NEGLECT, ABUSE AND VIOLENCE IN LATER LIFE:

Transcription

1 NEGLECT, ABUSE AND VIOLENCE IN LATER LIFE: INTERSECTIONALITY OF GENDER AND AGE Competing Paradigms of Elder Abuse: Learning from Intimate Partner Abuse, Active Aging, and Vulnerable Older Adult Research (Emphasis on Older Women) From an International Perspective Patricia Brownell, PhD, Associate Professor Emerita of Social Service, Fordham University, and Immediate Past President, National Committee for the Prevention of Elder Abuse Toronto, Ontario, November 22, 2017

2 Popula'on Ageing and Gender Global trend changing economics and socie3es around the world In 2012, people 60+ represented 11.5 percent of global popula3on; by 2050 will double to 22 percent. Older women outnumber older men: in 2012 for every 100 women age 60+ there were 84 men; for every 100 women age 80+ there were 61 men; by 2050, over 1 billion women 60+. The feminiza3on of ageing, represen3ng the intersec3on of age and gender, has important implica3ons for policy and prac3ce as the world con3nues to age Neglect, abuse and violence against older women remains largely invisible: it must become visible in order to end. 2

3 Differing Theore,cal Perspec,ves Different Research Frames based on different theore3cal bases use different age cohort data and different variables, and result in different and conflic3ng prevalence data. In3mate Partner Abuse: Old age may start at 30, 40, 50 or 60 or older Types of abuse: physical, sexual, psychological Underlying theory: power and control 3

4 In,mate Partner Violence Perpetrator categories: current or former spouse, partner or da3ng partner, or stranger in case of sexual abuse including rape Prevalence rates for older women: 1-3% (within year); 3-4% within 5 years Cumula3ve prevalence rates: (life3me 22% to 27%) 4

5 Ac,ve Ageing Age cohort: 60 years old and over Types of abuse: physical, sexual, psychological, financial exploita3on, neglect Perpetrator categories: Spouse/partner, adult children, grandchildren, other rela3ves, neighbors/friends, caregivers Prevalence rates for one year period: 10% - 39% Underlying theory: ageism 5

6 Vulnerable older Adult Perspec,ve Age ranges: 65 years and older Types of abuse: same as ac3ve ageing but some3mes including abandonment, self-neglect Perpetrator categories: same as ac3ve ageing but including strangers and some3mes self. Generally not disaggregated by gender so no prevalence rates generally reported Underlying theore3cal assump3on: vulnerability of vic3m (generally assumes cogni3ve impairment) 6

7 Human Rights Perspec,ve Uses life course, not life stage, perspec3ve Broadest range of perpetrators to include state actors as well Seangs can include ins3tu3onal seangs like care homes and prisons, as well a community Priori3zes race/ethnic minority popula3ons that are socially marginalized Types of abuse can include social isola3on, social exclusion and poverty Based on assump3on of older persons as rights holders and the state as duty bearer 7

8 UN Organiza,onal Changes to Promote Gender Equality UN Women founded in 2010 to include divisions focusing on women and human rights: Division for the Advancement of Women (DAW), Interna3onal Research and Training Ins3tute for the Advancement of Women (INSTRAW), United Na3ons Development Fund for Women (UNIFEM), and Office of the Special Advisor on Gender Issues and the Advancement of Women (OSAGI) Execu3ve Directors: Michelle Bachelet; Phumzile Mlambo-Ngcuka Value Perspec3ve feminist; shihs between life course perspec3ve and older women as other category 8

9 Division of Economic and Social Affairs Focal Point on Ageing Rosemary Lane Value perspec3ve: ac3ve ageing; aging gender neutral Language related to older women: girls and women of all ages all women and girls NGO involvement: NGO Commilee on the Status of Women (CSW); NGO Commilee on Ageing (IDOP) 9

