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Elder Abuse Training Materials

Elder Abuse Training Materials. Co-funded by the Rights, Equality and Citizenship (REC) Programme of the European Union under Grant Agreement no JUST/2015/RDAP/AG/VICT/9320.

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Elder Abuse Training Materials

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  1. ElderAbuseTrainingMaterials Co-funded by the Rights, Equality and Citizenship (REC) Programme of the European Union under Grant Agreement no JUST/2015/RDAP/AG/VICT/9320

  2. Thistrainingmaterialhas been produced with the financial support of the Rights, Equality and Citizenship Programme (2014-2020) of the European Union (Grant Agreement no JUST/2015/RDAP/AG/VICT/9320). The contents of this trainingmaterialare the sole responsibility of Women’sSupport and InformationCenter NPO and can in no way be taken to reflect the views of the European Commission.

  3. Elder Abuse/Agism and Sexism Sirkka Perttu MSc (Health Care), RN slperttu@gmail.com WHOSEFVA/2016-2018/WLF

  4. Ageism and elder abuse • Ageism is a process of systematic stereotyping of and discrimination against people because they are old (Butler 1989) • The attitudes and practices that ignore, patronize, insult or trivialize older persons (The Respect Aging 2013) • Ageism results in prejudicial and stigmatizing attitudes and behaviour that belittle and exclude people because of their age, denies their autonomy and dignity and creates barriers to exercising their human rights on an equal basis. • Ageism is central to understanding and confronting elder abuse (Biggs and Philipson (1994) • Social ageism, therefore acts as a ‘permessor’, a factor that permits elder abuse to happen (Biggs and Lowenstein, 2011). WHOSEFVA 2016-2018/SirkkaPerttu/WLF

  5. Ageism/Sexism • Both men and women experience ageism in the form of stereotyping • older women face the cumulative effects of gender discrimination throughout their lives; • women experience not only ageism but also sexism; a combination of age and gender discrimination puts older women at increased risk of violence and abuse • Sexism • Negative stereotyping, prejudice or discrimination against people on the basis of sex • Involves negative attitudes, false information and mistaken beliefs about people of a certain sex • Ageism experienced by women is rooted in sexism The Respect Aging 2013. • 'Double jeopardy' refers to the fact that women experience a worse ageing experience than men due to the double combination of sexism and ageism (Marvin Formosa 2001) WHOSEFVA 2016-2018/SirkkaPerttu/WLF

  6. Elder abuse – prevalence in EU Sirkka Perttu MSc (Health Care), RN WHOSEFVA2016-2018/WLF

  7. Prevalence rates of elder abuse in Europe • Information available concerns the different levels of development of research throughout the European countries: • Some countries have a rich history of prevalence research on elder abuse, other countries have just begun to tackle the issue of elder abuse and neglect • There is only limited research exploring abuse and neglect of older people in Europe; generally the research is inadequate and inconsistent, or it doesn’t exist • The prevalence rates vary between 0,8 % - 29,3 % • Men 0,7 % - 15 % • Women 0,9 % - 23,3 % • Very limited information on abuse of older women and men in Europe De Donder, L. et al. 2011. • Both women and men experience abuse and/or neglect in later life, especially when they show signs of disability and become dependent on others for help in practicing their daily activities Melchiorre M.G. et al. 2016. WHOSEFVA 2016-2018/SirkkaPerttu/WLF

  8. Men and women as victims of abuse according European studies • United Kingdom (UK) study on mistreatment reported that 3.8% of women and 1.1% of men were victims. When neglect was excluded, the prevalence of abuse continued to be significantly higher for women (2.3%) than men (0.6%). Biggs S et al. 2009. • In Ireland, women (2.4%) were more likely than men (1.9%) to report experiences of maltreatment in the previous 12 months, especially concerning interpersonal violence. Naughton C et.al 2010. WHOSEFVA 2016-2018/SirkkaPerttu/WLF

  9. Men and women as victims of abuse according European studies • In care homes, women seemed to be more often abused than men.  Juklestad O. 2001. • However, some of the above mentioned studies indicate that men were more financially abused.  Biggs S, et al. 2009. WHOSEFVA 2016-2018/SirkkaPerttu/WLF

