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Barry Kidd 2010 1
ELDER ABUSE
RECOGNITION AND THE EMS
RESPONSE
Barry Kidd 2010 2
WHAT IS ELDER ABUSE?
“Elder abuse is the infliction of harm on an
older person”. Abuse is any act or failure to
act that endangers the health and/or well
being of the older person. Such action or
inaction is especially harmful when it occurs
within a relationship where there is an
expectation of trust.
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ELDER ABUSE
Elder abuse is the
maltreatment of
an older or elderly
individual
Barry Kidd 2010 4
Elder abuse can have many forms
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Abuse may be :
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Physical Abuse
Physical abuse includes any act of
violence – whether or not it results in
physical injury. Intentionally inflicting
pain or injury that results in either
bodily harm or mental distress is
abuse.
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Physical abuse may include, for example:
 Beating
 Burning or scalding
 Pushing or shoving
 Hitting or slapping
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 Rough handling
 Tripping
 Spitting.
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 Physical abuse against older adults
may also include:
 Tying them to furniture
 Using or misusing physical restraints
 Excessively restraining them through
the use of alcohol, tranquillizers or other
medication
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ELDER ABUSE
 Forcing them to remain in beds or
chairs
 Forcing them to remain in rooms
(including locking them in).
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Sexual
Any form of sexual activity with a
person without the consent of that
person.
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Spiritual abuse or neglect may include:
 Using their religious or spiritual beliefs
to exploit, manipulate, dominate or
control them
 Ridiculing their beliefs
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 Preventing them from engaging in
spiritual or religious practices
 Acting in a disrespectful way toward
their spirituality.
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Emotional / Psychological
Includes attempts to dehumanize or
intimidate older adults. Any verbal or
non-verbal act that reduces their sense
of self-worth or dignity and threatens
their psychological and emotional
integrity is abuse. This type of abuse
may include, for example:
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ELDER ABUSE
Threatening to use violence
Threatening to abandon them
Intentionally frightening them
Making them fear that they will not
receive the food or care they need
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ELDER ABUSE
 Lying to them
 Failing to check allegations of abuse
against them
 Insulting, swearing, or name calling
Making derogative or slanderous
statements about them to others
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ELDER ABUSE
 Intentionally misinterpreting their
traditional practices
 Repeatedly raising the issue of death
with them
 Telling them that they are too much
trouble
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ELDER ABUSE
 Ignoring or excessively criticizing them
 Being over-familiar and disrespectful
 Unreasonably ordering them around
 Treating them like servants
 Treating them like children
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ELDER ABUSE
 Socially isolating them, or failing to let them
have visitors
 Withholding important information that they
have a right to know
 Demeaning them because of the language
they speak
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Financial
The unethical or illegal misuse of
the money, property, or other
assets of an older adult, including
placing inappropriate pressure on
an older person in order to gain
access to her or his assets.
Barry Kidd 2010 21
Violation of Human / Civil Rights
The unlawful or unreasonable
denial of fundamental rights and
freedoms normally enjoyed by
adults.
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ELDER ABUSE
Neglect
The failure to provide the necessities of life
such as proper food, fluids, suitable clothing,
a safe and sanitary place of shelter, proper
medical attention, personal care, and
necessary supervision. There are several
forms of neglect, including active neglect,
passive neglect, self-neglect, and
abandonment
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ELDER ABUSE
Much abuse occurs within
relationships where there is an
expectation of trust. Some of
these relationships include:
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in a family,
between a husband and a wife,
between friends,
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ELDER ABUSE
between an older adult and
someone they rely on such as an
accountant, care worker, or other
paid person,
when someone is providing
services in an older adult’s home.
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ELDER ABUSE
Not all abuse is a result of
individual action and not all abuse
occurs within a personal
relationship. Sometimes older
adults are targeted because the
abusers think they will be easier
targets.
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ELDER ABUSE
Sometimes abuse is a result of how
older people are treated at a
societal level. Systemic abuse, for
example, can happen when policies
or practices take away a person’s
independence and dignity.
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ELDER ABUSE
 This sometimes happens when other
people are making decisions for the
older person and may be rooted in
ageism
Barry Kidd 2010 29
ELDER ABUSE
What causes
elder abuse?
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ELDER ABUSE
The causes of elder abuse are
extremely complex. Abuse generally
does not occur because of only one
factor but is a combination of
circumstances that can be intensified
and complicated by particular life
events.
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ELDER ABUSE
Poor or negative attitudes about
aging and the resulting behaviors
are a form of discrimination
called ageism, which is
frequently the root of
disrespectful and abusive
behaviors toward older persons.
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ELDER ABUSE
An inaccurate understanding of
the needs and capabilities of
older persons, insensitivity to the
wishes of the older person, and
additional stressors in one’s life
can also lead to a variety of
abusive behaviors.
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ELDER ABUSE
Oftentimes, people who exercise
power over others by pressuring,
threatening or taking advantage of
vulnerable older persons don’t know
that their behaviour or attitudes are
wrong or considered abusive.
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ELDER ABUSE
Elder abuse is sometimes a
continuance of existing abuse
and violence which can be
present in families and other
relationships.
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ELDER ABUSE
This abuse can be intensified by a
variety of risk factors such as a
change in lifestyle (like retirement);
employment or financial difficulties;
disputes over property/money;
physical illness; mental/psychiatric
illness; addictions;
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ELDER ABUSE
lack of additional supports;
isolation; changing relationships
with family and/or friends; and
declining lack of independence
due to increasing physical frailty.
Barry Kidd 2010 37
ELDER ABUSE
Beliefs about the role and
expectations of women and men,
disability, race or homophobia are
also causes of violations of older
persons
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ELDER ABUSE
While opinions vary on whether
care giving by a partner, relative
or friend causes abuse, there is
little evidence to support this
notion.
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ELDER ABUSE
Lack of awareness and education about
the role and expectations of care giving
as well as an inability to access or the
lack of community services and
supports is a significant issue for many
persons giving and receiving care.
