Elder Abuse Victims and Services

1

• Elder Abuse Victims and Services
• Lisa Nerenberg MSW, MPH
• The 11th Asian Post Graduate Course
  
  on Victimology and
  Victim Assistance
• July 22, 2011
• University of Indonesia, Jakarta

2
f
What is Elder Abuse?

• The definition is evolving
• Traditionally, referred to mistreatment by family
  members or people in positions of trust or
  confidence, and required that elders be
  vulnerable or dependent.
• Definition has expanded to include victims of
  consumer fraud targeted against elders, abuse in
  institutions.
• Increasingly viewed as elder rights issue.

3
Extent of Problem

• One in 10 older adults in U.S. report emotional,
  physical, sexual mistreatment, or potential
  neglect each year (Acierno et. al., 2009)
• Emotional abuse 4.6
• Physical abuse 1.6
• Sexual abuse 0.6
• Potential neglect (need for assistance not
  addressed) 5.1
• Current financial abuse 5.2
• Lifetime financial exploitation by non-family
  6.5.
• N5777

4
Physical Abuse

• Use of physical force that may result in bodily
  injury, physical pain, or impairment. It includes
  inappropriate physical and chemical restraint.

5
Sexual Abuse
Non-consensual sexual contact of any kind with an
elder person. Includes rape, sodomy, molestation,
and sexual contact with anyone who is incapable
of giving consent.
6
Emotional Abuse
Infliction of anguish, pain, or distress through
verbal or non-verbal acts. Includes verbal abuse,
humiliation, harassment, coercion, and isolation.
7
Financial, or Material, Exploitation
Illegal or improper use of an elder's funds,
property, or assets. May include robbery, theft,
fraud, extortion, forgery, identity theft, and
withholding care in order to preserve an elders
estate or hasten his/her decline (by someone who
stands to benefit or inherit).
8
Abandonment
Desertion of an elder by an individual who has
physical custody of the elder or by a person who
has assumed responsibility for providing care to
the elder.
9
Neglect

• Refusal or failure to fulfill any part of a
  caregivers obligations or duties to an elderly
  person

10
Isolation

• Preventing elders from having visitors, receiving
  mail, or using the phone or computer
• Confining elders to rooms, homes, or apartments
• Preventing elders from using assistive devices
  like canes, glasses, or hearing aids that enable
  them to receive information or communicate with
  others
• Preventing elders from using social services or
  reporting problems
• Blocking elders access to radios, televisions,
  or newspapers

11
Institutional Abuse

• Abuse committed in long-term care facilities
  (nursing homes, residential care facilities, and
  assisted living facilities)

12
Reasons for Abuse

• Financial gain
• Dysfunction (including substance abuse and mental
  illness)
• Caregiver issues
• Power and control
• History of conflict

13
Risk Factors of Older Persons

• Depends on
• Type of abuse
• Setting
• Culture or country

14
General Risk factors

• Isolation
• Gender. More reports of abuse to women
• Women over-represented in higher age brackets
• Men may actually be at greater risk
• Physical and/or cognitive impairments
• Shared living arrangement
• Physically or verbally aggressive
• Recent losses
• Residents of facilities who lack families,
  advocates, or friends

15
Risk factors by type of abuse

• Victims of neglect more likely to have physical
  impairments (Pillemer Finkelhor, 1988)
• Victims of physical abuse more likely to live
  with abusers (Pillemer Finkelhor, 1988)
• Victims of financial abuse vary by type of abuse
• Victims of misused documents likely to have
  cognitive impairments (Rabiner, O'Keeffe,
  Brown, 2006)
• Victims of consumer fraud (e.g. investment fraud)
  less likely to have cognitive impairment (NASD
  Investor Education Foundation, WISE Senior
  Services, AARP Foundation, 2006).
• Dementia. 48 of caregivers for dementia patients
  were psychologically or physically abusive
  (Wiglesworth et. al., 2010)

16
Victims perceptions of abuse is culturally
determined

• Study of attitudes of European-American,
  African-American, Puerto Rican and
  Japanese-American older adults found that
  African-American and Japanese-American seniors
  view psych abuse as worst form (Anetzberger,
  Korbin, Tomita, 1996).
• Korean elders identify financial, psychological,
  and physical abuse, and neglect within context of
  "hyo," the traditional value of filial piety
  (Chang Moon, 1997).
• In Japanese, German, Brazilian, Israeli, and
  African American cultures, placing parents in
  nursing homes is viewed as abuse (Patterson
  Malley-Morrison, 2006).