  10. Older women and men as victims of abuse • Both women and men experience abuse and/or neglect in later life, especially when they show signs of disability and become dependent on others for help in practicing their daily activities (Melchiorre M.G. et al. 2016) • “Older women face greater risk of physical and psychological abuse due to discriminatory societal attitudes and the nonrealization of the human rights of women”. (MIPAA 2002). • The vast majority of older victims of sexual violence are women Statistics Canada. (2013). In The Respect Aging 2013. WHOSEFVA 2016-2018/SirkkaPerttu/WLF

  11. Violence against older women • Evidence indicates that older women in need of services are more likely to be living with their abusers, and experience psychological/emotional abuse as high rates as younger women • even for nondependent older women, physical and verbal abuse is occurring at rates similar to, or higher than, those for younger women” (Mouton et.al 2004) • invisible perpetrators/seemingly harmless – older men • There is also the question of intentionality when the abuser has a cognitive impairment or a psychiatric illness. Barron Jackie (2007) WHOSEFVA 2016-2018/SirkkaPerttu/WLF

  12. EU-wide survey General results (women 18 to 74 years old and live in the EU): • According to FRA (European Fundamental Rights Agency)“Violence against women: an EU-wide survey” (carried out in 2012) in average 19% of women over 60 had experienced partner violence since they were 15 and 3% in the past 12 months. The percentages were 17% and 3% with respect to non-partner violence. • 66% of women did not report the most serious incident of partner violence to the police or another organization (‘Main Results’, p.60) FRA – European Union Agency for Fundamental Rights 2012. WHOSEFVA 2016-2018/SirkkaPerttu/WLF

  13. European Union Agency for Fundamental Rights (FRA) Survey on violence against women 2012 WHOSEFVA 2016-2018/Sirkka Perttu/WLF

  14. WHOSEFVA 2016-2018/SirkkaPerttu/WLF

  15. WHOSEFVA 2016-2018/SirkkaPerttu/WLF

  16. Physical injuries sustained in the most serious incident of physical and/or sexual violence by a partner since the age of 15; % of the victims of the age of 60-74 years; FRA survey VAW 2012 WHOSEFVA 2016-2018/Sirkka Perttu/WLF

  17. WHOSEFVA 2016-2018/SirkkaPerttu/WLF

  18. Contacting organisations or services as a result of the most serious incident of physical and/or sexual violence by a partner since the age of 15; % of the victims of the age of 60-74 years; FRA survey VAW 2012 WHOSEFVA 2016-2018/Sirkka Perttu/WLF

  19. WHOSEFVA 2016-2018/SirkkaPerttu/WLF

  20. Types of assistance women victims of violence would have needed – but did not get – following the most serious incident of physical and/or sexual violence by a partner since the age of 15/FRA WHOSEFVA 2016-2018/SirkkaPerttu/WLF

  21. WHOSEFVA 2016-2018/SirkkaPerttu/WLF

  22. Prevalence rates of abuse of older women, 60+ (%) (n=707) (AVOW 2011; Finland, Austria, Portugal, Lithuania and Belgium)Luoma M-L et al. 2011. WHOSEFVA 2016-2018/Sirkka Perttu/WLF

  23. Perpetrators of older women (60+)(AVOW 2011; Finland, Austria, Portugal, Lithuania and Belgium)Luoma M-L et al. 2011. WHOSEFVA 2016-2018/Sirkka Perttu/WLF

  24. Violence against older women in Austria • About one out of four (23.8 %) older women (60+) living in private households in Austria experienced some form of violence and abuse in the past year. • The most common type of abuse is emotional abuse (19.3 %), followed by neglect (6.1 %), and financial abuse (4.7 %). • 6.9 % of the older women experienced one kind of abuse in the past year. One out of eight (12.4 %) either encountered several kinds of abuse occasionally, or one form of abuse (very) often. 4.5 % of the older women very victims of severe abuse, i.e. frequent and multiple forms of violence. Perpetrators of abuse • In most cases, the current partner or spouse of the older woman was the perpetrator, especially with respect to emotional and sexual abuse and the violation of personal rights. • Children or children in law were the most frequently mentioned perpetrators in cases of neglect and financial abuse. Gert Lang &Edith Enzenhofer 2011. WHOSEFVA 2016-2018/SirkkaPerttu/WLF

