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February 2010 - Elder Abuse Screening and Assessment

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Welcome

This edition of the Elder Abuse E-Bulletin focuses on elder abuse screening and assessment. The abuse and neglect of older adults is a serious and prevalent problem that is often not readily identified by service providers, community or family members. This e-bulletin provides an overview of screening and assessment issues and highlights new research and tools that aim to increase elder abuse detection, intervention and prevention.

The Elder Abuse E-bulletin is a quarterly e-newsletter for those interested in addressing and preventing the abuse of older adults in Canada. It is produced by the Public Health Agency of Canada (PHAC), as part of its role under the Government of Canada's Federal Elder Abuse Initiative (FEAI).

For more information on the Government of Canada’s elder abuse initiatives, visit seniors.gc.caExternal Site or call 1-800-O-Canada (1-800-622-6232). For people using a teletypewriter device (TTY), call 1-800-926-9105.

We want to hear from you. Please send your comments and feedback to our editor at ncfv-cnivf@phac-aspc.gc.ca.

Note: The terms "abuse of older adults", "elder abuse" and "abuse of seniors" are used interchangeably throughout this e-bulletin.


Fast Fact

Screening for Intimate Partner Violence in Health Care Settings

Some researchers in the elder abuse field have turned to the domestic and intimate partner violence literature for insight into the effectiveness of screening and detection tools in health care settings. For example, a recent McMaster University study examining the effectiveness of the universal screening of women, aged 18 to 64 years, for intimate partner violence found that:

  • All women, in the screened and non-screened groups, showed reductions in exposure to violence across time – these reductions were not, however, associated with screening.
  • At 18 months, observed recurrence of intimate partner violence among screened vs. non-screened women was 46% vs. 53%, which is not statistically significant.
  • Women in the screened groups showed higher improvement in quality of life and depression, compared to non-screened groups, but these differences were small and not statistically significant when the analysis accounted for the high rate of participants lost to follow-up.
  • There were no differences in the frequency of using violence-related health and social services for screened vs. non-screened women.
  • Many women must be screened to identify one woman who discloses abuse.
  • There were no harms associated with screening as implemented in this study.

This research suggests there is a lack of evidence to support universal screening for intimate partner violence in health care settings. Nevertheless, proponents maintain that the consequences of violence and the opportunity to intervene offer a sufficient rationale to support its implementation. Some have recommended that case finding – which involves identifying women who present with specific signs and symptoms of abuse, and providing referrals and information – may be preferable to universal screening.

Source: MacMillan HL, Wathen CN, Jamieson E, et al, for McMaster Violence Against Women Research Group. Screening for intimate partner violence in health care settings. A randomized trial. JAMA 2009; 302 (5) : 493-501 External Site.


Feature Article

Elder Abuse Screening, Assessment and Intervention Tools for Canadian Health Care Providers

Over the past two decades, the abuse and neglect of older adults has emerged as an area of interest and concern for Canadian health care providers. Health care providers are looking for effective ways of identifying older adults who may be experiencing abuse and how to appropriately meet their needs.

It is well recognized that abuse and neglect can have significant impacts on older adults’ physical and mental health. Research has also shown that living under the stress of abuse can lead to earlier mortality among older women and menFootnote 1.

Older adults are two to three times more likely than younger persons to be in contact with health care providers. Health care providers are well positioned to detect abuse or neglect among older adults as they may be one of few contacts in the community, especially for those seniors who are isolatedFootnote 2.

Contact with older adults can occur in a wide variety of circumstances including

  • acute care settings (family physicians, nurses, care aides);
  • hospitals (emergency, urgent care, crisis services, planned surgery);
  • home care/support;
  • care assessment units;
  • public health settings; and
  • other health care settings.

