Abuse of any kind is abhorrent, and abuse of elderly persons is one of the more shameful forms. Dr. Payne's slim book (188 pages of text) highlights this enormous problem.
Payne briefly discusses a broad range of abuse, including physical and emotional harm and financial exploitation, at the hands of family members, businesses, criminals, and health care institutions and their staff members. Adult children and grandchildren are frequently the perpetrators of abuse, sometimes seeking an older relative's money or other resources, sometimes overwhelmed by the burden of caring for an older relative, and sometimes acting out of frustration (with understandable feelings but despicable behavior). The elderly are easy marks for criminals of all kinds, from strong-arm types to con artists. Because of their need for care and insecurity about their future, many elderly persons tolerate terrible treatment at home and in institutions, in return for the hope that the abuser will not abandon them.
Crime and Elder Abuse emphasizes the illegality of abuse of elderly persons, with well-referenced comments about business and criminal fraud and health care regulations. Legislation designed to prevent abuse and neglect of the elderly, reporting laws, and protective-services agencies are discussed. The book also touches on investigational methods and the opportunities to improve them.
I wish Payne had dealt with fear of crime in more detail, since the theft of one's freedom is perhaps the greatest abuse of all. An older person who has been attacked by a burglar or mugger fears going outdoors and perhaps even opening a window. News of crime and victimization forces many older people, even those who have not been abused, into isolation.
This book is consistent in its organization and easy to use. Each of the seven sections has a good concluding summary and a few short review questions. The references are collected at the end of the book, along with subject and author indexes. On the other hand, the book is not comprehensive and does not provide in-depth discussions. It reads somewhat like a review article, with only brief paragraphs on many important topics, leaving the reader to obtain more extensive information from the references. The referencing of the text is a strong point of the book. There are well over 500 citations, most of which are fairly recent. However, frequent citations often interrupt the flow of the text and do not leave room for the author's own thoughts (and I suspect he has much more to say).
William H. Reid, M.D., M.P.H.
Copyright © 2001 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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