  25. Abuse and Neglect of Older People in United Kingdom • Overall, 2.6% of people aged 66 and over living in private households reported that they had experienced mistreatment involving a family member, close friend or care worker during the past year. • Four types of abuse were examined: psychological, physical and sexual abuse and financial abuse. • Women were more likely to say that they had experienced mistreatment than men (3.8% of women vs. 1.1% of men). • Men aged 85 and over were more likely to have experienced financial abuse than men in the younger age groups, whereas women aged 85 and over were more likely to have been neglected. O’Keeffe M. et al. 2007. WHOSEFVA 2016-2018/SirkkaPerttu/WLF

  26. Abuse and Neglect of Older People in United Kingdom • Women were more likely to say that they had experienced mistreatment than men (3.8% of women vs. 1.1% of men). • Men aged 85 and over were more likely to have experienced financial abuse than men in the younger age groups, whereas women aged 85 and over were more likely to have been neglected. • Looking at the prevalence of abuse excluding neglect, it increased with age for men, but decreased with age for women. O’Keeffe M et al. 2007. UK Study of Abuse and Neglect of Older People. WHOSEFVA 2016-2018/SirkkaPerttu/WLF

  27. Elder Abuse in GreecePrevalence (%) of abuse and injury during the past 12 months, people 60-84 years Psychological = e.g. undermined or belittled what you do; Physical = e.g. kicked you; Sexual  = e.g. touched you in a sexual way against your will; Financial = e.g. tried to make you give money, possessions or property; Injury = e.g. you passed out from being hit on the head. Melchiorre M.G et al 2014. WHOSEFVA 2016-2018/SirkkaPerttu/WLF

  28. Violence committed against men in Finland • A random sample of 1900 men and 1200 women was interviewed • The questionnaire comprised detailed questions of violence since the age of 15 and in the past 12 months • 4 perpetrator groups: strangers, acquaintances, partners and ex-partners • 15–74 years old Finns • response rate was 45 percent Markku Heiskanen & Elina Ruuskanen 2011. WHOSEFVA 2016-2018/SirkkaPerttu/WLF

  29. Prevalence of violenceagainstmen/FinlandMarkku Heiskanen & Elina Ruuskanen 2011. Figures on partner violence calculated across men living in a partnership/having lived in a partnership

  30. Injuries and psychological consequences by perpetrator category and gender, % of cases (most recent incident)Markku Heiskanen & Elina Ruuskanen 2011.Men and women aged 15–74 years WHOSEFVA 2016-2018/SirkkaPerttu/WLF

  31. Care provided by a doctor or other health care personnel across perpetrator groups by gender, %Markku Heiskanen & Elina Ruuskanen 2011.Men and women aged 15–74 years WHOSEFVA 2016-2018/SirkkaPerttu/WLF

  32. (1/2) ConclusionsViolenceexperiencedbymendifferfromwomen’sexperiences/FinlandMarkku Heiskanen & Elina Ruuskanen 2011. • Prevalence of partnerviolence is the samebymen and women, But • Men’s victimization is mostly physical violence and threats committed by strangers • Also threats and violence by acquaintances was common for men. • Prevalence of ex-partnerviolence is twice as common bywomen • Sexual violence is more common for women than men • Womensuffermoreoftenthanmen for injuries and psychologicalconsequencescausedbypartnerviolence Markku Heiskanen 2012 WHOSEFVA 2016-2018/SirkkaPerttu/WLF

  33. (2/2 Conclusions)Violenceexperiencedbymendifferfromwomen’sexperiences/FinlandMarkku Heiskanen & Elina Ruuskanen 2011. • Especially in previous partner relationships, beating, strangling, beating the head against something, and sexual violence were directed at women more often than at men • There was no difference regarding victimization to physical violence, but women had experienced more often threats and sexual violence in a partner relationship. • In the violence by strangers and acquaintances – for instance in regards of beating with a fist or more serious forms of violence – the victims were mostly men. • Womenreportpartnerviolence to the policemoreoftenthanmen WHOSEFVA 2016-2018/SirkkaPerttu/WLF

  34. Working with older survivors - Professionals’ experiences and self-care : Vicarious trauma, Secondary traumatic stress, Compassion fatigue and Burnout Sirkka Perttu MSc (Health Care), RN slperttu@gmail.com WHOSEFVA 2016-2018/WLF

