caredata CD Full Text - copyight NISW/Russell House Publications Elder Abuse in Spain Joaquin de Paul Ochotorena & Jose Luis Larrión Zugasti Joaquin de Paul Ochotorena is a Professor of Psychology at the University of Pais Vasco. Jose Luis Larrión Zugasti is a geriatrician in the Servicio Navarro de Salud, Pamplona. To understand elder abuse in Spain one needs to have an understanding of how social welfare has developed in the last few years. Systems of social protection did not begin to be developed until the end of the 1970s. For political reasons, the isolation of Spain with regard to Europe resulted in the slow progress of both welfare and the means to support social protection. Till then, an assistance model, based on an untrained workforce and charitable resources, was the norm. This meant that certain subjects in relation to family violence, like child abuse and neglect, and domestic violence against women, did not begin to be addressed in Spain until the middle of the 1980s, whereas other countries in Europe had already developed them in the 1960s and 1970s. Spanish resources and institutions for social protection became more significant throughout the 1980s. During the 1980s, the subject of abuse had begun to be studied and treated in Europe and the USA. Whilst Spain was slow to catch up in the areas of child and family abuse, it is now becoming aware of elder abuse at the same time as other European countries. A number of factors may have influenced this state of affairs. Firstly, a significant number of professionals who work with elderly people (specialized medical staff in gerontology, social workers, psychologists) have been taking an interest in the quality of care that elderly people receive in their families and in the institutions. Secondly, professional teams that are dedicated to the study of child abuse and family violence already exist, and they are ready to deal with the subject of elder abuse within their speciality. Thus, we can affirm that in spite of the backward nature of social welfare, Spain is likely to address elder abuse in similar ways to the rest of Europe. We find there are a series of steps in the attribution of importance and resources to socially difficult themes (child abuse, rape, etc): 1. denial of problem; 2. assertion that the more severe cases are rare occurrences; 3. recognition of the variety and extent of the problem and development of studies; 4. creation of the first programmes for intervention (hot-lines, specialized services, admission places, foster care). The general public does not have any particular awareness of elder abuse; however, professionals working with the elder population recognize the evidence of the problem. Peralta & Riera (1995) pointed out that the majority of social service professionals who work with the elderly considered them potential victims of neglect, physical and economic abuse. On the other hand, in recent years (1993 to 1995), individual and collective situations of elderly people who are victims of neglect in private institutions have featured in the mass media and the courts of justice. This has meant that the public is beginning to be aware
of elder abuse as a problem. Although not a frequent occurrence, it can be very severe in certain circumstances. Even so, physical and economic abuse does not often occur when older people live with their families. In Spain we have no data about the incidence and diversity of the problem, nor research or intervention programmes. However, there are some indications that professionals and institutions are beginning to understand and quantify this phenomenon and to formulate responses to it. Symbolically, the first event that highlighted elder abuse was a Convention of Geriatric Nursing (V Congreso Nacional de Enfermeria Geriatrica y Gerontologica, Toledo, 1993), at which papers were presented. An earlier survey on elder abuse (Marin et al., 1990) had been published. In 1993 the Ombudsman of Spanish Autonomous Communities produced a report, which drew attention to the abandonment of the elderly and recommended that Spanish legislation should adopt measures to prevent and intervene in such situations (VIII Jornadas de Coordination entre Defensores del Pueblo, 1993). The National Ombudsman has produced a report about elder abuse which occurs in some institutions for elderly people. In 1994, the Generalitat de Catalunya requested research about elder maltreatment, abuse and discrimination (Departament de Benestar Social, 1994). This was published and led to the first report about this subject in Spain (Peralta & Riera, 1995). Larrión and De Paul (1994) also published a theoretical review about the subject. In 1990, Marin et al. published research into the epidemiological characteristics of elder abuse. Following this process, in May of 1995, there was the significant event of the first symposium in Spain to be completely devoted to elder abuse. This generated an elaborate body of documentation about basic questions of elder abuse which will be of great advantage in the future. Amongst the earlier reports, the research of Peralta & Riera (1995) and Marin et al. (1990) may provide important information about this problem in Spain, but we must be cautious about the interpretation of these pioneering studies. Nevertheless, in Spain it can be confirmed that cases of elder abuse are found in similar proportion to other countries. Marin et al. (1990) shows that 8.6 per cent of patients over 65 years old who enter a tertiary centre are considered to be victims of elder abuse, and they present the same kind of symptoms that are indicated by international studies. Peralta & Riera s study (1995) shows cases of physical neglect, and physical, economic and psychological abuse. In addition, they reveal cases of elder abuse inside the family and not just in the more likely locations of nursing home or hospital. This work identifies some of the risk factors for elder abuse situations: women; older age; health problems; physical disability or psychological illness; economic support or broken family. Marin et al. (1990) remark that the factors presenting a higher risk for elder abuse included: women, people who live alone, persons with a high level of dependence, and above all, mentally ill people. Although professionals, researchers and public institutions are aware of these indicators, the response of the public welfare system to elder abuse is still in its very early stages. In Spain, the welfare system is extraordinarily de-centralised; there are different competencies in each autonomous region. Therefore, politically, the field of welfare for older people is characterised
