Elder abuse and neglect in Canada: causes and policy responses

Women's Issues

Women Elderly Abuse / Oppression / Missing Voices of the Elderly / Policies (Canada)

The older generation of people today is more visible, more active, and more independent than ever before. They are living longer and staying in better health. Unfortunately, as the population grows older, so does the hidden problem of elder abuse, exploitation, and neglect. Every year an estimated 2.1 million older people are victims of physical, psychological, or other forms of abuse and neglect. It is thought that for every case of elder abuse and neglect that is reported to authorities, experts estimate that there may be as many as five cases that have not been reported. Recent research has suggested that elders who have been abused tend to die earlier than those who are not abused, even with a lack of chronic conditions or life threatening diseases (Elder Abuse and Neglect: In Search of Solutions, 2010).

Previous research has attempted to understand the issue of elder abuse. Explanations have ranged from decreased physical and mental abilities of the senior attributable to the aging process to the caregiver stress model which focuses on difficulties in balancing conflicting roles and responsibilities. Researchers have also suggested that individuals who abuse seniors may have learned this behavior through either witnessing or suffering abuse themselves. Other explanations for senior abuse look to the perpetrators' characteristics, dependencies between abusers and their senior victims, negative societal attitudes, discrimination against older adults, and a history of spousal abuse that continues into old age. In a lot of cases it is a combination of these factors that is seen as being responsible for the abuse inflicted on seniors (Family Violence in Canada: A Statistical Profile, 2007)

Definition of Elder Abuse and Neglect

Elder abuse consists of the infliction of physical, emotional, or psychological harm on an older person. Elder abuse can take the form of financial exploitation or intentional or unintentional neglect of an older adult by the caregiver. Physical abuse can vary from slapping or shoving to severe beatings. When a caregiver or other person uses sufficient force to cause unnecessary pain or injury the behavior can be regarded as abusive. Physical abuse can include such things as hitting, beating, pushing, kicking, pinching, burning, or biting. It can also consist of such acts against the older person as over or under-medicating, depriving the person of food, or exposing the person to severe weather either deliberately or inadvertently (Elder Abuse and Neglect: In Search of Solutions, 2010).

The different types of elder abuse and neglect that exist include:

Domestic Elder Abuse -- which refers to any of several forms of maltreatment of an older person, by someone who has a special relationship with the older adult, such as a spouse, a sibling, a child, a fried, or a care giver in the person's home.

Physical Abuse -- is the applying of physical force that may result in bodily injury, physical pain, or impairment. Physical abuse may include striking, hitting, beating, pushing, shoving, shaking, slapping, kicking, pinching, and burning.

Sexual Abuse- consists of non-consensual sexual contact of any kind with an older adult. This can include unwanted touching along with all types of sexual assault or battery, sodomy, coerced nudity and sexually explicit photography.

Psychological or Emotional Abuse -- consist of the infliction of anger, pain or distress through verbal or nonverbal acts. It can comprise of verbal assaults, insults, threats, intimidation, humiliation and harassment.

Material Abuse -- which is also known as financial abuse involves the improper exploitation of an older person's funds, property and assets.

Neglect -- is the intentional or unintentional behavior on the part of a care giver. It typically involves the refusal or failure to provide an older person with the necessities of life such as water, food, clothing, shelter, personal hygiene, medicine, comfort and personal safety.

Self Neglect -- this occurs when an older adult refuses or fails to provide themselves with the necessities of life.

Abandonment -- is the desertion of an older adult by an individual who has assumed responsibility for providing care for that person (McDonald, Collins and Dergal, 1999, pp. 426-428).

Challenges to the Definitions

Due to the fact that there are so many definitions of elder abuse it is often difficult to compare or pool data that is collected in order to gain a good understanding of the problem that exists. This definitional disarray is often attributed to a number of factors. One of the biggest reasons is seen as the fact that all of the definitions have been established with different perspectives -- the abused older person, the caregiver, the health professional, the lawyer, the police, the social workers and the policy maker. This makes a move toward embracing and listening to the diversity of perspectives and moving towards a consensus a slow going process (McDonald, Collins and Dergal, 1999, p. 428).