10 NGO Community NGO Commilee on Ageing (Ac3ve Ageing) NGO Commilee on the Status of Women (Feminist) Sub-Commilee on Older Women (Intersec3onality of gender and age; linked both commilees above); disbanded in NYC in 2016 In 2010, moved from CSW to Ageing; in 2015 disbanded from Ageing in NY; con3nues in Commilees linked to Geneva and Vienna UN sites Role of NGOs with consulta3ve status: two func3ons provide expert informa3on to the UN (ECO SOC accredited NGOs; provide informa3on about the UN s ac3vi3es to the public (DPI accredited NGOs) 10

11 Documents promo,ng Human Rights of Older Women: SoK Law Madrid 2002 Interna3onal Plan of Ac3on on Ageing (nonbinding); 5 and 10 year reviews Conven3on for the Elimina3on of All Forms of Discrimina3on Against Women (binding), General Recommenda3on No. 27, Human Rights of Older Women (non-binding) Special Rapporteur on Domes3c Violence: Report on Older Vic3ms (Rashida Manjoo) Independent Expert on Human Rights of Older Persons: Report on Older Women (Rosa Kornfeld-Male) 11

12 WORLD ELDER ABUSE AWARENESS DAY World Elder Abuse Awareness Day (WEAAD) became a UN Day in December 2010, when the UN General Assembly voted to add WEAAD to the UN Calendar of special days June 15 is the designated day to reflect on the neglect, abuse and violence experienced by older people as a human rights viola3on WEAAD was first proposed by Dr. Elizabeth Podniek, of Toronto, Canada, who served as Vice President of the Interna3onal Network for the Preven3on of Elder Abuse (INPEA) and was one of its founding members in 1997 INPEA was recognized as an NGO with Special Consulta3ve Status by the UN in 2004, and is the only such NGO that focuses solely on preven3on of elder abuse from an interna3onal perspec3ve

13 NEGLECT, ABUSE AND VIOLENCE AGAINST OLDER WOMEN In a number of UN documents, older women are iden3fied as especially vulnerable to human rights abuses related to neglect, abuse and violence. These include: Madrid 2002 Interna3onal Plan of Ac3on on Ageing; CEDAW General Recommenda3on No. 27; Sustainable Development Goals (SDG); and Discussion Paper and Follow-up to the Expert Group Mee3ng on Neglect, Abuse and Violence Against Older Women.

14 Older Adult Abuse in Three Frames: Implica,ons for Older Women - fragmenta,on Neglect, abuse and violence against older women can be understood as : In3mate Partner Abuse (UN Women) (US DV system) Ac3ve Ageing (DESA) (US Aging system) Vulnerable Older Adult (High Commission for Human Rights rights based approach) (US APS system) 14

15 Imagine the next 3 slides depict women age 74 years When we think about domes3c violence we think ohen think about women of reproduc3ve age; When we think about abuse of older women in the community we ohen think about older mothers who are homebound and dependent, leading to caregiver stress; When we think about elder abuse, we ohen think about the elderly in nursing homes. 15

16 First, IPV 16

17 Ac,ve Ageing 17

18 Vulnerable Older Adult 18

19 What do these three women have in common? What is different? They are all the same age They are all vic3ms of family abuse They are all vic3ms of physical abuse They are all women What is different?! Their health status differs! They appear to have differing cogni3ve status! They represent different stereotypes of older women and abuse 19

20 Defini,ons of Older Adult Abuse: IPV In3mate partner abuse is defined as violence against women that incorporates in'mate partner violence (IPV), sexual violence by any perpetrator (spouse/partner; da,ng partner), and other forms of violence against women, such as physical violence commiced by acquaintances or strangers (Saltzman et al., 2002). This defini3on was developed by an expert panel convened by the United States of America (USA) Centers for Disease Control and Preven3on in 1996 to formulate a uniform defini3on and recommended data elements for gathering surveillance data on in3mate partner violence. This forms the basis of IPV research globally 20

