Perspectives on elder abuse in Ireland Dr. Amanda Phelan

1. Perspectives on elder abuse in Ireland Dr. Amanda Phelan Co-Director National Centre for the Protection of Older People Amanda.phelan@ucd.ie/01 7166482

2. A single or repeated act or lack of action occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person or violates their human and civil rights’ Protecting our Future (2002). Irish Definition

3. Typologies • Physical abuse • Psychological Abuse • Financial abuse • Sexual abuse • Neglect (commission/omission) • Ageism • Stranger abuse not recognised • Self Neglect

4. Health Service Executive Structure Elder Abuse Services in Ireland

5. National Center for the Protection of Older People • Established in 2008 • Lead by the School of Nursing, Midwifery and Health Systems with collaborations from the School of Applied Social Science, School of Public Health and Population Science, the School of Medicine and Medical Science and the Geary Institute. • Negotiated programme of research.

6. Outputs to date

7. Overt & and covert ageist perceptions (Phelan 2009, 2010, 2011, 2013) Confusion of physical and mental decline with elder abuse. Family Busy practice area Difficult topic Don’t know what to do Uncomfortable Assumption that care facilities are satisfactory. What influences the visibility of elder abuse?

8. Family, Professional carers, Close friend Neighbours, Acquaintances Strangers Measuring Prevalence of Abuse in Ireland • Interviews with 2021older people • Position of Trust relationship

9. Operational Definition In the previous 12-months Financial ≥1 incident money or possessions stolen, forced to sign over property, change will Physical≥1 incidents slapped, pushed, restrained Sexual ≥1 incident sexually spoken to touched Psychological≥ 10 incidents or serious impact insulted, threatened, excluded, prevented seeing people Neglect≥ 10 incidents or serious impact refusal or failure of carer to help with activities of daily living such as shopping, washing or dressing Inter-personal abuse

10. Irish Prevalence Prevalence of mistreatment was 2.2 %(95% CI 1.41, 2.94) Population 10,201(6598, 13,757) Clustering of abuse: 25% (psychological abuse) Mistreatment Types

11. Perpetrators Adult Children 50% of the over mistreatment Relationship of Perpetrator to the Older Person

12. Impact & Response 84% perceived mistreatment had a very serous impact Physical/Sexual abuse 100% Financial abuse 89% Psychological Abuse 68% Neglect 50% Response to Mistreatment

13. Alternative Definition Any mistreatment since 65 years Any Mistreatment 4% Psychological 2.4% Financial 1.4% Neglect 1.2% Physical/Sexual 0.7% • Mistreatment wider Community (12-mth) • Any Mistreatment 2.9% • Financial 1.8% • Psychological 1.7% • Physical/Sexual 0.7% • Neglect 0.3%

14. Findings of Prevalence Study • 12-month prevalence of abuse & neglect 2.2% • Over 10,000 people • Older person characteristics • Female • Age • Lower socio-economic circumstances • Health especially mental health • Social isolation • Perpetrator characteristics • Adult Children • Male • Middle age • Unemployment • Addiction

15. How big is the problem? Age 65 yrs & POT Age 65 yrs wider community 12 mth Position of trust 12 mth wider community 4.0% 5.5% 2.2% 2.9% 10,201 13,429 18,764 25,735

16. Prevalence of Elder Abuse ‘Impressionistic estimates’ (Bonnie & Wallace 2003) HSE referrals (2,302 in 2011) vs. prevalence.

17. Elder abuse & dementia • Studies complicated by data being collected primarily from caregivers. • May not recognise abusive behaviours • Under-reporting • Pathological caregivers may not engage in research. • Physical, psychological and neglect

18. Elder Abuse & Dementia Older people with dementia are particularly prone to abuse (Cooper et al 2008, Wiglesworth et al 2010 ) Family caregivers may be unaware of actions that are abusive (Beech et al. 2005). In a study Caring for Relative with dementia (CARD) over half reported physical or psychological abuse and one third met the criteria of significant abuse (Cooper et al. 2009).

19. Financial abuse • Nest egg • Family members and strangers were found to have perpetrated the abuse through spending money without permission, forced signing over of money/assets or having a forged signature. • Family members were also found to have made imprudent decisions regarding finances, stolen money and also not provided the older person with copies of financial transactions. (Acierno et al. 2009) • Older people are 34 percent more likely than people in their 40s to lose money though scams (Research & Consulting 2013) • Easy List, Mooch list!

20. Autonomy Vs. Risk. Organisational ‘whistle-blowing’ policy (internal & external). Confidentiality policy. Issues

21. Responses • Address ageism • Safeguarding approach • Change culture- education, values and beliefs. • Increase detection: contacts with older people, financial institutions • Multi disciplinary Interventions to meet individual need- health and social care, police and legal. • Status functional capacity. • Advocacy and empowerment • ‘Best interests’

22. The substance of decision making • Welfare extends beyond safety and physical health….to happiness. • We must adapt a pragmatic common sense and robust approach to the identification, evaluation and management of perceived risk…sensible risk appraisal not avoidance of risk • Disproportional risk (Munby 2011)

23. Conclusions • Societal Reform: Safeguarding approach: Legislation, policy. • Education of older people and society • Multi-disciplinary and multi-agency response. • Promote financial autonomy • Ensure ‘best interests’. • Screen, ask and assess financial capacity • Financial institutions • Independent advice

24. Thank you for your attention Amanda.phelan@ucd.ie 01 7166482