I'm going to try not to speak to what has already been said.
I would like to thank you for inviting me here as a witness, and I would like to commend the committee for looking at a very serious issue that has been hidden for a very long time.
I am the director of the Institute for Life Course and Aging at the University of Toronto. Our mandate is research and education.
I'm also the scientific director of the National Initiative for the Care of the Elderly, which is an organization committed to knowledge transfer, generally in the field of aging. We have 1,400 members. We produce knowledge in the form of what we call pocket tools, which we've had over 400,000 requests for. This easy tool was developed by a physician--he may be coming to this committee--and it's for identifying if elder abuse is suspected. There are only eight questions. It's very simple and is based on research.
Everything that NICE does is based on research--all of the pocket tools. As well, these pocket tools have been put up onto hand-helds for professionals to use, but older people use them and caregivers use them. Anybody and everybody can use them. As I've said, we've had tons of requests.
NICE is made up of an interdisciplinary group of people who bridge the university to the community. We have doctors, lawyers, anthropologists, psychologists, social workers, nurses, physicians, etc. They're all formed into teams that work together to produce these pocket tools. There are seven teams. The last two teams that were formed are on financial literacy in older women and on elder abuse. Everyone here is on the elder abuse team, which has produced a lot of work.
Having said that, what I want to talk about, given what everybody else has said, is research in this country, in which I think the government has played a very important role and needs to play an even more important role in the future. I'm going to make four points.
Number one is that in this country the last study of prevalence of elder abuse was done in 1999. The one prior to that, already alluded to, was done in 1989. We are way behind schedule in terms of knowing what's going on. The first study, which was done by Podnieks in 1989, was a very fine study of 2,008 people, but what was found in that particular study was that gender didn't matter, so hat being female did not matter.
The second study, by Pottie Bunge, which was done on the General Social Survey run by the federal government through Statistics Canada, also found that gender didn't matter, which is very interesting. Today, I will tell you, there are exactly 14 studies of prevalence. Prevalence is how many cases occurred in one year, as opposed to incidence, which is how many new cases occurred in one year.
What the problem has become is that we actually don't know the size of the problem in this country, yet we keep throwing money at it, hoping to solve it. What I'm arguing for is that we need to do better research that actually starts at the beginning. The beginning is how we define elder abuse.
I can talk about the 14 studies that have been done in the community and the nine that have been done in institutions, and I can say to you, for example, that in Sweden, 11% of people are abused in institutions, compared to 72% in Germany--right off the wall. Because there is no agreement around.... I mean, we do use the World Health Organization's definition, but it has to be operationalized into a study.
The problem is that nobody agrees on what elder abuse is. In the community, you can go from 0.8% in Spain to 18% in Israel. The variation is huge. In the Canadian studies it came out around 4%. In the latest U.K. studies, it was 2.6%. In Ireland it was 3%.
Why do definitions matter? They matter to all of us for the following reasons.
Definitions matter because that's who we include when we count the size of the problem. If we don't have a definition or we have a weak definition, we never know exactly how big the problem is.
Secondly, if we don't know how big the problem is, or if we don't even know what elder abuse is and what we include in it, we don't know what the legislation should cover. If we don't know the nature of the problem, we don't know what type of treatment to offer people. If we don't know the nature of the problem, we don't know who's eligible for services.
As a simple example, if you decide you are not going to include sexual abuse, your numbers are going to be lower, the problem is going to remain as big, and you probably can't compare it with those of other countries like Israel, Great Britain, and Spain.
All of this turns into money. The government has been arguing that we need core services and we need to pay for them. How many core services do we need and how much should they be? If we don't know what the problem is, we can't make that decision. That's the first point I want to make.
The second is that the two studies we have done in Canada basically didn't find gender to be a relevant variable at the time. I'm not saying that a whole bunch of other studies in the world have found that gender matters. As Dr. Gutman has been saying, the Americans did the risk factors for abuse: those that we know for sure are confirmed, those for which we have contesting evidence, and those in between, for which we have some evidence for and some against. Most studies out there today are for and against the matter of gender.
What I'm trying to say is that in Canada, we really don't know. We don't know for sure if gender is an issue. I would argue that gender will be an issue in the most neglected area, which is institutional abuse. I have done a study with Charmaine. The fastest-growing population in this country is 85 years of age and over. That population is women. That population is most likely to be housed in a nursing home.
Of the people in nursing homes today, the average age is 85. They tend to be cognitively impaired. They tend to have two or three diagnoses. They are socially isolated. Only 12% of them still have companions or partners. Something like 60% live away from their families. You can see the opportunity in the institutions just waiting to happen. When you talk about cutbacks and all the rest of it--like lack of staffing--you may have a disaster on your hands. Just from anecdotal information from where I've been, there are horrendous cases there. I'm not saying there aren't in the community, too, because there are.
The third point I want to make is that we talk a lot about intervention. We say that we need intervention. The problem from a research perspective, worldwide, is that we do not have good evidence to support what intervention we should be using. The latest study was done--fortunately by a Canadian--in 2009. It looked at 1,253 studies of interventions around the world, in two languages. It found only eight studies qualified to be included as a half-decent piece of research.
Of those eight, the researchers could not conclude which approach was best. It seemed to suggest, in conformity with what this government is doing today, that education was a good thing. Educating people about abuse seemed to be one of the mechanisms that had some support. So we have to be careful when we talk about what we need. We don't know for sure what it is.
The last point I want to make is that Canada may be ready to move forward. We're all involved in this. NICE has done a huge study on the definition of elder abuse in the Canadian context. It can be expanded or contracted to be used locally, nationally, or internationally. Almost everybody involved in preventing elder abuse in Canada has been part of this. We have had consensus meetings. We are going to have one tomorrow. I don't know how much consensus we will get, but we're going at it all day tomorrow with government policy-makers, practitioners, and researchers.
I would argue that HRSDC has put a lot of money into this and into developing the Canadian scene. Some of the way we went about it is really different from around the world.... We've had the data analyzed by outsiders and they say that Canada has made a huge contribution in starting to move forward in the field, at last. Done. I think you guys need to think about it. You've already invested a lot of money in this and I think it's time to move forward for a prevalence and incidence study, both in the community and really in the institutions.