  35. Professionals’ experiences in working with older survivors • Work with violence problems differs from traditional social or health care work • The worker has to take a clear stance against violence - learned neutral approach to work and clients’ doesn’t work • the victims need affirmation of their abusive experiences to help them to overcome the abuse • abusive experiences have to be validated by another person to feel that they were being believed • a stance is an ethical obligation in the profession working with human beings in violence prevention work • That might cause uncomfortable feelings • Can cause a process of difficult experiences, memories and emotions of oneself WHOSEFVA 2016-2018, Sirkka Perttu/WLF

  36. Professionals’ experiences in working with older survivors • Working with an older survivor might cause contradictory/ambivalent feelings in the professionals: • she/he faces the situation but feels having not enough skills or support from others what to do • that can result feelings of helplessness or withdrawal from the case • Fear (of perpetrator) • Anger • Helplessness, frustration • I do my best and nothing happens • Takes too much time • Victims doesn’t do what we have agreed • Same things happen again and again WHOSEFVA 2016-2018, Sirkka Perttu/WLF

  37. Professionals’ experiences in working with older survivors • Omnipotence • I know what should be done, I can solve the situation • Ambivalent feelings (empathy – confusion – anger) • Overprotecting attitude and behaviour of the helper • Many older victims lack the capacity to protect themselves (helplessness of old person) • Dealing the pain and suffering of the victims • Helper feels the feelings of the victim and carries them inside • Frustration of the inadequate or lack of services or quality of services for older abused persons • No simple solutions • Valued area of work? WHOSEFVA 2016-2018, Sirkka Perttu/WLF

  38. Professionals’ experiences in working with older survivors Professional work is also influenced by: • Own possible experiences of violence and survival • Own experiences due to help and support • Self-awareness essential and working on own feelings and emotions → professionalempowerment • Awareness of own fears and attitudes • Safe and supportive working team and organisation can support that process WHOSEFVA 2016-2018, Sirkka Perttu/WLF

  39. Professionals’ reactions in violence prevention work • The negative psychological reactions the professionals may experience when working with vulnerable and traumatized clients: • Vicarious trauma (VT) • Secondary traumatic stress (STS)(Work-related traumatic stress) • Compassion fatigue (CF)/Post Traumatic Stress Disorder (PTSD) Jason M. Newell and Gordon A. MacNeil 2010. Sprang et al. 2007. • Burnout WHOSEFVA 2016-2018, Sirkka Perttu/WLF

  40. Professionals’ reactions in violence prevention work/VT • Vicarious traumatization refers to “a process of cognitive change resulting from repeated empathic engagement with trauma survivors” • alterations in one’s sense of self; changes in world views about key issues such as safety, trust, and control; and changes in spiritual beliefs • profound inner cognitive changes Jason M. Newell and Gordon A. MacNeil 2010. WHOSEFVA 2016-2018, Sirkka Perttu/WLF

  41. Professionals’ reactions in violence prevention work/VT • Professionals who listen to clients’ stories of fear, pain, and suffering may feel similar fear, pain, and suffering because they care. • Therapists who work with rape victims, for example, may develop a general disgust for rapists that extends to all males • Over caring or emotional abandonment (at sensitivity level) of victims, cynical and dismissive attitudes, lack of motivation to help, apathy • Trauma work can increase the professional’s sense of own vulnerability and can disrupt sense of safety WHOSEFVA 2016-2018, Sirkka Perttu/WLF

  42. Professionals’ reactions in violence prevention work/VT • Symptoms, frequently unnoticed, may range from psychological issues such as • anxiety, disconnection, avoidance of social contact, becoming judgmental, anger, depression, somatization, sleep disturbances, nightmares, feeling powerless, exhaustion (physical or emotional), disrupted beliefs about self and others • Physical symptoms of exhaustion such as • nausea, headaches, general constriction, bodily temperature changes, dizziness, fainting spells, and impaired hearing Ginny Sprang et al. 2007. WHOSEFVA 2016-2018, Sirkka Perttu/WLF

  43. Professionals’ reactions in violence prevention work/STS • Secondary traumatic stress results from • engaging in an empathic relationship with an individual suffering from a traumatic experience and bearing witness to the intense or horrific experiences of that particular person’s trauma • helping or wanting to help a traumatized or suffering person [or client]” • Are more outer behavioral symptoms • May include a full range of PTSD symptoms Jason M. Newell and Gordon A. MacNeil 2010. WHOSEFVA 2016-2018, Sirkka Perttu/WLF

