Awareness and prevention of abuse and exploitation of older persons

1. Awareness and prevention of abuse and exploitation of older persons Ageism and abuse in the care relationship Jeannette Fortin Program : New Horizon for Seniors Program (NHSP) Associationfranco-yukonnaise(AFY) Yukon Public Legal Education Association (YPLEA) February 2014

2. Ageism and the abuseof older persons • To increase awareness of ageism and the abuse of older persons in a context of care relationships. Overall objective:

3. Presentation outline • Ageism • Abuse or ill-treatment • Ageism in the care relationship • Abuse in care, the risk factors • The portrait of the abuser and the victim • Under-reporting • The consequences • Remedies

4. What is ageism • A process by which persons are stereotyped anddiscriminatedagainst on the basis of age in a manner similar to that of racism and sexism (Dr. Robert Butler, 1975). It is…. possible that ageism and discrimination on the basis of age are, in our societies …. the most invisible forms of discrimination…and the best tolerated …. (Pellissier, 2009, p. 5.).

5. Why talk of ageism? • To avoid marginalisation • To increase awareness • To prevent abusive behaviours • To change the social outlook on ageing • To ensure the quality • of the care relationship

6. Three kinds of stereotypes • Stereotypes that only present a negative or alarmist view of undeniable facts: «demographic tsunami»; • Standardisation: assigning certain characteristics – psychological, social, economic – to all persons of a certain age; • Scape-goating: accused of being responsible for most of society’s socio-political ills. Pellissier, J. (2009). Âgisme et stéréotypes. http://www.aqg-quebec.org/docs/Revue/Vie_vieillissement _o9_vol_7_no2-bonifieEricSedent.pdf

7. Caregivers, service providers, professionals, policy makers: you are guilty of ageism when you consider seniors as: • dependant, vulnerable, costly, weak, useless, deaf, uncompromising, sick, technophobes, babblers, etc. • wise, rich, always available, constantly traveling, etc.  • good mentors, transmitters of history, etc. • fond of children and wonderful grandparents Des exemples précis d’âgisme. http://www.aqg-quebec.org/262/Des-exemples-precis.gerontologie

8. Self-inflicted ageism: Is it possible? • “I’m lucky to be still here…” • “I think I’m getting Alzheimer …..” Birthday cards: • “Happy Birthday, it’s amazing that you’re still fit… “ • “At 60, you have the combined wisdom of 6 ten-year-old children , the intelligence of 3 twenty-year-old youths, the wits of 2 thirty-year-old persons, and the memory of 60 one-year-old babies.”

9. Ageism: a kind ofexclusion Ageism: a kind of marginalisation Forerunner of Elder Abuse

10. Abuse, what is it? “an isolated or repeated act, or the absence of appropriate intervention, that occurs in a relationship of trust and causes harm or distress to an older person.” (WHO, excerpted from the Toronto Declaration of 2002) http://www.medileg.fr/Maltraitance-envers-les-personnes http://maltraitanceaines.gouv.qc.ca/

11. Forms of abuse • Physical abuse • Psychological abuse • Sexual abuse • Human rights violations • Material and financial abuse • Negligence http://maltraitanceaines.gouv.qc.ca/

12. Behaviours and telltale signs Physical abuse • struck • pushed • roughed-up • made to wait for help Assaultive behaviours, the older person is: Telltale signs: • bruises • weight losses • evasive answers • behavioural changes http://maltraitanceaines.gouv.qc.ca/

13. http://www.radio-canada.ca/regions/ontario/2013/05/19/005-maltraitance-personnes-agees-residence-st-joseph.shtml#tophttp://www.radio-canada.ca/regions/ontario/2013/05/19/005-maltraitance-personnes-agees-residence-st-joseph.shtml#top

14. Behaviours and telltale signs Psychological abuse • humiliated • threatened • infantilized • ignored • isolated Assaultive behaviours, the older person is: Telltale signs: • dependence upon others • depression • absence of hygiene • alcohol or medication consumption • loss of cognitive functions (rapid decline) http://www.youtube.com/watch?v=TT-wlkA90Do http://maltraitanceaines.gouv.qc.ca/

