Microsoft PowerPoint - Briony Dow_06Oct_09 elder abuse

							   The National Ageing Research
             Institute

               What is elder abuse?



                     Dr Briony Dow

          NARI Seminar 6th October, 2009




               National Ageing Research Institute




                      Overview
• What is elder abuse?

• Why is elder abuse important?

• Prevalence

• What triggers elder abuse?

• National and international policy responses
   – Protective vs empowerment

• NARI study

• Care-giving scenario

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         What is elder abuse?
The World Health Organisation defines elder
  abuse as:

“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”
(World Health Organization, 2008).




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         Types of elder abuse1
• Financial abuse
  – Illegal or improper use of a person’s money, property
    or financial resources by someone with whom they
    have a relationship implying trust
• Physical abuse
  – Non-accidental acts that result in physical pain or
    injury or physical coercion
• Sexual abuse
  – Unwanted sexual acts, including sexual contact, rape,
    language or exploitation




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         Types of elder abuse (cont)
• Psychological or emotional abuse
    – Inflicting mental stress via actions and threats that cause
      fear and/or feelings of shame and powerlessness
• Social abuse
    – Forced isolation of older people, restricting and stopping
      social contact with others – may also serve to hide the
      abuse
• Neglect
    – Failure of carer or responsible person to provide life
      necessities, food, shelter, clothing, medical care, as well as
      refusal to let others provide that care

    1   With respect to Age – 2009, Victorian Government Elder Abuse Practice Guide




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          Definition does not include
•   Acts that do not cause harm or distress
•   Consumer-based circumstances
•   Professional misconduct
•   Harassment and criminal acts
•   Self-neglect or mistreatment

• Residential care (in Vic Govt definition)




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  Why is elder abuse important?
• Ageing population
• Vulnerability of
  some older people
• Reliance on family
  carers – may
  induce stress
• Serious
  consequences,
  including increased
  mortality (Baker,
  2007)


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       Prevalence of elder abuse
• Range of prevalence rates depending on sampling and
  definitions
• Cooper et al, 2008 – systematic review
   – population prevalence 3.2%-27.5%
   – family carers 5%- 55% (higher rates tend to be verbal)
   – professional carers 0.03% (Singapore ED) to 21.5% (public
     Trustees Canada)
• Count of cases by ACAT staff in NSW – 1.2% (n=5246)
  (Kurrle et al, 2007)
• People with AD and their carers – sub-sample of
  community sample – 28% (n=86) (Cooper et al, 2008)
• Need for prevalence study in Australia




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        What triggers elder abuse?
• Carer stress?
• Most care of older people provided by family
  carers
• May come at a cost to carers’
    –   Mental health – depression
    –   Physical health – lack of opportunity for PA
    –   Social health – isolation
    –   Financial health – unable to work, contribute to
        superannuation etc
• Often highly satisfactory to both parties



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     Contributing factors within care
               relationship
• Prior dysfunctional relationship
    – Ongoing family violence
    – Revenge
• Carer depression/stress
• Lack of outside supports
• Isolation
• Poverty
• Mental health issue and/or drug and alcohol abuse
• Care recipient cognitive impairment – especially when
  physical function is not diminished (Cooper et al, 2008)
• Gender – males more likely to perpetuate abuse than
  females



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              Policy responses
• Victorian Govt – 11 recommendations
  –   Education
  –   Senior Rights Victoria
  –   Development of interagency protocols
  –   Research into prevalence, detection and prevention
  –   With respect to Age – 2009
• Rights-based and empowerment approach
• No mandatory reporting
• Recognition of older people as adults with
  right to decide re their care relationship



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              Policy responses
• US approach – Prof Laura Mosqueda (California)
  – Mandatory reporting in some states
  – Adult protective services
  – Interagency cooperation
  – Links between medical services, police, forensics,
    training and education
  – More of a protective approach – strong focus on
    detection
• UK approach – (Filinson, 2006)
  –   No Secrets – Department of Health Guide
  –   No mandatory reporting
  –   Interagency cooperation
  –   Remedial rather than punitive approach


              National Ageing Research Institute
 NARI study – what is elder abuse?
• Replication and extension of UK study
  (Selwood et al, 2007)
• Caregiving scenario
• 13 behavioral responses
• Rated as
  –   Good idea and helpful
  –   Possibly useful
  –   Not sure
  –   Unlikely to help
  –   Bad idea not abusive
  –   Abusive


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                  Collaborators
• Prof Susan Koch, Latrobe University, School of
  Nursing
• Dr Dina LoGuidice, Melbourne Health
• Ms Maree Mastwyk, St Vincent’s Health
• Dr Kathryn Ellis, AIBL study
• NARI team:
  –   Ms Courtney Hempton
  –   Dr Briony Dow
  –   Mr Nicolas Cortes
  –   Prof David Ames



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                      Caregiving scenario
Tom lives with his mother, Joyce Smith, who has dementia. Her memory
is now very poor and she asks the same questions again and again. She
regularly forgets where she has put her pension book and accuses him of
stealing.
She is often agitated at night and sometimes wakes her son up by coming
into his room and emptying out drawers.
Mr Smith is out at work from 8am to 6pm and Joyce is normally alone in
the house. She does not usually go out alone because she loses her way.
Twice in the last month, Joyce has left the house on her own during the
day and got lost, and on one occasion the police brought her home.
Lately Joyce has become increasingly hostile towards her son when he
asks her to have a bath, and her personal hygiene is deteriorating. Her
GP has prescribed her some sedative tablets but she often refuses to
take them.
Mr Smith wants to continue looking after his mother at home but is
unsure what to do about her behaviour.


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                       Responses
1. Arrange for his mother to wear an ID bracelet so people
   will know who she is if she wanders again NA
2. Camouflage the front door by covering it with a curtain
   to prevent her wandering out the house NA
3. Accept that it is her choice not to be clean A
4. Lock her in the house while he is at work A
5. Ask her doctor about medication that might help the
   situation NA
6. Not answer when she asks about her pension book
   because anything he says makes her more angry PA
7. Tell her she cannot have her breakfast until she has had
   a bath PA



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              Responses (cont)
8. Tell her that if things continue the way they are going
    then she will have to live elsewhere PA
9. Sit her in an armchair with a table over her lap so she
    cannot get up while Tom is out shopping A
10. Contact local services to request day care because she
    is not safe to be left alone NA
11. Put a daily chart in her room reminding her to have a
    bath NA
12. Hide the tablets in her morning cereal or tea PA
13. Not take her to family gatherings such as her grand
    daughter’s birthday if she is likely to behave in an
    embarrassing way PA



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               Study questions
• Do respondents perceptions of abuse concur
  with No Secrets (UK) or definition?
• Are there differences between professional
  carers and informal carers in perceptions of
  abuse?




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            UK study findings
• 74 family and 38 professional carers

• Professionals and carers had different views to
  each other and guidelines:
  – More health professionals than carers correctly
    identified preventing someone moving by placing a
    chair in front of them as abusive
  – More carers than health professionals correctly
    identified accepting someone as not clean as abusive




             National Ageing Research Institute