The concept of Elder Abuse

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The Concept of Elder Abuse: Breaking the Silence was presented to HelpAge International by Bridget Penhale from UEA, Norwich in May 2011. Bridget is a European Board Member, INPEA

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The concept of Elder Abuse

  1. 1. The Concept of Elder Abuse: Breaking the Silence Bridget Penhale UEA, Norwich European Board Member, INPEA
  2. 2. Introduction and Background <ul><li>Historical aspects </li></ul><ul><li>Global phenomenon </li></ul><ul><li>Recent recognition, increasing concern </li></ul><ul><li>An under-developed concept </li></ul><ul><li>Different perspectives involved </li></ul>
  3. 3. Contextual matters <ul><li>Community care </li></ul><ul><li>Demographic changes </li></ul><ul><li>Medical and technological advances </li></ul><ul><li>Legal and Rights agenda </li></ul><ul><li>Advocacy </li></ul>
  4. 4. What is Abuse? <ul><li>Definitional issues </li></ul><ul><li>A taboo topic </li></ul><ul><li>Need for consensus? </li></ul><ul><li>Private issue or public concern? </li></ul><ul><li>Adult protection or elder abuse? </li></ul><ul><li>Risk, vulnerability and protection </li></ul>
  5. 5. The Importance of Naming <ul><li>Silence about the topic </li></ul><ul><li>Comparative lack of recognition </li></ul><ul><li>Problems with terminology </li></ul><ul><li>Naming is essential: what is named…. </li></ul><ul><li>Primacy of the individual and personal </li></ul><ul><li>Social construction of abuse and violence </li></ul><ul><li>Importance of professional identification </li></ul>
  6. 6. Definitions of Abuse (1) <ul><li>A single or repeated act or lack of appropriate action occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person </li></ul><ul><li>Action on Elder Abuse, UK (1995) </li></ul>
  7. 7. Definitions of Abuse (2) <ul><li>Abuse is the violation of an individual’s human and civil rights by any other person or persons </li></ul><ul><li>No Secrets, UK (2000) </li></ul><ul><li>Abuse, like beauty, is in the eye of the beholder </li></ul><ul><li>Callahan (1986) </li></ul>
  8. 8. Types of Abuse <ul><li>Physical abuse </li></ul><ul><li>Sexual abuse </li></ul><ul><li>Psychological abuse </li></ul><ul><li>Financial or material abuse </li></ul><ul><li>Neglect </li></ul><ul><li>Societal abuse </li></ul><ul><li>Discriminatory abuse </li></ul>
  9. 9. Features of Abuse <ul><li>Physical or sexual assault </li></ul><ul><ul><li>Issues of consent </li></ul></ul><ul><li>Deprivation </li></ul><ul><li>Issues relating to medication </li></ul><ul><li>Involuntary isolation or abandonment </li></ul><ul><li>Financial abuse and exploitation </li></ul>
  10. 10. The Need for Differentiation <ul><li>Different types of abuse </li></ul><ul><li>Different settings and locations </li></ul><ul><li>Different participants </li></ul><ul><li>Different witnesses </li></ul><ul><li>Different responses and interventions </li></ul>
  11. 11. Critical Factors <ul><li>Social and cultural contexts </li></ul><ul><li>Gender and power relations </li></ul><ul><li>Not just family and interpersonal relationships </li></ul><ul><li>Personal, cultural and structural levels </li></ul><ul><li>Ageism as a master category </li></ul>
  12. 12. Barriers to Identification <ul><li>Mistreatment occurs in private </li></ul><ul><li>Societal views and attitudes: </li></ul><ul><ul><li>Violence </li></ul></ul><ul><ul><li>Families </li></ul></ul><ul><ul><li>Disability </li></ul></ul><ul><ul><li>Care practices </li></ul></ul><ul><li>Reluctance to report </li></ul><ul><li>Failure of professionals to detect </li></ul>
  13. 13. The Concept of Elder Abuse (1) <ul><li>An Aging issue? </li></ul><ul><li>A complication of caregiving? </li></ul><ul><li>The Family violence perspective </li></ul><ul><ul><li>Prevention, punishment and protection </li></ul></ul><ul><li>Apparent tensions </li></ul><ul><ul><li>service and helping orientation </li></ul></ul><ul><ul><li>justice and criminalisation orientation </li></ul></ul>
  14. 14. The Concept of Elder Abuse (2) <ul><li>Different images of Aging </li></ul><ul><li>Different systems of policy and practice </li></ul><ul><li>Are these applicable? </li></ul><ul><li>What are the views of elders? </li></ul><ul><li>What of models of empowerment? </li></ul>
  15. 15. International Network for the Prevention of Elder Abuse (INPEA) <ul><li>Established at IAG World Congress, 1997 </li></ul><ul><li>Mission Statement and Objectives, 1998 </li></ul><ul><li>Focus on </li></ul><ul><ul><li>increasing awareness of abuse and neglect </li></ul></ul><ul><ul><li>promoting education and training </li></ul></ul><ul><ul><li>advocacy </li></ul></ul><ul><ul><li>research </li></ul></ul><ul><li>NGO Status, 2003 </li></ul><ul><li>Website: http://www.inpea.net </li></ul>
