Policies and Practices to tackle Elder Abuse. Silvia Perel-Levin ILC GA, INPEA Chair, NGO Committee on Ageing-Geneva Brussels, 16 June 2015

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1 Policies and Practices to tackle Elder Abuse Silvia Perel-Levin ILC GA, INPEA Chair, NGO Committee on Ageing-Geneva Brussels, 16 June 2015

2 Definitions WHO (adopted def. by Action on elder abuse UK) : Elder abuse is a single or repeated act or lack of appropriate action, occurring within any relationship in which there is an expectation of trust, that causes harm or distress to an older person

3 Definitions The NYC Elder Abuse Center: a single or repeated act, or lack of appropriate actions, which causes harm, risk of harm, or distress to an individual 60 years or older and occurs: a) within any relationship where there is an expectation of trust; or b) when the targeted act is directed towards an elder person by virtue of age or disabilities.

4 Types of abuse 1. Physical 2. Psychological/emot ional abuse characteristics Infliction of pain or injury (slapping, hitting, kicking, forcefeeding, restraint ) Infliction of mental anguish (verbal aggression or threat, social isolation, humiliating statements ). 3. Financial/material abuse Improper exploitation and/or use of funds or resources(theft, coercion to deprive the older person of his or her assets) 4. Sexual abuse Non-consensual contact of any kind (Suggestive talk, forced sexual activity, touching, fondling) 5. Neglect Intentional or unintentional failure to meet Older Persons needs (failure to provide adequate food, clothing, shelter, medical care, hygiene, or social stimulation).

5 Types of abuse characteristics 6. Societal abuse Ageism, lack of appropriate pensions, discrimination Alternative classification? Neglect Violation isolation, abandonment and social exclusion of human, legal and medical rights Deprivation of choices, decisions, status finances and respect WHO/INPEA 2002

6 The Gender dimensions: OHCHR Working Group on discrimination against women in law and practice Women s poverty and quality of life in older age: culmination of women s life course Situation in retirement: test for the quality of women s economic and social life. Discriminatory laws and practice: forced early retirement, Gender pension gap, dependency

7 The costs of elder abuse Direct and indirect costs Physical and mental health consequences Suicide Social isolation Services: Emergency care, health, social services, criminal justice, home support, long term-care USA: In 2009, federal agencies spent: $11.9 million for activities related to elder abuse $649 million for programs on violence against women. (Xinqi Dong, the Gerontologist 2013)

8 (Some) Policy frameworks Human Rights mechanisms Active Ageing Framework Charter of Fundamental Rights of the EU European Charter of the rights and responsibilities of older people in need of long-term care and assistance Recommendation CM/Rec(2014)2 of the Committee of Ministers to member States on the promotion of human rights of older persons Madrid International Plan of Action

9 Policy frameworks Inter-American Convention on Protecting the Human Rights of Older Persons 15 June The Americas Becomes First Region in the World to Have an Instrument for the Promotion and Protection of the Rights of Older Persons

10 Who deals with elder abuse? Others Health Justice Diplomacy Police Employment Welfare Education

11 Risk factors? Societal Community Relationship Individual Societal Community Relationship Individual Dementia / Depression Experienced abuse/ Aggression/ Dependence / disability Gender / Age Isolation/ Substance dependence

12 Risk factors Societal Community Relationship Individual Societal Community Relationship Individual Financial Dependence Emotional dependence Living arrangements Long-term abuse/violence Intergenerational transmission?

13 Risk factors Societal Community Relationship Individual Societal Community Relationship Individual Social isolation Concentration of poverty Widowhood Lack of support networks Erosion of intergenerational relations

14 Risk factors Societal Community Relationship Individual Societal Community Relationship Individual Ageism, wide discrimination Sexism/ racism Socio-economic factors/concentration of poverty Inheritance systems Migration of the young Weak police/criminal Justice

15 Ecological model Societal Community Societal Community Relationship Individual Relationship

16 Policy response Coordinated national plan Data collection Prevention Detection Intervention Training

17 Data collection Policy response Scope : incidence, prevalence disaggregated by gender and age cohorts Victims and perpetrators Using same definition and methodology Participatory research

18 Prevention Policy response Awareness raising:»professional»public information campaigns Legislation Life-long education

19 Working with the media and entertainment industry Terranova.org

20 European facts and the Global Status report on Violence Prevention 2014 Countries implementing violence prevention programmes on a large scale All region EU Public information campaigns 27% 29% Professional Awareness campaigns 37% 48% Residential care policies 39% 38% Caregiver support programmes 51% 57%

21 Detection Policy response Should we screen for elder abuse? Only a minority of doctors routinely ask older people about abuse However Practitioners using structured tools detect more cases of abuse than prevalence studies.

22 Example of tools EASI Elder Abuse Suspicion Index Less than 2 minutes to ask 97.2% of doctors felt it would have some or big practice impact.

23 Tools for the police Elder Abuse risk assessment Assessment and intervention reference guide Theft by persons holding power of attorney

24 Assessment apps

25 Intervention Policy response Multidisciplinary teams Interagency responses with clear referral protocols Support for victims Support for caregivers/families

26 NICE- Canadian pocket tools PREVENTION DETECTION INTERVENTION Coordinated Community Response Train the Trainer Elder Abuse Suspicion Index EASI Brief Abuse Screen for the Elderly (BASE) Caregiver Abuse Screen (CASE) Indicators of Abuse (IOA) Resources for Older Women In Hand An Ethical Decision-Making Framework Police Tool 1 - Elder Abuse Assessment and Intervention Reference Guide Police Tool 2 Theft by Person(s) Holding Power of Attorney Police Tool 3 - Elder Abuse Risk Assessment EARA Being Least Intrusive: An Orientation to Practice Financial Exploitation Self-Report Measure

27 NICE- Canadian pocket tools

28 Policy response Training Interdisciplinary training Professional curricula Continuing education Online courses Participation of older persons

29 Concluding remarks Towards a UN population-based study on abuse and violence against older persons Thank you