The Concept of Elder Abuse: Breaking the Silence

1
The Concept of Elder Abuse Breaking the Silence

• Bridget Penhale
• University of Sheffield, UK
• European Board Member,
• INPEA

2
Introduction and Background

• Historical perspectives
• Global phenomenon
• Recent recognition, increasing concern
• Different perspectives
• Complexities and confounding factors

3
What is Abuse?

• Definitional issues
• Hidden from public gaze
• Private issue or public concern?
• Adult protection or elder abuse?
• Contextual matters
• Exacerbating factors

4
The Importance of Naming (1)

• Silence about the topic
• Comparative lack of recognition
• An under-developed concept
• Naming is essential
• Primacy of the individual and personal

5
The Importance of Naming (2)

• Problems with terminology
• What is named and who is naming?
• Meanings and understandings are crucial
• Social construction of abuse and violence
• Importance of professional identification

6
Definitions of Abuse (1)

• 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
• Action on Elder Abuse, UK (1995)

7
Definitions of Abuse (2)

• Abuse is the violation of an individuals human
  and civil rights by any other person or persons
• No Secrets, UK (2000)
• Abuse, like beauty, is in the eye of the beholder
• Callahan (1986)

8
Types of Abuse

• Physical abuse
• Sexual abuse
• Psychological abuse
• Financial or material abuse
• Neglect
• Societal abuse
• Discriminatory abuse
• Institutional Abuse

9
Features of Abuse

• Physical assault
• Sexual abuse
• Deprivation
• Inappropriate medication
• Involuntary isolation, abandonment
• Financial abuse and exploitation
• Psychological abuse (emotional/verbal)
• Neglect

10
Definitions of Abuse (2)

• Abuse is the violation of an individuals human
  and civil rights by any other person or persons
• No Secrets, UK (2000)
• Abuse, like beauty, is in the eye of the beholder
• Callahan (1986)

11
The Need for Differentiation

• Different types of abuse
• Different settings and locations
• Different participants
• Different witnesses
• Different responses and interventions

12
Critical Factors

• Social and cultural contexts
• Gender and power relations
• Not just family and interpersonal relationships
• Personal, cultural and structural levels
• Ageism as a master category

13
The Concept of Elder Abuse (1)

• An Aging issue?
• A complication of caregiving?
• The Family violence perspective
• Prevention, punishment and protection
• Apparent tensions
• service and helping orientation
• justice and criminalisation orientation

14
The Concept of Elder Abuse (2)

• Different images of Aging
• Different systems of policy and practice
• Are these applicable?
• What are the views of elders?
• What of models of empowerment?

15
International Network for the Prevention of Elder
Abuse (INPEA)

• Established at IAG World Congress, 1997
• Initially representation from 12 countries
• Officers and Regional Representatives
• Mission Statement and Objectives, 1998
• National Representatives, 2000
• NGO Status, 2003
• Website development http//www.inpea.net

16
INPEA Objectives

• To increase public awareness
• To promote education and training
  (identification, treatment and prevention)
• To develop advocacy
• To stimulate research
• causes
• consequences
• prevalence
• treatment
• outcomes

17
Mission Statement

• Acknowledging the diversity of culture,
  background and lifestyle of the world population
  the International Network for the Prevention of
  Elder Abuse aims to increase society's ability,
  through international collaboration to recognise
  and respond to the mistreatment of older people
  in whatever setting it occurs, so that the later
  years of life will be free from abuse, neglect
  and exploitation.

18
Research Missing Voices

• Partnership with
• WHO Ageing and Life Course
• HelpAge International
• academic institutions
• Study of older people in community and primary
  health care settings in
• Brazil India
• Kenya Argentina
• Lebanon Canada
• Austria Sweden

19
Missing Voices Findings (1)

• Older people perceive abuse as
• Neglect isolation, abandonment, social exclusion
• Violation human, legal and medical rights
• Deprivation choices, decisions, status, finances
  and respect

20
Missing Voices Findings (2)

• Key categories of abuse identified
• Structural and societal abuse
• Neglect and abandonment
• Disrespect and ageist attitudes
• Psychological, emotional and verbal abuse
• Physical abuse
• Legal and financial abuse

21
Missing Voices Findings (3)

• Important contextual aspects
• Social and institutional arrangements
• Retirement and social roles of older adults
• Long-term care institutions
• Health care professionals as abusers victims
• Culture-specific influences as abuse

22
Missing Voices Findings (4)

• Two key factors underpinning abuse
• Gender
• Socio-economic status
• Crucial points
• Prevailing view women, especially poor, widowed
  or childless most affected
• Respondents agreed poor older people suffer most

23
Missing Voices Findings (5)

• Direct Quotes
• He must have needed the money (Canada)
• 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)
• One rude word said to an old man is stronger
  than stabbing him with a knife (Lebanon)
• People talk down to us- call us sweetie or
  dearie - tell us what to do (Canada)

24
Missing Voices Findings (6)

• Direct Quotes
• Respect is better than food and drink
  (Lebanon)
• Older people are a big headache and a waste
  of scarce resources, the biggest favour you could
  do to me as an older peoples organisation is to
  get them out of my hospital (Kenya)
• To institutionalise an old person is like
  kidnapping someone (Argentina)

25
Missing Voices Conclusions

• Strategies proposed by the focus group
  participants
• Awareness and education
• Training of professionals
• Empowerment of elders
• Role of the media
• Recreation facilities
• Structural solutions
• Research

26
Missing Voices Recommendations

• Key Action points
• To develop a screening and assessment tool
• To develop an education package on elder abuse
• To develop and disseminate a research methodology
  Kit
• To develop a Minimum Data Set concerning elder
  abuse
• To disseminate research findings widely
• To develop a global inventory of good practice
• To mobilise civil society through raising
  awareness of the widespread magnitude and problem
  of elder abuse

27
INPEA and Education

• National and international representation
• Contributions to WHO and UN reports
• Input into CD-ROM (UK)
• Dissemination, research and advocacy for elder
  abuse issues
• Political advisory roles (Brazil, UK)
• With Pan American Health Organisation
• primary health care manual.

28
INPEA and the future

• Research project with WHO GREATGlobal Response
  Against Elder Abuse Together
• developing action points from Missing Voices
• Dissemination across the World
• NGO Participant, UN Day for Older People, New
  York, October 2003
• Environmental Scan
• World Elder Abuse Awareness Day, 2006
• Website development http//www.inpea.net

29
European Developments

• 20 countries represented in INPEA
• North/South East/West
• Over 100 members
• Mainly groups/organisations
• National or country representatives
• 11 countries

30
European Perspectives

• Culturally and economically diverse region
• Definitional issues
• 20 year time span
• Legislation and policies
• Intervention strategies
• Research and publications

31
Other European developments

• In EEA
• France, Italy, Belgium helplines
• Germany pilot projects
• Norway national centre
• Switzerland assessment tools
• Spain national survey
• Portugal institutional focus
• Accession countries early work
• Future research, education, prevention, responses

32
The Way Forward?

• Improve recognition awareness of abuse
• Develop standards systems of accountability
• Develop appropriate responses interventions
• Promote education training
• Improve knowledge understanding
• International collaboration to prevent abuse