15. Behaviours and telltale signs Sexual abuse The older person is: • a victim of touching, assault or exhibitionism • ridiculed for their need to live their sexuality • compelled to listen to suggestive language • non respect of their intimacy Telltale signs: • lesions in the genital area • sleep disorders • aggressive behaviours • distrust of others • anxiety at bath time http://maltraitanceaines.gouv.qc.ca/

16. Behaviours and telltale signs Rights violations Rights are violated when the older person:   Telltale signs: • is a victim of ageism • is made to accept others’ decisions when he or she has the capacity to decide for him- or herself • non-observance of the confidentiality of their personal information • non-observance of their capacity to intervene in a discussion • deprivation of freedom of choice in daily activities http://maltraitanceaines.gouv.qc.ca/ http://www.suretequebec.gouv.qc.ca/aines/la-surete-vous-conseiles lle/situations-abus-aines.jsp

17. Behaviours and telltale signs Negligence Telltale signs The older person is a victim of negligence when someone around them: • neglected hygiene • malnutrition • social isolation • etc. • fails to do something necessary for their wellbeing • N.B. intentionally or through ignorance… http://www.suretequebec.gouv.qc.ca/aines/la-surete-vous-conseiles lle/situations-abus-aines.jsp

18. Behaviours and telltale signs Fraud, theft and deception The older person is a victim of material or financial abuse when he or she is subjected to: • emotional blackmail to obtain their money • theft of possessions, jewelry • pressures to bequeath their property • fraud through identity theft • fraud by telemarketing • etc.

19. Benevolence and ageism in the care relationship Ageism • Benevolence/Beneficence • Benevolence : a feeling by which one wants the good of another person. A process by which people are stereotyped and discriminated against on the basis of their age in a manner similar to that of racism and sexism (Dr. Robert Butler, 1975) • Beneficence : a principle of medical ethics in which one must do good to or cause good to be done to others

20. Ageism: old age = Decline • Old age: sleepless nights, less reliable memory, stiffer joints, etc. • Old age and disease are not synonymous, nor is one inevitably brought on by the other. • To negate the concepts of progress and compensation in the aging person = ageism Guinchard-Kunstler, P., & Renaud, M-T., (2006),p. 105

21. Old age - disease and ageism (continued) Stereotypical equation: aging = decline Caregivers who internalise negative images on aging The quality of the care relationship in jeopardy • “You know, she’s still quite bright!” Compliments or the admission of the incompetence of the person to still have at that age, opinions, reasoned impressions, founded, potentially contestable… like any other opinion… Guinchard-Kunstler& Renaud, (2006),p. 105

22. Ageism: its linguistic expressions • in the care relationship • “Let’s change your little bandage” • “You know, at that age, they’re like babies” • “It’s time to change your diaper” “ …change your incontinence briefs or protective undergarment” • “We shall go on our walk” “I’ll accompany you, Mrs... on your walk” Every word has a specific meaning, each word can be helpful or harmful......

23. Linguistic expressions: • “Isn’t she cute” • “It’s amazing how young you are…!” (Pellissier, 2012) • “At your age, it’s unbelievable...!” (Pellissier, 2012) • “He/she’s a special case” 1http://www.aqg-quebec.org/docs/Depliantexposition_versionfinale.pdf

24. Abuse The words to say it: • use of overly familiar language • exaggerated intonations • volume too high or too low • numerous repetitions • sighs “Not now” “Hurry up” “I don’t have the time” “Make an effort” “Here, everybody’s the same” Empathy and willingness to listen A luxury

25. Abuse The words to say it: • taking charge of: in taking, there is to take (to confiscate) • to prolong home maintenance is sometimes to lock up • institutionalization: connotation of locking away Guinchard Kunstler & Renaud, (2006), p. 179. http://books.google.ca/books?id=VZzkkCvLmOoC&pg=PA173&lpg=PA173&dq=La+vieillesse+maltrait%C3%A9e&source=bl&ots=bEGeVFyY6I&sig=SBXaGLxcY5mxUK3cf5euRJ4b5qo&hl=fr&sa=X&ei=bNo4UrrsNoLfiALE-4HICQ&ved=0CHIQ6AEwCQ#v=onepage&q=La%20vieillesse%20maltrait%C3%A9e&f=false