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ELDER ABUSE
The additional stresses of providing care
coupled with any of the above factors
may make already unhealthy
relationships more strained and difficult.
This creates a greater risk of abuse.
Dependency can contribute to
increased feelings of guilt, resentment
or obligation by the person receiving
care.
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ELDER ABUSE
There are also circumstances
where the care giver is
dependent on the person
requiring care which can affect
the relationship and lead to
abuse of the caregiver by the
care recipient
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ELDER ABUSE
What are the different types and
signs of elder abuse?
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ELDER ABUSE
While some of these signs and symptoms
may be a result of other issues, they may
alert you to the possibility of abuse. Consider
these signs if you suspect someone is being
abused. Also keep in mind that many older
adults will experience more than one type of
abuse at the same time.
Barry Kidd 2010 44
Physical
Abuse
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ELDER ABUSE
Physical abuse is defined as the
use of physical force that may
result in bodily injury, physical
pain, or impairment.
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ELDER ABUSE
Physical abuse may include such
acts of violence as striking (with or
without an object), hitting, beating,
pushing, shoving, shaking,
slapping, kicking, pinching, and
burning.
Barry Kidd 2010 47
ELDER ABUSE
Inappropriate use of drugs and
physical restraints, force-feeding,
and physical punishment of any
kind are also examples of physical
abuse.
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ELDER ABUSE
Signs and symptoms of physical
abuse may include but are not
limited to:
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 bruises, black eyes, welts, lacerations,
and rope marks;
 bone fractures, broken bones, and skull
fractures;
 open wounds, cuts, punctures,
untreated injuries in various stages of
healing;
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ELDER ABUSE
 sprains, dislocations, and internal
injuries/bleeding;
 broken eyeglasses/frames, physical signs of
being subjected to punishment, and signs of
being restrained;
 laboratory findings of medication overdose or
under-utilization of prescribed drugs
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 an older person’s sudden change in
behaviour;
 "doctor-hopping" where an older person
frequently changes doctors or other
care providers in order to avoid
detection of abuse; and
 an older person’s report of being
physically abused.
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ELDER ABUSE
Sexual Abuse
Sexual abuse is defined as non-
consensual sexual contact of any kind
with a person. Sexual contact with any
person incapable of giving consent is
also considered sexual abuse.
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ELDER ABUSE
It may include unwanted touching, all
types of sexual assault or battery
(such as rape, sodomy, coerced
nudity), sexually explicit
photographing, the forcing or
coercing of degrading, humiliating, or
painful sexual acts.
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ELDER ABUSE
Signs and symptoms of sexual
abuse may include but are not
limited to:
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ELDER ABUSE
bruises around the breasts or
genital area;
unexplained venereal disease or
genital infections;
unexplained vaginal or anal
bleeding;
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torn, stained, or bloody
underclothing; and
an older person’s report of being
sexually assaulted or raped.
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Emotional or Psychological
Abuse
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Emotional or psychological abuse is defined
as the infliction of anguish, pain, or distress
through verbal or nonverbal acts.
Emotional/psychological abuse may include
verbal assaults, insults, threats, intimidation,
humiliation, and harassment.
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ELDER ABUSE
Treating an older person like an infant or child;
isolating an older person from her/his family,
friends, or regular activities; actively
withholding access to grandchildren; giving
an older person the "silent treatment;" and
enforced social isolation are also examples of
emotional/psychological abuse.
Barry Kidd 2010 60
ELDER ABUSE
Signs and symptoms of
emotional/psychological abuse may
include but are not limited to:
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ELDER ABUSE
being emotionally upset or agitated;
being extremely withdrawn and
non-communicative or non-
responsive;
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ELDER ABUSE
unusual behaviour usually
attributed to dementia (e.g.,
sucking, biting, rocking); and
an older person’s report of being
verbally or emotionally mistreated
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ELDER ABUSE
Financial Abuse
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ELDER ABUSE
Financial abuse (sometimes
referred to as financial or material
exploitation) is defined as the illegal
or improper use of an older
person’s funds, property, or assets.
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ELDER ABUSE
Examples include cashing an older
adult's cheque(s) without
authorization or permission; forging
an older person's signature;
misusing or stealing an older
person's money or possessions.
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ELDER ABUSE
Coercing or deceiving an older
person into signing any document
(e.g., contracts or will); and the
improper use of conservatorship,
guardianship, or power of attorney.
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ELDER ABUSE
Signs and symptoms of financial or
material exploitation may include but
are not limited to:
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ELDER ABUSE
 sudden changes in bank account or
banking practice, including an
unexplained withdrawal of large sums of
money by a person accompanying the
older adult;
 the inclusion of additional names on an
older person’s bank signature card;
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ELDER ABUSE
 abrupt changes in a will or other financial
documents;
 unexplained purchases or abuse of funds by
persons appointed as Power of Attorney;
 unexplained disappearance of funds or
valuable possessions;
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ELDER ABUSE
 substandard care being provided or bills
unpaid despite the availability of
adequate financial resources;
 discovery of an older person’s signature
being forged for financial transactions
or for the titles of her/his possessions;
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ELDER ABUSE
 sudden appearance of previously
uninvolved relatives claiming their rights
to an older person’s affairs and
possessions;
 unexplained sudden transfer of assets
to a family member or someone outside
the family;
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ELDER ABUSE
 the provision of services that are not
necessary; and
 an older person’s report of financial
exploitation.
 unauthorized withdrawal of the older
person’s funds using her or his ATM
card;
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ELDER ABUSE
Neglect
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ELDER ABUSE
Neglect is the refusal or failure to
provide an older person with such
life necessities as food, water,
clothing, shelter, personal hygiene,
medicine, comfort, personal safety,
and other essentials included in an
implied or agreed-upon
responsibility to an older person.
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ELDER ABUSE
Neglect may also include failure of
a person who has fiduciary/
management responsibilities to
provide care for an older person
(e.g., pay for necessary home care
services) or the failure on the part
of an in-home service provider to
provide necessary care.
