Native Stock/Angel Wynn
SPOTTING ELDER ABUSE & WORKING WITH OLDER VICTIMS National Clearinghouse on Abuse in Later Life (NCALL)
Presenter 2
Juanita Davis, J.D. NCALL Associate Director
NCALL’s Work 3
NCALL is committed to creating a world that respects the dignity of older adults and enhances the safety and quality of life of older victims and survivors of abuse. We engage communities to foster a collaborative, inclusive, survivor-centered response to abuse in later life.
Agenda 4
Why
address elder abuse? Overview of elder abuse Responding to abuse in later life Resources
5
Why Address Elder Abuse?
Persons depicted in this presentation are models and are used for illustrative purposes only.
10,000 Americans turn 65 every day 10,000 Americans turn 65 every day. Acierno, R., Hernandez, M. A., Amstadter, A. B., Resnick, H. S., Steve, K., Muzzy, W., & Kilpatrick, D. J. (2010).
Older women comprise more than half (55.8%) of the adult population age 65 and older. United States Census Bureau (2012).
6
Racial and ethnic minority populations have increased Racial and ethnic minority populations have increased from 5.7 million in 2000 (16.3% of the elderly population) to 8.5 million in 2011 (21% of the elderly). They are projected to increase to 20.2 million in 2030 (28% of the elderly). http://www.aoa.gov/Aging_Statistics/Profile/2012/docs/2012profile.pdf.
7
1 in 10 community-residing older adults 1 in 10 communityresiding older adults reported experiencing elder abuse in the past year. Acierno et al. (2010).
Archstone Foundation
8
About 2/3 of elder abuse victims are women
About 2/3 of elder abuse victims are women. Lifespan of Greater Rochester, Inc., Weill Cornell Medical Center of Cornell University, & New York City Department for the Aging. (2011).
9
About 2/3 of elder abuse victims are women. Lifespan of Greater Rochester, Inc., Weill Cornell Medical Center of Cornell University, & New York City Department for the Aging. (2011).
Elder Abuse and Dementia
Three international studies found overall rates of abuse of people with dementia by their caregivers ranged from 34 – 62%. http://www.ncea.aoa.gov/Resources/Publication/docs/NCEA_Dementia_ResearchBrief_2013. pdf
10
Sexual Abuse in Later Life In the community, older victims of sexual abuse were violated most often by spouses/partners. Acierno, et al., (2010).
In facilities, employees responsible for care (43%) or other residents (41%) were most likely offenders. Ramsey-Klawsnik, H., Teaster, P. B., Mendiondo, M. S., Marcum, J. L., & Abner, E. L. (2008).
11
Higher risk of death Elders who experienced abuse, even modest abuse, had a 300% higher risk of death when compared to those who had not been abused. Dong X, Simon M, Mendes de Leon C, Fulmer T, Beck T, Hebert L, et al. (2009).
12
The Toll of Elder Abuse The cumulative toll of elder abuse has not yet been quantified but is estimated to afflict more than 5 million people and cost many billions of dollars a year. Department of Justice, 2014. Elder Justice Roadmap.
Archstone Foundation
13
Elder Abuse Is Mostly Hidden For every 1 case of elder abuse that comes to light . . .
another 24 do not Source: NYS Elder Abuse Prevalence Study; Weill Cornell Medical College, NYC Department for the Aging; Lifespan; (2011)
14
For every 1 case of financial exploitation that comes to light, 44 do not. For every 1 case of neglect that comes to light, 57 do not.
