Elder dignity, abuse and neglect - EDAN

1. Elder dignity, abuse and neglect - EDAN Zdenek Kalvach Prague

2. History • 1962 battered child syndrome • Modification to child abuse and neglect (CAN) • 1975 granny battering (Burston, Br Med J. ) • Modification to elder abuse/ elder abuse and neglect (EAN)

3. Diversification • Physical abuse - violence • Emotional abuse • Sexual abuse • Financial abuse • Neglect • Self-neglect • Others

4. Multilevel problem • Events: systematic versus casual • Causes: general versus proper • Forms: huge versus questionable

5. Multilevel problem 1. Level of ones´s huge guilt (pathology, adict, criminality) • Cruel violence • Sexual abuse • Financial exploitation • Gross neglect

6. Multilevel problem 2. Level of mistakes under stress • Burn out syndrome • Helpless informal caregivers • Lack of staff in hospitals/ nursing homes • Common neglect • Common restraints

7. Multilevel problem 3. Level of ignorance, and banal evil • Bad stereotyped approaches • Lack of knowledge on risks and demands • Ageistic rules = socialy acceptable systematic humiliation

8. Dichotomy or continuum? Gerontology • Dichotomy of „normal behaviour“ versus EAN (social/medical pathology) • Problem with international and intercultural standardization

9. Dichotomy or continuum? Medicine • Continuum from health to pathology • Disease versus sickness • Disease - xenochtonic event • Sickness - autochtonic condition, subclinical course, „I do not feel well“ – without patognomic symptoms

10. Dichotomy or continuum? Can gerontology learn from medicine? • Dichotomy of „normal behaviour“ versus EAN (social/medical pathology) • Continuum from „normal behaviour“ to EAN • I do not well in this relation/community/ care • I do not feel comfortable, safe – without patognomic symptoms • Continuum of Elder Dignity, Abuse and Neglect - EDAN

11. Elder Dignity, Abuse and Neglect EDAN Including • „Set of untimely minutiae“ • Early warning signs • Lack of respect • Lack of interest in him/her • Diminution of competency, satisfaction, safety • Noteless beginning of tiredness of caregivers, path of agressor, „occasion of sin“

12. Elder Dignity, Abuse and Neglect EDAN Aspects of • Perpetrator (intent, guilt) • Sufferer (suffering, feelings, expectation) • Future development (risks, progression) • Context and degree • Early prevention • General anti-ageistic atmosphere in society

13. Two concepts of care/support of the frail elderly • Existencial (holistic) concept of meaningful life • Dignity: substantial premise • Existential EDAN • Biological/economic (reductionist) concept of (cheap) basic care • Supported by demographic alarmism • Dignity: luxury • Basic EAN – beating, violence, sexual abuse, starvation, …

14. Existential concept of EDAN and care of the frail elderly Suffering from • Lack of dignity • Lack of sense and communication • Becoming a burden Adoption of • Meaning of life (V.E. Frankl) • Sense of coherence (A. Antonovsky) • Transcendence (A. Maslow)

15. A. Antonovsky: New paradigm of medicine (and EAN?)

16. Existential concept of EDAN and care of the frail elderly • „Health is more than mere absence of disease“ – WHO, A. Antonovsky • … being a state of complete physical, mental and social well-being • Quality assisted life is more than mere absence of violence, abuse and neglect as unsatisfaction of basic needs • … being a continuity of one´s meaning of life, one´s sense of coherence, participation, respect and dignity

17. Existential concept of EDAN and care of the frail elderly • Pathogenesis • Salutogenesis • Dignitogenesis – goalseeking methodical tailored measures to support one´s meaning of life, sense of coherence and self-respect. • Not only to be careful not to destroy dignity in family life, health care and social services but also to want to strenghten it actively.