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The intentional withholding of the
necessities of life is referred to as
active neglect; and the
unintentional failure to provide
proper care is referred to as
passive neglect.
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ELDER ABUSE
Passive neglect is often a result of
lack of knowledge, experience, or
ability to provide care
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ELDER ABUSE
Signs and symptoms of neglect (whether
active or passive) may include but are not
limited to:
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dehydration, malnutrition, untreated
bed sores, and poor personal
hygiene;
unattended or untreated health
problems;
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 hazardous or unsafe living
condition/arrangements (e.g., improper
wiring, no heat, or no running water);
 unsanitary and unclean living conditions
(e.g. dirt, fleas, lice on person, soiled
bedding, fecal/urine smell, inadequate
clothing); and
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 an older person’s report of being
neglected.
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Self-neglect involves the behaviour of
an older person that threatens her/his
own health or safety. Self-neglect
generally is observed in an older person
as a refusal or failure to provide
herself/himself with adequate food,
water, clothing, shelter, personal
hygiene, medication, and safety
precautions.
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The definition of self-neglect does not
include a situation in which a mentally
competent older person, who
understands the consequences of
her/his decisions, makes a conscious
and voluntary decision to engage in
acts that threaten her/his health or
safety as a matter of personal choice.
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Abandonment
Abandonment is the desertion of an
elderly person by an individual who
has assumed responsibility for
providing care for that person, or by
someone with physical custody of
an older adult.
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ELDER ABUSE
This is a form of neglect and can
include deserting an older adult at a
hospital, a nursing facility (or other
similar institution), deserting an
older adult at a shopping centre or
other public location.
Barry Kidd 2010 86
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What role does culture
play?
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Behaviours considered to be
abusive in any given society can
vary. Certain behaviours may not
be considered inappropriate or a
violation of rights.
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For example, if there are specific
cultural expectations of children
regarding the ownership of property
or money belonging to the parent,
this may be thought to be
acceptable and proper.
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In some societies, abuse is not
discussed or considered a concern.
Most cultures regard disrespect
and poor treatment of older
persons to be unacceptable but
there can be many complicating
factors
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It is important when dealing with
any individual from another culture
to learn about their beliefs,
practices and understandings about
aging and abuse.
Barry Kidd 2010 91
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Consider these questions:
Barry Kidd 2010 92
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What language do people
understand? Do they nod in
agreement or do they in fact realize
what is being said?
What are commonly accepted
gender roles (men and women) of a
particular culture?
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Does any cultural practice violate
rights or prevent individuals from
living as they wish?
 Is there a clear understanding of
the Canadian concept of human
rights?
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Are there differences in how
families and generations relate to
one another in a particular culture?
What are attitudes regarding
behaviours of various generations
toward one another
?
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Who makes decisions in the
family?
What role do older persons play in
the family or in their community?
Are there religious beliefs that
influence how family members
regard or treat one another?
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How does this cultural group
respond to having resources or
support provided from those in the
dominant culture/ society?
Do they look to their own cultural
group to address concerns or seek
support?
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 Does the older person have
associations with other seniors in
the community to discuss or
compare experiences?
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How many older people are
abused?
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It is difficult to say how many older
persons are abused, neglected, or
exploited, in large part because of a
lack of awareness and understanding of
elder abuse. Situations of abuse are
frequently not reported and the problem
remains greatly hidden.
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The best information available indicates
that between 4% and 7% of older adults
experience abuse.
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This means that in the Yukon
approximately 150 to 260 older people
experience harm and poor health or
well-being because of abuse.
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Because abuse is severely
underreported, it is believed that this
number is far greater
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Because women live longer than men
and there are more older women than
there are older men, elder abuse is and
will continue to be a significant women’s
issue.
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More older women are abused than
men, however, even when adjusted for
their greater numbers
Barry Kidd 2010 105
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Why isn’t it reported?
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There are a number of reasons why
abuse against older adults may not be
reported. Embarrassment, shame, and
fear are big obstacles to overcome for
many people to reach out for support or
assistance.
Barry Kidd 2010 107
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Because violence or deception is
increasingly regarded by our society to
be disturbing and wrong, many abused
persons do not reveal their experience
due to fear of the consequences to the
person who has victimized them.
Barry Kidd 2010 108
Older adults may not report abuse
because they:
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 fear more abuse
 want to protect family honour and/or
consider family break-up to be
unacceptable
 fear losing their independence
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 fear institutionalization (being placed in
a facility against their will)
 fear losing financial, physical, and/or
emotional support provided by the
abuser
 lack self-esteem and assertiveness;
believe “I deserve what I get” and
accept abuse as “normal”
Barry Kidd 2010 111
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 fear being denied access to
grandchildren
 feel hopeless about finding solutions
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 love the abuser and do not want to see
her/him criticized, particularly if it is their
own child who is abusing them
 may experience language difficulties
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 don’t know or understand their rights,
including how to act on them
 don’t know what services are available
to them
 may be depressed due to loneliness or
lack of proper nutrition.
Barry Kidd 2010 114
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We sometimes don’t see it
because:
Barry Kidd 2010 115
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 attitudes, behaviours, and
institutionalized practices in our society
promote ageism and devalue older
persons
 it is simply not reported and may be well
hidden
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 there is a lack of awareness about
abuse against older adults
 society believes in sanctity of the family
and the family’s right to privacy
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 use of force in certain circumstances is
seen as okay
 there are lack of options for dealing with
an abused older person
 we just don’t know what to do.
Barry Kidd 2010 118
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What makes an older adult
vulnerable to abuse?
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Some seniors are more at risk than
others. Those who are older, socially
isolated, have reduced cognitive
capacity, have disabilities and are
dependent, and those cared for by
people with an addiction (such as
alcohol, drugs or gambling) are at
higher risk.
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Social isolation and mental impairment
(such as dementia or Alzheimer's
Disease) are two factors that may make
an older person more vulnerable to
abuse. But, in some situations, studies
show that living with someone else (a
caregiver or a friend) may increase the
chances for abuse to occur.
