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Elder Abuse Presentation

Discussing the different types of Elder Abuse, Causes and prevention, and Legislation.

Emma Scharfenberg

on 29 November 2012

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Transcript of Elder Abuse Presentation

Introduction Conclusion Physical Abuse Sexual Abuse Emotional Abuse Financial Abuse Abandonment Neglect Legislation Elder Abuse Financial or material
exploitation of seniors is defined as the illegal or improper use of an elder's funds, property, or assets. (Payne, 2012) Elder Financial Abuse The most common form of elder abuse is financial Sometimes a senior's physical or mental health diminishes to the point where they will require financial assistance. Salespeople
Telephone solicitors
Finance service professionals
Health care workers
Con artists Who are other frequent Predators? Can anyone guess who is most frequently responsible for financially abusing a senior? Their own family members. Because elder financial abuse is greatly under reported and undocumented, the severity and extent is difficult to determine and
accurate estimates are difficult to obtain. Financial Abuse is Seriously Under-Reported - Shame (86%)
- Concern about their family members' responses (83%)
- Feeling that it is too late and nothing can be done (80%)
- Failure to notice financial abuse has occurred. (70%) Victims are Reluctant to report victimization due to

- Health care professionals and law enforcement not properly educated and prepared to handle such crimes

- Lack of awareness in public causes these crimes to keep occurring. Lack of research is problematic Warning signs of declining financial abilities may be subtle at first; and family members may be slow or unwilling to recognize them. - Women are twice as likely as men to be victims of elder financial abuse.

- Average age of victimization is 80 years old.

- They mostly live alone

- Frailty and being cognitively impaired are also factors. Typical Victims - 60% of abusers are family members

- Family members often feel a sense of entitlement and believe that they have a right to their parent’s or relative’s money and home.

- 40% are not related to victims

- offenders often claim that the “stolen” items were actually gifts from the older person Typical Abusers - Cognitive Impairment
- New found interest in get-rich-quick schemes.
- Large withdrawals from bank accounts
- Sudden changes in behavior towards finances
- Items or cash missing from the senior’s household
- A complete lack of Knowledge about their own financial status Warning signs
- Suspicious changes in wills, power of attorney, or property titles
- Unpaid bills
- Anxiety about their personal finances
- Financial activity the senior could not have done
- Unnecessary services, goods, or subscriptions Warning Signs - Memory lapses - Failure to pay bills or paying multiple times

- Disorganization - misplacing financial documents, cheques, tax forms.

- Declines in cheque book management skills

- Everyday Arithmetic mistakes Cognitive Declines -Theft is also problematic among professionals who work with seniors. Property and cash are often taken from the elders residents.

-Evidence shows that those who steal most often are nursing attendants who had been on the job a relatively short time.

-Theft is generally higher around Christmas time and birthdays.
(Payne, 2012) Nurses and Financial Abuse Over half of Health care workers who stole from patients were in positions such as:
- Health Care Aides
- Food services
- Maintenance and
- Housekeeping

**Predictors of employee theft included job satisfaction and negative attitudes about patients.
(Payne, 2012) Nurses and Financial Abuse Unfortunately it is difficult to teach financial abusers not to commit these crimes.

It relies mainly on personal moral compass and an intolerance for unethical gain. - Need to be more aware of the signs and risks of financial abuse

- Education should be provided and mandatory for those who work with elders

- Researchers should more thoroughly research financial elder abuse to help train professionals
(Manthorpe, 2012) Nurses and Social Workers -It is important to intervene in ways the respect the older person’s autonomy.
-Help with financial tasks.
- Communicate; ask about elder's finances and make sure there is nothing suspicious going on. How can you help? - Speak to seniors while they are still mentally fit and healthy, and educate them on the dangers of financial abuse.

- Get papers in order, including a will and a power of attorney.

