Institute for Life Course and Aging 2016-2017 Seminars & - - PowerPoint PPT Presentation

Institute for Life Course and Aging 2016-2017 Seminars & Workshops “Understanding Elder Mistreatment: What Do We Know?”

David Burnes, B.Sc., M.S.W., P.hD Assistant Professor, University of Toronto Factor-Inwentash Faculty of Social Work Affiliate Scientist, Baycrest, Rotman Research Institute http://socialwork.utoronto.ca/profiles/david-burnes/ david.burnes@utoronto.ca

Presentation Overview

Elder Mistreatment (EM)

• A. Population demographic backdrop
• B. Community-based EM
• C. EM in long-term care – resident-to-

resident aggression

LCP Emergence

2) Changes in Population Composition

• Age structure

Overall changing Structure of Population Age Demographics

• Baby boomers
• Declining birth rates
• Increased life expectancy

Population Age Demographics

Baby Boomer

• A person born following WWII (1946 –

1964)

• Disproportionately high birth rate
• This relatively large age cohort is now enter

later adulthood

Declining Birth Rates

Global Female Life Expectancy

Can life expectancy keep going up? How high can it go?

Percentage Change in the World’s Population by Age: 2010-2050

Aging Population in Canada

Maclean’s, 2012 – Statistics Canada data

Population aged 65+ expected to double over next 25 years – 5M to 10.5M

9

Ontario

Ontario Ministry of Finance, 2013

Population 65+ expected to double over next 25 years – 2M to 4.2M

10

What does this mean for EM? Scope of EM will keep getting bigger, bigger, bigger

EM Typologies

EM

Community Institutional Settings

Community Elder Mistreatment

An intentional act or omission occurring in a relationship of trust, which causes harm or serious risk of harm to a vulnerable older adult

• r deprives an older adult of basic needs.

Emotional Physical Sexual Financial Acts Neglect (Omission)

Vulnerability Relationship

• f Trust

Older Age EM B C A

A = Self-Neglect or Stranger-Perpetrated Events (crime,scams) B = … C = Mistreatment of Adults with Disability Impaired capacity for self-care

• r self-protection (financial,

physical, functional, mental, cognitive, emotional, etc.) Expectation of trust arises from law or social convention:

• Family
• Caregivers (paid)
• Friends/Neighbours
• Professionals

Blurred?

What is the difference between domestic/intimate partner violence and EM?

• In scenarios of long-term domestic violence,

does domestic violence become EM simply because the victim becomes older than a designated age (e.g., 60 or 65)?

• How do we draw the line between domestic

violence and EM?

Vulnerability Relationship

• f Trust

Older Age EM B C A

A = Self-Neglect or Stranger-Perpetrated Events (crime,scams) B = Domestic or Intimate Partner Violence C = Mistreatment of Adults with Disability Impaired capacity for self-care

• r self-protection (financial,

physical, functional, mental, cognitive, emotional, etc.) Expectation of trust arises from law or social convention:

• Family
• Caregivers (paid)
• Friends/Neighbours
• Professionals

Blurred?

Difference between domestic/intimate partner violence and EM?

• If violence against a partner is initiated or becomes

more severe due to the older partner’s age- associated vulnerability, then it is properly characterized as EM

• Conceptually, vulnerability (not age) is the

determinative concept

• But, in practice and research, age cut-off is typically

age 60 or 65.

How Else is EM Different than DV/IPV

• Types of mistreatment
• EM includes neglect and financial exploitation
• Types of perpetrators
• EM is much broader – includes perpetrators in

any relationships of trust including children, neighbors, professionals, etc.

Frequency

• Confusion/inconsistency both conceptually and

in research

• Should single acts be included and for what

types of EM?

• Move field towards greater clarity and

conceptual rationale (e.g., WHO report)

What do we know about EM in the community?

Consequences/Costs

Individual

• Mortality (3X)
• Psychological distress (e.g., anxiety, depression)
• Poor physical health
• Injury (e.g., upper extremities)
• Financial loss

Societal Costs

• Hospitalization
• Nursing home placement
• Emergency room use
• Social service, legal, and law enforcement

Strong EM Risk Factors

Victim Trusted Other

Functional Impairment Mental Illness Poor Physical Health Substance Abuse Cognitive Impairment Dependency (financial) Poor Mental Health Low Income Lower Age Low Social Support Pillemer, Burnes, Riffin, & Lachs (2015)

International 1-Year Prevalence by EM Type

Pillemer, Burnes, Riffin, & Lachs (2015)

1 2 3 4 5 6 7 8 9 10 Series 1

Canada/US 1-Year Prevalence by EM Type

4.8 4.1 3.9 1.7 0.5

(Acierno et al., 2011; Amstadter et al., 2011; Burnes et al., 2015)

9.5

1-Year Prevalence

Approximately 1 out of every 10 adults aged 60 or

• lder experiences some form of EM each year
• 475,000, Canada
• 190,000, Ontario