Characteristics of the Victims and Perpetrators

Researchers have found that victims of psychological and physical abuse usually have reasonably good physical health, but suffer from psychological problems. Their abusers often have a record of psychiatric illness and/or substance abuse. They tend to live with the victim and depend on them for financial assets. Patients with dementia, who exhibit disruptive behavior and who live with family care givers are more likely to be victims of physical abuse. Their abusive care givers may suffer from low self-esteem and clinical depression. There is usually not a typical victim of financial abuse, but when the abused is dependent on the abuser, the financial abuse tends to be more serious. Victims that suffer from neglect tend to be very old, with cognitive and physical incapacitates. Their dependency on their care givers serves as a source of stress (McDonald, Collins and Dergal, 1999, p. 436).

Theories

Situational Model

A very widely acknowledged perspective on the cause of elder abuse is the situational model. It has its basis in the mainstream perspectives on child abuse and family violence. A well-known basis of the situational model is that stressful situations cause the caregiver to abuse the older person, who is usually viewed as the source of the stress because of some type of physical or mental impairment. This approach involves mistreatment as a rational response to stressful situations. "The situational variables that this theory associates with abuse include factors related to the caregiver and the older person as well as the social and economic conditions of both parties" (McDonald, Collins and Dergal, 1999, p. 437).

Social Exchange Theory

This theory is established on the assumptions that social interaction involves an exchange of rewards and punishments between at least two people and that all people seek to maximize rewards and minimize punishments. The social exchange perspective argues that as people get older, they become more powerless, vulnerable and dependent on their caregivers, and it is these characteristics that place them at risk for abuse. It is thought that the older adult remains in the abusive relationship only as long as the satisfaction of his or her needs exceed the costs of the maltreatment (McDonald, Collins and Dergal, 1999, pp. 437-438).

Symbolic Interaction Approach

The Symbolic Interaction approach has developed from the family violence literature and focuses on the interactive processes between the older adult and the caregiver. This perspective emphasizes not only the behaviors of the older person and the caregiver, but also both people's symbolic interpretations of such behavior. This analysis of elder abuses centers on the different meanings that people attribute to violence and the consequences these meanings have in certain situations. Social learning, or modeling, is part of this perspective. The theory proposes that abusers learn how to be violent from witnessing or suffering from violence, and the victims, in suffering abuse, learn to be more accepting of it (McDonald, Collins and Dergal, 1999, p. 438).

Care-giver Stress Theory

The caregiver-stress theory describes abusers as well-meaning individuals who want to be caring but have an isolated incident of abusive behavior when they lose control under significant pressure. It is well-known that care giving can be difficult and stressful. The work is often hard, and the hours are long. Many caregivers work for very low pay, or are family members who are giving their time and resources. It is because of these things that many people believe that stressed caregivers occasionally snap, become abusive, and say or do things they would not normally do (Brandl, 2000, p. 41).

Risk factors of Abuse

Elder abuse often takes place where the senior lives. It is found most often in the home where abusers are apt to be adult children, other family members such as grandchildren or spouses/partners of elders. Institutional settings such as long-term care facilities have also been found to be sources of elder abuse (Elder Abuse and Neglect, 2009). The risk factors that lead to this abuse include:

Individual factors - Cognitive and physical impairments of the abused older person have been strongly identified in the early studies as risk factors for abuse. Gender has been thought by some to be a defining factor in elder abuse on the grounds that older women may have been subject to oppression and economically disadvantaged all of their lives. In a study of the prevalence of elder abuse in the United States, financial difficulties on the part of the abuser did appear to be an important risk factor (Krug, 2002, pp. 130-131).

Relationship factors - in the early theoretical models, the level of stress of caregivers was seen as a risk factor that linked elder abuse with care of an elderly relative. While the accepted image of abuse depicts a dependent victim and an overstressed caregiver, there is growing evidence that neither of these factors properly accounts for cases of abuse. Although researchers do not deny the component of stress, they tend now to look at it in a wider context in which the quality of the overall relationship is a causal factor. Today, the belief is that stress may be a contributing factor in cases of abuse but does not by itself account for the entire phenomenon.