- Have information of family attorneys, financial providers, and insurance brokers Prevention Where to get help? http://www.polleverywhere.com/my/polls o Defined as a single or repeated act where someone knowingly brings physical harm to an elderly person that results in pain or injury
o Some definitions also include a “lack of response” into the definition What does physical abuse include? o Striking (with or without an abject)
o Hitting or pushing
o Kicking
o Shaking
o Burning
o Use of physical restraints
o Force-feeding Increasing factors related to physical abuse o Vulnerability related to age
o Mental health issues (anxiety or depression)
o Dementia
o Alzheimer’s disease
o Alcohol or substance abuse
o Women are more likely than men to be physically abused
o History of being abused
o Divorced or widowed
o Isolation
o Cultural differences Who is most likely to be a physical abuser? oAdult child (31.7%)
oSpouse or partner (31.7%)
oSiblings (4.9%)
oGrandchild (7.3%)
oNephew, niece, or other relative (9.8%)
oFriend or roommate (14.6%)
oAbusers are mostly male What are the most common types of serious injuries related to physical elder abuse? o Open wounds (56.1%)
o Internal injuries (24.4%)
o Fractures (22.0%) Why are most elders afraid of admitting to being physically abused? oEmbarrassment
oCommitted by a caregiver
oNo other options
oLimited resources
oLimited energy What is Emotional Abuse? The national center on Elder abuse defines emotional or psychological abuse as the infliction of anguish, pain or distress through verbal or non-verbal acts. Emotional Abuse includes: -verbal assaults
-putdowns Spouse Abuse Physical Abuse in Homecare Settings Study of Women's Abuse oMost research has been done on female victims
oOlder women are less likely to be abused in a relationship than younger ones
oAbuse earlier in a relationship can increase the risk of elder abuse
oCauses include: unexpected disability, retirement, role changes
oDepends on views of marriage (Walsh, Ploeg, Lohfeld, Horne, MacMillan 2007) o Study revealed elders abused by family members, other elderly people, and mainly by employees
o Nine forms of physical abuse were identified
o 12% of employees confessed 1 or more types of physical abuse
o 2% of elders confessed to being abused by an employee Effects of Physical Elder Abuse Prevention oStudy was done to examine the effects of physical abuse on older women (age 50-79 years)
oSurveyed over 93,000 women in the US
o12.1% had been physically abused
oFound that victims had developed mood disorders, posttraumatic stress disorders, depression or anxiety disorders
o47% of victims reported abuse started after age 55 (Mouton, Rodabough, Rovi, Brzyski, Katerndahl 2010) For yourself
oStay active with relationships
oAttend educational seminars or support groups
For others
oKeep in touch with older family members
oListen to the concerns of older adults oDepressive symptoms
oFeeling trapped and alone
oStrained relationships
oIncreased stress Emotional Abuse -common form
-overlooked Why? -Emotional abuse occurs over a period of time and is made up of a series of incidents whereas sexual and physical abuse can be constituted just by one incident
-Most individuals don't realize the abuse
-Acceptable and normal forms of communication can be misinterpreted Characteristics of Elder Abusers -don't live alone
-age, gender, marital status, ethnicity or income level are not factors that contribute to elder abuse Continued... the desertion of an older adult by an individual who had physical custody or otherwise has assumed responsibility for providing care for the older adult What is Abandonment? What Effects does Abandonment Have on an Elder? can cause emotional distress
leads to feelings of loneliness and isolation
can endanger their overall health Study on Social Isolation Why do Caregivers Abandon Elders? caregivers may become overwhelmed with the role
there could be certain factors which disable the person from providing adequate care a study was done which shows:
elderly people who keep in regular contact with family are shown to feel less isolated The Affects of Social Support Networks studies have shown that having a strong social support network significantly decreases the feeling of loneliness - who's more likely to abuse elders?(Health Canada,1999a).

-(Kapp, 1999;Quinn, 1998)

-It was also found that individuals that were abused as a child are more likely to be abusers as an adult Interconnecting Forms of Abuse -2007 study
- abuse is cyclical, abuse occurs throughout the lifetime, exposure to multiple forms of abuse is common and spousal abuse continues into older life.
-One participant stated "[when the] grandparents are abusive, the kids...become abusive". Interconnecting Forms of Abuse - study concluded a vicious circle

- a victim believed that abuse is based on upbringing Interconnecting Forms of Abuse - continuation of spousal abuse into elder abuse

-usually occurs with women

- the abuse escalated as the marriage went on longer

-victims grew to accept abuse and just live with it Causes of Elder Abuse -caregiver and stress theory

-“however, research alone fails to support the idea that caregivers alone is the primary cause” (Wilber & McNeilly, 2001)

-caregiver has intrapersonal or interpersonal issues

-abuse becomes a generation to generation pattern Sticks and Stones May Break my Bones -2011 study on emotional abuse effects

-impact of abuse

-developmental problems and negative outlooks on life Sticks and Stones May Break my Bones - denying abuse causes hardships on victims

-abusive relationships as a child mirror future adult relationships

-adult behavior affected by memory of childhood Elder Mistreatment: Risk, Vulnerability and Early Mortality - higher mortality rate

-common causes of death in mistreated adults

Victims of EM (early mortality) are usually also victims of other stressors Prevention of Elder Abuse -advocates for seniors

