1. Perspectives on elder abuse in Ireland Dr. Amanda Phelan Co-Director National Centre for the Protection of Older People Amanda.phelan@ucd.ie/01Amanda.phelan@ucd.ie/01 7166482

2. Irish Definition A single or repeated act or lack of action occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person or violates their human and civil rights’ Protecting our Future (2002).

3. Typologies Physical abuse Psychological Abuse Financial abuse Sexual abuse Neglect (commission/omission) Ageism Stranger abuse not recognised Self Neglect

4. Health Service Executive Structure National Steering Committee Regional Steering Committee Dedicated Regional Officer 32 Senior Case Workers for the Protection of Older People Sub committees 1) media and public awareness group, 2) staff awareness and curriculum group, 3) policies, procedures, protocols and guidelines groups and 4) financial abuse of older people group. Elder Abuse Services in Ireland

5. National Center for the Protection of Older People Established in 2008 Lead by the School of Nursing, Midwifery and Health Systems with collaborations from the School of Applied Social Science, School of Public Health and Population Science, the School of Medicine and Medical Science and the Geary Institute. Negotiated programme of research.

6. Outputs to date

7. What influences the visibility of elder abuse? Overt & and covert ageist perceptions (Phelan 2009, 2010, 2011, 2013) Confusion of physical and mental decline with elder abuse. Family Busy practice area Difficult topic Don’t know what to do Uncomfortable Assumption that care facilities are satisfactory.

8. Measuring Prevalence of Abuse in Ireland Family, Professional carers, Close friend Neighbours, Acquaintances Strangers Interviews with 2021older people Position of Trust relationship

9. In the previous 12-months Financial ≥1 incident money or possessions stolen, forced to sign over property, change will Physical ≥1 incidents slapped, pushed, restrained Sexual ≥1 incident sexually spoken to touched Psychological ≥ 10 incidents or serious impact insulted, threatened, excluded, prevented seeing people Neglect ≥ 10 incidents or serious impact refusal or failure of carer to help with activities of daily living such as shopping, washing or dressing Operational Definition Inter- personal abuse

10. Prevalence of mistreatment was 2.2 % (95% CI 1.41, 2.94) Population 10,201 (6598, 13,757) Clustering of abuse: 25% (psychological abuse) Irish Prevalence Mistreatment Types

11. Adult Children 50% of the over mistreatment Perpetrators Relationship of Perpetrator to the Older Person

12. 84% perceived mistreatment had a very serous impact Physical/Sexual abuse 100% Financial abuse89% Psychological Abuse 68% Neglect50% Impact & Response Response to Mistreatment

13. Any mistreatment since 65 years Any Mistreatment 4% Psychological 2.4% Financial1.4% Neglect 1.2% Physical/Sexual0.7% Alternative Definition Mistreatment wider Community (12-mth) Any Mistreatment 2.9% Financial 1.8% Psychological 1.7% Physical/Sexual 0.7% Neglect 0.3%

14. Findings of Prevalence Study 12-month prevalence of abuse & neglect 2.2% Over 10,000 people Older person characteristics Female Age Lower socio-economic circumstances Health especially mental health Social isolation Perpetrator characteristics Adult Children Male Middle age Unemployment Addiction

15. How big is the problem? 2.2% 12 mth Position of trust 2.9% 12 mth wider community 4.0% Age 65 yrs & POT 5.5% Age 65 yrs wider community 10,20118,76413,42925,735

16. Prevalence of Elder Abuse ‘Impressionistic estimates’ (Bonnie & Wallace 2003 ) HSE referrals (2,302 in 2011) vs. prevalence. Abuse percentageStudy and Year Prevalence: 2-4%O Keefe et al. 2007 (UK), Naughton et al 2010 (IRE) Prevalence : 18.4%Lowenstein (2003) (Israel) Prevalence: 11.4%Acerino et al (2010) (US) Prevalence: 10%Amstader (2011) (South Carolina) Prevalence: 1:24Lifespan of Greater Rochester Inc.et al 2011 (NYS)

17. Elder abuse & dementia Studies complicated by data being collected primarily from caregivers. May not recognise abusive behaviours Under-reporting Pathological caregivers may not engage in research. Physical, psychological and neglect

18. Elder Abuse & Dementia Older people with dementia are particularly prone to abuse (Cooper et al 2008, Wiglesworth et al 2010 ) Family caregivers may be unaware of actions that are abusive (Beech et al. 2005). In a study Caring for Relative with dementia (CARD) over half reported physical or psychological abuse and one third met the criteria of significant abuse (Cooper et al. 2009).

19. Financial abuse Nest egg Family members and strangers were found to have perpetrated the abuse through spending money without permission, forced signing over of money/assets or having a forged signature. Family members were also found to have made imprudent decisions regarding finances, stolen money and also not provided the older person with copies of financial transactions. (Acierno et al. 2009) Older people are 34 percent more likely than people in their 40s to lose money though scams (Research & Consulting 2013) Easy List, Mooch list!

20. Issues Autonomy Vs. Risk. Organisational ‘whistle-blowing’ policy (internal & external). Confidentiality policy.

21. Responses Address ageism Safeguarding approach Change culture- education, values and beliefs. Increase detection: contacts with older people, financial institutions Multi disciplinary Interventions to meet individual need- health and social care, police and legal. Status functional capacity. Advocacy and empowerment ‘Best interests’

22. The substance of decision making Welfare extends beyond safety and physical health….to happiness. We must adapt a pragmatic common sense and robust approach to the identification, evaluation and management of perceived risk…sensible risk appraisal not avoidance of risk Disproportional risk (Munby 2011)

23. Conclusions Societal Reform: Safeguarding approach: Legislation, policy. Education of older people and society Multi-disciplinary and multi-agency response. Promote financial autonomy Ensure ‘best interests’. Screen, ask and assess financial capacity Financial institutions Independent advice

24. Thank you for your attention Amanda.phelan@ucd.ie 01 7166482