Barry Kidd 2010 121
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A history of domestic violence may also
make a senior more susceptible to
abuse. Families that have a history of
poor relationships or mental health
problems may also be at higher risk.
Barry Kidd 2010 122
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Elder abuse affects people of all
education levels, sexual orientation,
ability, and social, economic and ethnic
backgrounds and cultures. It affects
both men and women.
Barry Kidd 2010 123
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Who abuses older people?
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Most abuse is committed by someone
the senior knows, such as a family
member, friend, caregiver, landlord,
(paid) care provider, or a person who
provides a service (e.g. financial advisor
or home maintenance person).
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Abusers of older adults are both women
and men. Family members are more
often the abusers than any other group.
For several years, data showed that
adult children were the most common
abusers of family members.
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Recent information, however, indicates
spouses are the most common
perpetrators when data concerning
older adults and vulnerable adults is
combined.
Barry Kidd 2010 127
Are there criminal penalties for the
abusers?
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Some abusive actions are defined as
crimes, but not all abuse is considered
criminal. The Criminal Code of Canada
describes the different offences that
someone can be charged with if they
are accused of abusive actions toward
older adults.
Barry Kidd 2010 129
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The relevant provisions relate to
physical and sexual abuse, chronic
psychological abuse, neglect, loss of
rights (as under the Canadian Charter
of Rights and Freedoms), property theft,
breach of trust and breach of power of
attorney, extortion, fraud and false
pretences, and intimidation.
Barry Kidd 2010 130
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Because not all behaviour believed to
be abusive falls under the Criminal
Code, a range of resources and
supports are necessary to be able to
respond to cases of abuse.
Barry Kidd 2010 131
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It is also important to note that while
there are commonly accepted
definitions of abuse, the way abuse is
defined in legislation may vary. This
becomes important when one looks to
available legal responses, and it
emphasizes the need for a range of
resources and supports.
Barry Kidd 2010 132
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How can elder abuse be
prevented?
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As with all forms of violence, abuse
against older adults can be prevented.
We must:
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 Challenge ageist attitudes and beliefs
that devalue older adults.
 Treat older adults with the respect and
dignity they deserve.
 Work with older adults to empower
them to make healthy relationship
choices.
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 Offer alternatives to remaining in
abusive situations.
 Enhance informal support networks.
 Ensure seniors retain as much power
and control over their own lives as
possible.
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Provide information on services
and programs available to assist.
Encourage caregivers to access
support available to them.
Educate ourselves and others
about elder abuse.
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We must also foster positive
relationships between generations and
provide support to those caring for
seniors.
Barry Kidd 2010 138
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Educating seniors, professionals,
caregivers, and the public about abuse
is critical to prevention. It is important
that the issue of abuse is understood,
discussed by both professionals and
the public and confronted in our
communities.
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Responsibility of EMS
Barry Kidd 2010 140
ELDER ABUSE
Documentation
Put what you have observed in your
PCR
Put what your patient told you in your
PCR
Put what caretakers, family or
neighbours told you in your PCR
Barry Kidd 2010 141
ELDER ABUSE
Put results of your secondary
assessment in your PCR
Put your suspicions and your concerns
in your PCR
Document that you notified the
Emergency department
Barry Kidd 2010 142
ELDER ABUSE
According to Seniors’ Services and
Adult Protection, a Department of
Health and Social Services, all
complaints received by that
department are investigated.
Barry Kidd 2010 143
ELDER ABUSE
Barry Kidd 2010 144
ELDER ABUSE
Questions and Answers

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Elder abuse

  • 1. Barry Kidd 2010 1 ELDER ABUSE RECOGNITION AND THE EMS RESPONSE
  • 2. Barry Kidd 2010 2 WHAT IS ELDER ABUSE? “Elder abuse is the infliction of harm on an older person”. Abuse is any act or failure to act that endangers the health and/or well being of the older person. Such action or inaction is especially harmful when it occurs within a relationship where there is an expectation of trust.
  • 3. Barry Kidd 2010 3 ELDER ABUSE Elder abuse is the maltreatment of an older or elderly individual
  • 4. Barry Kidd 2010 4 Elder abuse can have many forms
  • 5. Barry Kidd 2010 5 Abuse may be :
  • 6. Barry Kidd 2010 6 Physical Abuse Physical abuse includes any act of violence – whether or not it results in physical injury. Intentionally inflicting pain or injury that results in either bodily harm or mental distress is abuse.
  • 7. Barry Kidd 2010 7 ELDER ABUSE Physical abuse may include, for example:  Beating  Burning or scalding  Pushing or shoving  Hitting or slapping
  • 8. Barry Kidd 2010 8 ELDER ABUSE  Rough handling  Tripping  Spitting.
  • 9. Barry Kidd 2010 9 ELDER ABUSE  Physical abuse against older adults may also include:  Tying them to furniture  Using or misusing physical restraints  Excessively restraining them through the use of alcohol, tranquillizers or other medication
  • 10. Barry Kidd 2010 10 ELDER ABUSE  Forcing them to remain in beds or chairs  Forcing them to remain in rooms (including locking them in).
  • 11. Barry Kidd 2010 11 Sexual Any form of sexual activity with a person without the consent of that person.
  • 12. Barry Kidd 2010 12 ELDER ABUSE Spiritual abuse or neglect may include:  Using their religious or spiritual beliefs to exploit, manipulate, dominate or control them  Ridiculing their beliefs
  • 13. Barry Kidd 2010 13 ELDER ABUSE  Preventing them from engaging in spiritual or religious practices  Acting in a disrespectful way toward their spirituality.
