Conundrum #7 Should older people be protected from bad choices PDF

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Question #7: Should Older People be Protected from Bad Choices? Social Vulnerabilities of Older People ● Individuals have different competencies as they age ● Despite the potential of increased vulnerabilities as people grow older, older persons are adults who have the right to make their own choices even when those choices seem questionable ● Why should older people be protected from risky choices that may lead to a greater quality of life for them? Interfering When People Make Bad Choices: Dilemma: When is it right to interfere with an other person’s actions if those actions constitute a danger to themselves? ● Legally, we’re not permitted to curtail a person’s freedoms unless they are unable to make decisions for themselves ● There are differences between child abuse and elder abuse ● An adult is always presumed to be mentally competent until proven otherwise Interfering When People Make Bad Choices: ● Is it abuse? ● Is it reducing his quality of life? ● Is it improving his sex life? ● Is it a crime? Questions Raised = Elder Abuse and Neglect = Basic right to live in risk or against better judgement of others. ● At what point does such behavior become self-neglect and justify intervention? ● What happens when others may be the cause of physical, psychological, or financial abuse? ● When harm is threatened, how do we assess mental capacity for decision making? ● Is there a difference between self-neglect and being neglected or abused by another? Types of Elder Abuse and Neglect: ● Self-Neglect ● Interpersonal ● Institutional A single act or repeated acts, or lack of appropriation action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person. Physical Abuse: ● Hitting, pushing, kicking ● Inappropriate use of drugs/restraints Psychological or Emotional Abuse ● Insults, treats, humiliation, controlling behavior, confinement and isolation

Sexual abuse ● Sexual contact without consent Financial exploitation ● Misusing/stealing a person's money or assets Neglect or abandonment ● Not providing food, housing or medical care Elder abuse is a hidden problem: 1 in 6 older adults worldwide have been abused in the past year Elder Abuse: Elder abuse is the outcome of a complex and troubled situation in which a wide range of medical, psychosocial, economic, and interpersonal factors converge. These factors interact to precipitate abuse. Elder abuse transcends all social and economic boundaries …crosses all racial and ethnic groups …men and women are equally likely to be mistreated. Prevalence Rates of Abuse in Canada: ● 7.5% of older adults were abused in the previous year. ● When neglect was added, 8.2% of older Canadians were neglected and abused. ● Limitation: Very few of the older Canadians who participated in the survey were ill or very frail, most were in their sixties and early seventies and most had higher levels of education. Prevalence by Forms of Abuse: ● Psychological or emotional abuse affecting 2.7% of older Canadians daily or almost daily. ● Financial abuse 2.6% ● Physical abuse 2.2%. ● Sexually abuse 1.6% in the past 12 months ● Neglect 1.2% Victims and Abusers: ● Abusers are more likely to be spouses or adult children. ● Women are victims of violence by their spouses in 36% of cases ....and by their children in 37% of cases. ● Men are most often abused by their adult children in 43% of cases and ….more likely to experience emotional and financial abuse

Control Wheel:

Risk Factors: Risk factors for being abused (victim)

Risk factors for being abusive (perpetrator)

Living with others

Living with others

Social isolation

Social isolation

Dementia

Mental illness (depression)

Gender - women

Alcohol and drug misuse

Race

Hostility or anger problems

Physical Health

spouse/child of person being abused

Personality characteristics

Dependency on older adult

Dependency/caregiver stress

Childhood experience or violence

Signs of Abuse: Physical ● Unexplained injuries, bruising Neglect ● Lack of food, clothing, shelter or other necessities ● Changes in hygiene ● Signs of malnutrition Psychological ● Signs of depression or anxiety ● Passivity and very compliant ● Fearful and socially withdrawn Financial

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Sudden cash withdrawals Changes in financial situation

Elder abuse is rarely reported. Why?: Victims are often: ● Afraid of repercussion ● Dependant on abuser ● Afraid of institutionalization ● Feeling guilty or somehow at fault ● Feeling as if police cannot help ● Held back by cultural/ethnic values or beliefs Family, friends, and service providers: ● Do not recognize the signs of abuse ● Do not know who to go to ● Do not want to get involved ● Have been asked not to report ● Are afraid of repercussion ● Feel it is a private or confidential matter Reporting Elder Abuse: ● Occurs in family settings by someone in a position of trust ● May be situational-stress – caring for someone with high care needs, cognitive impairment, behavioural issues – caregiver stress ● Focus is on family relations, personal characteristics, and lifestyle factors unique to the relationship ● May occur in both directions Questions Raised Quality of Life: What is it that constitutes quality of life—in short, what makes life worth living? Could an older person make a judgment that quality of life is more important than quantity, even if it means running risks to health and safety or having relationships that others might regard as unorthodox? Perceptions of Quality of Life: Multifaceted phenomena: (physical health, emotional health, sense of independence, social relations, and environment) Life satisfaction: as person’s attitude toward past and present life as a whole Morale: a specific feeling, whether optimistic or pessimistic, about the future Perceptions of Quality of Life: ● Old age alone isn’t related to poor morale or unhappiness ● But physical health is a strong predictor of subjective well-being