by inequalities and diversity between different communities. There is no epidemiological data about all the populations in Spain. Only two studies, previously mentioned, have undertaken research in this field but their results cannot be generalised for all people over 65 years old in Spain. Therefore, we do not have a comprehensive view of the quantity, typology and risk factors about elder abuse in Spain. Specific programmes in this field cannot be found. In the majority of autonomous communities, elder abuse situations in residential care are known to the inspection services, which make observational visits. Also, there are complaint books or suggestion boxes. There are no programmes for training professionals or informing citizens about the problem, the risk factors and their importance. Neither are there systems for communication between professionals and citizens or affected older people. Few people suffering maltreatment have access to telephones for urgent problems. Generally, there is a total absence of investigation. Professionals for elderly people have not received specific training or been made aware of relevant information about abuse. Legally, a total absence of specific judicial regulation can be observed. However, victims of elder abuse can have recourse to certain legislation that can be applied in these situations. When there are violent incidents against life, corporal integrity or freedom, the legal system can apply some sanctions that are similar to those for other offences (murder, physical injuries, threats, compulsions or illegal detentions). In some cases of elder abuse which may fall short of an offence of violence, but nonetheless occasion moral or material damage, the responsible person could be obliged to repair the damage caused (1902 art. of Civil Code). However, more specific laws about elder abuse are in two articles. One refers to familial abandonment (487 art.of Penal Code); the other one alludes to violence inside the family (425 art. of Penal Code). The first article could be applied to the neglect of elders by sons, daughters or other members of the family. It sanctions this failure to assist those who are in need, whatever the cause. Nevertheless, the legal system only applies to material assistance and of parents to sons. The second article applies only when we have proven abusive behaviour, for example if the carer does physical violence towards an incapacitated elderly person. Some doubt can exist about the incapacity of elder people and in the forthcoming penal code this term is clarified. In the administrative/judicial field some autonomous communities have instituted different initiatives in relation to elder abuse. In 1990, the community of Madrid created a commission for judicial defence and protection of adults and, in 1995, an agency for the protection of adults. This is being used to help adult persons who have been declared legally incompetent, and it could be applied to cases where elderly people fall into this category and are vulnerable to maltreatment. They have set up a permanent telephone help-line to be used by elderly people in situations of maltreatment. Recently, Catalunya have created an official judicature (n.40) exclusively for elderly people who suffer abuse. Castilla and León has taken global initiatives about elder people, although we must await the development of these measures to evaluate their efficiency. These initiatives are a clear indication of the interest in the well-being of older people and the problem of elder abuse. This community has developed a sector regional plan for elderly people. This plan has a training and research remit, with a priority to investigate and study
maltreatment. However, it has also established a preventive service and telephone information facility to advise elderly people in cases of maltreatment. Before we finish this brief exposition about the interest in, resources for, and research related to, elder abuse in Spain, we suggest some sociological and cultural characteristics which may be particular to Spain (and other Latin and Mediterranean cultures) and which form a backdrop against which elder abuse may be understood. * The low level of social, familial and individual mobility. In spite of migrations from the South (Andalucia & Extremadura) to the North of Spain (Pais Vasco y Catalunya), from villages to urban areas, we can assess a tendency to live in the place of birth. * The family unit and permanent contact are valued. Frequently, families have close relationships. * The percentage of divorces and family breakdown is limited. This can increase the frequency of problems between couples and physical aggression, but minimises the dispersal of family members. * Children very frequently continue to live with the family. This situation can provoke pressure on adults, because they have begun to care for their elderly parents. * High levels of unemployment force sons and daughters without employment to depend on their elder parents economically for a long time. This situation can, in certain circumstances, be seen as economic abuse. * The high price of housing and the scarcity of cheap rented accommodation forces parents, sons and daughters to live together for long periods in spite of conflict situations. * The low cultural and educational level of elder people compared to other European countries is a factor which renders them relatively defenceless in society. Acknowledgements: The authors of this paper are grateful for advice and information provided by: Mr. Olayo Gonzalez, on legal issues; Mr. Carles Riera & Mr. Andoni Peralta for information received about their survey; persons in charge of the Autonomous Communities of Madrid, Valencia, Cantabria, Castilla and León and Andalucia (Ms Maria Camilleri) for information received about elderly peoples programmes; and also to Concepcion Paramo for their assistance in the preparation of this manuscript. References V Cogreso Nacional de Enfermeria Geriatrica y Gerontologica. (1993) Libro de Congresos Caja de Ahorros de Castilla la Mancha (Ed). Toledo, Departament de Benestar Social. (1994) Maltractaments, abusos i discriminations a la gent gran, a Catalunya. Generalitat de Catalunya (Ed). (En catalan).
VIII Journadas de Coordinacion entre defensores del Pueblo (1994) Gabinete de Estudios del Defensor del Pueblo (Ed). Madrid. Larrión J.L. & De Paul J. (1994) El sindrome del anciano maltratado. Medicina Clinica, 102: pp.216-219. Marin, N. et al. (1990) Sindrome del maltrato y abuso en el anciano Revista Espanola de Geriatria y Gerontologia, 25 supl. (1):66 Peralta, A. & Riera, C. (1995) Dimensio i Caracteristiques dels abusos que pateix la gent gran a Catalunya. (Unpublished manuscript). caredata CD Full Text - copyight NISW/Russell House Publications