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Services for Abused Older Canadians

Elizabeth Dow Pittaway, DSW

Service providers and researchers collaborated in a national research project to gain a better understanding about which services and interventions were used by older abused people. Very little has been published specifically related to abuse and neglect of older Aboriginal or multicultural groups and not much is known about the types of services that are most responsive to older victims of abuse.

The goals of the Services for Abused Older Canadians project (Pittaway & Gallagher, 1995) were to examine various service agencies in order to determine the suitability of different models and services in meeting the needs of a wide range of abused older Canadians and to examine accessibility of services given ethnic and regional differences. Another major purpose was to examine in depth the dynamics of abuse, through qualitative case studies and chart extractions.

A multi-method approach was used. Information was gathered from agency-based surveys (n=32); focus group interviews with service providers (n=26); reviews of client records accessed through 44 agencies (n=542); and, in-depth face-to-face interviews with older people (n=34) who identified themselves as being abused or neglected.

This article highlights a few of the findings of the study. The client records showed that clients ranged from 55 to 103 years of age; the average was 77. Thirty-six different ethnocultural groups were identified in the sample. The majority (74%) were female and most were widowed (44%). Of the client charts that were reviewed within this study, psychological abuse (40.7%) was most evident, followed by physical abuse (28.6%), material abuse (26.6%), and then neglect (12.1%).

Abusers were most likely to be a son or husband. An analysis of the abused clients' marital status, by the type of abuse they suffered, showed that married people were substantially more likely to be physically and psychologically abused while widowed people were more likely to be materially abused or neglected. Most had limited support from families or friends, with few having advocates.

While most agencies saw responding to abuse of older people as part of their mandate, fewer than half had formal response protocols, policies and/or procedures, and few had routine screening mechanisms for abuse. Many intervention strategies were identified, along with the type of abuse that predicted service utilization.

Physical abuse predicted use of law enforcement services and help with financial abuse, support groups, crisis shelters,crisis help, and transportation. Psychological abuse predicted the use of counselling or therapy, information services, medical or nursing care, respite, adult day care, and case consultation, training, in addition to the use of law enforcement services and help with financial abuse.

Material abuse predicted the use of law enforcement, help with financial abuse, use of legal advice or aid, respite, accommodation and residence, seniors' drop in, and advocacy. Neglect predicted the use of transportation, medical or nursing care, respite, accommodation and residence, assessment, resource centre, home support services, counselling or therapy, support groups, case consultation and training, and inter-agency coordination.

Older abused clients identified barriers to help-seeking which included the lack of social support, fear of reprisal, language or ethnocultural value barriers, lack of confidentiality, and limited or no available services, including transportation.

Cultural and rural/urban issues reported by focus group participants included the need to recognize cohort, language and cultural differences within the various cultural groups; the need to assist cultural leaders with identification of abuse issues within their own cultural groups; the difficulties of finding translators; and, maintaining confidentiality in rural communities.

Some Aboriginal issues included the widespread negative impact of Residential Schools, the reluctance of people to leave their home or land, even when abused; and, difficulties associated with stepping outside of the extended family to solve problems in cases of abuse.

Based on the literature, patterns of family violence where abusive relationships are observed often lead to a higher prevalence of abuse in future relationships compared to individuals who do not observe abuse in the family. This factor indicates the importance of assessing and documenting any history of abuse. This study found that no previous history of abuse or neglect was documented in two-fifths (44.8%) of the client records. There was evidence of previous reports of abuse or neglect in 156 records (31.5%). A few records (n=17, 3.4%) documented that prosecution had occurred. Only 18 charts (3.3%) had documentation that indicated that clients were abused as children. However, there were 209 charts (38.6%) that recorded indications of abuse in adulthood by a current abuser. Other documentation showed that 'other' trusted individuals had also abused 53 (9.8%) clients.

Not unexpectedly, clients' records showed that they often blame themselves for the abuse (n=80, 27.3%) or saw the abusive act as secondary to alcohol (n=55, 18.7%). Only 8.8% of clients were recorded as stating that the abusive act was secondary to stress, with physical illness, change of residence and onset of mental illness being the most stressful events.

Among the alleged abusers (10.9%) who reported stress as an explanation of abuse, heavy drinking, use of drugs and onset of mental illness ranked highest. Abusers were much more likely to blame their victim in order to deflect their own wrong-doing (n=91, 31.1%); and expressed that they deserved or were entitled to material assets (n=64, 21.8%) that belonged to their victims. Service providers identified the complexity of issues and challenges such as territorial disputes: "People (service providers) are often entrenched in their own little protective turf wars. It can really lead to an abusive environment - and this is the group that is purportedly leading the show. You can't be looking to eradicate abuse and be abusive."

A number of challenges arose in relation to linkages within communities. For example, when community meetings concerning elder abuse are held, certain professional groups appear to be reluctant to get on board.

"Some people are getting help from multiple sources and nobody knows it...like the doctor may keep the case to himself while a social worker also spends hours of her time on the case."

In addition, inadequate staff and too heavy case loads were mentioned by the agency groups. Several group members expressed their frustrations with the legal system and commented on the way women are treated by lawyers and the justice system. As one woman put it,

"I once got the police and courts involved in a situation and there was a new measure of abuse introduced."

In a remote northern community, accessible only by airplane, Aboriginal participants talked about their perceptions of the inappropriateness of some services by non-Aboriginal workers. These participants stated that the whole community jokes about the "so-called experts" who briefly "drop-in" to deliver services.

Ethical issues were identified. For example, many group participants described how they felt it was unethical practice to raise people's awareness about an issue if you don't have the resources in place to deal with it.

Aboriginal participants talked about the potential complications of life on a reserve, when everyone is related to everyone else.

"If you're in an Indian community the social worker might be your uncle or the Community Health Representative might be your niece and maybe they'll get you help.... It's kind of a double-edged sword. If it's somebody that's a supportive niece to you or a supportive uncle, that's probably a good thing because then they really know you. If it's somebody who's not supportive and maybe is connected to the victimizing part of your family or whatever, they're not going to help you".

In summary, more agencies, services and communities are becoming aware of the need to address the issue of abuse and neglect of older people. It is recognized that there may be several theories to explain the occurrence of abuse or neglect. However, not only are the dynamics between victims and abusers complex but so are the issues and dynamics between service providers and community organizations.

Several policy, practice, and research recommendations have been made based on the findings of this study. In addition, A Guide to Enhancing Services for Abused Older Canadians (Pittaway & Gallagher, 1995) has been developed to assist communities to deal with the issue of abuse and neglect of older people.

Copies of the guide and research report are available in English or French from:

Dr. Elizabeth D. Pittaway
Centre on Aging, University of Victoria
P.O. Box 1700, MS 6369
Victoria, B.C., V8W 2Y2

or

The Interministry Committee
on Elder Abuse, Office for Seniors
Province of British Columbia,
Ministry of Health and
Ministry Responsible for Seniors,
1515 Blanshard Street,
Victoria, B.C., Canada, V8W 3C8

The Services for Abused Older Canadians project was conducted under the auspices of the University of Victoria; sponsored by the Interministry Committee on Elder Abuse for the Province of British Columbia and funded by Health Canada, Family Violence Prevention Division. Co-investigators included Drs. Laurel Strain and John Bond (Prairies); Dr. Elizabeth Podnieks (Ontario); Dr. Jordan Kosberg and Daphne Nahmiash (Quebec) and Dr. Michael Stones (Maritimes). The researchers acknowledge the contribution of the many service providers and clients throughout this project.