Under-estimated prevalence:

• Under-reporting among elders
• Excludes cognitive impairment
• Excludes older adults in institutional settings

Hidden Problem

The majority of EM victims remain hidden and never interface with formal support

• USA - Acierno et al. (2010): 1 out of every 6 (18%)
• NYS - Lachs and Berman (2011): 1 out of 24 (4%)
• SC - Amstadter et al. (2011): 1 out of every 8 (13%)
• Boston - Pillemer & Finkelhor: 1 out of 14 (7%)

Only 4% to 18% of victims seek formal support

Prevalence Studies

NO YES

EM measured as a dichotomous outcome

Prevalence Studies

NO YES YES

20 40 60 80 100 120 140 2 7 15 18 21 24 30 36 42

Frequency/Multiplicity of Elder Mistreatment Past Year

Emotional Abuse N = 399

Frequency Frequency/Multiplicity

5 10 15 20 25 30 35 2 6 12 18 25 36

Frequency Frequency/Multiplicity

Physical Abuse N = 51

5 10 15 20 25 30 35 2 12 16 19 24 42 63

Frequency/Multiplicity

Neglect N = 89

Burnes, Pillemer, & Lachs, 2015

Mean: 2 to 10 events per year Mean: 2 to 10 events per year Mean: 1 to 2 events per year

Emotional Physical Neglect

Younger Age Younger Age Younger Age Living Alone w Perpetrator Living Alone w Perpetrator Living Alone w Perpetrator Higher Education Lower Education Hispanic Lower Income Functional Impairment

Mistreatment Severity Correlates

Shared Living Arrangement Severity Alone with Perpetrator Presence of Non- Perpetrators

Victim Appraisals of Mistreatment

5 10 15 20 25 30 35 40 45 Not Serious Somewhat Serious Very Serious

Emotional Abuse

5 10 15 20 25 30 35 40 45 Not Serious Somewhat Serious Very Serious

Physical Abuse

5 10 15 20 25 30 35 40 45 Not Serious Somewhat Serious Very Serious

Neglect

Distribution of perceived seriousness levels among victims of emotional abuse, physical abuse and neglect

N = 106 N = 51 N = 66

Burnes, Lachs, Burnette, & Pillemer, 2016

EM in Institutional Long-Term Care (LTC) Settings

Elder Mistreatment in LTCs

EM is the most common type of complaint made to LTC regulatory authorities

Staff Resident Resident Staff Resident Resident

Chronology and Intensity of Public and Academic Interest of Interpersonal Violence in LTC Settings

Staff-to-Resident

• Approximately 10% of LTC staff self-report

physically abusive acts towards residents  Excessive restraint  Pushing, grabbing, pinching  Hitting, slapping

• Approximately 40% of LTC staff self-report

psychologically abusive acts towards residents  Yelling, insulting, swearing  Denying food or privileges as punishment

Staff-to-Resident Risk Factors

Characteristics of staff who are more likely to mistreat residents:  Poor job satisfaction (frequently thinks about quitting)  Tend to view residents as child-like  High sense of burn-out  Stressful personal life

Resident-to-Resident Aggression

Negative, aggressive and intrusive verbal, physical, sexual, and material interactions between long- term care residents that in a community setting would likely be unwelcome and potentially cause physical or psychological distress or harm to the recipient (Pillemer et al., 2012; McDonald et al., 2015)

What Do We Know About RRA?

Approximately 20% of LTC residents experience some form of RRA Most common forms of RRA

• Verbal (e.g., screaming, cursing) – 9.1%%
• Physical (e.g., hitting, pushing) – 5.2%
• Sexual (e.g., inappropriate touching) – 0.6%
• Other (property damage, privacy invasion) – 5.3%

Most common areas in LTC:

• Resident rooms – 37%
• Dinning room – 37%
• Activity/common area – 24%

(Lachs et al., 2016)

Consequences of RRA?

Physical injury

• Lacerations, bruising, fractures (Shinoda-Tagawa et al., 2004)

Poor psychosocial status

• Depression, anxiety, social loneliness, low self-

esteem, low life satisfaction, unpleasant living environment (Castle, 2012; Trompetter et al., 2011) Canadian LTC residents perceive RRA as a normal part

• f nursing home life (Lapuk, 2007)

Chronic stress and potential trauma have cumulative, detrimental long-term effects on health and quality of life

(Friedman & McEwen, 2004)

Theoretical Framework

Social-Ecological Model

RRA

Individual

LTC Environment

Social Interactions

Theoretical Framework

Social-Ecological Model

Example: One resident walking with a cane yells insults at another resident in a wheelchair

• Linear: RRA is more likely among residents

with functional impairment

• SEM: RRA event is a result of this resident

who is in a wheel-chair coming across another resident who is dealing with pain and cognitive mis-intepretation, who are both passing one another in a hallway that is too narrow.