Abuse of Older Abuse of Older ManitobansManitobans

Moira Horgan – JonesNetwork Coordinator

MANITOBA NETWORK FOR THE PREVENTION OF ABUSE OF OLDER ADULTS

Outline of PresentationOutline of Presentation

Obtain a better understanding of the prevalence of abuse of older Manitobans

Differentiate types of abuseRecognize risk factorsDiscuss medical implications of abuse of

older adultsWhat you should do if you suspect abuse

IntroductionIntroductionLanguage: Elder, senior, older adultManitoba Network for the Prevention

of Abuse of Older Adults (MNPAOA)Mission

To act as a central point of contact for provincial efforts and to support regional and community initiatives to prevent abuse of older adults.

Vision Older adults in Manitoba will live in a safe

environment of respect and dignity.

Network GoalsNetwork Goals

Support Regional and Community Efforts

Develop/Adapt Education and Training Resources

Raise Public AwarenessEncourage research and advise on

issues relating to abuse of older adults

NetworkNetworkFunded by the Seniors and

Healthy Aging SecretariatLed by MSOS Housed at MSOSOver 30 partners and growingStudy of other Canadian

NetworksWebsiteBuilding our Future

A Little Bit of TriviaA Little Bit of TriviaClassical Greek culture supported

euthanasia for the incurable old.

Some ancient cultures supported ritual suicide of tribal elders during drought so food and water could be reserved for the more productive young.

King Lear – Shakespeare writes about the king’s maltreatment by his sons.

Canadian HistoryCanadian History 1973  Newfoundland passes  the Neglected Adults Welfare Act,

creating a mandatory reporting obligation for “any person who has information which leads him to believe that an adult is a neglected adult...”.

Early mention of abuse & neglect in Canadian literature in the 1980s. Local service providers in some communities are beginning to identify family violence as an issue affecting older adults.

1980 New Brunswick's Child and Family Services and Family Relations Act addresses child and adult welfare and includes disabled and older adults.

1985  First elder abuse conference held in British Columbia (SPARC Committee on Elder Abuse)

1986 Nova Scotia enacts the Adult Protection Act, creating a mandatory reporting duty for “every  person who has information, whether or not it is confidential or privileged, indicating that an adult is in need of protection..."

1988 Prince Edward Island enacts the Adult Protection Act. 1989 Formation of an informal coalition in British Columbia to

begin addressing abuse and neglect of older adults. Subsequently becomes the BC Coalition to Eliminate Abuse of Seniors.

1989 The Ryerson Study, 1st national study of the prevalence of abuse and neglect in later life in Canada, is conducted.

 Establishment of the Ontario Network for the Prevention of Elder Abuse (incorporated 1992).

Canadian History (1990)Canadian History (1990) 1990s Development of New Horizons and other Health

Canada family violence prevention initiatives. These provide many Canadian communities with their first opportunity to explore abuse issues in later life.

1990 Ontario Nursing Home Act sets out some of the rights of residents living in nursing homes.

1991  Annual Canadian Association on Gerontology discussion meeting in Toronto: "Do We Need a Canadian  Committee for the Prevention of Elder Abuse".

1993 First national conference on elder abuse held. 1994 B.C. Coalition to Eliminate Abuse of Seniors becomes

a non profit provincial organization to raise awareness of abuse and neglect in later life.

1998  Roundtable discussion at Canadian Association on Gerontology  in Halifax, NS. "Creating a  Canadian Network for the Prevention of Elder Abuse". Bylaws established and criteria developed.

1999  2nd  National Conference on Elder Abuse held in Toronto, ON. 

1998 Alberta enacts Protection for Persons in Care Act. 1999 2nd National Conference on Elder Abuse, Toronto,

Ontario, March 21-23, 1999.

Canadian History (2000)Canadian History (2000) 2000 Canadian Network for the Prevention of Elder Abuse is

created as a legal entity. 2000  British Columbia proclaims Part 3 of Adult Guardianship Act,

which provides support and assistance for abused or neglected adults who are unable to seek it on their own. Encourages voluntary reporting of abuse. Recognizes community networks.

2002 Yukon launches first Elders Conference. 2002  Canada is the host location for the development of the

Toronto Declaration on the Global Prevention of Elder Abuse.  Declaration is based on the recommendations of the United Nations International Plan of Action adopted by all countries in Madrid, 2002.

2003 Quebec Network for the Prevention of Elder Abuse is created.

2003 Regional senior abuse prevention network develops in Alberta.

2003 1st official recognition (proclamation) by the City of Toronto. Other cities in Ontario follow in 2003 and 2004.

2003 1st provincial senior abuse awareness campaign (Alberta). 2003  Yukon passes the Adult Protection and Decision Making Act, 

Dec. 17, 2003. Proclamation is planned for April 1, 2005. 2004  Newfoundland and Labrador holds their first provincial

conference on senior abuse. 2004  (October 19) Ontario marks its first Elder Abuse Awareness

Day.

