Perspectives on elder abuse in Ireland - PowerPoint Presentation

Slide1

Perspectives on elder abuse in Ireland

Dr. Amanda Phelan

Co-Director National Centre for the Protection of Older People

Amanda.phelan@ucd.ie/01

7166482Slide2

Irish Definition

A single or repeated act or lack of action occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person or violates their human and civil rights

’ Protecting our Future (2002).Slide3

Typologies

Physical abuse

Psychological AbuseFinancial abuseSexual abuseNeglect (commission/omission) AgeismStranger abuse not recognisedSelf NeglectSlide4

Health Service Executive Structure

Elder Abuse Services in

IrelandSlide5

National Center for the Protection of Older People

Established in 2008

Lead by the School of Nursing, Midwifery and Health Systems with collaborations from the School of Applied Social Science, School of Public Health and Population Science, the School of Medicine and Medical Science and the Geary Institute. Negotiated programme of research.Slide6

Outputs to dateSlide7

What influences the visibility of elder abuse?

Overt & and covert ageist perceptions (Phelan 2009, 2010, 2011, 2013) Confusion of physical and mental decline with elder abuse.

FamilyBusy practice areaDifficult topicDon’t know what to do

Uncomfortable

Assumption that care facilities

are satisfactory.Slide8

Measuring Prevalence of Abuse

in Ireland

Family, Professional carers, Close friend

Neighbours, Acquaintances

Strangers

Interviews with 2021older people

Position

of

Trust relationshipSlide9

In the previous 12-months

Financial

≥1

incident money or possessions stolen, forced to sign over property, change will

Physical

≥1

incidents slapped, pushed, restrained

Sexual

≥1

incident sexually spoken to touched

Psychological

≥

10

incidents or serious impact insulted, threatened, excluded, prevented seeing people

Neglect

≥

10

incidents or serious impact refusal or failure of carer to help with activities of daily living such as shopping, washing or dressing

Operational Definition

Inter-personal

abuse

Slide10

Prevalence of mistreatment was

2.2 %

(95% CI 1.41, 2.94)

Population

10,201

(6598, 13,757)

Clustering of abuse: 25% (psychological abuse)

Irish Prevalence

Mistreatment Types

Slide11

Adult Children 50% of the over mistreatment

Perpetrators

Relationship of Perpetrator to the Older PersonSlide12

84% perceived mistreatment had a very serous impact

Physical/Sexual abuse 100%

Financial abuse 89%

Psychological Abuse 68%

Neglect 50%

Impact

& Response

Response to MistreatmentSlide13

Any mistreatment since 65 years

Any Mistreatment 4%

Psychological 2.4%

Financial 1.4%

Neglect 1.2%

Physical/Sexual 0.7%

Alternative

Definition

Mistreatment wider Community (12-mth)

Any Mistreatment 2.9%

Financial 1.8%

Psychological 1.7%

Physical/Sexual 0.7%

Neglect 0.3%Slide14

Findings of Prevalence Study

12-month prevalence of abuse & neglect 2.2%

Over 10,000 people

Older person characteristics

Female

Age

Lower socio-economic circumstances

Health especially mental health

Social isolation

Perpetrator characteristics

Adult Children

Male

Middle age

Unemployment

AddictionSlide15

How big is the problem?

2.2%

12 mth

Position of trust

2.9%

12

mth

wider

community

4.0%

Age 65 yrs & POT

5.5%

Age 65 yrs wider

community

10,201

18,764

13,429

25,735Slide16

Prevalence of Elder Abuse

‘Impressionistic

estimates’ (Bonnie & Wallace 2003

)

HSE

referrals

(2,302 in 2011) vs. prevalence.

Abuse percentage

Study

and Year

Prevalence:

2-4%

O Keefe et al. 2007 (UK),

Naughton

et al 2010 (IRE)

Prevalence

: 18.4%Lowenstein (2003) (Israel)Prevalence: 11.4%Acerino et al (2010) (US)

Prevalence: 10%Amstader (2011) (South Carolina)Prevalence: 1:24Lifespan of Greater Rochester Inc.et al 2011

(NYS)Slide17

Elder abuse & dementia

Studies complicated by data being collected primarily from caregivers.

May not recognise abusive behavioursUnder-reportingPathological caregivers may not engage in research.Physical, psychological and neglect Slide18

Elder Abuse & Dementia

Older people with dementia are particularly prone to abuse (Cooper et al 2008,

Wiglesworth

et al 2010 )

Family caregivers may be unaware of actions that are abusive (Beech et al. 2005).

In a study Caring for Relative with dementia (CARD) over half reported physical or psychological abuse and one third met the criteria of significant abuse (Cooper et al. 2009).Slide19

Financial abuse

Nest egg

Family members and strangers were found to have perpetrated the abuse through spending money without permission, forced signing over of money/assets or having a forged signature.Family members were also found to have made imprudent decisions regarding finances, stolen money and also not provided the older person with copies of financial transactions. (Acierno et al. 2009)O

lder

people are 34 percent more likely than people in their 40s to lose money though scams

(Research & Consulting 2013)

Easy List, Mooch list!Slide20

Issues

Autonomy Vs. Risk.

Organisational ‘whistle-blowing’ policy (internal & external).Confidentiality policy.Slide21

Responses

Address ageism

Safeguarding approachChange culture- education, values and beliefs.Increase detection: contacts with older people, financial institutionsMulti disciplinary Interventions to meet individual need- health and social care, police and legal.Status functional capacity.Advocacy and empowerment‘Best interests’Slide22

The substance of decision making

Welfare extends beyond safety and physical health….to happiness.

We must adapt a pragmatic common sense and robust approach to the identification, evaluation and management of perceived risk…sensible risk appraisal not avoidance of riskDisproportional risk (Munby 2011) Slide23

Conclusions

Societal Reform:

Safeguarding approach: Legislation, policy.Education of older people and societyMulti-disciplinary and multi-agency response.Promote financial autonomyEnsure ‘best interests’.Screen, ask and assess financial capacityFinancial institutionsIndependent adviceSlide24

Thank you for your attention

Amanda.phelan@ucd.ie

01 7166482