Perspectives on elder abuse in Ireland

Dr. Amanda PhelanCo-Director National Centre for the Protection of Older

People

Amanda.phelan@ucd.ie/01 7166482

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).

Typologies

• Physical abuse• Psychological Abuse• Financial abuse• Sexual abuse• Neglect (commission/omission) • Ageism• Stranger abuse not recognised• Self Neglect

Health Service Executive Structure

National Steering Committee

Regional Steering Committee

Dedicated Regional Officer32 Senior Case Workers for the Protection

of Older People

Sub committees 1) media and public awareness group, 2) staff awareness

and curriculum group, 3) policies, procedures, protocols and guidelines groups and 4) financial abuse of older

people group.

Elder Abuse Services in Ireland

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.

Outputs to date

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.• Family• Busy practice area• Difficult topic• Don’t know what to do• Uncomfortable• Assumption that care facilities are satisfactory.

Measuring Prevalence of Abuse in Ireland

Family, Professional carers, Close friend

Neighbours, Acquaintances

Strangers

Interviews with 2021older people

Position of Trust relationship

In the previous 12-monthsFinancial ≥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

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

Adult Children 50% of the over mistreatment

Perpetrators

Relationship of Perpetrator to the Older Person

84% perceived mistreatment had a very serous impactPhysical/Sexual abuse 100%Financial abuse 89%Psychological Abuse 68%Neglect 50%

Impact & Response

Response to Mistreatment

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%

Findings of Prevalence Study

• 12-month prevalence of abuse & neglect 2.2%

• Over 10,000 peopleOlder person characteristics

FemaleAgeLower socio-economic circumstancesHealth especially mental healthSocial isolation

Perpetrator characteristicsAdult ChildrenMaleMiddle ageUnemploymentAddiction

How big is the problem?

2.2%

12 mthPosition of trust

2.9%

12 mth wider community

4.0%

Age 65 yrs & POT

5.5%

Age 65 yrs wider community

10,201 18,76413,429 25,735

Prevalence of Elder Abuse

‘Impressionistic estimates’ (Bonnie & Wallace 2003 ) HSE referrals (2,302 in 2011) vs. prevalence.

Abuse percentage Study and YearPrevalence: 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: 1:24 Lifespan of Greater Rochester Inc.et al 2011 (NYS)

Elder abuse & dementia

• Studies complicated by data being collected primarily from caregivers.

• May not recognise abusive behaviours• Under-reporting• Pathological caregivers may not engage in

research.• Physical, psychological and neglect

Elder Abuse & DementiaOlder 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).

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)

• Older people are 34 percent more likely than people in their 40s to lose money though scams (Research & Consulting 2013)

• Easy List, Mooch list!

Issues• Autonomy Vs. Risk.

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

• Confidentiality policy.

Responses

• Address ageism• Safeguarding approach• Change culture- education, values and beliefs.• Increase detection: contacts with older people, financial

institutions• Multi disciplinary Interventions to meet individual need-

health and social care, police and legal.• Status functional capacity.• Advocacy and empowerment• ‘Best interests’

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 risk

• Disproportional risk (Munby 2011)

Conclusions

• Societal Reform: Safeguarding approach: Legislation, policy.

• Education of older people and society• Multi-disciplinary and multi-agency response.• Promote financial autonomy• Ensure ‘best interests’.• Screen, ask and assess financial capacity• Financial institutions• Independent advice

Thank you for your attention

Amanda.phelan@ucd.ie01 7166482