  • 14. Barry Kidd 2010 14 Emotional / Psychological Includes attempts to dehumanize or intimidate older adults. Any verbal or non-verbal act that reduces their sense of self-worth or dignity and threatens their psychological and emotional integrity is abuse. This type of abuse may include, for example:
  • 15. Barry Kidd 2010 15 ELDER ABUSE Threatening to use violence Threatening to abandon them Intentionally frightening them Making them fear that they will not receive the food or care they need
  • 16. Barry Kidd 2010 16 ELDER ABUSE  Lying to them  Failing to check allegations of abuse against them  Insulting, swearing, or name calling Making derogative or slanderous statements about them to others
  • 17. Barry Kidd 2010 17 ELDER ABUSE  Intentionally misinterpreting their traditional practices  Repeatedly raising the issue of death with them  Telling them that they are too much trouble
  • 18. Barry Kidd 2010 18 ELDER ABUSE  Ignoring or excessively criticizing them  Being over-familiar and disrespectful  Unreasonably ordering them around  Treating them like servants  Treating them like children
  • 19. Barry Kidd 2010 19 ELDER ABUSE  Socially isolating them, or failing to let them have visitors  Withholding important information that they have a right to know  Demeaning them because of the language they speak
  • 20. Barry Kidd 2010 20 Financial The unethical or illegal misuse of the money, property, or other assets of an older adult, including placing inappropriate pressure on an older person in order to gain access to her or his assets.
  • 21. Barry Kidd 2010 21 Violation of Human / Civil Rights The unlawful or unreasonable denial of fundamental rights and freedoms normally enjoyed by adults.
  • 22. Barry Kidd 2010 22 ELDER ABUSE Neglect The failure to provide the necessities of life such as proper food, fluids, suitable clothing, a safe and sanitary place of shelter, proper medical attention, personal care, and necessary supervision. There are several forms of neglect, including active neglect, passive neglect, self-neglect, and abandonment
  • 23. Barry Kidd 2010 23 ELDER ABUSE Much abuse occurs within relationships where there is an expectation of trust. Some of these relationships include:
  • 24. Barry Kidd 2010 24 ELDER ABUSE in a family, between a husband and a wife, between friends,
  • 25. Barry Kidd 2010 25 ELDER ABUSE between an older adult and someone they rely on such as an accountant, care worker, or other paid person, when someone is providing services in an older adult’s home.
  • 26. Barry Kidd 2010 26 ELDER ABUSE Not all abuse is a result of individual action and not all abuse occurs within a personal relationship. Sometimes older adults are targeted because the abusers think they will be easier targets.
  • 27. Barry Kidd 2010 27 ELDER ABUSE Sometimes abuse is a result of how older people are treated at a societal level. Systemic abuse, for example, can happen when policies or practices take away a person’s independence and dignity.
  • 28. Barry Kidd 2010 28 ELDER ABUSE  This sometimes happens when other people are making decisions for the older person and may be rooted in ageism
  • 29. Barry Kidd 2010 29 ELDER ABUSE What causes elder abuse?
  • 30. Barry Kidd 2010 30 ELDER ABUSE The causes of elder abuse are extremely complex. Abuse generally does not occur because of only one factor but is a combination of circumstances that can be intensified and complicated by particular life events.
  • 31. Barry Kidd 2010 31 ELDER ABUSE Poor or negative attitudes about aging and the resulting behaviors are a form of discrimination called ageism, which is frequently the root of disrespectful and abusive behaviors toward older persons.
  • 32. Barry Kidd 2010 32 ELDER ABUSE An inaccurate understanding of the needs and capabilities of older persons, insensitivity to the wishes of the older person, and additional stressors in one’s life can also lead to a variety of abusive behaviors.
  • 33. Barry Kidd 2010 33 ELDER ABUSE Oftentimes, people who exercise power over others by pressuring, threatening or taking advantage of vulnerable older persons don’t know that their behaviour or attitudes are wrong or considered abusive.
  • 34. Barry Kidd 2010 34 ELDER ABUSE Elder abuse is sometimes a continuance of existing abuse and violence which can be present in families and other relationships.
  • 35. Barry Kidd 2010 35 ELDER ABUSE This abuse can be intensified by a variety of risk factors such as a change in lifestyle (like retirement); employment or financial difficulties; disputes over property/money; physical illness; mental/psychiatric illness; addictions;
  • 36. Barry Kidd 2010 36 ELDER ABUSE lack of additional supports; isolation; changing relationships with family and/or friends; and declining lack of independence due to increasing physical frailty.
  • 37. Barry Kidd 2010 37 ELDER ABUSE Beliefs about the role and expectations of women and men, disability, race or homophobia are also causes of violations of older persons
  • 38. Barry Kidd 2010 38 ELDER ABUSE While opinions vary on whether care giving by a partner, relative or friend causes abuse, there is little evidence to support this notion.
  • 39. Barry Kidd 2010 39 ELDER ABUSE Lack of awareness and education about the role and expectations of care giving as well as an inability to access or the lack of community services and supports is a significant issue for many persons giving and receiving care.
  • 40. Barry Kidd 2010 40 ELDER ABUSE The additional stresses of providing care coupled with any of the above factors may make already unhealthy relationships more strained and difficult. This creates a greater risk of abuse. Dependency can contribute to increased feelings of guilt, resentment or obligation by the person receiving care.
  • 41. Barry Kidd 2010 41 ELDER ABUSE There are also circumstances where the care giver is dependent on the person requiring care which can affect the relationship and lead to abuse of the caregiver by the care recipient
  • 42. Barry Kidd 2010 42 ELDER ABUSE What are the different types and signs of elder abuse?
  • 43. Barry Kidd 2010 43 ELDER ABUSE While some of these signs and symptoms may be a result of other issues, they may alert you to the possibility of abuse. Consider these signs if you suspect someone is being abused. Also keep in mind that many older adults will experience more than one type of abuse at the same time.
  • 44. Barry Kidd 2010 44 Physical Abuse
  • 45. Barry Kidd 2010 45 ELDER ABUSE Physical abuse is defined as the use of physical force that may result in bodily injury, physical pain, or impairment.
  • 46. Barry Kidd 2010 46 ELDER ABUSE Physical abuse may include such acts of violence as striking (with or without an object), hitting, beating, pushing, shoving, shaking, slapping, kicking, pinching, and burning.
