Elder abuse and family care of older people in Europe: some reflections based on EUROFAMCARE and rel

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Elder abuse and family care of older people in
Europesome reflections based on EUROFAMCARE and
related findings
Presentation for the meeting of the FERPA
Executive Committee, Brussels, 28-29 October
2008

• Lamura G., Mnich E., Wojszel B., Krevers B.,
  McKee K., Mestheneos L., Melchiorre M.G.,
  Principi A., Fabbietti P. Döhner H.
• on behalf of the EUROFAMCARE research group

Address for correspondence I.N.R.C.A.,
Department of Gerontological Research, Via S.
Margherita 5, 60124, Ancona, Italy e-mail
g.lamura_at_inrca.it
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The EUROFAMCARE (EFC) group

• Germany Döhner H. (Co-ordinator), Kofahl C.,
  Lüdecke D., Mnich E., Kohler S., Lange N., Seidl
  K., Meyer M. (Hamburg) and Rothgang H., Becker
  R., Timm A., Knorr K., Lessmann O. (Bremen)
• Greece Mestheneos E., Triantafillou J., Prouskas
  C., Kontouka S., Goltsi V., Loukissis A.,
  Mestheneou K.
• Italy Lamura G., Balducci C., Melchiorre M.G.,
  Quattrini S., Spazzafumo L., Polverini F.,
  Principi A., Gianelli M.V.
• Poland Bien B., Wojszel B., Synak B.,
  Czekanowski P., Bledowski P., Pedich W.
• Sweden Öberg B., Krevers B., Johansson S.L.,
  Davidson T.
• UK McKee K., Nolan M., Barber L., Brown J.
• AGE-European Older People's Platform Parent
  A.-S., Patel J., Daurèle C., Pflüger K., Thorpe
  E.
• The EUROFAMCARE study (2004-2005)
• - topic situation of supports for family carers
  of older people in EU
• - methodology survey based on 6.000 face-to-face
  interviews
• - web-site www.uke.uni-hamburg.de/eurofamcare

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Contents of presentation

• Family carers burden and elder abuse
  introduction
• Risk factors for carers burden and potential
  situations of neglect
• Final remarks

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Family carers burden and elder abuse
introduction

• Family care is the most relevant form of support
  provided to dependent older people in the
  community (often continuing even after
  institutionalisation).

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Family carers burden and elder abuse
introduction

• Family care is the most relevant form of support
  provided to dependent older people in the
  community (often continuing even after
  institutionalisation).
• Most people provide family care for positive
  motivations, such as love, affection and
  emotional bonds, and derive from it positive
  feelings.

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What factors influence families decision to care?
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Family carers burden and elder abuse

• Family care represents the most relevant form of
  support provided to dependent older people living
  in the community (often continuing when the older
  person is institutionalised).
• Most people provide family care for positive
  motivations, such as love, affection and
  emotional bonds, and derive from it positive
  feelings.
• Sometimes, however, family care becomes the only
  solution available, i.e. no longer a free
  choice

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What factors influence families decision to care?
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Family carers burden and elder abuse

• Family care represents the most relevant form of
  support provided to dependent older people living
  in the community (often continuing when the older
  person is institutionalised).
• Most people provide family care for positive
  motivations, such as love, affection and
  emotional bonds, and derive from it positive
  feelings.
• Sometimes, however, family care becomes the only
  solution available, due to a feeling of
  duty/obligation towards the older person or the
  lack of care alternatives.
• For these and other reasons, family care might
  become then also a stressful, burdening
  experience

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Carers burden in the EUROFAMCARE study

• Components identified by carers as responsible
  for a negative impact of caregiving
• negative effects on physical health and emotional
  well-being
• difficulties in relations with family and
  friends
• financial difficulties
• sensation that caregiving is too demanding and
  makes carers feel trapped.

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Frequency of negative effects due to caregiving
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Family carers burden and elder abuse

• Family care represents the most relevant form of
  support provided to dependent older people living
  in the community (often continuing when the older
  person is institutionalised).
• Most people provide family care for positive
  motivations, such as love, affection and
  emotional bonds, and derive from it positive
  feelings.
• Sometimes, however, family care becomes the only
  solution available, due to a feeling of
  duty/obligation towards the older person or the
  lack of care alternatives.
• For these and other reasons, family care might
  become then a stressful, burdening experience
• leading to the abuse of the older person who is
  actually supposed to be cared for.

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Frequency of elder abuse by family carers

• Different definitions and methodologies in
  collecting data lead to divergent findings in
  terms of prevalence of elder abuse perpetrated by
  family caregivers (NCEA 2002). Taking for
  instance physical abuse
• 5 (Paveza et al 1992)
• 6 (Pillemer Suiter 1992)
• 11 (Compton et al. 1997)
• 12 of all callers to a help line for caregivers
  (Coyne et al 1993)
• 23 of non-spousal carers (Wolf 1996).

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Elder abuse and caregivers burden risk factors

• Risk factors for elder abuse often represent
  predictors of caregivers stress and burden as
  well.

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Caregiver burden and elder abuse risk factors

• Different studies suggest that risk factors for
  carers burden and stress also predict elder
  abuse (Anetzberger 1987 Compton et al. 1997
  Paveza et al 1992 Coyne et al 1993 Pillemer
  Suiter 1992), with regard to
• cohabitation
• amount of care provided
• care recipients behavioural disturbances
• carers depression low self-esteem
• carers subjective perception of (past)
  relationship with care recipient (including
  situations of mutual abuse)
• carers feeling about help received from support
  networks.

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Elder abuse and caregivers burden risk factors

• Risk factors for elder abuse often represent
  predictors of caregivers burden and stress.
• Interventions able to reduce carers burden are
  likely to have a preventive effect on elder
  abuse, too.

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The framework of elder abuse and carers burden
Risk factors
()
Elder abuse
Carers burden
Carers stress
Preventing factors
(-)
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Elder abuse and caregivers burden risk factors

• Risk factors for elder abuse often represent
  predictors of caregivers burden as well.
• Interventions able to reduce carers burden are
  likely to have a preventive effect on elder
  abuse, too.
• By means of a scale measuring the frequency of
  negative caregiving aspects, we could identify
  some factors which increase the probability for
  carers to experience high burden.

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Risk factors for carers burden(odds-ratioprobab
ility for carer to experience high burden)
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Potential risk factors for neglect( of
carers willingness to continue caregiving)
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Potential risk for neglect by country( of
carers unwilling to continue caregiving)
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Restrictions reported by employed carers

N 4427 only carers lt 65 years
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Employment status of family carers by country
Employed
Not employed
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Restrictions reported by not employed carers

N 2093 only carers lt 65 years
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Carers using support services, by country

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Service characteristics considered most important

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Households employing privately paid migrant home
care workers

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Migrant home carers in Italy by kind of
employment contract
Lucchetti et al. 2005
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• Thank you!