Elizabeth Podnieks

Elder Abuse: The Canadian Experience

ABSTRACT Abuse and neglect of older adults occurs in all Canadian communities and solutions require the coordinated efforts of society at large. Amelioration entails more than a legislative approach. Prevention of this growing problem is a social responsibility that requires networking and collaboration between different disciplines in all sectors of the community. This article will discuss elder abuse in Canada from a historical perspective, as well as current legislation, model programs, and research initiatives. It is intended to allow for comparison from the various countries presented in this volume. Hopefully, readers will find some models, or ideas, they may wish to explore or even replicate within their own jurisdictions.

Elder Mistreatment: An International Narrative

This eclectic overview of global reports on elder mistreatment reflects both the diversity of the work of the authors and the situations in the countries described. Some nations frame elder mistreatment as a human rights issue; others trace the development of emerging programs and practices as they articulate strategies designed to identify, prevent, and reduce the problem, while recognizing the shifting context in which elder mistreatment takes place. This article sheds light on the way different countries share their stories, policies, and initiatives, which stimulate discussions and debates of various aspects and cultural nuances of elder mistreatment. The data presented provide a platform for increased action toward preventing elder mistreatment and celebrate successes while looking for new ways to address challenges.

WorldView Environmental Scan on Elder Abuse

In response to a growing and worldwide recognition of elder abuse, the WorldView Environmental Scan on Elder Abuse was undertaken. It represented an attempt to collect both information on the nature of the problem of elder abuse and responses to it from a global perspective. The first of its kind, the Scan gathered information about elder abuse as well as on related legislation and policy, services and programs, educational resources and needs, training, and past and ongoing research. A total of 53 countries responded to the survey questionnaire, with 362 respondents representing the six world regions designated by the World Health Organization. Findings revealed that factors contributing to elder abuse include changing social and economic structures, isolation of victims, inadequate knowledge of laws and services, intergenerational conflict, and poverty. Barriers to seeking resources to intervene and protect older adults include the culture of the country, language issues, literacy, stigma, lack of mobility, lack of funding, and insufficient familiarity with and access to the internet. The data serve as a catalyst to take action, both globally and nationally, while emphasizing the changes necessary to protect the rights and dignity of older adults.

Institutional abuse of older adults: what we know, what we need to know

Although Canadian policies support “aging in place,” there still will be a number of older adults who will require institutional care in the future. Most research on elder abuse, however, has focused on domestic abuse and has paid less attention to institutional abuse. The purpose of this article is to comprehensively review current research to identify gaps in knowledge and methodological issues in the study of institutional abuse. Overall, 49 studies in English and 20 studies in French were reviewed, and 11 key-informant interviews were conducted with methodological experts. Methodological challenges are addressed in light of the review and interviews.

Developing a Research Agenda on Resident-to-Resident Aggression: Recommendations From a Consensus Conference

This article provides an overview of the development of a research agenda on resident-to-resident aggression (RRA) in long-term care facilities by an expert panel of researchers and practitioners. A 1-day consensus-building workshop using a modified Delphi approach was held to gain consensus on nomenclature and an operational definition for RRA, to identify RRA research priorities, and to develop a roadmap for future research on these priorities. Among the six identified terms in the literature, RRA was selected. The top five priorities were: (a) developing/assessing RRA environmental interventions; (b) identification of the environmental factors triggering RRA; (c) incidence/prevalence of RRA; (d) developing/assessing staff RRA education interventions; and (e) identification of RRA perpetrator and victim characteristics. Given the significant harm RRA poses for long-term care residents, this meeting is an important milestone, as it is the first organized effort to mobilize knowledge on this under-studied topic at the research, clinical, and policy levels.

