Global Strategy Elder Abuse

The WHO-INPEA Global Strategy for the Prevention of Elder Abuse Silvia M. Straka Gerry Bennett Alexandre Kalache Silvia Perel Levin

Agenda Background and context Elder abuse: definition Ageism The global context: population ageing WHO-INPEA action research project Research component: two key findings Implications for social work

Background and context

Elder abuse: definition

Ageism

The global context: population ageing

WHO-INPEA action research project

Research component: two key findings

Implications for social work

Elder Abuse Defined Elder abuse is 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 (INPEA-WHO definition, adopted from Action on Elder Abuse, 1995)

Elder abuse is 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

(INPEA-WHO definition, adopted from Action on Elder Abuse, 1995)

Some Categories of Elder Abuse Physical abuse Neglect (physical, emotional) Psychological and verbal abuse Financial/material exploitation Violation of rights

Physical abuse

Neglect (physical, emotional)

Psychological and verbal abuse

Financial/material exploitation

Violation of rights

Consequences of Elder Abuse Consequences are devastating and include: Increased mortality and morbidity Poor quality of life Emotional distress Loss of property and security

Consequences are devastating and include:

Increased mortality and morbidity

Poor quality of life

Emotional distress

Loss of property and security

Ageism Elder abuse is one of the most extreme forms of ageism Ageism remains one of the least recognized forms of oppression Ageism intersects with other forms of oppression (e.g. gender, race, class, etc.)

Elder abuse is one of the most extreme forms of ageism

Ageism remains one of the least recognized forms of oppression

Ageism intersects with other forms of oppression (e.g. gender, race, class, etc.)

Lack of a Structural Analysis While links to ageism have long been acknowledged, theory and practice remain focused at the micro-level Elder abuse has been constructed by professionals and experts It is viewed as a problem of individual and family pathology Voices of older adults are missing from the discourse

While links to ageism have long been acknowledged, theory and practice remain focused at the micro-level

Elder abuse has been constructed by professionals and experts

It is viewed as a problem of individual and family pathology

Voices of older adults are missing from the discourse

Global Context: Population Ageing The problem of elder abuse assumes new significance in the context of global ageing By 2025, the global population of people over age 60 will double to 1.2 billion 1 million people turn 60 every month 80% of these are in the developing world

The problem of elder abuse assumes new significance in the context of global ageing

By 2025, the global population of people over age 60 will double to 1.2 billion

1 million people turn 60 every month

80% of these are in the developing world

WHO Response Recognized the problem and initiated an action-research project Partners: INPEA HelpAge International Researchers from various academic institutions

Recognized the problem and initiated an action-research project

Partners:

INPEA

HelpAge International

Researchers from various academic institutions

Goals of the Action-Research Project Exploratory research component: Attitudes, beliefs and perceptions about elder abuse held by older adults and health care professionals Action component: Develop global action strategies against elder abuse by key stakeholders

Exploratory research component:

Attitudes, beliefs and perceptions about elder abuse held by older adults and health care professionals

Action component:

Develop global action strategies against elder abuse by key stakeholders

Research Methodology Focus groups in 8 countries 5 developing countries: Argentina, Brazil, India, Kenya, Lebanon 3 developed countries Canada, Austria, Sweden 8 focus groups per country 4 groups for health care professionals 4 groups for older adults

Focus groups in 8 countries

5 developing countries:

Argentina, Brazil, India, Kenya, Lebanon

3 developed countries

Canada, Austria, Sweden

8 focus groups per country

4 groups for health care professionals

4 groups for older adults

Qualitative Data Analysis Local experts analyzed the data and produced national reports (translated into English) National reports were subject to further analysis and synthesis Synthesis report was produced

Local experts analyzed the data and produced national reports (translated into English)

National reports were subject to further analysis and synthesis

Synthesis report was produced

Stage II: Action Component An international working group of key stakeholders met in Geneva in October 2001 National reports and the international syntheses were presented and provided the basis for the development of concrete action strategies The final report, aimed at policy makers, was launched at the UN World Assembly on Ageing in Spain in April, 2002 The action strategies are in process of implementation by the project partners

An international working group of key stakeholders met in Geneva in October 2001

National reports and the international syntheses were presented and provided the basis for the development of concrete action strategies

The final report, aimed at policy makers, was launched at the UN World Assembly on Ageing in Spain in April, 2002

The action strategies are in process of implementation by the project partners

Key Focus Group Themes How do older adults and health care workers understand: the roles of older adults in their societies and the problems they face the problem of elder abuse and its possible solutions

How do older adults and health care workers understand:

the roles of older adults in their societies and the problems they face

the problem of elder abuse and its possible solutions

Two Key Findings The findings provide the basis from which to begin to redefine elder abuse to incorporate a broader perspective. In particular, two key categories of abuse were identified: Structural and societal abuse Disrespect and ageist attitudes

The findings provide the basis from which to begin to redefine elder abuse to incorporate a broader perspective.