26. Abusive behaviours (continued): • doing it instead of the older person (cocooning) • making them wait unduly • compelling them to eat, to go to bed early… • compelling them to wear incontinence briefs (“just in case”) • giving medication improperly or withholding it • speaking only to the accompanying person…

27. Abusive behaviours (continued) The first major abusethat we inflict upon older personsis to give them the helpthat we believethey need.

28. Institutional violence: commendable or gone awry • abusive rules and rigid schedules • sudden room changes • breach of privacy • non-compliance with treatment (e.g. medication, dressings, etc.) • threats of expulsion • insufficient or improperly trained staff • unsafe facilities http://tremintin.com/joomla/index.php?option=com_content&task=view&id=545&Itemid=85

29. Let us house the elderly in prisons. They will be entitled to a shower every day, video surveillance in case of problems, three meals a day, access to a library, a computer, TV, cable, a gym. Let us house criminals in nursing homes. They will be entitled to cold meals, lights out at 8 pm, one bath per week, will live in a small room and pay $1500 to $2000 a month.

30. Ageism and violence in the hospital? • Biomedical approach? • Timed care interventions (overly technical procedures) • Caregivers’ approach regarding disabilities (association young = autonomy; older persons: disabilities = loss of autonomy) Morbidity in the hospital • Contribution to the stigmatisation of older persons • Contribution to loss of autonomy • Etc.

31. Values and beliefs that influencehealth professionals • productivity and independence • fear of dying (old age – loss of autonomy - death) • Distancing Ageism Older persons’ potential / perceived primarily as declining Bourbonnais, & Ducharme (2010). Sous la direction de Lagacé https://www.google.ca/search?hl=fr&site=imghp&tbm=isch&source=hp&biw=1366&bih=543&q=medecins&oq=medecins&gs_l=img.12..0l10.7252.17826.0.20437.27.20.5.1.1.3.549.4289.1j8j7j2j0j1.19.0....0...1ac.1.35.img..9.18.2695.6NWg3b_6zao#hl=fr&q=personnes+%C3%A2g%C3%A9es&tbm=isch

32. Ageism and violence in the hospital? Workers have: • practiced harsh or rough handling • laughed at and insulted patients or residents • made embarrassing comments • pushed residents • Mr. Joly has had very little to drink for several days. The doctor is worried about dehydration and asks that he be encouraged to drink. • Why do you think he refuses to drink? http://www.nurseone.ca/Default.aspx?portlet=StaticHtmlViewerPortlet&ptnme=Elder%20Abuse&plang=11

33. Abuse in the care relationship Mrs. Fox • “… they speak to me as if… you didn’t know anything. They speak to you in a condescending way instead of treating you with respect… it’s a peculiar sort of person who… might want to appropriate a part of you in order to reduce your capacity of being… they are…diminishing you…when they speak to you as to a child.” Lagacé, M. (2012) Lagacé, M. (2012) . Le prisme déformant de l’âgisme. http://www.aqg-quebec.org/docs/Revue/Vie_vieillissement_09_vol7_no2-bonifieEricSedent.pdf.

34. Violence in the home • Reduction of services covered by the State: financial issues • Increase of other stakeholders’ role • insufficient financial resources • family: insufficient knowledge and training • facilities: inadequate and unsafe • Imposition of the high cost related to the care(disadvantaged seniors) • greater difficulties in evaluating the quality of family care • failure to provide medical follow-up in the home • failure to ensure a sufficient number of home care workers • failure to provide sufficient family respite • etc. Lafrenière, (2009)

35. Risk factors of abuse Violence triggered by: • exhaustion offamiliesorprofessionals • ignorance of the needs of older persons • greed • Dependence (96% of cases) • Inability to express needs • Isolation • Financial vulnerability http://www.nurseone.ca/Default.aspx?portlet=StaticHtmlViewerPortlet&ptnme=Elder%20Abuse&plang=11 http://www.video.tv/documentaire/la-vieillesse-maltraitee

