How to identify potential elder abuse

Elder abuse, whether it’s physical, emotional, psychological, or financial, is a reality in our society.

It affects 10 per cent of older adults, and, say the experts, identifying it is the first step in preventing it.

That is not a simple task because victims often are afraid of alienating a caregiver who may be a family member or worse, reprisals. Often abused or exploited seniors do not recognize themselves as victims.

To assist in that process, Dr. Mark Yaffe, professor of family medicine at McGill and affiliated to St. Mary’s Hospital, led a group that developed the Elder Abuse Suspicion Index (E.A.S.I.) – a short questionnaire used by healthcare professionals when they suspect elder abuse.

The questionnaire has been well received by professionals and seniors, in Montreal and elsewhere in North America, Yaffe told his audience May 24 at the Gelber Centre.

The Cummings Centre Social Action Committee organized the talk.

The survey asks whether in the past six months, there has been neglect:

Has anyone prevented you from getting food, clothes, medication, glasses, a hearing aid, medical care, or tried to stop you from being with someone you wanted to be with?

On verbal or emotional abuse: have you been upset because someone talks to you in a way that makes you feel ashamed or threatened?

On financial or material abuse: has anyone forced you to sign papers or to give them money against your will?

On physical abuse: has anyone made you feel afraid, touched you in a way you did not want, or hurt you physically?

The broader question asks whether in the past year you have avoided eye contact with those around you, felt withdrawn, experienced malnourishment, hygiene issues, cuts, bruises,
inappropriate clothing or medication, and compliance issues.

“If the answer is yes to any of these questions, one needs to ask more specific questions,” Yaffe told the audience of some 100.

Sexual abuse covers both physical and psychological abuse, and includes undesired sexual contact, touching, rubbing, or masturbation that is forced, tricked, coerced, manipulated, or happened when the senior lacked the capacity to consent.

Once identified, what can be done? Is legislation the answer?

In three of ten provinces, there is some form of mandatory reporting, and Quebec is examining a bill that deals with mandatory reporting of abuse by institutions. In the U.S. 47 states have mandatory reporting, but Yaffe questions its usefulness.

“In the U.S., it has not had any impact on decreasing the prevalence of abuse,” he said.

Some victims will not seek punitive action because they are embarrassed that the perpetrator is a family member, Yaffe noted. And as a consequence, the senior might end up in an institution where abuse continues.

Statistically speaking, if there are 1.32 million Quebecers age 65 and over, and if the 10 per cent abuse figure is applied, that could mean mandatory reporting of 132,000 abuse cases.

Because our socio-legal system is not equipped for this volume, Yaffe suggested the criteria for mandatory reporting would have to be carefully defined.

Elder abuse could be rooted in social problems such as marital abuse or dysfunctional families that extend into old age. The emphasis should be on dealing with individual dysfunctionality before seniors reach the age when they can no longer fend for themselves.

“Elder abuse is closely linked to family caregiving … no level of government has done an adequate job in ensuring that families are adequately supported financially and socially to be able to look after senior relatives at home.”

“Legal recourse, we don’t believe is going to be a solution for a good proportion of elder abuse,” Yaffe said.

As an alternative, he pointed to the free elder abuse clinic run by lawyer Ann Soden out of the Atwater Library. It has adopted a mediation approach to the problem.

“She works exceptionally hard to bring the perpetrator and the victim together to see whether there is a compromise that can be reached to decrease the acts of abuse or their severity,” he said.

“No mediation is perfect, but if it decreases the episodes of abuse, then it’s successful.” He quoted from American Jewish theologian, Rabbi Abraham Joshua Heschel, who said: “A test of a people is how it behaves toward the old. It is easy to love children … But the affection and care for the old, the incurable, the helpless are the true gold mines of a culture.”

Roula Marinos, Royal Bank branch manager on Queen Mary, reported that Ontario Provincial Police have declared that financial abuse of seniors has reached epidemic proportions.

“Financial abuse starts off slowly, with a little transaction here, and then it kind of snowballs,” she said. The person perpetrating misuse could be a trusted family member, friend, neighbour, or caregiver. The most vulnerable are those who are alone, and have no close relatives nearby, she said. Marinos recommended seniors think twice and even consult a lawyer before turning over ATM or credit cards to someone else, placing limits on power of attorney, and monitoring use of any joint accounts.

“Do not share your personal identification with anyone,” Marinos warned. Marrick Bertrand, a Quebec government help-line supervisor, and social worker Lidia Volvich, suggested calling Elder Abuse Hotline (1-888-489-2287) to discuss any mistreatment issues. It operates seven days a week from 8 am to 8 pm, is bilingual, and has access to interpreters in other languages.

If there is an emergency, seniors are asked to call 911, or for questions of concern, and for non-urgent health issues, Info-Santé at 811.

Sometimes, a call from an intervention staffer associated with the hotline can have a dissuasive effect on the perpetrator, they said.

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