  • 47. Barry Kidd 2010 47 ELDER ABUSE Inappropriate use of drugs and physical restraints, force-feeding, and physical punishment of any kind are also examples of physical abuse.
  • 48. Barry Kidd 2010 48 ELDER ABUSE Signs and symptoms of physical abuse may include but are not limited to:
  • 49. Barry Kidd 2010 49 ELDER ABUSE  bruises, black eyes, welts, lacerations, and rope marks;  bone fractures, broken bones, and skull fractures;  open wounds, cuts, punctures, untreated injuries in various stages of healing;
  • 50. Barry Kidd 2010 50 ELDER ABUSE  sprains, dislocations, and internal injuries/bleeding;  broken eyeglasses/frames, physical signs of being subjected to punishment, and signs of being restrained;  laboratory findings of medication overdose or under-utilization of prescribed drugs
  • 51. Barry Kidd 2010 51 ELDER ABUSE  an older person’s sudden change in behaviour;  "doctor-hopping" where an older person frequently changes doctors or other care providers in order to avoid detection of abuse; and  an older person’s report of being physically abused.
  • 52. Barry Kidd 2010 52 ELDER ABUSE Sexual Abuse Sexual abuse is defined as non- consensual sexual contact of any kind with a person. Sexual contact with any person incapable of giving consent is also considered sexual abuse.
  • 53. Barry Kidd 2010 53 ELDER ABUSE It may include unwanted touching, all types of sexual assault or battery (such as rape, sodomy, coerced nudity), sexually explicit photographing, the forcing or coercing of degrading, humiliating, or painful sexual acts.
  • 54. Barry Kidd 2010 54 ELDER ABUSE Signs and symptoms of sexual abuse may include but are not limited to:
  • 55. Barry Kidd 2010 55 ELDER ABUSE bruises around the breasts or genital area; unexplained venereal disease or genital infections; unexplained vaginal or anal bleeding;
  • 56. Barry Kidd 2010 56 ELDER ABUSE torn, stained, or bloody underclothing; and an older person’s report of being sexually assaulted or raped.
  • 57. Barry Kidd 2010 57 ELDER ABUSE Emotional or Psychological Abuse
  • 58. Barry Kidd 2010 58 ELDER ABUSE Emotional or psychological abuse is defined as the infliction of anguish, pain, or distress through verbal or nonverbal acts. Emotional/psychological abuse may include verbal assaults, insults, threats, intimidation, humiliation, and harassment.
  • 59. Barry Kidd 2010 59 ELDER ABUSE Treating an older person like an infant or child; isolating an older person from her/his family, friends, or regular activities; actively withholding access to grandchildren; giving an older person the "silent treatment;" and enforced social isolation are also examples of emotional/psychological abuse.
  • 60. Barry Kidd 2010 60 ELDER ABUSE Signs and symptoms of emotional/psychological abuse may include but are not limited to:
  • 61. Barry Kidd 2010 61 ELDER ABUSE being emotionally upset or agitated; being extremely withdrawn and non-communicative or non- responsive;
  • 62. Barry Kidd 2010 62 ELDER ABUSE unusual behaviour usually attributed to dementia (e.g., sucking, biting, rocking); and an older person’s report of being verbally or emotionally mistreated
  • 63. Barry Kidd 2010 63 ELDER ABUSE Financial Abuse
  • 64. Barry Kidd 2010 64 ELDER ABUSE Financial abuse (sometimes referred to as financial or material exploitation) is defined as the illegal or improper use of an older person’s funds, property, or assets.
  • 65. Barry Kidd 2010 65 ELDER ABUSE Examples include cashing an older adult's cheque(s) without authorization or permission; forging an older person's signature; misusing or stealing an older person's money or possessions.
  • 66. Barry Kidd 2010 66 ELDER ABUSE Coercing or deceiving an older person into signing any document (e.g., contracts or will); and the improper use of conservatorship, guardianship, or power of attorney.
  • 67. Barry Kidd 2010 67 ELDER ABUSE Signs and symptoms of financial or material exploitation may include but are not limited to:
  • 68. Barry Kidd 2010 68 ELDER ABUSE  sudden changes in bank account or banking practice, including an unexplained withdrawal of large sums of money by a person accompanying the older adult;  the inclusion of additional names on an older person’s bank signature card;
  • 69. Barry Kidd 2010 69 ELDER ABUSE  abrupt changes in a will or other financial documents;  unexplained purchases or abuse of funds by persons appointed as Power of Attorney;  unexplained disappearance of funds or valuable possessions;
  • 70. Barry Kidd 2010 70 ELDER ABUSE  substandard care being provided or bills unpaid despite the availability of adequate financial resources;  discovery of an older person’s signature being forged for financial transactions or for the titles of her/his possessions;
  • 71. Barry Kidd 2010 71 ELDER ABUSE  sudden appearance of previously uninvolved relatives claiming their rights to an older person’s affairs and possessions;  unexplained sudden transfer of assets to a family member or someone outside the family;
  • 72. Barry Kidd 2010 72 ELDER ABUSE  the provision of services that are not necessary; and  an older person’s report of financial exploitation.  unauthorized withdrawal of the older person’s funds using her or his ATM card;
  • 73. Barry Kidd 2010 73 ELDER ABUSE Neglect
  • 74. Barry Kidd 2010 74 ELDER ABUSE Neglect is the refusal or failure to provide an older person with such life necessities as food, water, clothing, shelter, personal hygiene, medicine, comfort, personal safety, and other essentials included in an implied or agreed-upon responsibility to an older person.
  • 75. Barry Kidd 2010 75 ELDER ABUSE Neglect may also include failure of a person who has fiduciary/ management responsibilities to provide care for an older person (e.g., pay for necessary home care services) or the failure on the part of an in-home service provider to provide necessary care.
  • 76. Barry Kidd 2010 76 ELDER ABUSE The intentional withholding of the necessities of life is referred to as active neglect; and the unintentional failure to provide proper care is referred to as passive neglect.
