elder abuse victims lisa nerenberg
Elder Abuse Victims and Services
Lisa Nerenberg MSW, MPH
The 11th Asian Post Graduate Course
on Victimology and Victim Assistance
July 22, 2011
University of Indonesia, Jakarta
f
What is Elder Abuse?
The definition is evolving
Traditionally, referred to mistreatment by family members
or people in positions of trust or confidence, and required
that elders be “vulnerable” or “dependent.”
Definition has expanded to include victims of consumer
fraud targeted against elders, abuse in institutions .
Increasingly viewed as “elder rights” issue.
Extent of Problem
One in 10 older adults in U.S. report emotional, physical, sexual
mistreatment, or potential neglect each year (Acierno et. al., 2009)
Emotional abuse: 4.6%
Physical abuse 1.6%
Sexual abuse: 0.6%
Potential neglect (need for assistance not addressed): 5.1%
Current financial abuse: 5.2%
Lifetime financial exploitation by non-family: 6.5%.
N=5777
Physical Abuse
Use of physical force that may result in bodily injury, physical
pain, or impairment. It includes inappropriate physical and
chemical restraint.
Sexual Abuse
Non-consensual sexual contact of
any kind with an elder person.
Includes rape, sodomy, molestation,
and sexual contact with anyone who
is incapable of giving consent.
QuickTime™ and a
decompressor
are needed to see this picture.
Emotional Abuse
Infliction of anguish, pain, or distress through
verbal or non-verbal acts. Includes verbal abuse,
humiliation, harassment, coercion, and isolation.
Financial, or Material, Exploitation
Illegal or improper use of an elder's funds, property, or assets.
May include robbery, theft, fraud, extortion, forgery, identity
theft, and withholding care in order to preserve an elder’s
estate or hasten his/her decline (by someone who stands to
benefit or inherit).
Abandonment
Desertion of an elder by an individual who has physical custody of
the elder or by a person who has assumed responsibility for
providing care to the elder.
Neglect
Refusal or failure to fulfill any part
of a caregiver’s obligations or
duties to an elderly person
QuickTime™ and a
decompressor
are needed to see this picture.
Isolation
Preventing elders from having visitors, receiving mail, or using
the phone or computer
Confining elders to rooms, homes, or apartments
Preventing elders from using assistive devices like canes,
glasses, or hearing aids that enable them to receive information
or communicate with others
Preventing elders from using social services or reporting
problems
Blocking elders’ access to radios, televisions, or newspapers
Institutional Abuse
Abuse committed in long-term care facilities (nursing homes,
residential care facilities, and assisted living facilities)
Reasons for Abuse
Financial gain
Dysfunction (including substance abuse and mental illness)
Caregiver issues
Power and control
History of conflict
Risk Factors of Older Persons
Depends on:
Type of abuse
Setting
Culture or country
General Risk factors
Isolation
Gender. More reports of abuse to women
Women over-represented in higher age brackets
Men may actually be at greater risk
Physical and/or cognitive impairments
Shared living arrangement
Physically or verbally aggressive
Recent losses
Residents of facilities who lack families, advocates, or
friends
Risk factors by type of abuse
Victims of neglect more likely to have physical impairments
(Pillemer & Finkelhor, 1988)
Victims of physical abuse more likely to live with abusers
(Pillemer & Finkelhor, 1988)
Victims of financial abuse vary by type of abuse
Victims of misused documents likely to have cognitive
impairments (Rabiner, O'Keeffe, & Brown, 2006)
Victims of consumer fraud (e.g. investment fraud) less
likely to have cognitive impairment (NASD Investor Education
Foundation, WISE Senior Services, & AARP Foundation, 2006).
Dementia. 48% of caregivers for dementia patients were
psychologically or physically abusive (Wiglesworth et. al., 2010)
Victims’ perceptions of abuse
is culturally determined
• Study of attitudes of European-American, AfricanAmerican, Puerto Rican and Japanese-American
older adults found that African-American and
Japanese-American seniors view psych abuse as
worst form (Anetzberger, Korbin, & Tomita, 1996).