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Subjective rating of one’s own health reflects individual coping style and not simply objective physiological function Research has found a positive relation between self-determination (agency) and quality of life

Questions Raised Sexuality: What patterns of sexual behavior are most prevalent in later life? What is the relationship between sexuality and mental health in later life? What are the signs that an older person is being sexually exploited? Sexuality in Later Life: ● Human beings need and express intimacy and love in many ways throughout the life course. ● Yet, sex among older adults has long been a topic for humor. ● There are many individual differences in how persons express their sexuality. ● Sexual decline is more likely to be determined by marital status, general physical health, or the feelings of an older person about sexuality—rather than by chronological age and normal aging changes. ● Sexual activity in late life is best explained by the continuity theory of aging. ● In fact, the best predictor of sexual behavior in late life is earlier sexual behavior. ● The difference in statistical findings on sexuality between men and women reflects the changing sex ratio in later life. ● Men typically remain fertile into their 80s while women experience menopause and loss of fertility in their 50s. Questions Raised Crime and Safety: Are older people more likely than others to be crime victims? Do older people fear crime more than other age groups? What is the impact of crime and the fear of crime on the quality of life of older people?

Is it a crime?:

Older Adults as Victims of Crime ● People over age 65 have lower rates than other age groups for serious crimes such as robbery, personal theft, assault, and rape. ● The victimization rate for older adults is lower than the rate for the rest of the population. ● While fear of crime is widely believed to be more common among older adults than younger people, this stereotype in exaggerated ● The biggest threats to older people come from financial exploitation. ● Defining “exploitation” is difficult. ● How to prove a crime was committed if the presumed “victim” doesn’t report financial exploitation? ● Whether or not we’re justified in interfering for a person’s own good? ● How we go about determining what a person’s “own good” is? ● What is culturally appropriate, when families may value sharing assets with younger generations? Financial Scams, Abuse, and Consumer Protection: ● Financial scams and harms targeting seniors that are perpetrated by strangers ● Financial abuse and harms that are committed by someone who is known to the senior ● Consumer protection relates to the prevention of other harms such as high-pressure sales tactics and overbilling ● 75% of seniors reported having experienced misleading or aggressive sales practices (CRTC). ● Top 5 forms of fraud among seniors (aged 60+) reported to the Canadian Anti-Fraud Centre were: extortion, service-tech support scams, phishing, personal information, and fake prizes ● Seniors accounting for 29% of all reported cases of fraud reported as combined loss over $31 million.

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Competition Bureau estimates that only 5% of fraud incidents are reported to law enforcement.

Email | Text Scams: #1 Scam: Romance scam (that is, when someone pretends to have romantic intentions towards a victim to gain access to their financial resources) led to losses of over $9M among seniors, accounting for approximately 25% of all losses Intervention in the Lives of Vulnerable Older Adults: It is possible to restrict an individual’s freedoms for his or her own good through legal procedures. Application for Psychiatric Assessment (Form 1) ● Form 1 is a legal procedure whereby people can be placed in psychiatric hospitals against their will. Capacity Assessment - Public Guardian (Form 4) ● Formal assessment of a person's mental capacity to make decisions about property and personal care. Intervention in the Lives of Vulnerable Older Adults Guardianship through the Office of the Public Guardian: 1. Guardianship of the person—the guardian has the power to determine where the older person will live and what treatment or services, he or she may receive 2. Guardianship of the estate—the guardian has power to manage property and take over financial affairs. Often, relatives are willing and able to take over as guardians Intervention in the Lives of Vulnerable Older Adults: ● Disregard for the rights of older adults; yet, discrimination based on age is enshrined in the Canadian Charter of Rights and Freedoms, Canadian Human Rights Act, and the provincial human rights codes ● Failings of our guardianship system – self neglect!! Preventing Abuse: ● Public Awareness Campaigns ● Training and Tools for Professionals ● Crisis shelter and housing – respite programs ● Universal screening, assessment, interventions ● Support – legal, financial, social ● Duty to report – Banks, other gatekeeper services Institutional Abuse: Institutional Abuse or Neglect May be a single incident of poor professional practice or part of a larger pattern of ill treatment, such as Inadequate care and nutrition ● Low standards of nursing care ● Inappropriate or aggressive staff-client interactions ● Overcrowding ● Substandard or unsanitary living conditions ● Misuse of physical restraints or medications

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Ineffective policies to meet residents’ needs Low levels of supervision

Military Report 2020 1,650 military personnel were deployed to 5 LTCH in Toronto and 25 in Quebec The report “highlighted serious concerns about shortages of personal protective equipment, staffing shortages, and failures to follow basic procedures to keep both residents and staff safe....