In particular, two key categories of abuse were identified:

Structural and societal abuse

Disrespect and ageist attitudes

Structural and Societal Abuse Participants from developing countries primarily blamed governments and structural factors for the mistreatment they suffer Responsibility for prevention and intervention is clearly seen as a government responsibility “ societal abuse”: most important type of abuse and root cause of most other types of abuse Covers a wide range of issues

Participants from developing countries primarily blamed governments and structural factors for the mistreatment they suffer

Responsibility for prevention and intervention is clearly seen as a government responsibility

“ societal abuse”: most important type of abuse and root cause of most other types of abuse

Covers a wide range of issues

Examples of Societal Abuse Inadequate pensions Inadequate accommodation National economic crises Impacts of changes in social roles Inadequate funding and access to heath and social services

Inadequate pensions

Inadequate accommodation

National economic crises

Impacts of changes in social roles

Inadequate funding and access to heath and social services

Disrespect and Ageist Attitudes Experiences of disrespect are viewed by older adults as: a cause of all other forms of abuse an important form of abuse in itself “Respect is better than food and drink” “One rude word said to an old man is stronger than stabbing him with a knife” Lebanon report

Experiences of disrespect are viewed by older adults as:

a cause of all other forms of abuse

an important form of abuse in itself

“Respect is better than food and drink”

“One rude word said to an old man is stronger than stabbing him with a knife”

Lebanon report

Some Causes of Disrespect Changes in societal values Negative images and stereotypes of older adults through the media Westernization as bringing new attitudes and values Younger generation particularly disrespectful

Changes in societal values

Negative images and stereotypes of older adults through the media

Westernization as bringing new attitudes and values

Younger generation particularly disrespectful

Disrespect in the Health Care System “ The disoriented elder, who may be intoxicated by medication, is taken [and treated] as a headstrong child. This is quite violent; a professional to take out the prothesis, take out the device, remove the eyeglasses [from the older person], then he [the older person] agitates. When he agitates, [the professional] medicates … this is violence; there are also cases in which he [the professional] says, “I won’t let your daughter in if you keep [behaving] like that.” Brazil report

“ The disoriented elder, who may be intoxicated by medication, is taken [and treated] as a headstrong child. This is quite violent; a professional to take out the prothesis, take out the device, remove the eyeglasses [from the older person], then he [the older person] agitates. When he agitates, [the professional] medicates … this is violence; there are also cases in which he [the professional] says, “I won’t let your daughter in if you keep [behaving] like that.”

Brazil report

Disrespect in Government and Commercial Institutions “At the post office or at the railway station you are not supposed to speak too slowly and you are treated badly when you have a hearing problem.” Austria report

“At the post office or at the railway station you are not supposed to speak too slowly and you are treated badly when you have a hearing problem.”

Austria report

Disrespect on Public Transport “Disrespect starts from the moment the elder gets to a bus stop. When he hails the bus to stop, the first thing the driver says [to himself] is, ‘Don’t stop here as it is full of six-five [people aged 65 or over].’ The elder hails, but them [drivers] keep going. Or they stop way ahead, so the poor old guy has to run to catch the bus. It is mean.” Brazil report

“Disrespect starts from the moment the elder gets to a bus stop. When he hails the bus to stop, the first thing the driver says [to himself] is, ‘Don’t stop here as it is full of six-five [people aged 65 or over].’ The elder hails, but them [drivers] keep going. Or they stop way ahead, so the poor old guy has to run to catch the bus. It is mean.”

Brazil report

Disrespect in Society at Large “[Older adults] feel disregarded, insulted, ignored by government or social security agencies, or mistreated in shops, in public transport, etc.; the general feeling is that the elderly are pushed to the edge of society.” Austria report

“[Older adults] feel disregarded, insulted, ignored by government or social security agencies, or mistreated in shops, in public transport, etc.; the general feeling is that the elderly are pushed to the edge of society.”

Austria report

Some Implications for Social Work Implications for theory: challenges the existing micro-level conceptualization of elder abuse and identifies directions for theory development Implications for policy: inadequate social policies affecting older people can result in conditions that increase the risk of elder abuse Implications for practice: practitioners need to understand the structural roots of the problem and engage in social action

Implications for theory:

challenges the existing micro-level conceptualization of elder abuse and identifies directions for theory development

Implications for policy:

inadequate social policies affecting older people can result in conditions that increase the risk of elder abuse

Implications for practice:

practitioners need to understand the structural roots of the problem and engage in social action

….Implications Implications for research: new research questions will be generated These “new” forms of elder abuse, such as disrespect and its impact on older people, need to be studied Implications for education: elder abuse should be framed as a social justice issue the present micro-level approach to teaching elder abuse practice needs to be situated within a structural analysis Elder abuse courses need to include discussion around macro-level interventions to the problem International social work courses should include references to problems of ageing, including elder abuse

Implications for research:

new research questions will be generated

These “new” forms of elder abuse, such as disrespect and its impact on older people, need to be studied

Implications for education:

elder abuse should be framed as a social justice issue

the present micro-level approach to teaching elder abuse practice needs to be situated within a structural analysis

Elder abuse courses need to include discussion around macro-level interventions to the problem

International social work courses should include references to problems of ageing, including elder abuse

Importance and Contributions of the Project First multi-country set of information about elder abuse Richness of data Findings throw new light on how to perceive and approach elder abuse WHO has a unique position, which permits it to: convert the outcomes of the discussion into concrete action points assist primary health care workers globally to prevent elder abuse

First multi-country set of information about elder abuse

Richness of data

Findings throw new light on how to perceive and approach elder abuse

WHO has a unique position, which permits it to:

convert the outcomes of the discussion into concrete action points

assist primary health care workers globally to prevent elder abuse

Missing Voices Report WHO/INPEA (2002). Missing voices: Views of older persons on elder abuse. Geneva: WHO. www.who.int/hpr/ageing/elderabuse.htm

WHO/INPEA (2002). Missing voices: Views of older persons on elder abuse. Geneva: WHO.

www.who.int/hpr/ageing/elderabuse.htm