sampling Variability A common technique used to present and interpret statistical data that are subject to sampling variability is through the use of confidence bands. A frequently used convention is to determine a 95 percent confidence band for each estimate. The statistical interpretation of a 95 percent confidence band is that, if such a band were constructed from all possible samples that might have been selected, 95 percent of such bands would contain the true answer.

If the confidence band for an estimate is wide, relative to the size of the estimate itself, then this indicates that there is considerable uncertainty as to what the true value actually is. If, however, the band is narrow, then there can be confidence that the estimate is close to the true answer. Thus, for example, consider an estimate that a certain population characteristic is at the 10 percent level. If the confidence band for this estimate ranges from 1 percent to 19 percent, we can have confidence that the true level is something below 20 percent, but cannot draw any other inference with confidence. If an estimate of 10 percent is accompanied by a confidence band that ranges from 9 percent to 11 percent, then we can be confident that the true figure is little different from 10 percent. Because the NEAIS sampled a relatively small number of counties, agencies, and sentinels, for many of the rarer characteristics described in this report the confidence bands are relatively wide (like in the first example given in the previous paragraph).

When this has occurred, the estimates presented in the report are duly noted as having this characteristic. 4 The most important steps are the determination of overall probabilities of selection, calculation of nonresponse adjustments, and development of replicate weights. Unlike the sentinel records, there are no further sampling or nonresponse adjustments for the APS data, since all APS agencies in the sampled counties participated. One straightforward calculation is the annual ization of the data. The staggering of different-sized counties throughout 1996 minimized the potential for seasonal affect to bias the estimates. Accordingly, this estimate of elder abuse over these two-month periods was transformed to an estimate for the full 1996 -study year by multiplying the factor by six.

Conclusions? The results of the National Elder Abuse Incidence Study (NEAIS) strongly confirm the validity of the 'iceberg' theory of elder abuse that has been accepted in the aging research community for 20 years or more. The contribution the NEAIS has made to our understanding of the extent of elder abuse and neglect is graphically depicted by the large new middle area in Figure ES- 1 below. Figure ES- 1. Iceberg theory showing NEAIS identified unreported abuse and neglect, excluding self-neglect? Reported abuse and neglect: 70, 942 estimated new incidents substantiated by APS Unreported abuse and neglect: 378, 982 estimated new incidents reported by sentinels but not reported to APS.

Unidentified and unreported new incidents. The NEAIS findings lead to the following conclusions: Domestic elder abuse and neglect is a significant problem. NEAIS research shows that about 450, 000 unduplicated elders experienced abuse and neglect in domestic settings in 1996. More than five times as many of these incidents of abuse and neglect were unreported than were reported to and substantiated by APS agencies. l 'P 245 40609 ' When elders who experienced only self-neglect are included with those that were abused and neglected, the number increases to 551, 000 unduplicated elder persons in 1996. Almost four times as many of these incidents were unreported than were reported to and substantiated by APS agencies.

l 'P 248 41091 ' The NEAIS has measured a large and previously unidentified and unreported portion of elder abuse and neglect, and also has learned much about the characteristics of the victims and perpetrators of abuse and neglect. At the same time, it was not possible to identify and report on all previously hidden domestic elder abuse and neglect. Clearly, the NEAIS has not measured abuse, neglect, and self-neglect among those most isolated elders who do not leave their homes or who rarely come in contact with others in the community. Several of the characteristics of abused and neglected elderly persons are particularly worrisome and challenge us to prevent and intervene in this tragedy: Our oldest elders (80 and over) are abused and neglected at two to three times their proportion of the elderly population. Female elders are abused at a higher rate than males. Almost half of substantiated abused and neglected elderly were not physically able to care for themselves.

In almost nine out of ten incidents of domestic elder abuse and neglect, the perpetrator is a family member. Adult children are responsible for almost half of elder abuse and neglect. Elderly self-neglect also is a problem, as evidenced by about 139, 000 unduplicated reports (some of the self-neglecting elderly may also be counted as being abused and / or neglected). Most victims of self-neglect are unable to care for themselves and are confused. This is a difficult and troubling problem, which warrants further research and study.

Despite the study's identification of over five times as many unreported incidents of elder abuse and neglect as incidents that were reported to and substantiated by APS agencies, some professionals and researchers in the aging field may have expected this multiplier to be larger than NEAIS found. The NEAIS estimate may be lower than those expectations because: Elder abuse and neglect are not as hidden and under-reported to APS agencies as they were at the time of earlier studies. Between 1986 and 1996, for example, official reports of abuse and neglect made to APS agencies throughout the country increased by 150 percent, while the total number of elderly persons aged 60 and over increased by only 10 percent. A much larger proportion of new incidents of domestic elder abuse and neglect was reported to official APS agencies in 1996 than was reported 10 years ago.

Still more of the unidentified and unreported area of the iceberg remains to be revealed, especially instances of abuse and neglect among seriously isolated elderly persons and those with little contact with community organizations. Limitations of NEAIS The NEAIS study design had some limitations that prevented it from making a definitive estimate of all incidents of elder abuse and neglect, including: . The sentinel approach tends to cause a certain amount of 'undermount' in the detection of domestic elder abuse because there are no community institutions in which most elders regularly assemble and from which sentinels can be chosen and elders observed (unlike schools in child abuse research)... Sentinels cannot observe and report abuse and neglect of elders who are isolated and / or have no or very limited contact with any community organizations...

Resource constraints for conducting the NEAIS limited the number of counties and sentinels sampled and the length of the reporting period. Consequently, the relatively small number of sentinel reports resulted in incidence estimates with wide confidence bands. Increasing the sample size and reporting period in future such studies would further improve the precision of incidence estimates through the calculation of narrower confidence bands. Implications of Findings and Future Research Questions and Issues The findings of the NEAIS suggest a number of important issues for policy development, practice, and training in addressing the problems of elder abuse, neglect, and self-neglect. Because states and localities historically have had responsibility for elder abuse reporting, investigation, and services, most of the implications are for state and local governments. These issues are discussed in the full report.

Finally, the report raises a number of research questions and issues for researchers and service providers, including suggesting areas for future research of the incidence and nature of elder abuse and neglect. Conclusion The NEAIS has documented the existence of a previously unidentified and unreported stratum of elder abuse and neglect, thus confirming and advancing our understanding of the 'iceberg' theory of elder abuse. NEAIS estimates that for every abused and / or neglected elder reported to and substantiated by APS, there are over five abused and / or neglected elders that are not reported. The study also documents similar patterns of under reporting of self-neglecting elders.

NEAIS acknowledges that it did not measure all unreported abuse and neglect. Our collective challenge-as policy makers, service providers, advocates, researchers, and our society as a whole, is to utilize this information to better the lives of our elderly citizens. 5 Using precisely developed standard errors, the NEAIS estimates that as many as 688, 948 or as few as 210, 900 elder persons may have been abused and / or neglected in domestic settings in 1996. 6 When self-neglecting elders are added, the estimate range is that as many as 787, 027 or as few as 314, 995 elder persons may have been abused, neglected, and / or self-neglecting in domestic settings in 1996


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