Global Strategy Elder Abuse

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A presentation to the 2002 CASSW conference on the World Health Organisation project of developing global strategies against elder abuse.

Published in: Health & Medicine

Global Strategy Elder Abuse

  1. 1. The WHO-INPEA Global Strategy for the Prevention of Elder Abuse Silvia M. Straka Gerry Bennett Alexandre Kalache Silvia Perel Levin
  2. 2. Agenda <ul><li>Background and context </li></ul><ul><ul><li>Elder abuse: definition </li></ul></ul><ul><ul><li>Ageism </li></ul></ul><ul><ul><li>The global context: population ageing </li></ul></ul><ul><li>WHO-INPEA action research project </li></ul><ul><li>Research component: two key findings </li></ul><ul><li>Implications for social work </li></ul>
  3. 3. Elder Abuse Defined <ul><li>Elder abuse is 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>(INPEA-WHO definition, adopted from Action on Elder Abuse, 1995) </li></ul>
  4. 4. Some Categories of Elder Abuse <ul><li>Physical abuse </li></ul><ul><li>Neglect (physical, emotional) </li></ul><ul><li>Psychological and verbal abuse </li></ul><ul><li>Financial/material exploitation </li></ul><ul><li>Violation of rights </li></ul>
  5. 5. Consequences of Elder Abuse <ul><li>Consequences are devastating and include: </li></ul><ul><ul><li>Increased mortality and morbidity </li></ul></ul><ul><ul><li>Poor quality of life </li></ul></ul><ul><ul><li>Emotional distress </li></ul></ul><ul><ul><li>Loss of property and security </li></ul></ul>
  6. 6. Ageism <ul><li>Elder abuse is one of the most extreme forms of ageism </li></ul><ul><li>Ageism remains one of the least recognized forms of oppression </li></ul><ul><li>Ageism intersects with other forms of oppression (e.g. gender, race, class, etc.) </li></ul>
  7. 7. Lack of a Structural Analysis <ul><li>While links to ageism have long been acknowledged, theory and practice remain focused at the micro-level </li></ul><ul><li>Elder abuse has been constructed by professionals and experts </li></ul><ul><li>It is viewed as a problem of individual and family pathology </li></ul><ul><li>Voices of older adults are missing from the discourse </li></ul>
  8. 8. Global Context: Population Ageing <ul><li>The problem of elder abuse assumes new significance in the context of global ageing </li></ul><ul><li>By 2025, the global population of people over age 60 will double to 1.2 billion </li></ul><ul><li>1 million people turn 60 every month </li></ul><ul><li>80% of these are in the developing world </li></ul>
  9. 9. WHO Response <ul><li>Recognized the problem and initiated an action-research project </li></ul><ul><li>Partners: </li></ul><ul><ul><li>INPEA </li></ul></ul><ul><ul><li>HelpAge International </li></ul></ul><ul><ul><li>Researchers from various academic institutions </li></ul></ul>
  10. 10. Goals of the Action-Research Project <ul><li>Exploratory research component: </li></ul><ul><ul><li>Attitudes, beliefs and perceptions about elder abuse held by older adults and health care professionals </li></ul></ul><ul><li>Action component: </li></ul><ul><ul><li>Develop global action strategies against elder abuse by key stakeholders </li></ul></ul>
  11. 11. Research Methodology <ul><li>Focus groups in 8 countries </li></ul><ul><ul><li>5 developing countries: </li></ul></ul><ul><ul><li>Argentina, Brazil, India, Kenya, Lebanon </li></ul></ul><ul><ul><li>3 developed countries </li></ul></ul><ul><ul><li>Canada, Austria, Sweden </li></ul></ul><ul><ul><li>8 focus groups per country </li></ul></ul><ul><ul><ul><li>4 groups for health care professionals </li></ul></ul></ul><ul><ul><ul><li>4 groups for older adults </li></ul></ul></ul>
  12. 12. Qualitative Data Analysis <ul><li>Local experts analyzed the data and produced national reports (translated into English) </li></ul><ul><li>National reports were subject to further analysis and synthesis </li></ul><ul><li>Synthesis report was produced </li></ul>
  13. 13. Stage II: Action Component <ul><li>An international working group of key stakeholders met in Geneva in October 2001 </li></ul><ul><li>National reports and the international syntheses were presented and provided the basis for the development of concrete action strategies </li></ul><ul><li>The final report, aimed at policy makers, was launched at the UN World Assembly on Ageing in Spain in April, 2002 </li></ul><ul><li>The action strategies are in process of implementation by the project partners </li></ul>
  14. 14. Key Focus Group Themes <ul><li>How do older adults and health care workers understand: </li></ul><ul><ul><li>the roles of older adults in their societies and the problems they face </li></ul></ul><ul><ul><li>the problem of elder abuse and its possible solutions </li></ul></ul>
  15. 15. Two Key Findings <ul><li>The findings provide the basis from which to begin to redefine elder abuse to incorporate a broader perspective. </li></ul><ul><li>In particular, two key categories of abuse were identified: </li></ul><ul><li>Structural and societal abuse </li></ul><ul><li>Disrespect and ageist attitudes </li></ul>