  44. Professionals’ reactions in violence prevention work/CF • Compassion fatigue is a syndrome consisting of a combination of the symptoms of secondary traumatic stress and professional burnout • A new term • A more general term describing the overall experience of emotional and physical fatigue that the professionals experience due to the chronic use of empathy when treating patients who are suffering in some way • The repeated use of empathy combined with the day-to-day work place difficulties and hurry • The experience of compassion fatigue tends to occur cumulatively over time. Jason M. Newell and Gordon A. MacNeil 2010. WHOSEFVA 2016-2018, Sirkka Perttu/WLF

  45. Professionals’ reactions in violence prevention work/CF • Common among individuals that work directly with trauma victims such as health care workers, psychologists, first aid responders • Are most common in the health care field • When health care professionals struggle with their responses to the trauma suffered by their patients • their mental health, relationships, effectiveness at work, and their physical health can suffer S Michie & S Williams 2003. WHOSEFVA 2016-2018, Sirkka Perttu/WLF

  46. Professionals’ reactions in violence prevention work/CF • Comprehensive: effects can spread out to all areas of life • impact on the family life • understanding and picture of the life and world can change • Contributing factors in health care e.g. • “culture of silence” • lack of awareness of symptoms • poor training in the risks associated with high-stress jobs WHOSEFVA 2016-2018, Sirkka Perttu/WLF

  47. Risk factors for Vicarious traumatization, Secondary traumatic stress and Compassion fatigue Micro level • Professionals with • a pre-existing anxiety disorder • mood disorder • personal trauma history (particularly child abuse and neglect) • high caseloads of trauma-related situations despite having little clinical experience practicing with trauma clients • individual use of maladaptive coping skills in response to trauma work, such as suppression of emotions, distancing from clients, and performing of abuse dynamics Jason M. Newell and Gordon A. MacNeil 2010. WHOSEFVA 2016-2018, Sirkka Perttu/WLF

  48. Risk factors for Vicarious traumatization (VT), Secondary traumatic stress (STS) and Compassion fatigue (CF) Macro level • Organizational features • organizational constraints/restrictions • inadequate supervision • lack of availability of client resources • lack of support from professional colleagues • organizational culture (values, norms) • Culture in an organization should acknowledge the existence of VT, STS, and CF as normal reactions to client traumas • An accepting organizational culture helps to ease stigmas if the trauma professionals experience reactions, such as feeling inadequate or incapable Jason M. Newell and Gordon A. MacNeil 2010. WHOSEFVA 2016-2018, Sirkka Perttu/WLF

  49. A multidimensional approach to burnout • Burnout phenomenon is associated with the work environment • Physical and emotional exhaustion that workers can experience when they have low job satisfaction and feel powerless and overwhelmed at work • Is often caused by e.g. new technologies and huge flow of information, financial constraints, shift work, a number of patients with difficult diagnoses, lack of continuous education and poor communication • Also lack of control over own work and little support from colleagues and the management • Unclear work role and high amounts of work are strong predictors of exhaustion Selmanovic S, Ramic E, Pranjic N, Brekalo-Lazarevic S, Pasic Z, Alic A. Stress at work and burnout syndrome in hospital doctors. Med Arh 2011;65(4):221–4. WHOSEFVA 2016-2018, Sirkka Perttu/WLF

  50. A multidimensional approach to burnout • Professional burnout is cumulative process of physical, emotional, and mental exhaustion, resulting from chronic exposure to populations that are vulnerable or suffering • Three distinct parts: emotional exhaustion, depersonalization, and reduced sense of personal accomplishment: • Emotional exhaustion is a state that occurs when a practitioner’s emotional resources become depleted by the chronic needs, demands, and expectations of their clients, supervisors, and organizations • Depersonalization (also referred to as cynicism) refers to the negative, cynical, or excessively detached responses to coworkers or clients and their situations • Reduction in one’s sense of personal accomplishment occurs when social workers feel inadequate when clients do not respond to treatment, despite efforts to help them. Jason M. Newell and Gordon A. MacNeil 2010. WHOSEFVA 2016-2018, Sirkka Perttu/WLF

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