Thank you.
Elder abuse is very much a women's issue. It is fact that, even after adjusting for greater numbers, proportionally more older women than older men are abused. It's also fact that abused older women seeking help are often in situations of triple jeopardy, experiencing ageism, sexism, and victim blaming.
Elder abuse is not gender-neutral. As some of us are old enough to remember, when maltreatment of older people first came to public attention in the 1970s, it was called "granny bashing". In the ensuing years, the gendered nature of elder abuse seems to have been lost.
Why? And with what consequences? Was it a reaction to the growth of the feminist movement? Was it a reflection of the social values and perspectives of the mostly male researchers? Or was it because of the dominant assumption in an ageist society that old age means dependency and diminished competence?
One of the consequences of thinking about old age as a time of diminished competency and dependency is that it tends to lead to viewing all old people as sick and weak, sexless and impotent, and incapable of making valid decisions on their own behalf. Another consequence is that it leads to legislation and services that are developed on a model appropriate for kids but not necessarily for old people.
I'm not here today to argue the pros and cons of mandatory reporting requirements, which tend to be the trend in the U.S.A., in Israel, in the former Yugoslav Republic of Macedonia, and in several of our provinces. I am here to draw attention to the situation of ignoring gender neutrality and the fact that what that does is remove from visibility the differences in power between men and women and some of the challenges of abusive behaviour.
I also want to point out that despite the fact that it's been known for some years now that the rates of physical abuse are similar among young women and women aged 50 and over, the myth still persists that violence against women is violence against young women.
Also, I want to draw attention to the fact that abuse and neglect of older women and older men is an international issue. There is overwhelming evidence that it's not just a social problem for the northern countries or the developed world, but rather that just as population aging is taking place worldwide we also have abuse of older women and older men taking place all over the world, including within those societies that traditionally have been viewed as venerating their old people.
When it comes to what elder abuse is, there are three definitions commonly used around the world. The most common is one that was developed by a U.K. charity in 1995 and subsequently adopted by the World Health Organization and my organization, the International Network for Prevention of Elder Abuse. It is “a single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person”.
A common theme in several of the definitions is this idea of abuse of power; hence, there is emphasis on the relationship between victim and perpetrator. What we see in elder abuse is to some extent classically the same kinds of things we see in bullying in younger people: threats, intimidation, and aggression. These are used to maintain power and control of older people.
But there is more. As Charmaine mentioned, the types of abuse that typically are viewed on the international scene would be physical, psychological, financial, and sexual. then there's the issue of neglect, and there's also systemic abuse, wherein we talk about rules and regulations that discriminate against older people. In institutions, you add to these the physical or chemical restraining of residents, depriving them of their dignity and choice of activities, etc.
In terms of the extent of the problem, I can give you details on homicide deaths attributed to elder abuse in Europe. In a recent WHO report, they estimate that approximately 8,300 people aged 60 and over die per year from homicide. About a third of those deaths are at the hands of a family member. That third is considered as an estimate of elder maltreatment as the cause of their demise.
As to hospital admissions, data from six European countries show a U-shaped pattern of hospital admissions for assault: high for people aged 60 to 64, falling for several successive five-year age bands, and then rising then again, tellingly, for people aged 90 and over.
There have been a number of surveys conducted around the world. Not all of them are methodologically sound. Of those that are, the suggestion that comes out from them is that somewhere between 3% and 10% of older people—60 and over—living in the community experience abuse and neglect in a one-year period. The most common types are financial and psychological, but it's not uncommon to have several types of abuse experienced by the same person. Institutional rates are harder to estimate, as there are very few sound studies.
Lynn has been involved in this area for a number of years and will talk more about definitions.
I want to mention that prevalence rates depend a lot on who is doing the reporting. What you will see is that what is viewed as abuse by a general practitioner is different from what is abuse as viewed by an old lady or her caregivers. There also are differences in what is viewed as abuse depending on people's ethnic backgrounds.
The implication is that it's not easy—this, as Charmaine said, is a complex area. There's a very diverse victim population that includes people of different socio-economic strata—rich, poor, and in between. It occurs in ethnocultural minorities. It occurs in the gay and lesbian community, as well as among straights.
In terms of perpetrators, in the case of community-dwelling elderly, the perpetrators are mainly within the informal support system: family, neighbours, and friends. We're only just beginning, really, to look at the situation of home care providers and home support workers of various types. In institutions, of course, the focus has been mainly on staff, but there's also some consideration of family who come to visit and, more recently, of systemic issues.
In terms of consequences, the impact of abuse and neglect goes much beyond the event. Physical abuse of old people, for example, can be more serious than abuse of younger people, because their bones are thinner, among other things, and it takes longer for them to heal.
There has been quite a lot of work done in looking at risk factors. Dating back to the early 2000s, there was an American study done that put them into three categories: those that are possible risk factors, those that are probable, and those that are contested.
It is interesting that the more recent data has picked up on one of the contested ones, which is this idea that somehow elder abuse is a result of caregiver stress. This is a really important one, because it can be used as an excuse. The data simply does not support that this should be considered as a major cause. If you do consider it a major cause, what happens is that the old lady gets blamed. Somehow she's the victim and she should be complying with and being nicer to this person who is caring for her. It takes away from looking at the power differences and at the characteristics of the perpetrator.
To sum up, if we want to move this field to the point of zero tolerance--which in my opinion is where it should be--then we need everybody to come together to the playing field. We need the women's movement. We need government at all levels. We need the gerontological community. We need the faith groups. In the past, there has been too much silo action in this area and not enough as a cohesive whole.
Thank you.