  • 77. Barry Kidd 2010 77 ELDER ABUSE Passive neglect is often a result of lack of knowledge, experience, or ability to provide care
  • 78. Barry Kidd 2010 78 ELDER ABUSE Signs and symptoms of neglect (whether active or passive) may include but are not limited to:
  • 79. Barry Kidd 2010 79 ELDER ABUSE dehydration, malnutrition, untreated bed sores, and poor personal hygiene; unattended or untreated health problems;
  • 80. Barry Kidd 2010 80 ELDER ABUSE  hazardous or unsafe living condition/arrangements (e.g., improper wiring, no heat, or no running water);  unsanitary and unclean living conditions (e.g. dirt, fleas, lice on person, soiled bedding, fecal/urine smell, inadequate clothing); and
  • 81. Barry Kidd 2010 81 ELDER ABUSE  an older person’s report of being neglected.
  • 82. Barry Kidd 2010 82 ELDER ABUSE Self-neglect involves the behaviour of an older person that threatens her/his own health or safety. Self-neglect generally is observed in an older person as a refusal or failure to provide herself/himself with adequate food, water, clothing, shelter, personal hygiene, medication, and safety precautions.
  • 83. Barry Kidd 2010 83 ELDER ABUSE The definition of self-neglect does not include a situation in which a mentally competent older person, who understands the consequences of her/his decisions, makes a conscious and voluntary decision to engage in acts that threaten her/his health or safety as a matter of personal choice.
  • 84. Barry Kidd 2010 84 ELDER ABUSE Abandonment Abandonment is the desertion of an elderly person by an individual who has assumed responsibility for providing care for that person, or by someone with physical custody of an older adult.
  • 85. Barry Kidd 2010 85 ELDER ABUSE This is a form of neglect and can include deserting an older adult at a hospital, a nursing facility (or other similar institution), deserting an older adult at a shopping centre or other public location.
  • 86. Barry Kidd 2010 86 ELDER ABUSE What role does culture play?
  • 87. Barry Kidd 2010 87 ELDER ABUSE Behaviours considered to be abusive in any given society can vary. Certain behaviours may not be considered inappropriate or a violation of rights.
  • 88. Barry Kidd 2010 88 ELDER ABUSE For example, if there are specific cultural expectations of children regarding the ownership of property or money belonging to the parent, this may be thought to be acceptable and proper.
  • 89. Barry Kidd 2010 89 ELDER ABUSE In some societies, abuse is not discussed or considered a concern. Most cultures regard disrespect and poor treatment of older persons to be unacceptable but there can be many complicating factors
  • 90. Barry Kidd 2010 90 ELDER ABUSE It is important when dealing with any individual from another culture to learn about their beliefs, practices and understandings about aging and abuse.
  • 91. Barry Kidd 2010 91 ELDER ABUSE Consider these questions:
  • 92. Barry Kidd 2010 92 ELDER ABUSE What language do people understand? Do they nod in agreement or do they in fact realize what is being said? What are commonly accepted gender roles (men and women) of a particular culture?
  • 93. Barry Kidd 2010 93 ELDER ABUSE Does any cultural practice violate rights or prevent individuals from living as they wish?  Is there a clear understanding of the Canadian concept of human rights?
  • 94. Barry Kidd 2010 94 ELDER ABUSE Are there differences in how families and generations relate to one another in a particular culture? What are attitudes regarding behaviours of various generations toward one another ?
  • 95. Barry Kidd 2010 95 ELDER ABUSE Who makes decisions in the family? What role do older persons play in the family or in their community? Are there religious beliefs that influence how family members regard or treat one another?
  • 96. Barry Kidd 2010 96 ELDER ABUSE How does this cultural group respond to having resources or support provided from those in the dominant culture/ society? Do they look to their own cultural group to address concerns or seek support?
  • 97. Barry Kidd 2010 97 ELDER ABUSE  Does the older person have associations with other seniors in the community to discuss or compare experiences?
  • 98. Barry Kidd 2010 98 ELDER ABUSE How many older people are abused?
  • 99. Barry Kidd 2010 99 ELDER ABUSE It is difficult to say how many older persons are abused, neglected, or exploited, in large part because of a lack of awareness and understanding of elder abuse. Situations of abuse are frequently not reported and the problem remains greatly hidden.
  • 100. Barry Kidd 2010 100 ELDER ABUSE The best information available indicates that between 4% and 7% of older adults experience abuse.
  • 101. Barry Kidd 2010 101 ELDER ABUSE This means that in the Yukon approximately 150 to 260 older people experience harm and poor health or well-being because of abuse.
  • 102. Barry Kidd 2010 102 ELDER ABUSE Because abuse is severely underreported, it is believed that this number is far greater
  • 103. Barry Kidd 2010 103 ELDER ABUSE Because women live longer than men and there are more older women than there are older men, elder abuse is and will continue to be a significant women’s issue.
  • 104. Barry Kidd 2010 104 ELDER ABUSE More older women are abused than men, however, even when adjusted for their greater numbers
  • 105. Barry Kidd 2010 105 ELDER ABUSE Why isn’t it reported?
  • 106. Barry Kidd 2010 106 ELDER ABUSE There are a number of reasons why abuse against older adults may not be reported. Embarrassment, shame, and fear are big obstacles to overcome for many people to reach out for support or assistance.
  • 107. Barry Kidd 2010 107 ELDER ABUSE Because violence or deception is increasingly regarded by our society to be disturbing and wrong, many abused persons do not reveal their experience due to fear of the consequences to the person who has victimized them.
  • 108. Barry Kidd 2010 108 Older adults may not report abuse because they:
  • 109. Barry Kidd 2010 109 ELDER ABUSE  fear more abuse  want to protect family honour and/or consider family break-up to be unacceptable  fear losing their independence
  • 110. Barry Kidd 2010 110 ELDER ABUSE  fear institutionalization (being placed in a facility against their will)  fear losing financial, physical, and/or emotional support provided by the abuser  lack self-esteem and assertiveness; believe “I deserve what I get” and accept abuse as “normal”
  • 111. Barry Kidd 2010 111 ELDER ABUSE  fear being denied access to grandchildren  feel hopeless about finding solutions
  • 112. Barry Kidd 2010 112 ELDER ABUSE  love the abuser and do not want to see her/him criticized, particularly if it is their own child who is abusing them  may experience language difficulties
  • 113. Barry Kidd 2010 113 ELDER ABUSE  don’t know or understand their rights, including how to act on them  don’t know what services are available to them  may be depressed due to loneliness or lack of proper nutrition.
