Elder dignity, Elder dignity, abuse and abuse and

neglect - EDANneglect - EDANZdenek KalvachZdenek Kalvach

PraguePrague

HistoryHistory

1962 battered child syndrome1962 battered child syndrome Modification to child abuse and Modification to child abuse and

neglect (CAN)neglect (CAN) 1975 granny battering (Burston, 1975 granny battering (Burston, Br Br

Med J.Med J. ) ) Modification to elder abuse/ elder Modification to elder abuse/ elder

abuse and neglect (EAN) abuse and neglect (EAN)

DiversificationDiversification

Physical abuse - violencePhysical abuse - violence Emotional abuseEmotional abuse Sexual abuseSexual abuse Financial abuseFinancial abuse NeglectNeglect Self-neglectSelf-neglect Others Others

Multilevel problem Multilevel problem

Events: systematic Events: systematic versusversus casual casual Causes: general Causes: general versusversus proper proper Forms: huge Forms: huge versusversus questionable questionable

Multilevel problemMultilevel problem

1. Level of ones´s huge guilt 1. Level of ones´s huge guilt (pathology, adict, criminality)(pathology, adict, criminality)

Cruel violenceCruel violence Sexual abuseSexual abuse Financial exploitationFinancial exploitation Gross neglectGross neglect

Multilevel problemMultilevel problem

2. Level of mistakes under stress2. Level of mistakes under stress Burn out syndromeBurn out syndrome Helpless informal caregiversHelpless informal caregivers Lack of staff in hospitals/ nursing homesLack of staff in hospitals/ nursing homes

Common neglect Common neglect Common restraintsCommon restraints

Multilevel problemMultilevel problem

3. Level of ignorance, and banal evil 3. Level of ignorance, and banal evil Bad stereotyped approaches Bad stereotyped approaches Lack of knowledge on risks and Lack of knowledge on risks and

demandsdemands Ageistic rules = socialy acceptable Ageistic rules = socialy acceptable

systematic humiliation systematic humiliation

Dichotomy or Dichotomy or continuum? continuum?

GerontologyGerontology Dichotomy of „normal behaviour“ Dichotomy of „normal behaviour“

versus EAN (social/medical pathology)versus EAN (social/medical pathology) Problem with international and Problem with international and

intercultural standardization intercultural standardization

Dichotomy or Dichotomy or continuum?continuum?

Medicine Medicine Continuum from health to pathology Continuum from health to pathology Disease Disease versusversus sickness sickness

Disease - xenochtonic event Disease - xenochtonic event Sickness - autochtonic condition, subclinical Sickness - autochtonic condition, subclinical

course, „I do not feel well“ – without course, „I do not feel well“ – without patognomic symptomspatognomic symptoms

Dichotomy or Dichotomy or continuum?continuum?

Can gerontology learn from medicine?Can gerontology learn from medicine? Dichotomy of „normal behaviour“ versus Dichotomy of „normal behaviour“ versus

EAN (social/medical pathology)EAN (social/medical pathology) Continuum from „normal behaviour“ to Continuum from „normal behaviour“ to

EANEAN I do not well in this relation/community/ careI do not well in this relation/community/ care I do not feel comfortable, safe – without I do not feel comfortable, safe – without

patognomic symptoms patognomic symptoms Continuum of Elder Dignity, Abuse and Continuum of Elder Dignity, Abuse and

Neglect - Neglect - EDANEDAN

Elder Dignity, Abuse and Elder Dignity, Abuse and Neglect Neglect EDANEDAN

Including Including „„Set of untimely minutiae“ Set of untimely minutiae“ Early warning signsEarly warning signs Lack of respectLack of respect Lack of interest in him/herLack of interest in him/her Diminution of competency, satisfaction, Diminution of competency, satisfaction,

safetysafety Noteless beginning of tiredness of Noteless beginning of tiredness of

caregivers, path of agressor, „occasion of caregivers, path of agressor, „occasion of sin“sin“

Elder Dignity, Abuse and Elder Dignity, Abuse and Neglect Neglect EDANEDAN

Aspects of Aspects of Perpetrator (intent, guilt)Perpetrator (intent, guilt) Sufferer (suffering, feelings, Sufferer (suffering, feelings,

expectation)expectation) Future development (risks, progression)Future development (risks, progression) Context and degreeContext and degree Early preventionEarly prevention General anti-ageistic atmosphere in General anti-ageistic atmosphere in

societysociety

Two concepts of Two concepts of care/support of the frail care/support of the frail

elderlyelderly Existencial (holistic) concept of Existencial (holistic) concept of

meaningful lifemeaningful life Dignity: substantial premiseDignity: substantial premise Existential EDANExistential EDAN

Biological/economic (reductionist) Biological/economic (reductionist) concept of (cheap) basic care concept of (cheap) basic care Supported by demographic alarmismSupported by demographic alarmism Dignity: luxuryDignity: luxury Basic EAN – beating, violence, sexual Basic EAN – beating, violence, sexual

abuse, starvation, …abuse, starvation, …

Existential concept of Existential concept of EDAN and care of the frail EDAN and care of the frail

elderly elderly Suffering from Suffering from Lack of dignityLack of dignity Lack of sense and communicationLack of sense and communication Becoming a burdenBecoming a burdenAdoption ofAdoption of Meaning of life (V.E. Frankl)Meaning of life (V.E. Frankl) Sense of coherence (A. Antonovsky)Sense of coherence (A. Antonovsky) Transcendence (A. Maslow) Transcendence (A. Maslow)

A. Antonovsky: New A. Antonovsky: New paradigm of medicine (and paradigm of medicine (and

EAN?)EAN?)

Existential concept of Existential concept of EDAN and care of the frail EDAN and care of the frail

elderlyelderly „„Health is more than mere absence of Health is more than mere absence of

diseasedisease“ – WHO, A. Antonovsky“ – WHO, A. Antonovsky … … being a state of complete physical, being a state of complete physical,

mental and social well-beingmental and social well-being Quality assisted life is more than mere Quality assisted life is more than mere

absence of violence, abuse and neglect absence of violence, abuse and neglect as unsatisfaction of basic needsas unsatisfaction of basic needs … … being a continuity of one´s meaning of being a continuity of one´s meaning of

life, one´s sense of coherence, life, one´s sense of coherence, participation, respect and dignityparticipation, respect and dignity

Existential concept of Existential concept of EDAN and care of the frail EDAN and care of the frail

elderlyelderly PathogenesisPathogenesis SalutogenesisSalutogenesis DignitogenesisDignitogenesis – goalseeking – goalseeking

methodical tailored measures to support methodical tailored measures to support one´s meaning of life, sense of coherence one´s meaning of life, sense of coherence and self-respect. and self-respect.

Not only to be careful not to destroy Not only to be careful not to destroy dignity in family life, health care and dignity in family life, health care and social services but also to want to social services but also to want to strenghten it actively. strenghten it actively.