• Korean elders identify financial, psychological, and
physical abuse, and neglect within context of "hyo,"
the traditional value of filial piety (Chang & Moon, 1997).
• In Japanese, German, Brazilian, Israeli, and African
American cultures, placing parents in nursing homes
is viewed as abuse (Patterson & Malley-Morrison, 2006).
Impact of abuse
Increased mortality
(Lachs, Williams, O'Brien, Pillemer &
Charlson, 1998)
Depression
Shame
Hopelessness
Isolation
Financial
(Mouton, Rodabough, Rovi, Brzyski, & Katerndahl,
2010; Begle, Strachan, Cisler, Amstadter, Hernandez, & Acierno, 2010).
Risk Factors of Abusers
Criminal record or a history of violence, substance
abuse, gambling and other debt
Sense of entitlement to the elder’s resources
Mental health problems including mental illness
Stress
Social isolation
Recent changes in family relationships or living
arrangements
Slightly more likely to be male
T Treatment
and
interventions
Treatment
and
interventions
reatment and interventions
Draw from multiple disciplines
Child abuse/mandatory reporting in U.S.
Mandate professionals and encourage concerned citizens to report to
public agencies
Public agencies investigate and offer services
Services are voluntary (many victims refuse out of fear, shame, loyalty
to abusers, etc.
Domestic violence
Prosecution (special prosecution units, forensics research, elder courts)
Shelters adapted for elders
Safety planning
Restraining orders
Treatment and interventions (cont.)
Public health
Caregiving
Public awareness to promote intergenerational respect
Universal screening by health care professionals
Screening of caregivers to detect high risk
Support to caregivers, including monetary aid, respite, training
Victimology/victim rights
Restorative Justice
Mediation
Restitution
International Focus
International Network for the Prevention of Elder Abuse
(INPEA)
World Elder Abuse Awareness Day (June 15) to raise
awareness
Studies elder abuse worldwide
International NGO Coalition for the Rights of Older People
(includes AARP, Global Action on Aging, HelpAge
International, International Network for the Prevention of
Elder Abuse, and others)
Who
WHO-INPEA Study
Goal: To identify key themes, perceptions, beliefs, and
attitudes about abuse by elders and health care workers in
developing and developed countries
Developing countries: Argentina, Brazil, India, Kenya,
Lebanon
Developed countries: Austria, Canada, Sweden
Participants asked:
What do you consider to be abusive conduct?
Contexts in which it occurs
Causes
Consequences
Seasonal patterns
Overall status, well-being, unmet needs of elders
Key findings
Focus groups viewed abuse as societal concern with
gender and socio-economic status emerging as key
factors.
Disrespect identified as most painful form of
mistreatment by older adults in all countries.
Themes
Poor suffer most.
Childless,widowed women most affected.
Lack of pensions (worldwide, only 30% of elders
covered by pension schemes).
Lack of access to health care and social services.
Decreasing rates of communicable diseases in
developing world have increased prevalence of longterm, disabling diseases.
Worst off are poor, elderly, and women
Negative attitudes about long-term care facilities
The
Changing social roles and breakdown of family
responsibilities
Themes (cont.)
Fewer women stay at home and provide care
Breakdown of family responsibilities, loss of filial piety Lack
of training and resources for health care providers, and
negative treatment results in poor treatment of patients.
Economic crises contribute
The media promotes ageist attitudes and negative
stereotypes.
Low status of health care providers results in lack of
training and resources results in poor treatment of
patients.
UN i
UN Initiatives
Convention on the Elimination of All Forms of Discrimination
Against Women (CEDAW)
Established working group to draft recommendations on older women’s
rights. Recommendations approved by General Assembly in 2010:
Defines older women as a separate category.
Recognizes elder abuse as a form of domestic violence .
Efforts to create a new UN convention on the Rights of Older
Persons
Madrid International Plan of Action on Ageing (MIPAA), an “aspirational
document” endorsed by 159 governments at 2nd World Assembly on Ageing
in 2002. Encourages governments to include older people in policies and
social and economic development policies;
Some nations and associations have taken steps
Lisa Nerenberg MSW, MPH
The 11th Asian Post Graduate Course
on Victimology and Victim Assistance
July 22, 2011
University of Indonesia, Jakarta
f
What is Elder Abuse?
