Types of Abuse
o?????Active Negligence- intentional bad treatment, such as not feeding, washing, or dressing the senior in clothes appropriate for the season, not giving medication or over-medicating, etc.
o????Financial abuse- when a wrong is done to the elderly person involving money or property. For example, robbery, coercing a senior or forcing a senior to give money or cheques, or misusing power of attorney.
o????Passive Negligence- unintentional, ill treatment of an older person, as a result of ignorance or good will. An example of this is someone who may take care of an elderly person without the proper conditions to do it or misuse of an elderly person?s medications and prescriptions, including withholding medication and overdosing
o????Physical abuse- an infliction of physical discomfort, pain or injury. For example, slapping, pushing, beating, etc.
o????Psychological abuse- any act, including social isolation, verbal assault, harassment, humiliation, intimidation, infantilization, or any other treatment which may diminish the elderly person?s sense of identity, dignity, and self-worth.
o????Religious/Spiritual Abuse- involves the distortion of a religious message meant to nurture and empower people. For example, exercising of false spiritual authority, shunning, etc. It may also involve the extortion of money or the altering of wills using manipulation or threats.
o????Sexual Abuse- any kind of sexual behaviour toward an elderly, including sexual assault, harassment or any sexual act against the senior.
o????Violation of Civil Rights- denial of an elderly person?s fundamental rights. For example: withholding information, denial of privacy, denial of visitors, restriction of liberty, censorship
?Who are the Abusers?
?Family members or friends
Informal or formal caregivers
Landlords or homeowners
A doctor, nurse, priest, minister, other religious leader, public transportation employee, social/community workers, etc.
People whom?seniors see as being trustworthy
People who rely on the senior such as the children or grandchildren who may use the senior?s home and/or money, etc.
Power plays a significant role in situations of abuse and neglect. It has been suggested that a society, which overvalues productivity and competition, devalues society?s weaker and more vulnerable members, such as seniors. Seniors are often subject to abuse because they are vulnerable to people who misuse their power.
Elder abuse and neglect interplays with both physical and mental health, along various dimensions. As the World Health Organization?s definition suggests, health is a state of, ?complete physical, mental, and social well-being, and not merely the absence of disease or injury.?
Some determinants of health include:
These determinants have implications, for older adults and in the prevention of elder abuse or neglect. By employing these determinants, we can assist in the prevention and early detection of signs of abuse and neglect, as well as identifying those situations where vulnerable older persons are at risk.
?Examples can be found at:
This? material was? prepared by Charmaine Spencer, LLM, Simon Fraser University, Vancouver, and Elizabeth Podnieks, EDD, Ryerson Polytechnic University, Toronto, for the workshop "Adults With Vulnerability: Addressing Abuse and Neglect", Toronto, January 13-14, 1997
-??????The social environment, largely determined by the mainstream culture, may perpetuate conditions such as marginalization, stigmatization, loss or devaluation of language, and lack of access to culturally appropriate health care and services.
-??????In addition, foreign born older adults must cope not only with the stresses of aging but also with the stresses of cultural change in an environment that often promotes economic powerless and social isolation.
-?????Education prepares people for problem solving, and helps provide them with a sense of control and mastery over their life.
-?????Only if one is aware of their rights, can one begin to seek the appropriate assistance. Education can give rise to this awareness.
-?????Education also increases opportunities for job and income security and satisfaction, and improves people's ability to access and understand information, which can help to keep them healthy.
It follows therefore, that by increasing education and awareness, to not only the abuser, but to the abused we may empower them reducing the risk of themselves becoming the victim of abuse by the more powerful abuser.
?Ethical Issues, Dilemmas, etc.
When is ?doing what?s best for a senior person? abuse? How can we balance a person?s right to autonomy (to act for themselves free of pressures from others), against society?s right to protect that person? When is it okay for a family member, adult children, etc., to interference with in seniors? life?
For example, Son insists that the best place for the mother to be is in a group home for older adults, but for the mother, this predicament is worse than death. She values her life in her own home and prefers to live that way even though it may be more expensive for her to have home are workers.
