12- An outreach worker who finds the forgotten elderly.  One of the most important areas that human services professionals should be involved with is that of finding and correcting situations of neglect and abuse. Significant harm is being done to the elderly through neglect and emotional, financial, and physical abuse and most of it is done in the older person's own home by relatives. Abuse is found in about 10% of older Americans and those most at risk are women over 80 who need help with Activities of Daily Living (ADLs) in whole or in part (Gray-Vickery, 2000). This is an extremely vulnerable population who may fear telling anyone about the abuse for several reasons, including:

       Some feel that they must have deserved the abuse due to

mistakes made in raising their abuser, often a son.

      Some fear what might happen to them if the abuser is removed from their life (i.e. taken to jail).

      They may feel that they could not cope on their own and fear being placed in a nursing homes.

      Some think that the abuse will stop or that the abuser simply "was not himself" at the time of the abuse.

      Some families have used abuse as a coping method for stress and do not understand other ways of dealing with stress.

      It is important to note that the most frequent problem is neglect; the older person neglecting themselves. If they have little respect for themselves, it may be easier for the abuser to support that low self esteem.

       Gray-Vickery (2000) gives a list of the warning signs of abuse for clinicians to watch for when providing services to the older adult. "Bruises, multiple fractures, injury in the 'bathing suit zone,' parallel injuries, burns, injuries to the face, rope burns, and patchy hair loss" are some of the items listed when looking for physical abuse. She also lists hat to look for in emotional abuse cases, which could seem to mimic brain disorders. One of the interesting signs would be a person "exhibiting fear in their own environment." Since they should be more comfortable there, this sign can be very telling of emotional abuse.

      There are further listings of what to look for in financial abuse cases, usually revolving around the older adult having extreme concern over their financial situation or, worse yet, having no idea what their finances are like and finding such things as utilities being shut off. She also lists what to look for in neglect which includes several measures of health decline and medications not being used properly.

      Elder abuse has followed in the same path of child abuse in recent years in as much as it has exposed the often shocking treatment of the elderly, usually in their own homes and usually perpetrated by their own child. Adult Case Management could provide a safety net for the abused and abuser alike by helping to defuse some of the issues that can lead to such treatment. In Nerenberg (2002) attempts in her article to find those precipitating motivations and develop workable responses. In her search, however, many research methodological problems have "...made it practically impossible to compare results and to build upon the work of others (Nerenberg, 2000)." She suggests that "it may be years" before practical information can be brought together from so many varied sources that have involvement in elder abuse. However, once the information sharing system is able to be put in place, the future should be greatly impacted with special emphasis on familial piety and how family members should work together.

       13- A teacher who educates the older adult on issues that will help the client be as independent as possible. Many people have unrealistic views  of the aging  process, so one area that the human services professional can teach the client/patient is a proper understanding of the aging process. This anticipatory socialization may help the client/patient prepare for their future more thoroughly.

     Jill Quadagno (2002) lists the prevalence of chronic conditions

over 65 with notable ones being:

            Arthritis at 45.3% in the 65-74 age cohort and 52.4% over age 75.

            Hypertension at 39.2% ages 65-74 climbing to 42% over age 75.

            Hearing impairment between 65-74 is 25.5% and after 75 years of

            age 37%

            Heart disease for the 65-74 age groups is listed at 26.8% and 36.4%

            for 75+.

     She also reports the group percentage by age of people who get

 Alzheimer's as less than one percent under age 75, but moving to

2.1% in the age group 75-79, up to 4.7% in the 80-84 year olds,

then 10.8 in the 85-89 age brackets, finishing with 24.8% in the 90-

94 years old age category.

     The dementia figures are a bit higher. Beginning in the 65-69 age

 groups, the incidence of dementia is 1.4%, then it climbs to 2.6% in

 the 70-74 years, to 4.7% in the group 75-79 years old, growing to

8.7% in the 80-84 age category, followed by 15.8% in the 85-89 year

 olds, and finally 29.0% in the 90-94 year old population.

     Diane E. Papalia and associates (1996) list late adulthood (65

years and over) adjustments:

            1- "Slowing of reaction time affects many aspects of functioning."

      2- Adaptation is required due to the many losses often experienced

          during this time of life.

            3- "Need arrives to find purpose in life to face impending death."

            4- Most people find ways to compensate for the declines in memory

                and most people are mentally alert.

     Nancy Shute (2001) suggests that "...it is becoming harder to tell

where middle age leaves off and old age begins."  According to her

research, in your 60s:

1-  High pitched frequencies are further eroded making conversations more difficult.

            2- Due to less efficiency in the pancreas, blood sugar level rises often

                moving into adult onset diabetes.

            3- Stiffness in the joints is noticeable in the morning due to the wear

                and tear of the cartilage.

            4- Sexual daydreams for men nearly disappear.

Shute, (2001), says that in your 70s,

            1- Blood pressure ranges are 20-25% higher than they were in your

                20s and artery walls are less flexible.

            2- Reaction time is slower as the brain ability to send messages to the

                 extremities slows.

            3- Due to brain changes, short-term memory and abilities to learn new

                spoken material decline.

            4- Over 50% of men have signs of coronary artery disease.

            5- Sweat glands decline raising the risk of heat-stroke.

     Shute lists typical age change in the 80s as:

1- Women may have lost over 50% of their bone mass in hips and upper 

     legs and are more prone to hip fractures and falling.

   2- Symptoms of Alzheimer's disease are found in almost 50% of those over

       85.

3- Compared with age 20, the 85 year old heart beats about 25% slower at

     maximum exertion but expands itself to allow more blood to be pumped 

     per beat.

    4- Personality, in absence of brain disease, does not change.