The Consequences of Elder Abuse

Increased life expectancy has resulted in a growing number of persons over age 65, and this number continues to escalate. The increasing population of older people has led to the prediction that aging is accompanied by greater physical and mental problems that result in dependency—and also lead to situations in which elders may be mistreated. The consequences of mistreatment for elders at large, for individuals, and for society as a whole are shown in this chapter, including physical and emotional consequences as well as mortality. The lived experiences of abused elders are explored, emphasizing not only vulnerabilities but also resilience, and the need to listen to older adults and involve them in the research, planning, and evaluation of all aspects of intervention. A determinant of health framework is used to provide a comprehensive method of inquiry into this complex topic, including such important elements as gender and culture, coping skills, the role of health services, and physical, social, and legal environments.

Best-Practice Guideline on the Prevention of Abuse and Neglect of Older Adults

Une revue systématique de la littérature a été effectuée afin d’identifier des moyens efficaces pour prévenir et combattre l’abus et la négligence envers les adultes âgés dans les établissements de soins de santé au Canada. L’examen a été fait en utilisant les bases de données qui ont été recherchés à partir de janvier 2000 à avril / mai 2013. En outre, les membres des groupes d’experts ont présenté les citations d’articles tirés des archives personnelles. Deux associés de recherche infirmier (ARI) ont selectionné chaque titre et chaque résumé pour l’inclusion. Après le coefficient d’objectivité a été déterminé entre les ARI (score Kappa de 0,76), les dossiers ont été divisés, évalués et les données extraites indépendamment. L’examen a révélé 62 études portant sur l’identification, l’évaluation et la réponse à l’abus et la négligence des personnes âgées; stratégies d’éducation, de prévention et de promotion de la santé; et soutien organisationnel au niveau du système pour prévenir et combattre ce type de maltraitance et de négligence. L’abus et la négligence envers les aînés demeure peu exploré en termes d’études fondées sur des preuves; par conséquent, il faut davantage de recherche dans tous les domaines décrites.A systematic review of the literature was conducted to identify effective approaches to preventing and addressing abuse and neglect of older adults within health care settings in Canada. The review was conducted using databases searched from January 2000–April-May 2013. Additionally, expert panel members submitted article citations from personal archives. Two research associates (NRA) screened each title and abstract for inclusion. After inter-rater reliability was determined between the NRAs (Kappa score of 0.76), the records were divided, appraised, and data extracted independently. The review resulted in 62 studies that focused on identifying, assessing, and responding to abuse and neglect of older adults; education, prevention, and health promotion strategies; and organizational and system-level supports to prevent and respond to abuse and neglect. Abuse and neglect of older adults remains under-explored in terms of evidence-based studies; consequently, further research in all of the areas described in the results is needed.

Introduction: Elder Abuse in Canada—Reports From a National Roundtable Discussion

The Government of Canada is addressing elder abuse through recent initiatives to raise awareness and develop and build on existing resources to combat this phenomenon. To support the Government’s priority, the departments of Human Resources and Skills Development Canada (HRSDC) and Justice Canada commissioned eight research articles in 2008 and then held an Expert Roundtable to summarize existing knowledge and gaps on different aspects of elder abuse and identify research priorities. Final condensed versions of six of these articles are presented in this special issue of the Journal of Elder Abuse & Neglect (JEAN ). These articles build significantly on the knowledge base of elder abuse from a conceptual, theoretical, legal, empirical, and operational perspective. Although all articles offer a Canadian vision, some also review international perspectives, strengthening the global vision on this issue and laying the foundation for further studies, including national prevalence surveys in community and institutional settings. Harbison, Coughlan, Beaulieu, Karabanow, VanderPlaat, Wildeman, and Wexler provide an overview of the theories and theoretical assumptions underlying the mistreatment and neglect of older people in community settings in “Understanding ‘Elder Abuse and Neglect’: A Critique of Assumptions Underpinning Responses to the Mistreatment and Neglect of Older People.” The authors provide a critical commentary illustrating how these theoretical understandings have become manifest in legislation, policies, and programs pertaining to “elder abuse and neglect” in Canada. Suggestions also are provided for changes in direction for policies, programs, and research.