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Rossini
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Number of Chronically Disabled Americans Age 65 and Over
Source: National Long Term Care Survey 1982-1994 (Kenneth Manton, Ph.D.)
(In Millions)
6.4
7.0 7.17.3
7.5
6.4
7.5
8.38.7
9.1
7.37.5
8.79.1
1982 1984 1986 1988 . 1990 1992 1994 1996 1998
4.0
6.0
8.0
10.0
Based on declining disabil i ty rate since 1982
If disabil ity rate did not change since 1982
(projected)
Note: The U.S. elderly population (age 65+) totaled 26.9 million in 1982, 30.8 million in 1989, 33.7 million in 1994, 34.1 million in 1996, and 34.8 million in 1998 (1996 and 1998 are projections).
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Damned nuisance, all those windows….
QuickTime™ and aTIFF (Uncompressed) decompressor
are needed to see this picture.QuickTime™ and a
TIFF (Uncompressed) decompressorare needed to see this picture.
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What, then, is time? If no one asks me, I know what it is.
If I wish to explain it to him who asks me, I do not know. Augustine, Confessions, Chapter XIV
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Aspects of aging in later life
• Positive• Inter-individual variability
– more complex
• Reduced reserve/homeostasis– homeostenosis
…, in a word, COMPLEXITY!
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Madrid Action Plan on Ageing
• Older persons and development
• Advancing health and well-being into old age
• Ensuring enabling and supportive environments
2002
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Madrid - 3 Priority Directions
• Older persons and development– 8 Issues, 14 Objectives, 107 Actions
• Advancing health and well-being into old age– 6 Issues, 13 Objectives, 81 Actions
• Ensuring enabling and supportive environments– 4 Issues, 9 Objectives, 51 Actions
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Ensuring enabling and supportive environments
• Neglect, abuse and violence– Eliminate all forms of neglect, abuse
and violence at older persons– Creation of support services to
address elder abuse
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Primary Care
• Practical, scientifically sound and socially acceptable
• Train primary healthcare worker in gerontology and geriatrics
Article 70
Article 75
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Specialist Needs
• Health care designed to need the specialist needs of older people must be made available, taking into account the introduction of geriatric medicine and gerontology into relevant university curricula and healthcare systems
Article 59
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Changing carepatterns
Ageism
Domestic violence
Gerontolism
Wisdom
Economic vulnerability
Disability
Heterogeneity
Child abuse
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Research, research, research….
Less than 50 empirical studies in the peer-reviewed literature
NAS, 2002
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Medline
• 25, 355 Domestic Violence• 1,108 include older people• 96 IPV and older people
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Invisibility….
• Lancet 2002, 2006• Limited to ages 15-49
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Elder abuse
First formal report 1975 First Irish reports 1990 NCAOP report 1998 Working Group 1999 Report accepted as health policy
2002 National implementation group 2003
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Working group
Older people Health Boards Social workers Public Health
Nurses Residential care
PsychiatrySocial WorkPsychologyINHOGardaí
Police Family doctors Geriatric Medicine Psychiatry of Old
Age Psychiatry
http://www.dohc.ie/publications/pdf/pof.pdf
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Elder Abuse
..is not a legal issue…it is a health and social care issue
Gordon AshtonGordon Ashton
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Philosophy
Care context Good practice Training Appropriate staffing
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‘‘A single or repeated act or lack of appropriate action
occurring within any relationship where there is an expectation of trust
which causes harm or distress to an older person or violates their human and civil rights.’’
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Types
• Psychological• Financial • Physical• Neglect• Sexual abuse
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UK Prevalence Study
• Neglect 1.1%• Financial 0.7%• Psychological 0.4%• Physical 0.4%• Sexual 0.2%
• 6% of those abused within previous year report 2 types of mistreatment
• Underestimate - no nursing homes, none with significant dementia
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Changes with age
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Association
• Women– Financial increases with age for men– Advanced age, more men than
women
• Poor health• Rented Accomodation• Loneliness
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Perpetrator
• 51% partner/spouse• 65% living in house• Interpersonal
– 80% men
• Financial– 56% men, overall younger
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Inquiries/referrals
02468
10121416
Neig
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Nu
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Th
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Old
Ag
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Old
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Alleged perpetrators
0123456789
10
Son Daughter Husband Neighbour Nephew Other Rel
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Main Abuse Allegations
0
2
4
6
8
10
12
14
Physical Psych Neglect Financial Sexual
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Abuse in institutions
• Institutional abuse– poor care standards, lack of a positive
response to complex needs, rigid routines, inadequate staffing and an insufficient knowledge base within the service
• Individual abuse– In particular, restraints
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Programme
Draft policies, procedures, guidelines
Pilot projects: accepted two areas Training brief, tender, evaluation Evaluation brief, tender, evaluation
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NationalRecommendation
s Implement current government policy
on health and social care for older people
National Implementation Group - DoHC National Centre for Study of Elder
Abuse Legislative
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Structure
• Regional – Steering Groups– Training
• LHA – Senior Case Worker– Manager– Clerical
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Senior Case Worker
• Positive experience with two disciplines
• Did not specify discipline• Outlined competencies
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Training
2-day for a small group of key personnel 74
One session for as many other healthcare personnel as possible (abbreviated by Foot and Mouth outbreak) 198
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Process themes
• Formality of procedures and signing one’s name
• Need to go through a line manager before making a referral
• ‘Fit’ between the procedure advocated and current practice in some work settings
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Resource themes
• Access to safe therapeutic environment
• Wider range of options• Out-of-hours service• Budget• Access to counselling services
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What has happened?
• Law Reform Commission• HSE implementation group• Steering Groups• Funding for 32 case workers• Funding for National Centre
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QuickTime™ and a decompressor
are needed to see this picture.
QuickTime™ and a decompressor
are needed to see this picture.
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Lifetime history IPV
0
5
10
15
20
25
30
35
24 34 44 54 64 >65
Age
%
Men
Women
CDC. Behavioral Risk Factor Surveillance System 2005
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Willingness to disclose by current age: “would not be willing to disclose if abused in future”
(SAVI, 2002)
0
1
2
3
4
5
6
7
8
9
10
18-24 25-29 30-39 40-49 50-59 60-69 70+Age group
Pe
rce
nta
ge
Women
Men
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Future
• More joint working between domestic violence and elder abuse constituencies
• Skills and options complementary
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QuickTime™ and aTIFF (Uncompressed) decompressor
are needed to see this picture.
Goya, age 80
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• Ma se in vece fossimo riusciti ad annoiarvi, credete che non s'è fatto apposta.
Manzoni, I Promessi Sposi