  16. 16. Structural and Societal Abuse <ul><li>Participants from developing countries primarily blamed governments and structural factors for the mistreatment they suffer </li></ul><ul><li>Responsibility for prevention and intervention is clearly seen as a government responsibility </li></ul><ul><li>“ societal abuse”: most important type of abuse and root cause of most other types of abuse </li></ul><ul><li>Covers a wide range of issues </li></ul>
  17. 17. Examples of Societal Abuse <ul><li>Inadequate pensions </li></ul><ul><li>Inadequate accommodation </li></ul><ul><li>National economic crises </li></ul><ul><li>Impacts of changes in social roles </li></ul><ul><li>Inadequate funding and access to heath and social services </li></ul>
  18. 18. Disrespect and Ageist Attitudes <ul><li>Experiences of disrespect are viewed by older adults as: </li></ul><ul><ul><li>a cause of all other forms of abuse </li></ul></ul><ul><ul><li>an important form of abuse in itself </li></ul></ul><ul><li>“Respect is better than food and drink” </li></ul><ul><li>“One rude word said to an old man is stronger than stabbing him with a knife” </li></ul><ul><li>Lebanon report </li></ul>
  19. 19. Some Causes of Disrespect <ul><li>Changes in societal values </li></ul><ul><li>Negative images and stereotypes of older adults through the media </li></ul><ul><li>Westernization as bringing new attitudes and values </li></ul><ul><li>Younger generation particularly disrespectful </li></ul>
  20. 20. Disrespect in the Health Care System <ul><li>“ The disoriented elder, who may be intoxicated by medication, is taken [and treated] as a headstrong child. This is quite violent; a professional to take out the prothesis, take out the device, remove the eyeglasses [from the older person], then he [the older person] agitates. When he agitates, [the professional] medicates … this is violence; there are also cases in which he [the professional] says, “I won’t let your daughter in if you keep [behaving] like that.” </li></ul><ul><li>Brazil report </li></ul>
  21. 21. Disrespect in Government and Commercial Institutions <ul><li>“At the post office or at the railway station you are not supposed to speak too slowly and you are treated badly when you have a hearing problem.” </li></ul><ul><li>Austria report </li></ul>
  22. 22. Disrespect on Public Transport <ul><li>“Disrespect starts from the moment the elder gets to a bus stop. When he hails the bus to stop, the first thing the driver says [to himself] is, ‘Don’t stop here as it is full of six-five [people aged 65 or over].’ The elder hails, but them [drivers] keep going. Or they stop way ahead, so the poor old guy has to run to catch the bus. It is mean.” </li></ul><ul><li>Brazil report </li></ul>
  23. 23. Disrespect in Society at Large <ul><li>“[Older adults] feel disregarded, insulted, ignored by government or social security agencies, or mistreated in shops, in public transport, etc.; the general feeling is that the elderly are pushed to the edge of society.” </li></ul><ul><li>Austria report </li></ul>
  24. 24. Some Implications for Social Work <ul><li>Implications for theory: </li></ul><ul><ul><li>challenges the existing micro-level conceptualization of elder abuse and identifies directions for theory development </li></ul></ul><ul><li>Implications for policy: </li></ul><ul><ul><li>inadequate social policies affecting older people can result in conditions that increase the risk of elder abuse </li></ul></ul><ul><li>Implications for practice: </li></ul><ul><ul><li>practitioners need to understand the structural roots of the problem and engage in social action </li></ul></ul>
  25. 25. ….Implications <ul><li>Implications for research: </li></ul><ul><ul><li>new research questions will be generated </li></ul></ul><ul><ul><li>These “new” forms of elder abuse, such as disrespect and its impact on older people, need to be studied </li></ul></ul><ul><li>Implications for education: </li></ul><ul><ul><li>elder abuse should be framed as a social justice issue </li></ul></ul><ul><ul><li>the present micro-level approach to teaching elder abuse practice needs to be situated within a structural analysis </li></ul></ul><ul><ul><li>Elder abuse courses need to include discussion around macro-level interventions to the problem </li></ul></ul><ul><ul><li>International social work courses should include references to problems of ageing, including elder abuse </li></ul></ul>
  26. 26. Importance and Contributions of the Project <ul><li>First multi-country set of information about elder abuse </li></ul><ul><li>Richness of data </li></ul><ul><li>Findings throw new light on how to perceive and approach elder abuse </li></ul><ul><li>WHO has a unique position, which permits it to: </li></ul><ul><ul><li>convert the outcomes of the discussion into concrete action points </li></ul></ul><ul><ul><li>assist primary health care workers globally to prevent elder abuse </li></ul></ul>
  27. 27. Missing Voices Report <ul><li>WHO/INPEA (2002). Missing voices: Views of older persons on elder abuse. Geneva: WHO. </li></ul><ul><li>www.who.int/hpr/ageing/elderabuse.htm </li></ul>

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