  16. 16. Research: Missing Voices <ul><li>Partnership with: </li></ul><ul><ul><li>WHO Ageing and Life Course </li></ul></ul><ul><ul><li>HelpAge International </li></ul></ul><ul><ul><li>academic institutions </li></ul></ul><ul><li>Study of older people in community and primary health care settings in: </li></ul><ul><ul><li>Brazil India </li></ul></ul><ul><ul><li>Kenya Argentina </li></ul></ul><ul><ul><li>Lebanon Canada </li></ul></ul><ul><ul><li>Austria Sweden </li></ul></ul>
  17. 17. Missing Voices: Findings (1) <ul><li>Older people perceive abuse as: </li></ul><ul><ul><li>Neglect : isolation, abandonment, social exclusion </li></ul></ul><ul><ul><li>Violation : human, legal and medical rights </li></ul></ul><ul><ul><li>Deprivation : choices, decisions, status, finances and respect </li></ul></ul>
  18. 18. Missing Voices: Findings (2) <ul><li>Key categories of abuse identified: </li></ul><ul><li>Structural and societal abuse </li></ul><ul><li>Neglect and abandonment </li></ul><ul><li>Disrespect and ageist attitudes </li></ul><ul><li>Psychological, emotional and verbal abuse </li></ul><ul><li>Physical abuse </li></ul><ul><li>Legal and financial abuse </li></ul>
  19. 19. Missing Voices: Findings (3) <ul><li>Important contextual aspects: </li></ul><ul><li>Social and institutional arrangements </li></ul><ul><ul><li>Retirement and social roles of older adults </li></ul></ul><ul><ul><li>Long-term care institutions </li></ul></ul><ul><ul><li>Health care professionals as abusers & victims </li></ul></ul><ul><ul><li>Culture-specific influences as abuse </li></ul></ul>
  20. 20. Missing Voices: Findings (4) <ul><li>Two key factors underpinning abuse: </li></ul><ul><ul><li>Gender </li></ul></ul><ul><ul><li>Socio-economic status </li></ul></ul><ul><li>Crucial points: </li></ul><ul><ul><li>Prevailing view: women, especially poor, widowed or childless most affected </li></ul></ul><ul><ul><li>Respondents agreed: poor older people suffer most </li></ul></ul>
  21. 21. Missing Voices: Findings (5) <ul><li>Direct Quotes: </li></ul><ul><li>* “He must have needed the money” (Canada) </li></ul><ul><li>* “Over school holidays, the first thing a family, who has a place to go to in the countryside does, is to grab the elder and put him/her in a hospital” (Brazil) </li></ul><ul><li>* “One rude word said to an old man is stronger than stabbing him with a knife” (Lebanon) </li></ul><ul><li>* “People talk down to us- call us ‘sweetie’ or ‘dearie’ - tell us what to do” (Canada) </li></ul>
  22. 22. Missing Voices: Findings (6) <ul><li>Direct Quotes: </li></ul><ul><li>* “Respect is better than food and drink” (Lebanon) </li></ul><ul><li>* “Older people are a big headache and a waste of scarce resources, the biggest favour you could do to me as an older people’s organisation is to get them out of my hospital” (Kenya) </li></ul><ul><li>* “To institutionalise an old person is like kidnapping someone” (Argentina) </li></ul>
  23. 23. Missing Voices: Conclusions <ul><li>Strategies proposed by the focus group participants: </li></ul><ul><ul><li>Awareness and education </li></ul></ul><ul><ul><li>Training of professionals </li></ul></ul><ul><ul><li>Empowerment of elders </li></ul></ul><ul><ul><li>Role of the media </li></ul></ul><ul><ul><li>Recreation facilities </li></ul></ul><ul><ul><li>Structural solutions </li></ul></ul><ul><ul><li>Research </li></ul></ul>
  24. 24. Missing Voices: Recommendations <ul><li>Key Action points: </li></ul><ul><li>To develop a screening and assessment tool </li></ul><ul><li>To develop an education package on elder abuse </li></ul><ul><li>To develop and disseminate a research methodology ‘Kit’ </li></ul><ul><li>To develop a Minimum Data Set concerning elder abuse </li></ul><ul><li>To disseminate research findings widely </li></ul><ul><li>To develop a global inventory of good practice </li></ul><ul><li>To mobilise civil society through raising awareness of the widespread magnitude and problem of elder abuse </li></ul>
  25. 25. Recent developments <ul><li>World Elder Abuse Awareness Day </li></ul><ul><li>INPEA world environmental scan </li></ul><ul><li>European level initiatives: </li></ul><ul><ul><li>Research: DAPHNE III Programme </li></ul></ul><ul><ul><li>Prevalence studies, specific projects </li></ul></ul><ul><ul><li>Policy level: MILCEA, EUSTaCEA </li></ul></ul><ul><ul><li>WHO European region </li></ul></ul><ul><li>WHO Violence and Injury Prevention </li></ul>
  26. 26. The Way Forward? <ul><li>Improve recognition and awareness of abuse </li></ul><ul><li>Develop standards and systems of accountability </li></ul><ul><li>Develop strategies to prevent and intervene </li></ul><ul><li>Promote education and training </li></ul><ul><li>Improve knowledge and understanding </li></ul><ul><li>International collaboration to prevent abuse </li></ul>
  27. 27. Contact details <ul><li>Bridget Penhale </li></ul><ul><li>School of Nursing and Midwifery </li></ul><ul><li>University of East Anglia (UEA) </li></ul><ul><li>Norwich </li></ul><ul><li>Tel: +44 (0)1603 597016 </li></ul><ul><li>Email: [email_address] </li></ul>

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