This example illustrates conflict between paternalism (son?s view) and autonomy (mother?s wishes).? Paternalism is essentially the idea of protecting people from harm, however, how we define harm may depend on our values, personal goals, ambitions, etc.
To what extent does the son?s action and/or beliefs in the above example reflect his own interests, his wife?s interests, or biases, etc.? It is imperative that we balance the individual?s right to autonomy and self-determination against society?s right to protect that person.
Autonomy, from the Greek word for "self rule," is the ability or capacity to make informed choices, free of coercion, based on one's own personal beliefs and values.? All adults are presumed to have decision-making capacity and are therefore afforded the freedom to make decisions for themselves in all areas of their lives. The concept of autonomy reinforces this right to be free from unwanted interference, which means that there must be legal justification for any curtailment of autonomy.?
In order to respect an individual?s autonomy we must provide opportunities for genuine choice. For example, only when we provide community resources can we say that seniors? are given the right to self-determination and only then are they empowered and safeguarded against the vulnerability of abusive situations.
The state, family and the individual, all have relative responsibilities in the care of the senior. However, a change in this equation of responsibility of care can leave seniors vulnerable to abuse.
Consider what privatization of homecare or healthcare, etc., does to the equation of responsibility between the state, family and individual, for the care of the senior person. It may shift the responsibility of care to the individual and their families, making it a personal responsibility. The senior who needs in-home assistance, for example, is now personally responsible, as is their family, for their condition and for their homecare response. Considering the determinants of health and the previously mentioned power relationships involved in abuse of senior persons, these situations have older adults with little choice and in less powerful positions, leaving them more vulnerable to abuse.
Capacity and undue influence, and their roles on decision making
The right to make decisions about how to live one?s life, however it must be clear that the individual understood what he/she was doing, when they signed the document transferring property, for example, or whether coercion/undue influences were employed, or whether the individual was not mentally capable of making that decision.
Often abusers may appeal to the senior?s incapability to make decisions for themselves, because they, ?don?t know what they?re talking about?, for example. The abuser/stronger person may use various manipulations over time to gain power and compliance. For example, they may isolate the weaker person, promote dependency, or induce fear and distrust of others. Since both undue influence and mental capacity raises the question of whether an individual is acting freely, the two concepts are often confused.
?The Ministry of Attorney General?s Office of the Public Guardian and Trustee (OPGT) investigates reports that someone is mentally incapable, is suffering harm, and needs essential help they are not getting.? For more information about OPGT?s services contact the closest office, listed in the Ontario government section of the blue pages of your telephone book, under ?Attorney General-Ministry of, Public Guardian and Trustee.? The OPGT offers other services and information about the administration of estates, for guardians of property, and about powers of attorney and living wills. Consult the link below for more information.
Consideration of Culture
Cultural values, beliefs, and traditions dictate family members' roles and responsibilities toward one another, how family members relate to one another, how decisions are made within families, how resources are distributed, and how problems are defined. Culture also influences how families cope with stress and if and when families will seek help from outsiders. Some things to consider when dealing with issues of abuse of older persons are:
- The role seniors play in the family and/or in the community
Who, within the family, do members turn to in times of conflict or strife
What conduct is considered abusive? For example, is it considered abusive to use an elder's resources for the benefit of other family members or to ignore a family member??
Religious beliefs, past experiences, attitudes about social service agencies or law enforcement, or social stigmas that may affect community members' decisions to accept or refuse help from outsiders
To whom do family members turn for help. For example, members of the extended family, religious leaders, physicians.
Trusted sources of information in the community, such as, newspapers, magazines, television and radio stations, shows, and personalities considered reliable.
How do persons with limited English speaking or reading skills get their information about resources?
[ B.C. Senior Advisory Council, A Delicate Balance: Assisting Elderly Victims of Abuse and Neglect. Position Paper adopted the SAC, June, 1992. [Located at, http://www.hlth.gov.bc.ca/seniors/SAC/docs/abuse.html, on April 14, 2002]