21 Defini,ons of older adult abuse: Ac,ve Ageing In the Toronto Declara3on on the Global Preven3on of Elder Abuse (2002), elder abuse is defined as a single or repeated act, or lack of appropriate ac'on, occurring within any rela'onship where there is an expecta'on of trust which causes harm or distress to an older person. It can be of various forms: physical, psychological, emo'onal, sexual, and financial or simply reflect inten'onal or uninten'onal neglect (WHO/INPEA, 2002). 21

22 Defini,on of Older Adult Abuse: Vulnerable Elders Abuse of vulnerable older adults refers to inten'onal ac'ons that cause harm or create a serious risk of harm (whether or not harm is intended) to a vulnerable elder by a caregiver or other person who stands in a trust rela'onship to the elder, or failure by a caregiver to sa'sfy the elder s basic needs or protect the elder from harm (NRC, 2003, p. 40). This defini3on of elder abuse was developed by an expert panel (Panel to Review Risk and Prevalence of Elder Abuse and Neglect) convened by the Na3onal Research Council of the United States Na3onal Academy of Science. This informs research in the medical model Care dependency on the part of the vic3m is assumed. 22

23 Forms of Abuse Against Older Women Physical Sexual Emo3onal or psychological Financial Exploita3on Neglect Abandonment Harmful tradi3onal prac3ces Femicide 23

24 Abuse Against Older Women as a Human Rights Viola,on Madrid 2002 Interna3onal Plan of Ac3on on Ageing: Older women face greater risk of physical and psychological harm due to discriminatory societal aatudes. United Na3ons Principles of Human Rights for Older Persons: Living a life of dignity, free of abuse, is an important human right for all older people, including older women. Conven3on for the Elimina3on of All Forms of Discrimina3on Against Women (CEDAW): Violence against women is rooted in historical and structural inequity in power rela3ons between men and women. 24

25 Prevalence of Abuse Against Older Women Prevalence es3mates range from 1-2% of older women up to 38% of older women age 60+. Discrepancies are due to differences in theore3cal frameworks, measures used and samples drawn. Es3mates of life3me experiences of abuse remain fairly stable at 20-23%. 25

26 In,mate Partner Abuse and Older Women IPV studies that include older women in study samples show the lowest prevalence of abuse. Defini3onal criteria limit perpetrator categories to spouse/ partners, da3ng partners and strangers in instances of rape. Types of abuse are limited to physical, psychological and sexual. Loca3ons of abuse include home and community. Ages of sample par3cipants are ohen limited to women up to age 49 (Example: WHO study on Domes3c Violence). 26

27 Ac,ve Ageing and Abuse Studies in the ac3ve ageing framework include samples age 60+. Generally limited to abuse in the community. Abuse can include physical, sexual, psychological, financial, and neglect. Categories of perpetrators can include, in addi3on to spouse/partners, adult children and other rela3ves, neighbors and formal and informal caregivers. Example: AVOW study in 5 European na3ons 27

28 Vulnerable Older Adult Abuse Can include abuse in ins3tu3onal seangs like care homes and hospitals as well as community based. Older adult subjects ohen age 65+ and have physical and cogni3ve impairments. Perpetrators can include spouse/partners, adult children and other rela3ves, formal and informal care providers, and other residents of care homes and ins3tu3ons. Types of abuse can include physical, sexual, psychological, financial, neglect, abandonment. Example: studies on nursing home abuse. 28

29 Implica,ons of Different Frameworks Low prevalence found among older women in IPV studies: older women are more likely to be widowed (without spouse/partners); less likely to be raped by strangers (WHO, 2005) High prevalence found among older women in ac3ve ageing studies: older women are more likely to live with adult children, to be vic3ms of financial abuse, and to be caregivers for impaired abusive family members (Luoma et al., 2010). Unknown prevalence among vulnerable elderly women in care homes and ins3tu3onal seangs: older women in these seangs are more likely to be unable to self-report abuse, to be unavailable for studies that require informed consent. 29