In her research paper, “Environmental Scan and Critical Analysis of Elder Abuse Screening, Assessment and Intervention Tools for Canadian Health Care Providers”, commissioned by PHAC under the Federal Elder Abuse Initiative, researcher Charmaine Spencer identifies several of the screening, assessment and decision making tools that are in use or in development within Canada, along with the context in which these have developed. The report introduces screening and assessment issues and highlights questions that have arisen in this area generally and more specific issues for older adults and health care providers. Some questions include “Should we actively screen for abuse and neglect (as opposed to simply being alert to signs), and if so, why?” and “Do we have the necessary training, skills and tools to do this well?”

There are sensitivities in the area of elder abuse screening and assessment. It is recognized that early identification and appropriate assistance has the potential for improving health care and quality of life for older victims.Footnote 3 However, determining the value of screening involves balancing potential benefits against potential harms. Many of the existing tools try to predict the risk of abuse or neglect occurring in the future, in contrast to screening for abuse currently happening. Universal screening of older adults may lead to individuals being labeled as victims and family members labeled as abusers; may initiate a process of further investigation; and it may infringe on rights. For that reason, the tools used must have a reasonable degree of accuracy; consider the diversity of seniors in Canada; and the approach used must not cause further harm.

It is clear that awareness, education and training are key in screening and assessing incidents of elder abuse effectively.

For more information about the research paper, contact Susan Crichton at 204-983-4527 or susan.crichton@phac-aspc.gc.ca


New Developments and Promising Approaches

2009 ONPEA National Conference

On November 3-4, 2009, the Ontario Network for the Prevention of Elder AbuseExternal Site (ONPEA) hosted a National Conference, National Perspectives on Elder Abuse: Join the Conversation, with the support of the Government of Canada and the Ontario Government. The intent of the conference was to facilitate knowledge exchange among stakeholders across Canada about “promising approaches” in elder abuse prevention and intervention. It was attended by more than 300 delegates from various sectors including professionals working in the area of elder abuse, health care sector, long-term care staff, front-line community staff, social service sector, justice sector and law enforcement.

A conference report will soon be available on the ONPEA website. The conference presentation handoutsExternal Site are available for download.

Manitoba Network for the Prevention of Abuse of Older Adults launches new website

On December 8, 2009, the Manitoba Network for the Prevention of Abuse of Older Adults (MNPAOA) launched its new website: www.olderadultabuse.mb.caExternal Site. It contains tools, resources and information on recognizing and preventing abuse of older adults. You can also subscribe to the Network's newsletter. Established in 2007, the MNPAOA is a partnership of Manitoba-based organizations united to eradicate abuse of older Manitobans. The Network utilizes the expertise, skill, knowledge and resolve of its artners to prevent abuse and to restore respect, dignity, independence and security to abused Manitobans.

Fraud Awareness Toolkit Project

In February 2010, the Saskatchewan Seniors Mechanism (SSM) will test a new toolkit developed to protect seniors from frauds and scams. The Fraud Cent$ ToolkitExternal Site has complete step-by step information on how to start a community anti-fraud presentation group. It will educate community-based organizations on creating their own volunteer group for interactive presentations designed to show seniors how to be safe. The toolkit includes a “how to” guide with information on how to set up volunteer groups, train volunteers on giving effective fraud and scam presentations, build community partnerships, schedule presentations, and find current local information on frauds and scams affecting Saskatchewan seniors.

If you would like to test the toolkit, please call 306-757-1898. To request your free toolkit, please e-mail SSM at friend@skseniorsmechanism.ca to be placed on the waiting list for the finished product.


Updates from Federal, Provincial and Territorial Governments

Alberta

On October 30, 2009, the Adult Guardianship and Trusteeship Act (AGTA) came into force, replacing the 30-year old Dependent Adults Act. The AGTA is for adults over the age of 18 years who are unable to make personal or financial decisions for themselves. This legislation addresses the current needs of Albertans by providing options and safeguards to protect vulnerable adults who may want assistance or are no longer able to make all of their own decisions. It provides a range of decision-making optionsExternal Site from less intrusive options, such as supported decision-makingExternal Site or co-decision-makingExternal Site, to full guardianshipExternal Site and trusteeshipExternal Site.