17
Impact of abuse

• Increased mortality (Lachs, Williams, O'Brien,
  Pillemer Charlson, 1998)
• Depression (Mouton, Rodabough, Rovi, Brzyski,
  Katerndahl, 2010 Begle, Strachan, Cisler,
  Amstadter, Hernandez, Acierno, 2010).
• Shame
• Hopelessness
• Isolation
• Financial

18
Risk Factors of Abusers

• Criminal record or a history of violence,
  substance abuse, gambling and other debt
• Sense of entitlement to the elders resources
• Mental health problems including mental illness
• Stress
• Social isolation
• Recent changes in family relationships or living
  arrangements
• Slightly more likely to be male

19
T Treatment and interventions reatment and
interventions
Treatment and interventions

• Draw from multiple disciplines
• Child abuse/mandatory reporting in U.S.
• Mandate professionals and encourage concerned
  citizens to report to public agencies
• Public agencies investigate and offer services
• Services are voluntary (many victims refuse out
  of fear, shame, loyalty to abusers, etc.
• Domestic violence
• Prosecution (special prosecution units, forensics
  research, elder courts)
• Shelters adapted for elders
• Safety planning
• Restraining orders

20
Treatment and interventions (cont.)

• Public health
• Public awareness to promote intergenerational
  respect
• Universal screening by health care professionals
• Caregiving
• Screening of caregivers to detect high risk
• Support to caregivers, including monetary aid,
  respite, training
• Victimology/victim rights
• Restorative Justice
• Mediation
• Restitution

21
International Focus

• International Network for the Prevention of Elder
  Abuse (INPEA)
• World Elder Abuse Awareness Day (June 15) to
  raise awareness
• Studies elder abuse worldwide
• International NGO Coalition for the Rights of
  Older People (includes AARP, Global Action on
  Aging, HelpAge International, International
  Network for the Prevention of Elder Abuse, and
  others)

22
Who
WHO-INPEA Study

• Goal To identify key themes, perceptions,
  beliefs, and attitudes about abuse by elders and
  health care workers in developing and developed
  countries
• Developing countries Argentina, Brazil, India,
  Kenya, Lebanon
• Developed countries Austria, Canada, Sweden
• Participants asked
• What do you consider to be abusive conduct?
• Contexts in which it occurs
• Causes
• Consequences
• Seasonal patterns
• Overall status, well-being, unmet needs of elders

23
Key findings

• Focus groups viewed abuse as societal concern
  with gender and socio-economic status emerging as
  key factors.
• Disrespect identified as most painful form of
  mistreatment by older adults in all countries.

24
Themes

• Poor suffer most.
• Childless,widowed women most affected.
• Lack of pensions (worldwide, only 30 of elders
  covered by pension schemes).
• Lack of access to health care and social
  services.
• Decreasing rates of communicable diseases in
  developing world have increased prevalence of
  long-term, disabling diseases.
• Worst off are poor, elderly, and women
• Negative attitudes about long-term care
  facilities

25
The
Themes (cont.)

• Changing social roles and breakdown of family
  responsibilities
• Fewer women stay at home and provide care
• Breakdown of family responsibilities, loss of
  filial piety Lack of training and resources for
  health care providers, and negative treatment
  results in poor treatment of patients.
• Economic crises contribute
• The media promotes ageist attitudes and negative
  stereotypes.
• Low status of health care providers results in
  lack of training and resources results in poor
  treatment of patients.

26
UN i
UN Initiatives

• Convention on the Elimination of All Forms of
  Discrimination Against Women (CEDAW)
• Established working group to draft
  recommendations on older womens rights.
  Recommendations approved by General Assembly in
  2010
• Defines older women as a separate category.
• Recognizes elder abuse as a form of domestic
  violence.
• Efforts to create a new UN convention on the
  Rights of Older Persons
• Madrid International Plan of Action on Ageing
  (MIPAA), an aspirational document endorsed by
  159 governments at 2nd World Assembly on Ageing
  in 2002. Encourages governments to include older
  people in policies and social and economic
  development policies
• Some nations and associations have taken steps