30 Implica,ons for Policy and Prac,ce Laws and services based on prevailing stereotype of elder abuse, for example, adult protec3ve services in the USA. Older adult protec3ve programs that assume cogni3ve incapacity not appropriate for IPV with older woman vic3m. DV services assuming IPV not appropriate for older women vic3ms of adult child abuse. Concept and Impact of polyvic3miza3on not generally recognized in elder abuse field. 30

31 What professionals and policy makers need to know about interven,ons: IPV IPV in later life: DV shelters ohen don t offer ageappropriate programs for older women; can t admit care dependent vic3ms Law Enforcement: older women may resist repor3ng abuse by family members to police Guardianships are not appropriate for vic3ms who have capacity Criminal and family court: may minimize abuse of older women although orders of protec3on can be helpful if used appropriately. 31

32 Ac,ve Ageing in the Community Aging service programs can provide temporary assistance with meals, social programs like senior centers, interim homecare, transporta3on to courts, link to law enforcement for seniors Adult Protec've Services (APS) may be useful in assessing capacity and need for social services; link to District Alorney offices; law enforcement; local and state service structure in US Community-based elder abuse programs with counseling, support groups are available in some communi3es (not many) Faith Communi'es can provide opportuni3es for outreach and abuse preven3on; limited capacity for assistance, interven3on for abuse among members and families. 32

33 Vulnerable Older Adult Abuse For community dwelling older women: APS services (interna3onally, Singapore has begun an APS-like program; most western countries have not however some provincial programs exist in Canada and UK) For ins'tu'onalized older women: Ombudsman services through aging service networks in USA, some APS services in jurisdic3ons that include nursing homes as part of territory For older women who lack capacity: guardianships; district alorney offices and forensic centers in USA 33

34 Life Course Perspec,ve Some studies have found correla3on between child abuse and elder abuse (McDonald & Thomas, 2014; Podnieks, 2000) University of Toronto. Includes older women in the life course trajectory (girls, women of reproduc3ve age, older women) Demonstrates cumula3ve disadvantages at intersec3ons of gender and age for older women Dis3nguishes between elites and other women Feminist gerontology provides framework for understanding abuse in later life. 34

35 Human Rights Perspec,ve Rights bearers and duty bearers/rights enforcers Governments responsible for enforcing human rights of older adults. Challenges residual approach to social welfare policy (charity by NGOs) Stresses en3tlement approach, rights based; empowerment 35

36 Barriers to Effec,ve Elder Abuse Prac,ce Ageism remains a significant barrier to effec3ve prac3ce with older women and abuse. Prac33oners and researchers must work together to reach a beler understanding of the unique needs of older women vic3ms of neglect, abuse and violence. Research can inform prac3ce. A new list serve of the NAPSA and NCPEA allows prac33oners to ask ques3ons of researchers about prac3ce concerns (r2plistserv@napsa-now.org). In a technical guide on producing sta3s3cs on violence against women promulgated by the United Na3ons Department of Economics and Social Affairs in 2013, readers are advised that some countries have opted to set an upper age limit for respondents, the reasons being that older people are more prone to memory recall problems and tend to have a general reluctance to discuss sensi8ve subjects It is also likely than an older age category will be too small to allow for separate analysis (United Na3ons, 2013, p.15). Misguided and misinformed statements like this discourage researchers from including older women in studies on violence against women, and seemingly encourage na3ons to exclude data on older women from domes3c violence reports that inform na3onal and interna3onal policy making. Funding limita3ons drive choices as well. Lack of research on older women and abuse limit policymakers and prac33oners ability to make informed choices about needed resources and appropriate interven3ons. 36