More information is available on the Alberta Seniors and Community Supports website at www.seniors.alberta.ca/opgExternal Site

New Brunswick

The Government of New Brunswick recently released the results of a survey measuring the public’s concerns and attitudes relating to various forms of violence. The 2009 Attitudinal Survey on Violence Against Women was designed to measure the effectiveness of education and prevention strategies – implemented by the government and community partners – by assessing attitudinal changes since 2002. The survey also examined differences in the views of Aboriginal people compared to non-Aboriginal people. The main areas examined in the 2009 survey were violence against women, child abuse, elder abuse, dating violence and violence against persons with disabilities.

The report (PDF Document)External Site can be downloaded from the Government of New Brunswick website.

Newfoundland and Labrador

The Government of Newfoundland and Labrador is allocating $200,000 per year from 2008 to 2012 toward the development of an education and training program aimed at promoting recognition, prevention and intervention in situations of violence toward older adults. This project is undertaken in the context of the provincial Violence Prevention InitiativeExternal Site, a multi-departmental, governmental-community partnership to find long-term solutions to the problem of violence against those most at risk in our society.

Training materials are being developed to address the learning needs of key stakeholders who have a role to play in preventing violence against older persons. Currently work is well underway in the development of training materials to support management in the province’s four regional health authorities as it works to ensure that staff is well-prepared and well-equipped in this area. Work is also underway with Aboriginal governments and organizations to support the development of violence prevention and intervention training for older adults in Aboriginal communities. Other audiences will be consulted at various stages throughout the course of the project.

The Women’s Policy OfficeExternal Site, as the lead agency for the provincial Violence Prevention InitiativeExternal Site, is directing this project with the collaboration of several partners, including the province’s Office for Aging and Seniors. Two Advisory Committees are currently helping to guide this work. For more information, readers are invited to contact Michelle Smith, director of the Violence Prevention Initiative, at michellesmith@gov.nl.ca, or Suzanne Brake, director of the Office for Aging and Seniors, at suzannebrake@gov.nl.ca.


Resource Corner

New Report Provides Current Data on Family Violence

The Canadian Centre for Justice Statistics has produced the 12th annual Family Violence in Canada: A Statistical Profile, 2009 report. The report provides current data on the nature and extent of family violence in Canada, as well as trends over time, to inform policy makers and the public about family violence issues. The report includes a section that examines the prevalence and nature of police-reported violent crimes committed against seniors (65 years and older) by members of their family in 2007.

The report is produced under the Family Violence Initiative and is available through the National Clearinghouse on Family Violence (NCFV). To order, please visit the NCFV website or call toll-free 1-800-267-1291.

New Handbook on How to Spot – and Stop – Elder Abuse

The Ontario Association of Social Workers (OASW) has released the second edition of its publication, Elder Abuse: A Practical Handbook for Service Providers. This practical, user-friendly and portable handbook contains 180 pages of current information on physical, psychological and financial abuse and neglect of older persons. Contents include chapters on identification and assessment; intervention and “decision trees” to guide service providers step-by-step; listings of relevant legislation, community and government organizations; a section on reading/website resources that has a strong focus on Canadian content and is Francophone-friendly; and much more.

The handbook’s Table of Contents (PDF Document)External Site is available for viewing. To obtain a copy of the handbook – free for an individual copy except for shipping/handling costs – for a limited time only, visit Shop OASW.


Key Dates and Events

April 18 to 24 - National Victims of Crime Awareness WeekExternal Site

This year marks the 5th annual National Victims of Crime Awareness Week (NVCAW) in Canada. The theme this year is Every Victim Matters. In commemoration of NVCAW 2010, an all-day federal symposium will be held in Ottawa on Monday, April 19, 2010, at Old City Hall (111 Sussex Drive). Further details will be disseminated in the coming months on the National Victims of Crime Awareness Week websiteExternal Site.