-better education on elder abuse

-watching for signs of abuse from caregivers

-behavior of elders

Forced exposure
Threatening Rape
Inappropriate or derogatory comments
Taking Sexually explicit photos of the victim
Forcing to view pornography What is Sexual Abuse? Any Form of unwanted sexual contact Including: Who are the Victims? Post Abuse Effects Common changes in behaviour: Loss of enjoyment in social activities
Fear of falling asleep
Fear of contracting an STD
Uncharacteristic anger Abusers What is Neglect? In the majority of reported cases men where the abusers
The victim is often dependent on their abusers
In most cases the abuser was previously known to the victim Untreated mental illness
sadistic or dominating personality
Substance abuse problems
Tendency to view wives as sexual property
Past Criminal history Common Characteristics of Abusers Family Member or Spouse
Volunteer or employee at care center
Other residents residing in the care center Most Often: Likely to be vulnerable due to physical or cognitive disability associated with age One study focused on the living situation of women who were reported to be abused: Women who were homeless or living in a domestic setting were more likely to be subjected to physical threats as a method of persuasion
Women living in an institutional setting were more likely to be threatened by authority Perception in the Courtroom One study: Designed to test mock jurors perceptions of elder sexual abuse Two Experiments: 1. Gender and relationship to alleged abuser
2.Relationship with the alleged abuser and location of the act The main findings: Location where the act(s) occurred was found to have a strong influence of the verdict
The jury was more likely to believe the victim if the abuser was an employee in a nursing home rather than a son. Problems with Reporting Abuse It is suspected that many cases go unreported, particularly in cases involving a male victim.
Reported cases are often incomplete because the victim is not able to recall all of the details of the assault. - failure to provide adequate goods or services necessary for a dependent person to function or for themselves (self- neglect) Signs of Neglect - inadequate social support
- inadequate self- medication
- inadequate prosthetic support
- unclean appearance
- senior is unsupervised
- underweight/ frail
- poor diet
- dehydrated
- confused
- bed sores Effects - Malnutrition
- Housing and health violations
- Threat of danger to self
- Stress
- Feeling lonely
- Illnesses
- Death Abuse Reported in Alberta 16 % of seniors neglected got reported of which only 4.1 % is supported by evidence in a period of approximately 11 months with 415 abuses Alberta Health (2012) Low abuse reporting (even by physicians) 1. Assumes others will report (social workers, nurses)
2. Lack of awareness
3. Lack of training
4. Concern about losing relationship with family
5. Denial that the family can be abusing
6. Reluctance to be involved in legal and court proceedings
7. Time pressures prevent case finding
8. Concern about safety and fear of involvement
9. Signs of elder abuse may mimic other common illnesses in the elderly (Abbey, 2009). Prevention (Dental Basis) A study done by dentist Michael Wiseman reveals that with great communication skills and performing thorough examination of the head and neck regions may help to signal suspected abuse. History -In 1973 Newfoundland was the first province to have a law in which it was mandatory to report adult abuse
- 1979: Manitoba Association on Gerontology first provincial gerontology to address the issue of neglect and abuse
- 1980's: Quebec, Manitoba, Newfoundland, Alberta and Ontario followed In 1993 research done by College of Nurses of Ontario revealed out of the survey done by 804 registered nurses and 804 registered nursing assistants that there were 37% verbal abuse and 32% physical abuse of the cases. Which emphasized the need for immediate action. Currently -there is no specific law just for elder abuse however each abuse is categorized based on these offenses:
Physical Abuse: Section 265
Assault and aggravated assaults(relating to health or financial situations ): Section 268
Emotional Abuse (threats/intimidation) : Section 423

- each province has different laws Laws in Alberta Is it legally an individual's obligation to report elder abuse? Laws in Alberta Yes, according to the Protection for Person's Care Act Programs in place to prevent elder abuse -The Ontario Network for the Prevention of Elder Abuse (ONPEA) formed in 1989
- International Network for the Prevention of Elder Abuse (INPEA) was established which included Canada, later
- The Canadian Network for the Prevention of Elder Abuse (CNPEA) was created World Elder Abuse Awareness Day - Created in collaboration with The International Network for the Prevention of Elder Abuse (INPEA), the Canadian Network for the Prevention of Elder Abuse (CNPEA) and the WHO to stress what elder abuse is and how it can be prevented
- On June 15, 2006 was the first World Elder Abuse Awareness Day Reporting Abuse Can be reported to the following:
-Protection for Persons in Care
- Police services if it's a criminal abuse
- Mental Health Patient Advocate Did you know....? Approximately 5 million people were over the age of 65 out of a 34 million population in 2011 - Stats Canada 2006 Meaning... - Population of elderly is expected to double by 2036
- More elders are likely to be abused/ neglected (Wiseman, 2008, p. 720) Prevention (Dental Basis) In terms of suspecting neglect: - if there is a great amount of plaque
- food debris in mouth
- broken dentures
- restorations
- caries
- conditions of prolonged untreated soft tissue (Wiseman, 2008, p. 717) Two forms of Neglect - Passive: failure to provide basic necessities, unintentional, done due to lack of resources and education
- Active: withholding of basic necessities, intentional History History - 1990's: after a publication of a national survey revealing 4% of Canadian population experiencing abuse and neglect which resulted in government funding research, programming, education and development of resource material Safeguards for Vulnerable Adults Information and Reporting Line at

Website for elder abuse in Albert:

Discussion? Most Common forms of Elder Abuse 1. Financial Abuse

2. Emotional Abuse

3. Physical Abuse Warning Signs Nurses Assistant, Krisann Henderson stole $25,000 worth of jewelry from an elderly resident Dusa Dolly Fofana, a Health Care Aide stole $12,000 from her residents. The victims of elder sexual abuse are most often women
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