elder abuse victims lisa nerenberg

(1)

Elder Abuse Victims and Services

Lisa Nerenberg MSW, MPH

The 11th Asian Post Graduate Course on Victimology and Victim Assistance

July 22, 2011

(2)

f

 _{The definition is evolving}

 Traditionally, referred to mistreatment by family members

or people in positions of trust or confidence, and required that elders be “vulnerable” or “dependent.”

 Definition has expanded to include victims of consumer

fraud targeted against elders, abuse in institutions

.

 Increasingly viewed as “elder rights” issue.

(3)

Extent of

Problem

 _{One in 10 older adults in U.S. report emotional, physical, sexual}

mistreatment, or potential neglect each year (Acierno et. al., 2009)  Emotional abuse: 4.6%

 Physical abuse 1.6%  Sexual abuse: 0.6%

 Potential neglect (need for assistance not addressed): 5.1%  Current financial abuse: 5.2%

 Lifetime financial exploitation by non-family: 6.5%.

(4)

Physical Abuse

(5)

Sexual Abuse

Non-consensual sexual contact of any kind with an elder person.

Includes rape, sodomy, molestation, and sexual contact with anyone who is incapable of giving consent.

QuickTime™ and a decompressor

(6)

Emotional Abuse

Infliction of anguish, pain, or distress through

(7)

Financial, or Material, Exploitation

(8)

Abandonment

Desertion of an elder by an individual who has physical custody of the elder or by a person who has assumed responsibility for

(9)

Neglect

Refusal or failure to fulfill any part of a caregiver’s obligations or

duties to an elderly person

(10)

Isolation

 _{Preventing elders from having visitors, receiving mail, or using}

the phone or computer

 _{Confining elders to rooms, homes, or apartments}

 _{Preventing elders from using assistive devices like canes,}

glasses, or hearing aids that enable them to receive information or communicate with others

 _{Preventing elders from using social services or reporting}

problems

(11)

Institutional Abuse

 _{Abuse committed in long-term care facilities (nursing homes,}

(12)

Reasons for Abuse

 Financial gain

 Dysfunction (including substance abuse and mental illness)  Caregiver issues

(13)



Depends on:



_{Type of abuse}



_Setting



_{Culture or country}

(14)

General Risk factors

 Isolation

 Gender. More reports of abuse to women

 Women over-represented in higher age brackets

 Men may actually be at greater risk

 Physical and/or cognitive impairments  Shared living arrangement

 Physically or verbally aggressive  Recent losses

 Residents of facilities who lack families, advocates, or

(15)

Risk factors by type of abuse

 Victims of neglect more likely to have physical impairments

(Pillemer & Finkelhor, 1988)

 Victims of physical abuse more likely to live with abusers

(Pillemer & Finkelhor, 1988)

 Victims of financial abuse vary by type of abuse

 Victims of misused documents likely to have cognitive

impairments (Rabiner, O'Keeffe, & Brown, 2006)

 Victims of consumer fraud (e.g. investment fraud) less

likely to have cognitive impairment (NASD Investor Education Foundation, WISE Senior Services, & AARP Foundation, 2006).

 Dementia. 48% of caregivers for dementia patients were

(16)

Victims’

perceptions of abuse

is culturally determined

• Study of attitudes of European-American, African-American, Puerto Rican and Japanese-American older adults found that African-American and

Japanese-American seniors view psych abuse as worst form (Anetzberger, Korbin, & Tomita, 1996).

• Korean elders identify financial, psychological, and physical abuse, and neglect within context of "hyo," the traditional value of filial piety (Chang & Moon, 1997).

(17)

Impact of abuse

 Increased mortality _{(Lachs, Williams, O'Brien, Pillemer &}

Charlson, 1998)

 Depression _{(Mouton, Rodabough, Rovi, Brzyski, & Katerndahl,}

2010; Begle, Strachan, Cisler, Amstadter, Hernandez, & Acierno, 2010).

 Shame

 Hopelessness  Isolation

(18)

Risk Factors of Abusers

 Criminal record or a history of violence, substance abuse, gambling and other debt

 Sense of entitlement to the elder’s resources  Mental health problems including mental illness  Stress

 Social isolation

 Recent changes in family relationships or living arrangements

(19)

T Treatment and interventions

reatment and interventions

 _{Draw from multiple disciplines}

 Child abuse/mandatory reporting in U.S.

 Mandate professionals and encourage concerned citizens to report to public agencies

 Public agencies investigate and offer services

 Services are voluntary (many victims refuse out of fear, shame, loyalty to abusers, etc.

 Domestic violence

 Prosecution (special prosecution units, forensics research, elder courts)  Shelters adapted for elders

 Safety planning  Restraining orders

(20)

Treatment and interventions (cont.)

 Public health

 Public awareness to promote intergenerational respect  Universal screening by health care professionals

 Caregiving

 Screening of caregivers to detect high risk

 Support to caregivers, including monetary aid, respite, training  Victimology/victim rights

 Restorative Justice  Mediation

(21)

International Focus

 International Network for the Prevention of Elder Abuse

(INPEA)

 World Elder Abuse Awareness Day (June 15) to raise

awareness

 Studies elder abuse worldwide

 International NGO Coalition for the Rights of Older People

(includes AARP, Global Action on Aging, HelpAge

(22)

Who

 Goal: To identify key themes, perceptions, beliefs, and

attitudes about abuse by elders and health care workers in developing and developed countries

 Developing countries: Argentina, Brazil, India, Kenya,

Lebanon

 Developed countries: Austria, Canada, Sweden

 Participants asked:

 _{What do you consider to be abusive conduct?}  _{Contexts in which it occurs}

 _Causes

 _Consequences  _{Seasonal patterns}

 _{Overall status, well-being, unmet needs of elders}

(23)



_{Focus groups viewed abuse as societal concern with}

gender and socio-economic status emerging as key

factors.



_Disrespect

_{identified as most painful form of}

mistreatment by older adults in all countries.

(24)

Themes



Poor suffer most.



Childless,widowed women most affected.



Lack of pensions (worldwide, only 30% of elders

covered by pension schemes).



Lack of access to health care and social services.

 Decreasing rates of communicable diseases in

developing world have increased prevalence of long-term, disabling diseases.

 Worst off are poor, elderly, and women

(25)

The

 Changing social roles and breakdown of family

responsibilities

 Fewer women stay at home and provide care

 Breakdown of family responsibilities, loss of filial piety Lack

of training and resources for health care providers, and negative treatment results in poor treatment of patients.

 Economic crises contribute

 The media promotes ageist attitudes and negative

stereotypes.

 Low status of health care providers results in lack of

training and resources results in poor treatment of patients.

(26)

UN i

 _{Convention on the Elimination of All Forms of Discrimination}

Against Women (CEDAW)

 Established working group to draft recommendations on older women’s rights. Recommendations approved by General Assembly in 2010:

 Defines older women as a separate category.

 Recognizes elder abuse as a form of domestic violence.

 _{Efforts to create a new UN convention on the Rights of Older}

Persons

 Madrid International Plan of Action on Ageing (MIPAA), an “aspirational

document” endorsed by 159 governments at 2nd World Assembly on Ageing in 2002. Encourages governments to include older people in policies and social and economic development policies;

 _{Some nations and associations have taken steps}