The definition is evolving
Traditionally, referred to mistreatment by family members
or people in positions of trust or confidence, and required
that elders be “vulnerable” or “dependent.”
Definition has expanded to include victims of consumer
fraud targeted against elders, abuse in institutions .
Increasingly viewed as “elder rights” issue.
Extent of Problem
One in 10 older adults in U.S. report emotional, physical, sexual
mistreatment, or potential neglect each year (Acierno et. al., 2009)
Emotional abuse: 4.6%
Physical abuse 1.6%
Sexual abuse: 0.6%
Potential neglect (need for assistance not addressed): 5.1%
Current financial abuse: 5.2%
Lifetime financial exploitation by non-family: 6.5%.
N=5777
Physical Abuse
Use of physical force that may result in bodily injury, physical
pain, or impairment. It includes inappropriate physical and
chemical restraint.
Sexual Abuse
Non-consensual sexual contact of
any kind with an elder person.
Includes rape, sodomy, molestation,
and sexual contact with anyone who
is incapable of giving consent.
QuickTime™ and a
decompressor
are needed to see this picture.
Emotional Abuse
Infliction of anguish, pain, or distress through
verbal or non-verbal acts. Includes verbal abuse,
humiliation, harassment, coercion, and isolation.
Financial, or Material, Exploitation
Illegal or improper use of an elder's funds, property, or assets.
May include robbery, theft, fraud, extortion, forgery, identity
theft, and withholding care in order to preserve an elder’s
estate or hasten his/her decline (by someone who stands to
benefit or inherit).
Abandonment
Desertion of an elder by an individual who has physical custody of
the elder or by a person who has assumed responsibility for
providing care to the elder.
Neglect
Refusal or failure to fulfill any part
of a caregiver’s obligations or
duties to an elderly person
QuickTime™ and a
decompressor
are needed to see this picture.
Isolation
Preventing elders from having visitors, receiving mail, or using
the phone or computer
Confining elders to rooms, homes, or apartments
Preventing elders from using assistive devices like canes,
glasses, or hearing aids that enable them to receive information
or communicate with others
Preventing elders from using social services or reporting
problems
Blocking elders’ access to radios, televisions, or newspapers
Institutional Abuse
Abuse committed in long-term care facilities (nursing homes,
residential care facilities, and assisted living facilities)
Reasons for Abuse
Financial gain
Dysfunction (including substance abuse and mental illness)
Caregiver issues
Power and control
History of conflict
Risk Factors of Older Persons
Depends on:
Type of abuse
Setting
Culture or country
General Risk factors
Isolation
Gender. More reports of abuse to women
Women over-represented in higher age brackets
Men may actually be at greater risk
Physical and/or cognitive impairments
Shared living arrangement
Physically or verbally aggressive
Recent losses
Residents of facilities who lack families, advocates, or
friends
Risk factors by type of abuse
Victims of neglect more likely to have physical impairments
(Pillemer & Finkelhor, 1988)
Victims of physical abuse more likely to live with abusers
(Pillemer & Finkelhor, 1988)
Victims of financial abuse vary by type of abuse
Victims of misused documents likely to have cognitive
impairments (Rabiner, O'Keeffe, & Brown, 2006)
Victims of consumer fraud (e.g. investment fraud) less
likely to have cognitive impairment (NASD Investor Education
Foundation, WISE Senior Services, & AARP Foundation, 2006).
Dementia. 48% of caregivers for dementia patients were
psychologically or physically abusive (Wiglesworth et. al., 2010)
Victims’ perceptions of abuse
is culturally determined
• Study of attitudes of European-American, AfricanAmerican, Puerto Rican and Japanese-American
older adults found that African-American and
Japanese-American seniors view psych abuse as
worst form (Anetzberger, Korbin, & Tomita, 1996).