Manitoba AchievementsManitoba Achievements 1999 Manitoba Law Reform Commission on Abuse 2001 Manitoba proclaims Protection for Persons in

Care Act. 2002 Establishment of a Manitoba Strategy on

Abuse of Older Adults 2003  Manitoba establishes "Expect respect"

initiative to help raise awareness of abuse and promote respect of older adults in the province.

2006 WEAAD June 15th 2006 Manitoba Network for the Prevention of Abuse

of Older Adults (MNPAOA) is established 2006 Establishment of an abuse line 2007 Establishment of a Safe Suite (A&O) 2008 First Manitoba Conference 2009 CAG in Winnipeg devotes one day to abuse

issues 2010 Building our Future – consultations and

strategy for change

The field of prevention of abuse and neglect of older adults in Canada is lagging behind other areas of family violence prevention. It is largely the case that multiple small-scale projects and a few noteworthy larger programs exist in a patchwork of service delivery and under-coordinated effort. It is also far from being able to use practice standards such as are available for other fields (e.g. health).

Promising approaches in the Prevention of Abuse and Neglect of older adults in Canada (2007)

Canadian Network for thePrevention of Elder Abuse (CNPEA)

Prevalence of Elder AbusePrevalence of Elder AbuseActual incidence and prevalence of elder

abuse is unknown and difficult to measure. It is believed that 4 -10% of all older adults

have been a victim at some time.As part of an1999 study, 4000 older

Canadians were interviewed to examine their experience regarding emotional and financial abuse as well as physical and sexual violence committed against them by children, caregivers and spouses.  ◦ approximately 7% of seniors interviewed

reported that they had experienced some form of emotional or financial abuse by an adult child, caregiver or spouse within the past five years

◦ emotional abuse was reported most frequently ◦ financial abuse was the second most reported

form of abuse ◦ almost 2% of older Canadians reported

experiencing more than one form of abuse

Why so difficult to measure?Why so difficult to measure?Vast majority (80%) of cases go

unreported or unsubstantiated.Definitions of abuse od older

adults can differ from agency to agency, and person to person.◦Subject to cultural interpretation

Definition of Abuse of Older Definition of Abuse of Older Adults Adults

According to the World Health Organization, abuse and neglect of older adults can be a single or a repeated act. It can occur in any relationship where there is an expectation of trust or where a person is in a position of power or authority.

Types of Elder AbuseTypes of Elder Abuse

Physical abuse Sexual abuse Emotional/psychological abuse Financial or material exploitation Abandonment Neglect Self-neglect

Physical AbusePhysical Abuse

The use of physical force that might result in bodily injury, physical pain, or impairment.◦Most readily substantiated form of abuse

Example: Mr. Smith is Mrs. Smith’s caregiver. Frustrated by Mrs. Smith’s refusal to bathe, Mr. Smith finally forces her into a bath and holds her there to clean her, resulting in bruises on her arms.

Sexual AbuseSexual AbuseNonconsensual sexual contact of any

kind with an older person.

Example: Mr. Jones, a midely demented resident in a supported housing complex mistakes Mrs. Doe, another resident, for his wife, and is found one afternoon lying on top of her in her bed and stroking her.

Emotional Emotional AbuseAbuseThe infliction of anguish,

pain, or distress

Example: Bill lives with his daughter, Susan, who provides him care. However, Susan constantly reminds Bill of the sacrifices she makes for him, tells him that he is ruining her life, and complains that he is a chore and a burden for her.

Financial ExploitationFinancial Exploitation

The illegal or improper use of an older person’s funds, property, or assets.

Example: In exchange for providing his mother with care, a son insists that she buy him alcohol and cigarettes, not leaving her enough money to pay for all of her medications.

AbandonmentAbandonmentThe desertion of an older person by an

individual who had physical custody or otherwise had assumed responsibility for providing care for an older person.

Example: Susan gets so frustrated with her demanding, agitated, father, that she storms out of the house one weekend for a “break,” leaving him completely alone and unsupervised for a number of days.

NeglectNeglectThe refusal or failure to

fulfill any part of a persons obligations or duties to an older personThe most difficult form of abuse to

validate

Example: Glenda is attempting to care for her frail mother while also caring for her four young children. Glenda is so busy with her children and home that her mother often goes unchanged after episodes of incontinence, resulting in a sacral ulceration.

Self-NeglectSelf-NeglectThe behaviors of an older person that

threaten his/her own health or safety.

Example: Beth tries to convince her father, John, to move into assisted living after he is diagnosed with early Alzheimer’s disease. He refuses, and when she finally visits him to speak to him in person, she finds him sitting alone in his house, physically weak and covered in filth. The house is filled with garbage and half-eaten meals, and infested with roaches.

