Like other types of violence, abuse of older adults includes physical, sexual and psychological abuse, as well as neglect. Older adults are also vulnerable to financial abuse, in which others make improper use of their resources (National Seniors Council, 2007).
Seniors over 85 years of age are the fastest growing age group in Canada. There are currently 645,000 seniors over 85 in Canada, and that is projected to reach 1.28 million by 2031. That will be a 98% increase over the next 20 years (Statistics Canada, 2010).
Elder abuse continues to be a taboo that is mostly underestimated and ignored across the world. Evidence is accumulating, however, to indicate that elder abuse is an important public health and societal problem (World Health Organization [WHO], 2002).
Prevalence rates or estimates exist only in some developed countries — ranging from 1% to 10% (WHO, 2002).
It is a challenge to estimate the prevalence and incidence of elder abuse in Canada. This is due to many factors such as under-reporting, confusion about what constitutes elder abuse, and a general lack of awareness, among other factors. However, based on available Canadian data, it is estimated that between 4% and 10% of older adults in Canada experience some type of abuse (National Seniors Council, 2007)
CNA and RNAO are currently looking to invite individuals into the Elder Abuse Awareness Knowledge Network, an e-forum for nurses and other health-care providers to discuss the care of older adults, with a focus on sharing of resources and strategies to support best practice.
Older adults are also at risk of abuse in institutions such as hospitals, long-term care residences, and other continuing care settings. A survey of nursing staff conducted by the College of Nurses of Ontario in the early 1990s found that:
20% reported witnessing abuse of residents in long-term care settings.
31% reported witnessing rough handling of patients/residents
28% reported witnessing workers yelling and swearing at patients/residents
28% reported witnessing embarrassing comments being said to patients/residents
10% reported witnessing other staff hitting or shoving patients/residents
(Ontario Network for the Prevention of Elder Abuse, 2011).
In a landmark study in the United States exploring elder abuse in long-term care settings: 36% of staff in long-term care settings reported having witnessed at least one incident of physical abuse of a resident in the previous year; 10% admitted having committed at least one act of physical abuse themselves; 81% had observed psychological abuse; and 40% indicated that they have psychologically abused residents in their care (Pillemer & Moore, 1990).
In institutions, abuse is more likely to occur where care standards are low, staff are poorly trained or overworked, interactions between staff and residents are difficult, the physical environment is deficient, and where policies operate in the interests of the institution rather than of the patients/residents (WHO, 2002).
What are the Risk Factors for Elder Abuse?
There are a number of factors that put older adults at risk for abuse. Those factors that may leave some older adults at risk for abuse and neglect include (University of Toronto, 2008):
Cognitive impairment (confusion):
Alzheimer’s disease and other dementias can lead to patients/residents behaving in ways that frontline staff may not understand. Without understanding the cognitive disorder, staff members may believe that the patient/resident is doing the behaviour “on purpose” or maliciously, and sometimes the staff member “retaliates.”
Physical conditions and dependency on others for care:
Difficulty with many activities of daily living, including bathing, dressing and toileting, necessitates dependence on others for assistance.
Inability to express wishes:
Cognitive status or communication difficulties (aphasia and other expressive difficulties, hearing problems, language barriers)
Social isolation — having few if any contacts with people inside or outside the facility, being “alone in a crowd”
Geographic isolation — where the facility or community is located, or as a result of a patient/resident being transferred, “uprooted” or required to take the first available space regardless of location
Lack of choice
People who need care and support may be forced by government policies or the availability of services to go where space is available, which may not be the place best suited to them. This in turn increases isolation.
A patient/resident with limited financial resources may have far fewer choices. He or she may be unable to move elsewhere if the care and assistance being provided is not adequate.
What are we doing about it? The PEACE Initiative
The Canadian Nurses Association (CNA) has partnered with the Registered Nurses’ Association of Ontario for the Promoting the Awareness of Elder Abuse in Long-Term Care pan-Canadian Initiative. The goal of this project, funded by the Government of Canada’s New Horizons for Seniors Program from 2010 to 2012, was to increase front-line service providers’ awareness and understanding of elder abuse while enhancing their capacity to respond to situations of abuse. Ten long-term care settings across Canada were selected as sites for raising awareness about elder abuse. These Prevention of Elder Abuse Centres of Excellence (PEACE sites) are committed to enhancing resident safety and quality care (read more about these leaders in raising awareness of elder abuse in long-term care).
This Knowledge Feature highlights the PEACE sites, the curriculum delivered at each of the sites, and the resources collated to inform this initiative. In addition, expert contributions from a variety of perspectives related to the issue of elder abuse (maltreatment) provide the context to explore this important safety issue. As health-care professionals, nurses follow a code of ethics that states, “Nurses work to prevent and minimize all forms of violence by anticipating and assessing the risk of violent situations and by collaborating with others to establish preventive measures” (CNA, 2008, p. 9). We have an ethical responsibility to promote dignity and respect for older persons. Do you have the knowledge to recognize, reveal and deal with elder abuse?
The next move: leading interprofessional collaboration
Collaborative practice is becoming the norm but to achieve this goal changes are needed in attitudes, in operations and in systems. We all have to recognize the importance of working with government, unions, regulators and other stakeholders.
Influenza is a serious illness that disproportionately affects certain populations who have a higher risk of complications. Influenza immunization, as the most effective method of preventing the flu, allows health-care workers to protect themselves, their families and those in their care.
Have You Thought About the Social Determinants of Health?
The health of Canadians is not shaped primarily by the medical treatments they receive or the lifestyle choices they make but by the living conditions they experience. These conditions have come to be known as the social determinants of health.
The resources within this section are offered to inform your cultural awareness, competency, and safety so as to enhance your capabilities to work with your clients in addressing their health and wellness needs