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Elder Abuse: Common Myths and Misconceptions, Acknowledgement and Prevention Of Elder Abuse In Residential Facilities.

Common Myths And Misconceptions

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“Senior abuse is rampant and on the rise”

It is very common to run across community discussions or media reports about “the hidden epidemic of elder abuse.”

The term “epidemic” is drawn from public health and refers to infectious conditions that are rapidly spreading in a short period of time.

In everyday language, people may simply mean a situation that is widely prevalent.

When abuse is characterized as an “epidemic” it becomes very easy for people to want fast ways to “fix the crisis” and seek easy responses such as television awareness ads without understanding its cause, extent and its multifaceted nature.

The truth is we still do not actually know how common the problem is among seniors, how severe the situations are and why they happen.

We do not know whether the problem of abuse and neglect is increasing, decreasing or remaining at the same level.

The fact that more people are living into the senior years and often well into their late years would seem to suggest we should expect to see more abuse or neglect cases, even if the prevalence rate for mistreatment remains the same.

We still have little information on which groups of seniors are most at risk of which types of harms and why.

Without that information, it is easy to fall back on preconceptions.

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Anything unfortunate that happens to a senior is “abuse”

Today some people use the terms “elder abuse” or “elder neglect” in a much broader context than these would have been used ten or fifteen years ago.

It is also increasingly common to see middle aged people (those in their 50s) included as part of “the senior discussion.” This will increase the numbers and can seriously conflate the issue.

In some respects, the language of “abuse” and “neglect” has been co-opted.

For example, it is common to see the idea of “financial abuse” not only being applied to families misusing a power of attorney, but to frauds and scams as well as ordinary consumer issues.

These are all different. They arise for different reasons and from different causes; they require different types of solutions.

Professionals such as dentists may note that many seniors may not have good access to services and call it “elder neglect.”

This may be a relevant systemic issue to consider and it may affect seniors’ quality of life but let’s avoid framing these matters as abuse or neglect.

The wider the way the language of abuse or neglect is being used, the easier it is to view all seniors as a vulnerable group, and therefore in need of having increased protection from the big, bad world.

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Seniors won’t report mistreatment

This oft repeated statement is simply not accurate. For example, Statistics Canada has conducted decades of victimization surveys and consistently found that older adults are much more likely than younger adults who have been victimized to report these matters to the police.

People of any age will talk and will let someone they trust know about a problem if it feels safe to do so. Sometimes, they simply want someone to listen, and sometimes they are looking for outside help.

However many friends, families and service providers today are still very judgmental of older adults who are experiencing abuse or neglect.

People may not understand why mistreatment happens or its dynamics.

They commonly feel the responsibility for the problem lies with the person being harmed.

People may blame the senior for not being strong-willed with family now or when they were growing up, or to look to another simple explanation.

People’s reactions like these create an unnecessary stigma about abuse and neglect. It makes discussing mistreatment feel unsafe. We can do better.

Acknowledgment And Prevention Of Elder Abuse In Residential Facilities

The United Nations designated June 15, 2015 as World Elder Abuse Awareness Day (WEAAD). Its objective is to shine a light on physical, emotional and financial abuse of seniors and to encourage all levels of government to implement policies for their safety and welfare.

Jewish Seniors Alliance of Greater Vancouver is part of the struggle to bring to awareness of the problem of elder abuse. The intention of this article is to explore ways to facilitate the reduction of such cases and the elimination of elder abuse. Ageism, cultural and socioeconomic processes affect elder abuse and render it a public health and human rights issue.

Section 15 (1) OF THE Canadian Charter of Rights and Freedoms states that “Every individual is equal before and under the law and has the right to the equal protection and equal benefit of the law without discrimination and, in particular, without discrimination based on race, national or ethnic origin, colour, religion, sex, age or mental or physical disability.” We must apply this standard equally to those who are residents in the care facilities and to the paid care givers who care for the residents.