Barriers Faced by Older Victims Older victims experience unique barriers that prevent them from seeking help and further complicate the process of addressing the abuse once it has been reported. www.ncall.us
15
Barriers for Older Victims? 16
17
Elder Abuse
Photos: Katherine Fogden, Smithsonian Institute; Madeline Kasper
Who Are the Victims? 18
Any
older adult (generally 60+) Disproportionately affected:
Persons who are isolated, living in poverty or who have cognitive impairments (e.g., dementia) Women (2/3) Residents or long-term care facilities
Where Does Elder Abuse Occur? 19
Private Public
dwellings
settings
Facilities,
residential settings
Who Commits Elder Abuse? 20
Intimate
partners Adult children and other family members Caregivers Fiduciaries Others who are or put themselves in positions of trust or authority/power Strangers
Why Does Elder Abuse Occur? 21
Persons motivated by: Greed Benefits of predatory behavior (sexual or financial) Power and control dynamics (similar to younger domestic violence)
Other reasons: Good intentions (caregivers who cause harm even if trying to provide care) Accidental injury Physical/mental health conditions (cannot control behavior)
21
22
Types of Abuse
Physical, Emotional Abuse 23
Physical:
hitting, pushing, kicking, or slapping Emotional: hurtful words, yelling, threatening, manipulating (“crazymaking” behavior), ignoring, isolation
Sexual Abuse 24
Hands
on Hand off Harmful genital practices Cite: Dr. Holly Ramsey Klawsnik
25
Case Example: Al
Al’s Story 26
Thoughts/Reflections? 27
Neglect 28
 The
failure to provide adequate or necessary care to a dependent person by a caregiver
Financial Exploitation 29
Illegal
or improper use of or dependence on an older adult's funds, property or assets. Because not all older adults use the banking system, consider cash, gold, jewelry, antiques, and homes as assets. Misuse of POAs (financial) Often co-occurs with other forms of abuse.
30
Case Example: Anne
Anne’s Story 31
Thoughts/Reflections? 32
33
Indicators of Abuse
Victim Indicators 34
General: isolated, withdrawn, fear, depression, changes in mood/behavior, coded language Physical: bruises, lacerations, pressure marks, broken bones (different stages of healing) Sexual: STIs, pain around breasts/genitals, sensitivity to touch Neglect: dehydration/malnutrition, untreated bedsores, issues with medicating, poor hygiene FE: missing assets, unpaid bills, new financial documents, lack of awareness of financial circumstances
Suspect Indicators 35
Inconsistent/conflicting explanation’s about injuries Belittles, controls, threatens, ignores, isolates Handles the victim adult roughly Always present, overly protective, speaks for victim Self-aggrandizing Charming and helpful toward professionals
Environmental Indicators 36
Unclean/unsanitary living environment Strong odors of urine and or feces Lack of food, medication Assistive devices out of reach or unused
Thoughts/Reflections? 37
38
Strategies for Supporting Older Victims
Strategy: Survivor-Centered Approach 39
 Promote
survivor safety and self-determination  Recognize the strength and resiliency of survivor  Provide resources and information to support survivor decisions
Meeting Survivors Where They Are At 40
Discussion #1 41
 How
can/do you do support older survivor’s resiliency in your work?
Strategy: Understanding Trauma 42
Acute
trauma Complex trauma Historical trauma
Trauma Aware 43
Historical Trauma 44
Discussion #2 45
 How
does trauma impact your work with older victims?
46
Collaboration and Referrals
Who Might Be Involved 47
Faith Leaders
Adult Protective Agencies
Private Law Firm
Advocates
Health Professionals
Ombudsman
Aging Services Network
Criminal Justice
Family and Friends
Discussion #3 48
 What
other referrals or resources might be available to older adults in your work?
Other Issues, Opportunities? 49
50
Resources
51
National Center for Reaching Underserved Victims of Crime
National Resource Center on Reaching Victims 52
Funded
by Office for Victims of Crime (OVC) Focused on underserved populations of crime victims, including older adults Provides technical assistance, training, consultation, mini-grants
Staying Connected to NCALL and Other Advocates 53
Sign up for our e-newsletter Join our listserv for advocates serving older survivors Join us Facebook: www.facebook.com/ncall.us/ Join us on Twitter: www.twitter.com/ncall_us Website: www.ncall.us
Final Questions/Comments? 54
Thank You! 55
Juanita Davis, J.D. Associate Director National Clearinghouse on Abuse in Later Life 1245 E. Washington Avenue, Suite 150 Madison, WI 53703 Email: jdavis@ncall.us