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Number of Chronically Disabled Americans Age 65 and Over

Source: National Long Term Care Survey 1982-1994 (Kenneth Manton, Ph.D.)

(In Millions)

6.4

7.0 7.17.3

7.5

6.4

7.5

8.38.7

9.1

7.37.5

8.79.1

1982 1984 1986 1988 . 1990 1992 1994 1996 1998

4.0

6.0

8.0

10.0

Based on declining disabil i ty rate since 1982

If disabil ity rate did not change since 1982

(projected)

Note: The U.S. elderly population (age 65+) totaled 26.9 million in 1982, 30.8 million in 1989, 33.7 million in 1994, 34.1 million in 1996, and 34.8 million in 1998 (1996 and 1998 are projections).


Damned nuisance, all those windows….

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What, then, is time? If no one asks me, I know what it is.

If I wish to explain it to him who asks me, I do not know. Augustine, Confessions, Chapter XIV


Aspects of aging in later life

• Positive• Inter-individual variability

– more complex

• Reduced reserve/homeostasis– homeostenosis

…, in a word, COMPLEXITY!


Madrid Action Plan on Ageing

• Older persons and development

• Advancing health and well-being into old age

• Ensuring enabling and supportive environments

2002


Madrid - 3 Priority Directions

• Older persons and development– 8 Issues, 14 Objectives, 107 Actions

• Advancing health and well-being into old age– 6 Issues, 13 Objectives, 81 Actions

• Ensuring enabling and supportive environments– 4 Issues, 9 Objectives, 51 Actions


Ensuring enabling and supportive environments

• Neglect, abuse and violence– Eliminate all forms of neglect, abuse

and violence at older persons– Creation of support services to

address elder abuse


Primary Care

• Practical, scientifically sound and socially acceptable

• Train primary healthcare worker in gerontology and geriatrics

Article 70

Article 75


Specialist Needs

• Health care designed to need the specialist needs of older people must be made available, taking into account the introduction of geriatric medicine and gerontology into relevant university curricula and healthcare systems

Article 59


Changing carepatterns

Ageism

Domestic violence

Gerontolism

Wisdom

Economic vulnerability

Disability

Heterogeneity

Child abuse


Research, research, research….

Less than 50 empirical studies in the peer-reviewed literature

NAS, 2002


Medline

• 25, 355 Domestic Violence• 1,108 include older people• 96 IPV and older people


Invisibility….

• Lancet 2002, 2006• Limited to ages 15-49

QuickTime™ and a decompressor

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Elder abuse

First formal report 1975 First Irish reports 1990 NCAOP report 1998 Working Group 1999 Report accepted as health policy

2002 National implementation group 2003


Working group

Older people Health Boards Social workers Public Health

Nurses Residential care

PsychiatrySocial WorkPsychologyINHOGardaí

Police Family doctors Geriatric Medicine Psychiatry of Old

Age Psychiatry

http://www.dohc.ie/publications/pdf/pof.pdf


Elder Abuse

..is not a legal issue…it is a health and social care issue

Gordon AshtonGordon Ashton


Philosophy

Care context Good practice Training Appropriate staffing


‘‘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 or violates their human and civil rights.’’


Types

• Psychological• Financial • Physical• Neglect• Sexual abuse


UK Prevalence Study

• Neglect 1.1%• Financial 0.7%• Psychological 0.4%• Physical 0.4%• Sexual 0.2%

• 6% of those abused within previous year report 2 types of mistreatment

• Underestimate - no nursing homes, none with significant dementia


Changes with age




Association

• Women– Financial increases with age for men– Advanced age, more men than

women

• Poor health• Rented Accomodation• Loneliness


Perpetrator

• 51% partner/spouse• 65% living in house• Interpersonal

– 80% men

• Financial– 56% men, overall younger


Inquiries/referrals

02468

10121416

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Alleged perpetrators

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Son Daughter Husband Neighbour Nephew Other Rel


Main Abuse Allegations

0

2

4

6

8

10

12

14

Physical Psych Neglect Financial Sexual


Abuse in institutions

• Institutional abuse– poor care standards, lack of a positive

response to complex needs, rigid routines, inadequate staffing and an insufficient knowledge base within the service

• Individual abuse– In particular, restraints


Programme

Draft policies, procedures, guidelines

Pilot projects: accepted two areas Training brief, tender, evaluation Evaluation brief, tender, evaluation


NationalRecommendation

s Implement current government policy

on health and social care for older people

National Implementation Group - DoHC National Centre for Study of Elder

Abuse Legislative


Structure

• Regional – Steering Groups– Training

• LHA – Senior Case Worker– Manager– Clerical


Senior Case Worker

• Positive experience with two disciplines

• Did not specify discipline• Outlined competencies


Training

2-day for a small group of key personnel 74

One session for as many other healthcare personnel as possible (abbreviated by Foot and Mouth outbreak) 198


Process themes

• Formality of procedures and signing one’s name

• Need to go through a line manager before making a referral

• ‘Fit’ between the procedure advocated and current practice in some work settings


Resource themes

• Access to safe therapeutic environment

• Wider range of options• Out-of-hours service• Budget• Access to counselling services


What has happened?

• Law Reform Commission• HSE implementation group• Steering Groups• Funding for 32 case workers• Funding for National Centre


Lifetime history IPV

0

5

10

15

20

25

30

35

24 34 44 54 64 >65

Age

%

Men

Women

CDC. Behavioral Risk Factor Surveillance System 2005


Willingness to disclose by current age: “would not be willing to disclose if abused in future”

(SAVI, 2002)

0

1

2

3

4

5

6

7

8

9

10

18-24 25-29 30-39 40-49 50-59 60-69 70+Age group

Pe

rce

nta

ge

Women

Men


Future

• More joint working between domestic violence and elder abuse constituencies

• Skills and options complementary


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Goya, age 80


• Ma se in vece fossimo riusciti ad annoiarvi, credete che non s'è fatto apposta.

Manzoni, I Promessi Sposi

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