36. Portrait of the abuser • Somebody like you and me, who forgot that their job often depends on older people • A man, a woman, their fellow human… Guinchard Kunstler & Renaud (2006, 84) Loved ones • Children: financial abuse and neglect • People hired to help • Grandchildren • Spouses or life partners (Harvey, 2010) Journal de Québec, 16 juin. http://vivrevieux.blogspot.ca/2010/06/denoncer-labus-envers-les-aines-du.html

37. Portrait of the victim • A vulnerable person • A person living alone • Often a woman, 75 and older, who lives alone and has a disability • A neighbour, your aunt, sister, brother, father or friend • And one day… perhaps you! https://www.google.ca/search?q=femme+victime&hl=fr&source=lnms&tbm=isch&sa=X&ei=vyHwUtWwPIu8oQStk4GYBA&ved=0CAcQ_AUoAQ&biw=1280&bih=810#hl=fr&q=femme+%C3%A2g%C3%A9e+triste&tbm=isch Harvey (2010) http://vivrevieux.blogspot.ca/2010/06/denoncer-labus-envers-les-aines-du.html

38. Under-reported violence? Reasons: • fear… of not being believed • lack of communications skills • fear of losing services, of being abandoned, of being institutionalised or of losing their place in a nursing home Image : http://www.radio-canada.ca/regions/quebec/2013/03/28/011-campagne-maltraitance-aines.shtml http://www.radio-canada.ca/regions/quebec/2013/03/28/011-campagne-maltraitance-aines.shtml

39. Under-reported violence? Fear • Neighbours don’t want to interfere in others’ affairs • Caregivers don’t want to antagonise the family • Families don’t want to lose their home care worker • Older persons are terrified of reprisals • Staff remains silent to avoid trouble with their employer • It isn’t easy to denounce a fellow-worker In all cases we tend not to believe the older person Guinchard Kunstler & Renaud 2006, p. 93

40. True stories…. from real life! • Rachel’s story • Serge’s story • Madame Dupuis’ story • Suzanne’s story • Peter’s story

41. The consequencesof ageism and abuse Psychological harm of interiorising ageist stereotypes : • self-inflicted ageist discrimination, the words you hear: • apologies for the trouble they give you • apologies for being a “burden” to others • in short, apologies for existing (Pellissier, 2009, p. 34)

42. Consequencesof ageism and abuse (continued) • prone to depressive behaviours: withdrawal, irritability… • will go so far as to refuse to eat, to drink… • will sometimes ask to die

43. It is essential… To change attitudes and alter the discourse on aging Older persons are a source of pride and their contribution to society is important http://www.lapresse.ca/le-quotidien/opinions/carrefour-du-lecteur/201303/22/01-4633723-combattre-lagisme.php Lagacé, M. (2012) . Le prisme déformant de l’âgisme. http://www.aqg quebec.org/docs/Revue/Vie_vieillissement_09_vol7_no2-bonifieEricSedent.pdf

44. How to deal with the abuseof older adults? Zero tolerance Denounce, otherwise who will know?

45. The prevention of abusebegins with the scrutinyof our own actions

46. Remedies: the older person The power to act: today and tomorrow (Empowerment) • Staying autonomous… in decision making • Self-stimulation through active participation in society • Creating an effective communications network • Reminding others that to live without being able to choose or taking chances… is to vegetate while waiting for death It’s better to get involved than to demonstrate that you are useless to society Guinchard Kunstler,& Renaud,(2006). Mieux vivre la vieillesse : 100 réponses aux questions des personnes âgées et de leur entourage. Éditions de l'Atelier.