• Korean elders identify financial, psychological, and
physical abuse, and neglect within context of "hyo,"
the traditional value of filial piety (Chang & Moon, 1997).
• In Japanese, German, Brazilian, Israeli, and African
American cultures, placing parents in nursing homes
is viewed as abuse (Patterson & Malley-Morrison, 2006).
Impact of abuse
Increased mortality
(Lachs, Williams, O'Brien, Pillemer &
Charlson, 1998)
Depression
Shame
Hopelessness
Isolation
Financial
(Mouton, Rodabough, Rovi, Brzyski, & Katerndahl,
2010; Begle, Strachan, Cisler, Amstadter, Hernandez, & Acierno, 2010).
Risk Factors of Abusers
Criminal record or a history of violence, substance
abuse, gambling and other debt
Sense of entitlement to the elder’s resources
Mental health problems including mental illness
Stress
Social isolation
Recent changes in family relationships or living
arrangements
Slightly more likely to be male
T Treatment
and
interventions
Treatment
and
interventions
reatment and interventions
Draw from multiple disciplines
Child abuse/mandatory reporting in U.S.
Mandate professionals and encourage concerned citizens to report to
public agencies
Public agencies investigate and offer services
Services are voluntary (many victims refuse out of fear, shame, loyalty
to abusers, etc.
Domestic violence
Prosecution (special prosecution units, forensics research, elder courts)
Shelters adapted for elders
Safety planning
Restraining orders
Treatment and interventions (cont.)
Public health
Caregiving
Public awareness to promote intergenerational respect
Universal screening by health care professionals
Screening of caregivers to detect high risk
Support to caregivers, including monetary aid, respite, training
Victimology/victim rights
Restorative Justice
Mediation
Restitution
International Focus
International Network for the Prevention of Elder Abuse
(INPEA)
World Elder Abuse Awareness Day (June 15) to raise
awareness
Studies elder abuse worldwide
International NGO Coalition for the Rights of Older People
(includes AARP, Global Action on Aging, HelpAge
International, International Network for the Prevention of
Elder Abuse, and others)
Who
WHO-INPEA Study
Goal: To identify key themes, perceptions, beliefs, and
attitudes about abuse by elders and health care workers in
developing and developed countries
Developing countries: Argentina, Brazil, India, Kenya,
Lebanon
Developed countries: Austria, Canada, Sweden
Participants asked:
What do you consider to be abusive conduct?
Contexts in which it occurs
Causes
Consequences
Seasonal patterns
Overall status, well-being, unmet needs of elders
Key findings
Focus groups viewed abuse as societal concern with
gender and socio-economic status emerging as key
factors.
Disrespect identified as most painful form of
mistreatment by older adults in all countries.
Themes
Poor suffer most.
Childless,widowed women most affected.
Lack of pensions (worldwide, only 30% of elders
covered by pension schemes).
Lack of access to health care and social services.
Decreasing rates of communicable diseases in
developing world have increased prevalence of longterm, disabling diseases.
Worst off are poor, elderly, and women
Negative attitudes about long-term care facilities
The
Changing social roles and breakdown of family
responsibilities
Themes (cont.)
Fewer women stay at home and provide care
Breakdown of family responsibilities, loss of filial piety Lack
of training and resources for health care providers, and
negative treatment results in poor treatment of patients.
Economic crises contribute
The media promotes ageist attitudes and negative
stereotypes.
Low status of health care providers results in lack of
training and resources results in poor treatment of
patients.
UN i
UN Initiatives
Convention on the Elimination of All Forms of Discrimination
Against Women (CEDAW)
Established working group to draft recommendations on older women’s
rights. Recommendations approved by General Assembly in 2010:
Defines older women as a separate category.
Recognizes elder abuse as a form of domestic violence .
Efforts to create a new UN convention on the Rights of Older
Persons
Madrid International Plan of Action on Ageing (MIPAA), an “aspirational
document” endorsed by 159 governments at 2nd World Assembly on Ageing
in 2002. Encourages governments to include older people in policies and
social and economic development policies;
Some nations and associations have taken steps