  • 114. Barry Kidd 2010 114 ELDER ABUSE We sometimes don’t see it because:
  • 115. Barry Kidd 2010 115 ELDER ABUSE  attitudes, behaviours, and institutionalized practices in our society promote ageism and devalue older persons  it is simply not reported and may be well hidden
  • 116. Barry Kidd 2010 116 ELDER ABUSE  there is a lack of awareness about abuse against older adults  society believes in sanctity of the family and the family’s right to privacy
  • 117. Barry Kidd 2010 117 ELDER ABUSE  use of force in certain circumstances is seen as okay  there are lack of options for dealing with an abused older person  we just don’t know what to do.
  • 118. Barry Kidd 2010 118 ELDER ABUSE What makes an older adult vulnerable to abuse?
  • 119. Barry Kidd 2010 119 ELDER ABUSE Some seniors are more at risk than others. Those who are older, socially isolated, have reduced cognitive capacity, have disabilities and are dependent, and those cared for by people with an addiction (such as alcohol, drugs or gambling) are at higher risk.
  • 120. Barry Kidd 2010 120 ELDER ABUSE Social isolation and mental impairment (such as dementia or Alzheimer's Disease) are two factors that may make an older person more vulnerable to abuse. But, in some situations, studies show that living with someone else (a caregiver or a friend) may increase the chances for abuse to occur.
  • 121. Barry Kidd 2010 121 ELDER ABUSE A history of domestic violence may also make a senior more susceptible to abuse. Families that have a history of poor relationships or mental health problems may also be at higher risk.
  • 122. Barry Kidd 2010 122 ELDER ABUSE Elder abuse affects people of all education levels, sexual orientation, ability, and social, economic and ethnic backgrounds and cultures. It affects both men and women.
  • 123. Barry Kidd 2010 123 ELDER ABUSE Who abuses older people?
  • 124. Barry Kidd 2010 124 ELDER ABUSE Most abuse is committed by someone the senior knows, such as a family member, friend, caregiver, landlord, (paid) care provider, or a person who provides a service (e.g. financial advisor or home maintenance person).
  • 125. Barry Kidd 2010 125 ELDER ABUSE Abusers of older adults are both women and men. Family members are more often the abusers than any other group. For several years, data showed that adult children were the most common abusers of family members.
  • 126. Barry Kidd 2010 126 ELDER ABUSE Recent information, however, indicates spouses are the most common perpetrators when data concerning older adults and vulnerable adults is combined.
  • 127. Barry Kidd 2010 127 Are there criminal penalties for the abusers?
  • 128. Barry Kidd 2010 128 ELDER ABUSE Some abusive actions are defined as crimes, but not all abuse is considered criminal. The Criminal Code of Canada describes the different offences that someone can be charged with if they are accused of abusive actions toward older adults.
  • 129. Barry Kidd 2010 129 ELDER ABUSE The relevant provisions relate to physical and sexual abuse, chronic psychological abuse, neglect, loss of rights (as under the Canadian Charter of Rights and Freedoms), property theft, breach of trust and breach of power of attorney, extortion, fraud and false pretences, and intimidation.
  • 130. Barry Kidd 2010 130 ELDER ABUSE Because not all behaviour believed to be abusive falls under the Criminal Code, a range of resources and supports are necessary to be able to respond to cases of abuse.
  • 131. Barry Kidd 2010 131 ELDER ABUSE It is also important to note that while there are commonly accepted definitions of abuse, the way abuse is defined in legislation may vary. This becomes important when one looks to available legal responses, and it emphasizes the need for a range of resources and supports.
  • 132. Barry Kidd 2010 132 ELDER ABUSE How can elder abuse be prevented?
  • 133. Barry Kidd 2010 133 ELDER ABUSE As with all forms of violence, abuse against older adults can be prevented. We must:
  • 134. Barry Kidd 2010 134 ELDER ABUSE  Challenge ageist attitudes and beliefs that devalue older adults.  Treat older adults with the respect and dignity they deserve.  Work with older adults to empower them to make healthy relationship choices.
  • 135. Barry Kidd 2010 135 ELDER ABUSE  Offer alternatives to remaining in abusive situations.  Enhance informal support networks.  Ensure seniors retain as much power and control over their own lives as possible.
  • 136. Barry Kidd 2010 136 ELDER ABUSE Provide information on services and programs available to assist. Encourage caregivers to access support available to them. Educate ourselves and others about elder abuse.
  • 137. Barry Kidd 2010 137 ELDER ABUSE We must also foster positive relationships between generations and provide support to those caring for seniors.
  • 138. Barry Kidd 2010 138 ELDER ABUSE Educating seniors, professionals, caregivers, and the public about abuse is critical to prevention. It is important that the issue of abuse is understood, discussed by both professionals and the public and confronted in our communities.
  • 139. Barry Kidd 2010 139 ELDER ABUSE Responsibility of EMS
  • 140. Barry Kidd 2010 140 ELDER ABUSE Documentation Put what you have observed in your PCR Put what your patient told you in your PCR Put what caretakers, family or neighbours told you in your PCR
  • 141. Barry Kidd 2010 141 ELDER ABUSE Put results of your secondary assessment in your PCR Put your suspicions and your concerns in your PCR Document that you notified the Emergency department
  • 142. Barry Kidd 2010 142 ELDER ABUSE According to Seniors’ Services and Adult Protection, a Department of Health and Social Services, all complaints received by that department are investigated.
  • 143. Barry Kidd 2010 143 ELDER ABUSE
  • 144. Barry Kidd 2010 144 ELDER ABUSE Questions and Answers