47. Remedies: caregivers Re-examining support in the care relationship • Change your outlook on old age (ageism) • Use the expertise of older persons • Don’t forget: older persons still have desires, needs and expectations • Respect the person’s values and right to make their own decisions • Obtain the person’s assent or agreement • Be aware of your protective role (Advocacy) • Recognise that abuse can occur everywhere… http://www.nurseone.ca/Default.aspx?portlet=StaticHtmlViewerPortlet&plang=11&ptnme=Other%20Resources%20-%20PEACE%20sites Harvey (2010) http://vivrevieux.blogspot.ca/2010/06/denoncer-labus-envers-les-aines-du.html http://www.aqg-quebec.org/264/Pistes-d-action.gerontologie Guinchard Kunstler,& Renaud,(2006). Mieux vivre la vieillesse : 100 réponses aux questions des personnes âgées et de leur entourage. Éditions de l'Atelier.

48. Remedies: policymakers Objectives • Develop an intervention policy regarding the abuse of older persons and their abusers • Ensure the dissemination of information (public awareness campaigns, networking between agencies) • Develop training programs and showcase training • Promote the quality of life of older persons and the quality of services offered • Raise ageism awareness • Increase community awareness of the aging phenomenon Hébert, Craig et & Douglas (2012) et AQG (2011) Le guide pratique En mains (2010). Chaire de recherche et de maltraitance envers les personnes aînées http: //www.maltraitancedes aines.com/fr http://www.aqg-quebec.org/docs/Depliant_AQG_2011.pdf

49. References Association québécoise de gérontologie ( 2012). Avez-vous tendance à faire de l’âgisme ? Campagne de sensibilisation. Association québécoise de gérontologie ( 2012). Des exemples précis d’âgisme. http://www.aqg-quebec.org/262/Des-exemples-precis.gerontologie. Association québécoise de gérontologie (2012). Sensibiliser vos milieux de travail à l'âgisme! http://www.aqg-quebec.org/298/Milieux-de-travail.gerontologie. Beaulieu, M. & Bergeron-Patenaude, J. (2012). La maltraitance envers les personnes âgées. Changer le regard. Les presses de l’université Laval. Bourbonnais, A. & Ducharme (2010). L'âgisme. Comprendre et changer le regard social sur le vieillissement, Laval (CAN) : Les Presses de l'Université Laval, pages 155-174. http://www.aqg-quebec.org/docs/Revue/Vie_vieillissement_09_vol7_no2-bonifieEricSedent.pdf Guinchard Kunstler, P., Renaud, M-T ( 2010) Mieux vivre la vieillesse 100 réponses aux questions des personnes âgées et leur entourage. Éditions de l’Atelier. Hébert, M., Craig, J., & Douglas, A. (2012). Collaboration interprofessionnelle. Stratégies pour lutter contre les mauvais traitements à l’égard des personnes âgées. Association canadienne des ergothérapeutes. Présentation Ppoint.

50. References Harvey, D. (2010). Dénoncer l’abus envers les aînés du Québec. Journal de Québec, 16 juin. http://vivrevieux.blogspot.ca/2010/06/denoncer-labus-envers-les-aines-du.html Hugonot, R. ( 1998 ). Violences invisibles. Reconnaître les situations de maltraitance envers les personnes âgée. Hugonot, R. (1998). ). La vieillesse maltraitée. Janvier Lafrenière, R. (2009) Soutien à domicile des personnes âgées en perte d’autonomie et questions éthiques. Vie et Vieillissement. Vol. 7, no2. Lagacé, M. (2012) . Le prisme déformant de l’âgisme. http://www.aqg-quebec.org/docs/Revue/Vie_vieillissement_09_vol7_no2-bonifieEricSedent.pdf Lagacé, M. (2010). L’âgisme. Comprendre et changer le regard social sur le vieillissement. Presses de l’université Laval. Pellissier, J. (2009). Âgisme et stéréotypes. http://www.aqg-quebec.org/docs/Revue/Vie_vieillissement _o9_vol_7_no2-bonifieEricSedent.pdf. Vézina,J.(2010). L'âgisme. Comprendre et changer le regard social sur le vieillissement., Laval (CAN) : Les Presses de l'Université Laval, 2010, pages 133-153. http://www.bdsp.ehesp.fr/Base/436632/