April 29 to 30 - Ontario Gerontology Association, 29th Annual ConferenceExternal Site, Toronto, ON

The 29th annual conference theme is Innovations in Aging: Transforming Our Future. This event will cover new research with implications for practice, new practices and policies that affect older people living at home, in the community or in institutional settings.

May 3 to 6 - International Federation on Ageing - 10th Global Conference, Melbourne, Australia

The 10th Global Conference on Ageing will provide a reliable platform for a global information exchange and point of connection for all working to generate positive social change for older people. The five themes that form the program framework – Climate Change; Social Inclusion; Human Rights; Resourcing Change; and Healthy Ageing – are expected to stimulate new conversations as well as explore in more depth more traditional subject areas.

May 27 to 30 - International Society for Gerontechnology - 7th World ConferenceExternal Site, Vancouver, BC

The conference will bring together people who design, develop, prescribe, research and use technology to enhance the functional capacity and quality of life of older adults. This event will provide a venue for dialogue between engineers, ICT experts, computer scientists, gerontologists, health and social care professionals, architects, social science researchers and educators and others working in this multi-disciplinary field.

June 15 - World Elder Abuse Awareness Day 2010External Site

June 15th is recognized globally as World Elder Abuse Awareness Day (WEAAD). This day is in support of the United Nations International Plan of Action that recognizes the significance of elder abuse as a public health and human rights issue. All countries, communities, neighborhoods and organizations interested in working to bring recognition and ultimately an end to elder abuse and neglect are urged to take part in the 5th annual WEAAD on June 15, 2010.

To learn more, and to download a free copy of the Community Guide World Day Tool Kit, please visit www.inpea.net/weaad.htmlExternal Site. The National Clearinghouse on Family Violence also distributes the World Elder Abuse Awareness Day kit and poster Abuse Hurts at any Age, free of charge and in English and French.

October 25 to 26 - Manitoba Elder Abuse Conference, Winnipeg, ON

The 2010 Manitoba Elder Abuse Conference will take place at the Victoria Inn, Winnipeg. The goal of the conference is to provide education and increase awareness of the abuse of older adults. It will also provide participants with increased resources and capacity to prevent, intervene, and reduce the harm associated with this issue. Presentations and information booths at the conference will focus on different aspects of elder abuse. More details to come.


Research

Researcher Profile

Charmaine Spencer is a Research Associate with the Simon Fraser Gerontology Research CentreExternal Site and an adjunct professor with the Gerontology Department at Simon Fraser UniversityExternal Site. Ms. Spencer has been conducting research on vulnerable populations of older adults for over fifteen years, including abuse and neglect of older adults in community and institutional settings. She examines this important social issue from several lenses, including gender, health, law, ethics and public policy.

Ms. Spencer has produced several documents for the federal government on abuse of older adults including analyses of the social costs of abuse and a discussion paper on institutional abuse in the mid 1990s. In 2003, she co-authored an environmental snapshot of abuse and neglect of older adults in Canada for the Federal/Provincial-Territorial Working Group on Seniors Safety and Security. Ms. Spencer has carried out over 10 separate research projects on various aspects of abuse and neglect of older adults, and worked with community groups on several more. She has published over 75 community and multidisciplinary academic papers on abuse in later life.

Much of Ms. Spencer's work represents Canadian and international “firsts”, such as the first in-depth look at financial abuse among older adults. Recent research has looked at immigration policy and abuse among sponsored seniors, mental competency issues and abuse issues in various housing settings.

Ms. Spencer also enjoys working collaboratively with others in this area. She is a co-researcher and the first author of two major documents prepared by the national project “A Way Forward: Promising Approaches in Abuse Prevention in InstitutionsExternal Site” funded by the Public Health Agency of Canada. Ms. Spencer is currently working on an Environmental Scan and Critical Analysis of Senior Abuse Screening, Assessment and Intervention Tools for Canadian Health Care Providers as a key activity of the Public Health Agency’s component of the Federal Elder Abuse Initiative.