Our hospitals and residential care facilities are crowded with people, often in their 80’s, with dementia, in particular, Alzheimer’s disease. They manifest symptoms of paranoia, hallucinations, agitation and rage which can be unsettling for them and their caregivers. It is known that antipsychotic drugs are sometimes inappropriately used to manage aggressive or agitated behaviours in residents who have dementia.The medications are used to control behaviours such as—elders acting out with aggression and violence, refusing to take medication or resisting medical procedures. The caregiver then has a problem. Sometimes patients are pushed down, sometimes they are restrained at the wrists and feet, sometimes they are shouted at, bullied or scorned. However, incidents of elder abuse are much more prevalent in the community than in residential care facilities.

Grace Hann of Jewish Seniors Alliance Peer Support Services was approached by the daughter of such a resident who wrote a graphic description of her mother’s “treatment” and  presented photographs of the bruises and contusions. “This woman had been cared for at home with 3 hours of daily assistance, however, after an aggressive episode, the private contractor stopped the service for 7 days for the safety of the caregivers. The next episode resulted in the elder being transferred to the hospital where the abuse occurred,” writes the daughter of the elderly, frail woman.

This is not an isolated case. Sometimes appropriate services are denied to elders who wish to remain at home.This hastens their entry into the hospital system and residential care facilities. The number of elders confined to institutional care is only a small percentage of the total senior population. In these institutions staffing is, at times, inadequate to a situation; training of staff is sometimes insufficient and there is a high turnover of health professionals and other caregivers. This replacement of staff members inhibits the ability of the elders to form trusting and calm relationships with their caregivers.

Prevention And Strategies For The Reduction Of Elder Abuse

1.  Home Care First: With adequate provision of the necessary services and home adaptations in the elders’ homes, persons with disabilities, both physical and cognitive, could maintain their personal dignity and be safe. In this way, residential facilities would be able to better accommodate those with more severe and advanced stages of impairment and disability.

2.  Design Improvements to Facilities and Environments frequented by seniors with Dementia: The remodelling or building of residential facilities which are more humane and more like “home” and the training of people to understand and facilitate those with dementia, are concepts being advanced here and in Europe.

3.  Customized Training Sessions: More comprehensive training about dementia and the care of people experiencing the behaviours associated with Alzheimer’s disease should be encouraged and supported by the administrators of residential care facilities. For example, Elder Abuse Ontario’s experienced Regional Consultants deliver customized training sessions in communities across the province whether in retirement homes, long-term care homes, community settings or agencies/ organizations that work or interact with seniors.

4.  Increase in home care workers: Basic services to help seniors stay in their homes are now more difficult than ever to access. Everyone is saying there just isn’t enough time (with clients) and the system isn’t responsive enough to make it work.

5.  Debriefing and Stress Management: Provide psychological services to caregivers who experience trauma and conflict with the aim of supporting these health care professionals and maintaining a stable group of staff members. Health minister Terry Lake said that violence against health professionals should not be deemed “just part of the job” (see Fayerman, April 7, 2015). “Three-quarters of nurses in southern Alberta who treat residential dementia patients frequently experience distress from being unable to give patients what they need.”  To further exacerbate the staffing situation, the province is seeing a decline in number of nursing graduates. More nurses left the profession than went into it in 2014.

This is but a summary of ways in which the system can be improved. We hope that our readers will read the articles described in the footnotes in order to get a fuller picture of the situation. Changes are being initiated, albeit, slowly. The general public, that is, us, can hasten these processes by being informed and getting involved in discussions about the care of our seniors.

Family members need to become aware or be made aware of the hospital’s or long term care facility’s written protocol for working with residents who are potentially physically aggressive, specifically how the protocol might be applied to their senior relative in a particular instance. When the institution’s response in handling an episode of alleged difficult behaviour occurs and the family is unhappy with the action taken, then the family and the staff need to sit down and problem solve.

Ken Levitt and Dolores Luber