Implicit throughout this chapter is the presumption that public health and health promotion approaches to prevention of various forms of domestic violence, including elder abuse and neglect, are promising strategies. Such strategies should not undermine existing efforts at treatment and early intervention but rather would be designed to approach the widespread problem of elder abuse from a broader, more fundamental vantage point. Government fiscal incentives, for example, should be reoriented to emphasize prevention and treatment rather than detection, investigation, and alternative placement. A key health promotion policy issue concerns the need of all families for some degree of support and education (an “enhancement” strategy rather than interception; see Melton and Barry, 1994).

In conjunction with health promotion efforts, program development should focus on providing information for caregivers of the elderly that is easily understood, practical, and accessible to all present and potential populations. In particular, attention should be directed to societal influences that play a role in elder abuse and neglect, especially in circumstances where families are exposed to major effects of poverty, health risks, and environmental conflict. Such a cross-cultural perspective would redirect the focus away from individuals and families and explore societal and cultural conditions that attenuate or exacerbate these problems. In a similar manner, policy planners need to advocate for the establishment of minimum standards of care for their own communities, taking into account the cultural diversity of the community and the imbalance in child-care and elder-care responsibilities on women.

SUMMARY

In sum, the absence of theory-based treatments and outcome research in the area of elder abuse remains striking. Similar to related family violence interventions such as child abuse and women abuse programs, existing elder abuse programs have been largely aimed at individual needs based on victim accounts of abuse and violence, rather than a theory of change based on population based epidemiology (Chalk and King, 1998). This victim response approach has been effective at attracting public attention and resource commitments, but it is inadequate in terms of providing a foundation for measurement and evaluation of long-term outcomes or program effects.

Funding for university-based research efforts is indicated to gather information on ways to address the needs of the elderly, as well as to enhance caregiver(s) functioning enough to ensure safety and proper care. This review points to the conclusion that behavioral and cognitive behavioral approaches show promise as effective means of assisting caregivers and reducing the stresses of caring for an elderly member. Small- and large-



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