Living arrangements, especially those with overcrowded conditions and a lack of privacy have been associated with conflict within families. Even though abuse can occur when the abuser and the older person suffering abuse live apart, the older person is more at risk when living with the caregiver (Krug, 2002, pp. 130-131).

Community and Societal factors - isolation of older people can be both a cause and a consequence of abuse. Many older people are secluded because of physical or mental issues. In addition the loss of friends and family members reduces the opportunities for social interaction.

Although there is little solid empirical evidence, societal factors are currently considered important as risk factors for elder abuse in both developing and industrialized countries. In the past the importance was generally placed on individual or interpersonal attributes as potential causal factors for elder abuse. Cultural norms and traditions such as ageism, sexism and a culture of violence are also now being recognized as playing an important underlying role (Krug, 2002, pp. 130-131).

Educating Professionals and at Home Caregivers

Education and public awareness programs have been vital for informing people in industrialized countries about elder abuse. Education involves teaching new information and changing attitudes and behavior, and is thus a fundamental preventive strategy. It can be conducted in a wide variety of ways -- for instance, in training sessions, seminars, continuing educational programs, workshops, and scientific meetings and conferences. Those who are targeted will include not only practitioners in the various relevant disciplines from medicine, mental health and nursing to social work, criminal justice and religion but also researchers, educators, policy-makers and decision makers (Krug, 2002, p. 138).

It is especially important for professionals to be able to identify that older people are abused and intervene constructively and appropriately. An important first step lies in finding ways to teach clinical staff to reflect on their own attitudes and beliefs about aging and violence in general. It is important for individuals, agencies and communities to critically reflect on their belief systems and examine how these influence their responses to elder abuse (McDonald, Collins and Dergal, 1999, pp. 451-452).

It is critical to introduce more gerontological content in the curriculum of health professionals. In a survey of 155 nursing schools across Canada it was found that a mean of 2.7 hours of instruction was devoted to elder abuse. Incorporating more systematic inclusion of violence content into the curricula is essential to helping to prevent this problem (McDonald, Collins and Dergal, 1999, pp. 451-452).

Education and training programs for caregivers is also essential. Caregiver support groups have a long history as a resource to assist in the care of the elderly, offering mutual support, stress reduction and problem soling strategies. The fundamental assumption is that the combination of social support and education and training will work together to reduce the likelihood that anger, aggression and conflict will emerge in the care giving relationship (McDonald, Collins and Dergal, 1999, pp. 451-452).

Future Direction

After looking at the developments that have occurred in regards to elder abuse and neglect in Canada it can be seen that some progress has been made, but there is still work to be done. Experts feel that in order to move forward there are several key issues that need to be looked and researched further. These include a national incidence study on abuse, a prevalence study on abuse in institutions, case control studies to determine risk factors for abuse and continued testing of screening and assessment instruments, increased education and training of health professionals along with the evaluation of practice, legislation and prevention programs (McDonald, Collins and Dergal, 1999, p. 452). The fact that so many people live to be old is one of the most remarkable achievements of the twentieth century and to be old and live in dignity free from all forms of abuse and violence must be a common goal for all societies of the twenty-first century (WHO/INPEA, 2002).

This is a very important issue that deserves all of the attention and focus that it can get. It is not an issue that is just occurs in Canada but unfortunately happens all across the world. There are many organizations at local levels as well as at national levels that are implanting strategies to try and prevent this abuse from occurring. In order to come up with a solution it is imperative that the problem is first understood to the fullest. Further research is needed so that the problem can completely be understood. Once this is done then and complete and comprehensive plan can be devised on how to prevent this phenomenon from occurring. The fact that elder abuse and neglect happens at all is a very sad but even sadder is the fact that there are civilized nations still allowing it to occur at the rate that it does.