Rossini

2. Rossini

5. Damned nuisance, all those windows….

6. 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

7. Aspects of aging in later life • Positive • Inter-individual variability • more complex • Reduced reserve/homeostasis • homeostenosis …, in a word, COMPLEXITY!

8. Madrid Action Plan on Ageing Older persons and development Advancing health and well-being into old age Ensuring enabling and supportive environments 2002

9. 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

10. 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

11. Primary Care Practical, scientifically sound and socially acceptable Train primary healthcare worker in gerontology and geriatrics Article 70 Article 75

12. 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

13. Economic vulnerability Heterogeneity Wisdom Domestic violence Ageism Gerontolism Child abuse Disability Changing care patterns

15. Research, research, research…. Less than 50 empirical studies in the peer-reviewed literature NAS, 2002

16. Medline • 25, 355 Domestic Violence • 1,108 include older people • 96 IPV and older people

17. Invisibility…. • Lancet 2002, 2006 • Limited to ages 15-49

18. 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

19. Working group • Older people • Health Boards • Social workers • Public Health Nurses • Residential care • Police • Family doctors • Geriatric Medicine • Psychiatry of Old Age • Psychiatry Psychiatry Social Work Psychology INHO Gardaí http://www.dohc.ie/publications/pdf/pof.pdf

20. Elder Abuse ..is not a legal issue…it is a health and social care issue Gordon Ashton Gordon Ashton

21. Philosophy • Care context • Good practice • Training • Appropriate staffing

22. ‘‘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.’’

23. Types • Psychological • Financial • Physical • Neglect • Sexual abuse

24. 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

25. Changes with age

26. Association • Women • Financial increases with age for men • Advanced age, more men than women • Poor health • Rented Accomodation • Loneliness

27. Perpetrator • 51% partner/spouse • 65% living in house • Interpersonal • 80% men • Financial • 56% men, overall younger

28. Inquiries/referrals

29. Alleged perpetrators

30. Main Abuse Allegations

31. 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

32. Programme • Draft policies, procedures, guidelines • Pilot projects: accepted two areas • Training brief, tender, evaluation • Evaluation brief, tender, evaluation

33. NationalRecommendations • Implement current government policy on health and social care for older people • National Implementation Group - DoHC • National Centre for Study of Elder Abuse • Legislative

34. Structure • Regional • Steering Groups • Training • LHA • Senior Case Worker • Manager • Clerical

35. Senior Case Worker • Positive experience with two disciplines • Did not specify discipline • Outlined competencies

36. 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

37. 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

38. Resource themes • Access to safe therapeutic environment • Wider range of options • Out-of-hours service • Budget • Access to counselling services

39. What has happened? Law Reform Commission HSE implementation group Steering Groups Funding for 32 case workers Funding for National Centre

41. Lifetime history IPV CDC. Behavioral Risk Factor Surveillance System 2005

42. Willingness to disclose by current age: “would not be willing to disclose if abused in future” (SAVI, 2002)

43. Future • More joint working between domestic violence and elder abuse constituencies • Skills and options complementary

44. Goya, age 80

45. Ma se in vece fossimo riusciti ad annoiarvi, credete che non s'è fatto apposta. Manzoni, I Promessi Sposi