37 CHALLENGES TO THE STEREOTYPES: Educa,ng professional and policymakers Miss Mary interview (from Terra Nova Films) challenges stereotype that older women refuse to discuss abuse. hlps://drive.google.com/drive/folders/0b0xctcqoe7yuqw90nefwdju5uuu Norman interview (from Terra Nova Films) challenges stereotype that older men are not vic3ms of abuse, including polyvic3miza3on. However, mo3ve for older women s involvement not examined. hlps://drive.google.com/drive/folders/0b0xctcqoe7yuy3ruoe55mtk1dtg Discussion of professional prac3ces in work with vic3ms from minority cultures. Na3onal Commilee for the Preven3on of Elder Abuse (NCPEA) online curriculum provides an excellent training and educa3onal resource for professionals and policymakers on polyvic3miza3on in later life. This can be downloaded from the US Department of Jus3ce Office of Vic3ms of Crimes website: hlps://ovclac.gov/views/trainingmaterials/dsponline_polyvic3miza3on.cfm

38 Recommenda,ons on how to promote interests of older women at the UN Expand defini3on of perpetrators beyond spouse/partner to other family members and trusted others; Con3nue to define domes3c violence of older women as human rights viola3on; Challenge marginaliza3on of older women within society and the interna3onal women s movement, as ageist and unacceptable; Ensure the voices of older women are included in all forums and discussions on women and domes3c violence. 38

39 Recommenda,ons on how to promote interests of older women at the UN Obtain data at country level on abuse of older women age 60 and above (disaggregated by age and gender); Include older women in documents on domes3c violence and women (for example, The World s Women, Trends and Sta3s3cs (DESA, 2010), has no men3on of older women and abuse in its DV sec3on); Conduct outcome research on interven3ons for older women vic3ms of abuse, including evalua3ons on legisla3on intended to protect older women from abuse; Within the DV movement, expand defini3ons of family violence beyond physical and sexual to include emo3onal abuse, financial exploita3on, abandonment and neglect;

40 Gaps in Preven,on and Interven,on Interna3onally, na3onal legisla3ve ini3a3ves, when they exist, largely have been bifurcated between domes3c violence and aging or protec3ve service approaches. Older women ohen fail to fit into either approach. When the problem is in3mate partner abuse, older women may be referred to aging service programs that lack capacity to address domes3c violence among elder spouse/partners. Older women may not meet the eligibility requirements for protec3ve services for the elderly, such as guardianships, if they are not physically or cogni3vely frail. Consequently, older women vic3ms of abuse are likely to fall between the cracks of a bifurcated legisla3ve and legal system. In addi3on, laws related to abuse and neglect of older women by family members or formal caregivers may be legislated but not funded. Policy implementa3on gaps; policy versus prac3ce.

41 Summary and Recommenda,ons This discussion of prevalence of neglect, abuse and violence against older women based on different and some3mes compe3ng conceptual frameworks demonstrates the difficul3es in using these data to understand and promote older women s right to live free of abuse. In order to address the current fragmenta3on in services to older women and neglect, abuse and violence, prac3ce and research communi3es must come together to address gaps in knowledge and prac3ce, eliminate ageist stereotypes, and reflect a more holis3c view of older women in society. 41

42 Summary and Recommenda,ons DV service system should acknowledge older women and plan to accommodate them. Shelters should be culturally, age, and gender sensi3ve. Shelters should be culturally, age, and gender sensi3ve. APS service system may be appropriate for older women who lack capacity. Nursing home-based shelter op3ons could be appropriate for care dependent vic3ms of abuse. Aging service system can work collabora3vely with law enforcement to address crimes against older women, par3cularly those commiled by adult rela3ves. Professionals should be familiar with elder abuse and the various service systems that serve older women vic3ms of neglect, abuse and violence. Interna3onal policy influenced by US and UK systems and services (for example, Singapore; Hong Kong). 42

43 Contact me for references and resources: Also: neglect-abuse-violence-older-women.pdf Thank you! 43