Keeping older people safe by preventing elder abuse and neglect.

Author:Peri, Kathryn
Position:Report
 
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Abstract

Preventing family violence, including the abuse and neglect of older people, is an important community and social policy issue in New Zealand. Although significant research and intervention activities have been undertaken to reduce family violence in general, less is known about the nature of elder abuse and neglect, and appropriate and effective prevention strategies in a New Zealand context. Drawing on qualitative interviews with older people and their caregivers, as well as service providers and non-governmental organisations that provide support to older people, this article discusses recent research findings related to societal-level risk and protective factors that may affect the incidence of elder abuse and neglect. Some of the factors identified include the need to pay attention to ageism and older people's rights, gender roles, and societal ideas about individuals and families. The findings have implications for policy and practice. Supporting community and societal change that reduces ageism and promotes positive and valued roles for older people will contribute to the wider goal. Practical strategies--such as the provision of information for older people, family and caters--that support the empowerment of older people may also help to minimise the risks of elder abuse and neglect.

INTRODUCTION

"All families and whanau should have healthy, respected, stable relationships, free from violence." (Taskforce for Action on Violence within Families)

Changing Demographics, Ageing Population

The 65 years and older population group is expected to grow steadily over the next 50 years. Projections indicate that 13% of the population will be 65 years and over by 2010, with an anticipated further growth to 25% by 2051 (Bryant 2003). The ethnic make-up of the New Zealand population is also expected to alter during this time, with the proportion of Maori, Pacific and Asian groups increasing relative to the current majority of those of New Zealand European descent (Statistics New Zealand 2004). The Maori population aged 65 and over is projected to increase from 3% currently to 7%, the equivalent Pacific group from 3% to 6%, and the Asian group from 4% to 8% (Statistics New Zealand 2004).

Increasing Awareness of Issues and Incidence Associated with Family Violence

Since the 1970s there has been increasing awareness of, and outcry against, the incidence of family violence within New Zealand. Much of this awareness and activity have focused on recognition of, and response to, intimate partner violence and child abuse and neglect (see Fanslow 2005 for a review).

Less activity has taken place to further our understanding of the scale and impact of elder abuse and neglect in New Zealand. Internationally, estimates of the percentage of older people who are abused ranges between I% and 10% of all older people (Lachs et al. 1997). A random sample of community-dwelling older people in the USA reported a prevalence rate of abuse in family settings of 32 abused older people per 1,000. Estimates of abuse are higher for older people with dementia who are being cared for by family caregivers. Other researchers have suggested that elder neglect is more common than elder abuse (Wolf and Pillemer 1989).

Obtaining accurate estimates of the prevalence of elder abuse and neglect in New Zealand will require having agreed definitions about what constitutes elder abuse and neglect, and an appropriate study being carried out to assess the frequency with which the abuse occurs. Such a study would also need to take into account methodological complexities such as issues associated with housing locations for older people and individuals' mental competency to respond.

Until such a study is conducted we are reliant on proxy information about the scale of the problem, such as cases that present to elder abuse and neglect services. Although this information is likely to under-report the occurrence of elder abuse and neglect, because it relies on the highly variable reporting practices of agencies and practitioners as well as the reporting by older people themselves, it does provide some indication of the elder abuse and neglect cases that are encountered in this country.

Defining Elder Abuse and Neglect

The literature shows that defining elder abuse and neglect is problematic and that definitions vary internationally. The reason for this difficulty arises from the differences in theories about the nature and causes of abuse and neglect of older people (Lachs and Pillemer 2004). New Zealand has adopted the New Zealand Age Concern Elder Abuse and Prevention Service definition: elder abuse and neglect are usually committed by a person known to the victim and with whom they have a relationship implying trust. A person who abuses an older person usually has some sort of control or influence over him or her.

in general, New Zealand figures indicate that reported cases of abuse and neglect are consistent with overseas figures (Age Concern NZ 2005). From July 2002 to June 2004 Age Concern New Zealand Inc. reported 1288 cases. Of these, 950 were a result of abuse and neglect, 104 cases were abuse or neglect from an institutional policy or practice, and the remaining 234 were cases of self-neglect. Most cases were women, aged between 75 and 84 years. There has been very little New Zealand research on the physical and other effects of elder abuse. However, case reports and anecdotal evidence indicate that such abuse can have wide-ranging and long-term effects on the older person's physical and mental health, finances, living arrangements and family/whanau relationships (Fanslow 2005). Other research has documented how the results of abuse and neglect on an older person diminish their ability to actively contribute as a member of their community (Age Concern NZ 2005).

Background

This research project was initiated by the Families Commission following a stakeholder workshop to identify research and information needs related to elder abuse and neglect. It was undertaken to improve our understanding of the risk and protective factors that may be associated with the elder abuse and neglect of older people in New Zealand (Families Commission 2008). The project utilised an ecological framework to explore these factors as they relate to elder abuse and neglect, drawing on information obtained from the perspective of older people, service providers, and coordinators of governmental and non-governmental organisations (see Figure 1 in Krug et al. 2002). The ecological model allows representation and exploration of the relationship between individual and contextual factors, and considers violence as being the product of multiple levels that influence behaviour. It has been advocated as a useful model for examining elder abuse and neglect by Fanslow (2005).

For this article we focused on identification and discussion of societal-level risk and protective factors associated with the occurrence or amelioration of elder abuse and neglect, because these are the factors that are most appropriately dealt with through actions at the level of social policy.

METHODS

Qualitative methods were used to capture data about elder abuse and neglect from a range of stakeholders. The sampling frame was designed to ensure that a wide range of expertise and knowledge was accessed. The sample consisted of: (a) older people, both those who had experienced elder abuse and neglect and those who had not; (b) health professionals, representatives of non-government organisations (NGOS) and other groups that provide services for older people; and (c) representatives from a range of different ethnic groups. Respondents were recruited from multiple regions around the country.

Data collection methods included face-to-face interviews, focus group interviews and telephone interviews. Interview guides were developed after consultation and review of the literature. The interview guide was designed to collect data across ecological levels, from the individual to the societal. Data analysis took a general inductive approach (Thomas 2006).

The following sections describe the recruitment procedures for each group of participants, data collection techniques, and interview topics covered.

Older People Who Had Experienced Abuse and/or Neglect

A two-stage recruitment procedure was used to contact and interview these people in a way that minimised the risk of re-traumatising them. Elder Abuse and Neglect Prevention (EANP) services made the first invitation to potential participants who were now in safe situations. Twenty-two EANP services from around New Zealand were invited to participate in the study. Eight declined, citing a lack of suitable clients as their main reason. From the remaining 14 services, eight EANP service coordinators agreed to help recruit older people who had experienced...

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