What does the evidence tell us about elder abuse?

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1 What does the evidence tell us about elder abuse? Associate Professor Briony Dow Director, National Ageing Research Institute Associate Professor of Ageing, University of Melbourne Elder abuse in an ageing society: Issues, challenges and approaches Sydney 27 th Sept 2016

2 To improve the health and wellbeing of older people through research and research translation

3 What is elder abuse? A single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person (WHO website) Physical threatening, punching shoving Psychological emotional blackmail, put downs Financial abuse of PoA, inheritance impatience, dodgy housing arrangements Social isolation of the older person Neglect not meeting care needs Sexual unwanted touching, forced to watch porn

4 Consequences of abuse Reduced QOL, increased morbidity and mortality 2500 deaths in Europe annually (WHO, 2011) Depression, anxiety, fear, unworthiness Suicide USD 5.3 billion in health costs annually $A million 2007/08 (Choo et al, 2013)

5 Prevalence of abuse No Australian prevalence study Range of international estimates Definition of abuse and person of trust, sample, settings all vary WHO (2015) estimated 2-14% in high and middle income countries Financial (1-9%) Psychological (1-6%) Physical (0-5%) Sexual (0-1%) Neglect (0-6%) Recent AIFs review concluded 2-10% prevalence in Aust with neglect higher

6 Analysis of Seniors Rights Victoria Helpline Data July 2012-June calls (60% abuse) Type of abuse Number of clients financial psychological physical social neglect sexual % of total (755)

7 Analysis of Seniors Rights Victoria Helpline Data 2 Clients 72.5% female Perpetrators 60% male 92% related to older person (family or de facto) 67% son or daughter Risk factors Living with adult child Living alone (financial) Substance abuse/gambling/mental health issues

8 Risk factors for abuse Older person Cognitive impairment/dementia Functional dependency/disability Poor physical health/ frailty Psychiatric illness/psychological problems Social isolation/lack of social support Co-residency with perpetrator (except for financial abuse) Loneliness Traumatic life events, including past abuse Low income/ income dependency Belonging to a minority/nondominant culture Substance abuse Person of trust Psychiatric/psychological problems Substance abuse Social isolation/lack of social support Childhood experience of family violence Caregiver stress Domineering personality traits Financial problems Dependency on older person

9 Conceptualising elder abuse - family violence? Similarities Power imbalance Reluctance to report Fear of consequences to self and perpetrator Fear of loss of relationship Lack of options Person being abused feels responsible Gendered Risk factors Misogyny/ageism Differences More often intergenerational Not always family Can be institutional More dynamic power relationships across life course Not always driven by anger/need to control Context of care relationships Neglect

10 Conceptualising elder abuse - caregiver stress? 25% of caregivers acknowledge abusive acts (Cooper et al, 2008) Mainly psychological shouting, threatening restraining locking in a room or restraining using a chair Not all caregivers abuse Also some are abused Caregiving interacts with family conflict and other issues

11 Approaches to elder abuse Protectionist Views older people as vulnerable/needing protection Focused on need to be cared for/stress of caring as explanatory Does not account for abuse of capable older people Often the perpetrator is the dependant Empowerment Assumes that adults are capable of making informed decisions Approach should be to empower them to take action/support them in their decisions Limitations for older people who have limited decision making capacity/dependent on others

12 Elder abuse is a complex overlap of issues to do with ageism, family violence and conflict, caregiving, gender and culture

13 What can be done to prevent/stop elder abuse?

14 Evidence based interventions older person Legal approaches (particularly for financial abuse) criminal justice and court orders protecting/restoring assets contracts and care planning Best when coupled with case management advocacy counselling support services (health, home and social support) Multidisciplinary teams Behavioural change approaches coping and resilience

15 Potential interventions Family-inclusive interventions mediation family group conferences Health justice partnerships Co-location of lawyer in health services

16 Caregivers Interventions can reduce risk factors (such as anxiety, depression and perception of burden) but no evidence of reduction in abuse/conflict Anger management interventions have been shown to reduce risk of physical abuse.

17 Interventions - professionals Educating health professionals about elder abuse can improve detection, knowledge and management.

18 Interventions - society No evidence that community awareness campaigns reduce elder abuse, but they have been shown to alter public perceptions of older people.

19 Questions to be answered Prevalence and nature in Australia Effective interventions/programs Including interventions for person of trust Institutional abuse collective responsibility?

20 Questions?

21 References Baker, P. R. A., Francis, D. P., Hairi, N. N., Othman, S., & Choo, W. Y. (2016). Interventions for preventing abuse in the elderly. Cochrane Database of Systematic Reviews(8). doi: / CD pub2 Choo, W. Y., Hairi, N. N., Francis, D. P., & Baker, P. R. A. (2013). Interventions for preventing abuse in the elderly (protocol): John Wiley & Sons, Ltd, Cooper, C., Selwood, A., & Livingston, G. (2008). The prevalence of elder abuse and neglect: a systematic review. Age and Ageing(2), 151. Johannesen, M., & LoGiudice, D. (2013). Elder abuse: a systematic review of risk factors in communitydwelling elders. Age and Ageing, 42(3), doi: /ageing/afs195 Joosten, M., Dow, B., & Blakey, J. (2015). Profile of elder abuse in Victoria: Analysis of data about people seeking help from Seniors Rights Victoria. Melbourne: National Ageing Research Institute and Seniors Rights Victoria. Kaspiew, R., Carson, R., & Rhoades, H. (2016). Elder abuse: Understanding issues, frameworks and responses. Canberra: Australian Institute of Family Studies. O'Donnell, D., Phelan, a., & Fealy, G. (2015). Interventions and services which address elder abuse: an integrated review: NCPOP, University College Dublin. Pillemer, K., Burnes, D., Riffin, C., & Lachs, M. S. (2016). Elder Abuse: Global Situation, Risk Factors, and Prevention Strategies. [Article]. Gerontologist, 56, S194-S205. doi: /geront/gnw004 World Health Organization. (2015). World report on ageing and health. Geneva: WHO. World Health Organization. (2011). European report on preventing elder maltreatment. In D. Sethi, S. Wood, F. Mitis, M. Bellis, B. Penhale, I. Iborra Marmolejo, A. Lowenstein, G. Manthorpe & F. Ulvestad Karki (Eds.): World Health Organization. World Health Organisation website

National Ageing Research Institute and Australian Association of Gerontology

National Ageing Research Institute and Australian Association of Gerontology The National Ageing Research Institute (NARI) is recognised as a leading research institute in the area of ageing including