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
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