Marie Beaulieu

Understanding 'Elder Abuse and Neglect': A Critique of Assumptions Underpinning Responses to the Mistreatment and Neglect of Older People

This article provides an overview of the ways in which the mistreatment and neglect of older people have come to be understood as a social problem, one which is underpinned by a variety of substantive and theoretical assumptions. It connects the process of conceptualizing elder abuse and neglect to political-economic and social evolution. The authors draw on a review of the literature, government sources, interest group websites, and their own research to provide a critical commentary illustrating how these understandings have become manifest in legislation, policies, and programs pertaining to “elder abuse and neglect” in Canada. Suggestions are provided for changes in direction for policies, programs, and research.

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.

Critical concepts in elder abuse research.

BACKGROUND This paper identifies core elements in principal definitions of elder abuse or mistreatment of older adults (EA/MOA) and discusses the relevance of four crucial concepts: age, vulnerability, trust, and power balance in relationships. METHOD A critical analysis of selected literature in EA/MOA with a focus on works from the last 10 years. RESULTS Current definitions of EA/MOA share commonalities regarding an understanding of elder abuse as a status offence, the inclusion of both acts and omissions, and the consideration of multiple levels of behavior and its effects. Definitions differ with regard to aspects as crucial as the intentionality of an abusive action and its actual or potential harmful effects. EA/MOA can be considered as a complex subtype of victimization in later life limited to victim-perpetrator relationships, where the perpetrator has assumed responsibility for the victim, the victim puts trust in the offender, or the role assigned to the offending person creates the perception and expectation that the victim may trust the perpetrator. Vulnerability is identified as a key variable in EA/MOA theory and research. With regard to neglect, the mere possibility of being neglected presupposes a heightened level of vulnerability. Power imbalance often characterizes victim - perpetrator relationships but is not a necessary characteristic of abuse. CONCLUSION Research on EA/MOA needs conceptual development. Confining phenomena of EA/MOA to specific relationships and tying them to notions of vulnerability has implications for research design and sampling and points to the limits of population-based victimization surveys.

Chapter 8 Fear of Crime Among the Elderly

Abstract The purpose of this study is to determine in what manner the elderly who experience chronic fear of crime are differentiable from those who are without fear or those with fluctuating fear over the years. Using data from the Quebec Longitudinal Study on Aging (QUELSA), variables related to fear of crime and mental health were compared by means of descriptive statistics and t-tests between groups to determine whether a varying expression of fear of crime influenced or was influenced by the individuals mental health. Results show that fear of crime consistently expressed over time is correlated with higher individual scores on the mental health scale. Therefore, at each testing periods, individuals expressing fear of crime have a significantly higher score of psychological distress (especially depression, anxiety and cognition) and negative affect than the other two groups. These findings lead to the recognition of elements that can guide intervention.

Meaning of Home in Later Life as a Concept to Understand Older Adults’ Housing Needs: Results from the 7 Age-Friendly Cities Pilot Project in Québec

To support older adults’ desire to age in place, their housing needs must be well understood. However, little research has explored housing needs from older adults’ point of view. This article, based on the results of 49 focus groups (n = 392) and one case study from the Age-Friendly Cities Project in Québec, Canada, uses the concept of meaning of home in later life to explore older adults’ housing needs. An overview presents how older adults express meaning of home and what their needs are regarding housing and relocation. Finally, the implications for decision makers and stakeholders are discussed.

[Validity 'and Utilities' clinic of a grid observation (PACSLAC-F) to evaluate the pain in seniors with dementia's living in the Long-Term Care ].

This study presents the validation of the French Canadian version (PACLSAC-F) of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC). Unlike the published validation of the English version of the PACSLAC, which was validated retrospectively, the French version was validated prospectively. The PACSLAC-F was completed by nurses working in long-term care facilities after observing 86 seniors, with severe cognitive impairment, in calm, painful or distressing but non-painful situations. The test-retest and inter-observer reliability, the internal consistency, and the discriminent validity were found to be satisfactory. To evaluate the convergent validity with the DOLOPLUS-2 and the clinical relevance of the PACSLAC, it was also completed by nurses during their work shift, with 26 additional patients, for three days per week during a period of four weeks. These results encourage us to test the PACSLAC in a comprehensive program of pain management targeting this population.

