Abuse of Older Manitobans

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Abuse of Older Manitobans

• Moira Horgan Jones
• Network Coordinator

MANITOBA NETWORK FOR THE PREVENTION OF ABUSE OF
OLDER ADULTS
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Outline of Presentation

• Obtain a better understanding of the prevalence
  of abuse of older Manitobans
• Differentiate types of abuse
• Recognize risk factors
• Discuss medical implications of abuse of older
  adults
• What you should do if you suspect abuse

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Introduction

• Language Elder, senior, older adult
• Manitoba 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.

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Network Goals

• Support Regional and Community Efforts
• Develop/Adapt Education and Training Resources
• Raise Public Awareness
• Encourage research and advise on issues relating
  to abuse of older adults

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Network

• Funded by the Seniors and Healthy Aging
  Secretariat
• Led by MSOS
• Housed at MSOS
• Over 30 partners and growing
• Study of other Canadian Networks
• Website
• Building our Future

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A Little Bit of Trivia

• Classical 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 kings
  maltreatment by his sons.

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Canadian 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).

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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.

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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.

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Manitoba 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 (AO)
• 2008 First Manitoba Conference
• 2009 CAG in Winnipeg devotes one day to abuse
  issues
• 2010 Building our Future consultations and
  strategy for change

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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 the Prevention of
Elder Abuse (CNPEA)
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Prevalence of Elder Abuse

• Actual 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

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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

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Definition of Abuse of Older 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.

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Types of Elder Abuse

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

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Physical 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. Smiths caregiver.
  Frustrated by Mrs. Smiths refusal to bathe, Mr.
  Smith finally forces her into a bath and holds
  her there to clean her, resulting in bruises on
  her arms.

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Sexual Abuse

• Nonconsensual 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.

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Emotional Abuse

• The 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.

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Financial Exploitation

• The illegal or improper use of an older persons
  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.

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Abandonment

• The 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.

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Neglect

• The refusal or failure to fulfill
  any part of a persons obligations or
  duties to an older person
• The 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.

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Self-Neglect

• The 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 Alzheimers 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.

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Prevalence of specific types of abuse

• Neglect 48.7
• Psychological 35.4
• Financial 30.2
• Physical 25.6
• Abandonment 3.6
• Miscellaneous 1.4
• Sexual 0.3

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Risk Factors for Abuse

• Substance abuse history by the caregiver
• Most likely alcoholism
• Incidence of addiction in an abuser is 35
• Older age
• Elderly in the gt80 age group are 2-3 times more
  likely to be abused or neglected.
• History of depression or mental illness of the
  care recipient
• Occurs in 45-50 of victims

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Risk Factors Continued

1. Low income
2. Social isolation
3. Minority status
4. Low level of education
5. Previous history of family violence

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Caregiver Burnout?

• Caregiver depression is sited as a separate risk
  factor for abuse.
• Perception of stress by the caregiver was
  correlated with increased abuse.
• Victims aggressive behavior toward caregivers
  has been shown to increase the probability of
  physical abuse.

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Recognizing the Abuser

• 47 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.

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Recognizing the Abused

• Suspicious 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

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Physical signs of abuse

• Poor hygiene
• Poor nutrition
• Poor skin integrity
• Contractures
• Pressure ulcers
• Dehydration
• Impaction
• Malnutrition
• Inappropriate dress

• Unexplained bruises
• Restraint marks on wrists
• Lacerations
• Abrasions
• Head injury
• Unexplained fractures
• Bite marks
• Inguinal rash
• Genital pain, itching

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Medical Implications of Abuse

• Reduced 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 visits
• Higher rate of hospitalization of abused
• Higher nursing home placement
• Abuse is an independent predictor for higher
  mortality.
• Abused are 3 times more likely to die.

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Why Health Care Providers Dont Ask

• Lack of training in recognizing abuse
• Lack of time in office to deal with issues
• Reluctance to attribute signs of mistreatment
• Victim isolation
• Subtle presentations
• Reluctance in confronting the offender
• Reluctance to report if abuse is only suspected
• Lack of knowledge of how to report
• Empathy with abuser
• Request of victim

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How 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.

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Screening Questions

1. Has anyone ever touched you without your consent?
2. Has anyone ever made you do things you didnt
   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 didnt
   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?

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Health Care Professional Responsibilities

1. 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.

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Who Reports Abuse?
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How to Report

• Call Seniors Abuse Line1 888 896-7183In
  Winnipeg(204) 945-1884
• Age Opportunity
• Confidential Intake Line(204) 956-6440
• Protection for Persons in Care Office1 866
  440-6366To report abuse in care
  facilities(204) 788-6366 in Winnipeg

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Summary

• Abuse 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

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Be Part of the Solution

• www.olderadultabuse.mb.ca

Organize an event for
World Elder Abuse Awareness Day June 15 - Wear
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