Charmaine Spencer is co-Chair of the Canadian Network for the Prevention of Elder Abuse, and is Canada’s representative to the International Network for the Prevention of Elder AbuseExternal Site.

Ms. Spencer can be reached at cspencer@shaw.ca.

Organizational Profile

The National Initiative for the Care of the ElderlyExternal Site (NICE) is an international network of researchers, practitioners, students and seniors dedicated to improving the care of older adults, both in Canada and abroad. NICE received funding from the New Horizons for Seniors ProgramExternal Site to launch the NICE "Elder Abuse theme team: Knowledge to ActionExternal Site" project. This project disseminates evidence-based tools for the detection, management and prevention of elder abuse. The project is about to disseminate the tools developed in the first year of the project. While some of the tools have been available for some time, all are in the final stages of being piloted to seek advice on any needed adjustments prior to printing large quantities for dissemination across Canada. Tools to date include

  • Elder Abuse Suspicion Index (PDF Document)External Site (EASI), developed by Dr. Yaffe, McGill University, and colleagues, for use by family physicians to gauge suspicion regarding senior patients who may be at risk.
  • Indicators of Abuse (PDF Document)External Site (IOA) and Caregiver Abuse Screen (PDF Document)External Site (CASE), developed by Drs. Myrna Reis and Daphne Nahmiash, for use by various allied health professionals for identifying risk and assisting with working toward prevention.
  • Elder Abuse Assessment and Intervention Reference Guide, developed by community organizations and police services in Hamilton, Ottawa and Toronto, for use by police in intervening in situations involving elder abuse.
  • En Mains/In Hands, developed by Dr. Marie Beaulieu, Université de Sherbrooke, is an ethical decision-making resource to assist a wide variety of professionals with thinking through their own values and triggers as they work to intervene in the most complex situations.

All tools will be available by March 2010 in both English and French and will also be made available at a number of training forums for responders in Vancouver, Regina, Toronto, Sherbrooke and Halifax. Elder abuse awareness-raising workshops are also being delivered by the project's five senior project coordinators in each community. Efforts are underway to determine how best to make tools and training available to other communities through the use of various affordable web-based technologies.

The "Elder Abuse Team: Knowledge to Action" projet will identify, pilot and disseminate four tools for screening, intervening/managing and/or preventing abuse of older adults each year. The final tool kit will include twelve user-friendly, evidence-based resources.

For more information about the project, or to find out who the Senior Coordinator is for your region, please contact Alison Leaney, National Project Coordinator, at alison.leaney@nicenet.ca or 604-865-0776.


In the next edition

The next Elder Abuse E-bulletin in June 2010 will focus on using social media in elder abuse prevention.


Content of the Elder Abuse E-Bulletin is provided as an information-sharing service; inclusion does not represent endorsement by PHAC or FEAI member departments.

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National Clearinghouse on Family Violence: Telephone 1-800-267-1291; TTY 1-800-465-7735; Fax (613) 941-8930; Centre national d'information sur la violence dans la famille; e-mail ncfv-cnivf@phac-aspc.gc.ca


Footnote 1

Lachs, M.S., Williams, C. S., O’ Brien, S., Pillemer, K.A. & Carlson, M. E. (1998). The mortality of elder mistreatmentExternal Site. Journal of the American Medical Association, 280, 428-432.

Footnote 2

Cohen, M., Halevy Levin, S.L., Gagin, R. & Friedman, G. (2007). Elder abuse: disparities between older people's disclosure of abuse, evident signs of abuse, and high risk of abuseExternal Site. Journal of the American Geriatrics Society, 55 (8), 1224-1230.

Footnote 3

Joubert, L. & Posenelli, S. (Oct. 2009). Responding to a “window of opportunity”: the detection and management of aged abuse in an acute and subacute health care settingExternal Site. Social Work in Health Care, 48 (7), 702 – 714.