A systematic review on community-based interventions for elder abuse and neglect

ABSTRACT Elder abuse and neglect is a societal issue that requires prevention and intervention strategies at the practice and policy level. A systematic review on the efficacy of community-based elder abuse interventions was undertaken to advance the state of knowledge in the field. The peer-reviewed literature between 2009 and December 2015 were searched across four databases. Two raters independently reviewed all articles, assessed their methodological quality, and used a modified Sackett Scale to assign levels of evidence. Four thousand nine hundred and five articles were identified; nine were selected for inclusion. Although there was Level-1 evidence for psychological interventions (n = 2), only one study on strategies for relatives (START) led to a reported decrease in elder abuse. There was Level-4 evidence for conservatorship, an elder abuse intervention/prevention program (ECARE), and a multidisciplinary intervention (n = 4), in which one study yielded significant decreases in elder abuse and/or neglect. The remaining three were classified as Level-5 evidence (n = 3) for elder mediation and multidisciplinary interventions. There are limited studies with high levels of evidence for interventions that decrease elder abuse and neglect. The scarcity of community-based interventions for older adults and caregivers highlights the need for further work to elevate the quality of studies.

Are older women forgotten in the fight against sexual violence

In light of this year’s International Women’s Day on March 8, we want to draw attention to the risk of neglecting older women in the discourse on women’s rights and in the recent campaigns around sexual victimisation. Sexual violence can induce long-lasting sexual, reproductive, physical, and mental health problems for victims and their peers, offspring, and community. In older adults, however, manifestations of these consequences are rarely recognised or linked to sexual victimisation. In contrast to the increasing research on elder abuse and neglect, sexual violence in older adults remains a largely under-researched area. In a meta-analysis of elder abuse prevalence in community settings, only 16 of 52 included studies addressed sexual violence. Moreover, reported prevalences of sexual violence in older adults were likely to be underestimated because of several methodological problems. First, most studies only included questions about rape, which is much less common than for example sexual harassment or sexual abuse without penetration. Second, in the majority of studies older adults were interviewed via telephone, which could lead to underreporting caused by safety issues, especially when victim and assailant live together. Third, all studies exclude cognitive impaired older adults who are known to be vulnerable to different types of abuse. And finally, all studies focus on assailants known to the victim, ignoring the fact that older adults can also be sexually offended by strangers. In summary, sexual violence in older adults is still too often conflated with other types of violence in the broader context of elder abuse and neglect. Although research shows that sexuality remains important in older age, older adults are frequently considered “asexual” in policies and practices. This assumption of asexuality may further enhance the risk of ignoring that older women can be sexually victimised and in need of tailored care. Even the leading organisations providing guidance on care, including WHO, ignore the complexity of sexual violence in older adults by not including “disrespect of (sexual) intimacy” and “sexual neglect” into their definition of elder abuse and neglect. This exclusion might lead to inadequate care of older adult victims of sexual violence. Revising the definition of elder abuse and neglect by including “sexual neglect”, as has recently been done by a group of academics and policy makers in Quebec, is of utmost importance. They defined “sexual neglect” as “a failure to provide privacy, failure to respect a person’s sexual orientation or gender identity, treating older adults as asexual beings and/or preventing them from expressing their sexuality, etc”. Altough older women are faced with several challenges that are linked to biological ageing, including physical and cognitive impairement, we argue that they are not suddenly exempted from sexuality nor to being prone to sexual violence exposure. Older women should be considered as much female as women of other ages with specific vulnerabilities and risks of sexual victimisation. We urgently call for increased attention to older women in research, policies, and health practices.

Crime Prevention Over the Life Course: Elder Abuse

Elder abuse encompasses a scope of single or repeated acts of violence and neglect occurring in a relation based on trust. Not always a crime, its several manifestations can be considered as deviance. Two criminological theories (Routine activity theory and the Situational action theory of crime causation) are exposed as alternatives for explaining and understanding elder abuse. These theories are illustrated through financial exploitation of older adults as well as seniors being abused by caregivers. The prevention strategies are focusing on the importance of guardians and the reduction in opportunities for potential abuser.