Prevalence of specific types of Prevalence of specific types of abuseabuseNeglect 48.7%Psychological 35.4%Financial 30.2%Physical 25.6%Abandonment 3.6%Miscellaneous 1.4%Sexual 0.3%

Risk Factors for AbuseRisk Factors for Abuse1. Substance abuse history by the

caregiver Most likely alcoholism Incidence of addiction in an abuser is 35%

2. Older age◦ Elderly in the >80 age group are 2-3

times more likely to be abused or neglected.

3. History of depression or mental illness of the care recipient

◦ Occurs in 45-50% of victims

Risk Factors ContinuedRisk Factors Continued4. Low income5. Social isolation6. Minority status7. Low level of education8. Previous history of family

violence

Caregiver Burnout?Caregiver Burnout?Caregiver depression is sited as a

separate risk factor for abuse.Perception of stress by the caregiver

was correlated with increased abuse.

Victim’s aggressive behavior toward caregivers has been shown to increase the probability of physical abuse.

Recognizing the AbuserRecognizing the Abuser47% of abuse cases are committed by the spouse.19% of abuse cases were committed by the adult

child.Males abuse more often than females.Caregiver dependence on the victim for financial

assistance, housing, or other needs increases the risk for abuse.

Alcohol abuse is the most common risk factor for physical abuse.

A poor relationship between caregiver and care recipient is a predictor of stress that leads to abuse.

Recognizing the Recognizing the AbusedAbusedSuspicious factors:

◦Frequent admissions to multiple hospitals

◦Surgeries secondary to trauma◦Irregular medical follow-up◦Inattention to established medical needs

Missed appointments Unfilled prescriptions

◦Multiple, vague, complaints

Physical signs of abusePhysical signs of abusePoor hygienePoor nutritionPoor skin integrityContracturesPressure ulcersDehydration ImpactionMalnutrition Inappropriate dress

Unexplained bruisesRestraint marks on

wristsLacerationsAbrasionsHead injuryUnexplained fracturesBite marks Inguinal rashGenital pain, itching

Medical Implications of Medical Implications of AbuseAbuseReduced quality of life of abused patients

◦ Worsened functional status◦ Progressive dependency◦ Poorly rated self-health◦ Feelings of helplessness◦ Continued and worsened social isolation,

stress and further psychological decline Frequent ER visitsHigher rate of hospitalization of abusedHigher nursing home placement Abuse is an independent predictor for

higher mortality. ◦ Abused are 3 times more likely to die.

Why Health Care Providers Don’t Why Health Care Providers Don’t AskAsk

Lack of training in recognizing abuseLack of time in office to deal with issuesReluctance to attribute signs of

mistreatmentVictim isolationSubtle presentationsReluctance in confronting the offenderReluctance to report if abuse is only

“suspected”Lack of knowledge of how to reportEmpathy with abuserRequest of victim

How to AskHow to Ask

Interview should be conducted privately.

Should take the form of dialogue when possible.

Make questions a “routine” part of the interview.

Document answers meticulously, using interviewees own words whenever possible.

Screening QuestionsScreening Questions1. Has anyone ever touched you without your

consent?2. Has anyone ever made you do things you didn’t

want to do?3. Has anyone taken anything that was yours

without asking?4. Has anyone ever hurt you?5. Has anyone ever scolded or threatened you?6. Have you ever signed documents you didn’t

understand?7. Are you afraid of anyone at home?8. Are you alone a lot?9. Has anyone ever failed to help you take care of

yourself when you needed help?

Health Care Professional Health Care Professional ResponsibilitiesResponsibilities1. To recognize or suspect abuse and

neglect when present.2. To treat any medical problems

associated with such maltreatment.3. To ensure a safe disposition for the

patient.

Who Reports Abuse?Who Reports Abuse?

How to ReportHow to ReportCall Seniors Abuse Line:

1 888 896-7183In Winnipeg:(204) 945-1884

Age & OpportunityConfidential Intake Line:(204) 956-6440

Protection for Persons in Care Office:1 866 440-6366To report abuse in care facilities:(204) 788-6366 in Winnipeg

SummarySummaryAbuse is a very prevalent problem among

the quickly expanding geriatric population.Recognition of risk factors for abuse will

help the health care provider to know when to further question patients for signs of abuse.

Only through awareness and a healthy suspicion can you detect mistreatment.

Older people often rely on their the health care provider to help in dealing with abuse.

Once it is reasonably suspected, elder mistreatment should be reported to the appropriate authorities

Be Part of the SolutionBe Part of the Solution

www.olderadultabuse.mb.ca

Organize an event for

World Elder Abuse Awareness Day June 15 - Wear purple