An age-old problem

By Michelle McDonagh. It is estimated that up to 5 per cent of older Irish people are victims of elder abuse, although some advocates for the elderly believe this figure represents only the tip of the iceberg and that the actual extent of abuse still remains hidden in this country.

Internationally renowned expert in elder abuse and self-neglect, Prof James O’Brien has just spent a six- month sabbatical in Ireland with Prof Des O’Neill at the Department of Medical Gerontology at Trinity College Dublin, investigating the largely unidentified problem of elder abuse in Ireland.

While the results of the research project, entitled Elder Abuse in Ireland Within an International Context, have not yet been published, O’Brien says there is no doubt from a preliminary analysis of the findings that elder abuse is a problem in this country.

“I think that perhaps elder abuse is definitely below the radar for the vast majority of the public. It’s hard to imagine it exists but it certainly does and we need to use whatever resources we can use to better address it,” he says.

Prior to 2002, elder abuse in Ireland was not fully recognised as a problem that warranted special action, policies and framework.

However, that changed with the publication of Protecting Our Future: Report of the Working Group on Elder Abuse . Des O’Neill, a consultant geriatrician at Tallaght hospital chaired the Elder Abuse national implementation group, which was disbanded earlier this year.

Although the policy, Protecting Our Future, has made significant advances in the area of elder abuse in Ireland, O’Brien warns that this work is still at a relatively early stage and needs to be supported and expanded.

“I felt the establishment of the national implementation group was a promising start. The document produced by the working party was very good and the idea of having senior case workers strategically placed throughout the country was clever. However, Ireland can’t afford to let the momentum lag on this work,” he says.

O’Brien returned to his post as professor of geriatrics at the University of Louisville, Kentucky earlier this month after what he describes as a “fantastic” sabbatical at Trinity College. A native of Thurles and a UCD graduate, O’Brien has been a major figure in researching and developing awareness of elder abuse and a related subject, self-neglect, in the US.

With a grant from Atlantic Philanthropies, he took the six-month sabbatical to work with Des O’Neill surveying Ireland’s response to elder abuse, working with GPs, lawyers, the HSE elder abuse services, geriatricians, old age psychiatrists, public health nurses and the financial sector.

He explains: “I sort of had this bias that GPs, particularly in Ireland, were in an advantageous position to detect elder abuse. In contrast with the US, many GPs in this country still do home visits and given that most abuse is perpetuated by family members, I felt having access to the home was probably key.”

The research involved an initial survey of GPs around the country which O’Brien believes will produce some interesting observations. This initial study spawned another survey of public health nurses and senior case workers who investigate allegations of elder abuse.

“It would appear that the prevalence of reporting is increasing as people become more aware of elder abuse and the public health nurses play a major role here.”

A further survey questioned geriatricians and old age psychiatrists about their experiences in dealing with patients who self-neglect, another area of interest for O’Neill.

The results of all this work will be published later this year and he highlights the importance of getting the data out as soon as possible, given the lack of research in this area.

In a recent research project published in the Journal of Elder Abuse and Neglect, O’Brien and O’Neill looked at the incidence of elder abuse in Ireland, the UK, Canada, Australia and Israel.

O’Brien remarks: “Each country had its own variants, but the consistent observation was that elder abuse does exist in all of these countries, no country is immune. It is estimated that anywhere between 2 and 10 per cent of individuals over the age of 65 have been victims in the past year.”

The most common form of elder abuse in Ireland, according to O’Brien, appears to be psychological abuse followed by neglect and financial abuse.

This is in contrast to the US where neglect is the main form of abuse of the elderly and self-neglect represents a large proportion of this.

“Probably the toughest form of elder abuse to detect is financial abuse and we have been working with the Law School at Trinity to try to research any publications dealing with this form of abuse. It’s an area that gets blurred quite easily,” he says.

“If a child is taking money from a parent, it’s difficult to determine how much is being given willingly or how much is being stolen as no parent wants to report their own child.”

ELDER ABUSE: HOW IT IS DEFINED 

The Protecting Our Future report defined elder abuse as: “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.”

It identified six forms of abuse: physical; sexual; psychological; financial or material; neglect and action of omission; and discriminatory abuse. Self-neglect was not included in the working group’s terms of reference.

A review of Protecting Our Future published earlier in 2010 found that the volume of elder abuse referrals was increasing, but varied across the State. It showed that psychological abuse was the most common form of alleged abuse followed by financial abuse and neglect. In 36 per cent of cases, more than one form of abuse was involved.

More than 80 per cent of cases referred related to people living at home and 44 per cent of alleged victims were aged 80 or over. The alleged victim was female in 67 per cent of cases.

And, according to the review, the alleged abuser generally had a close relationship with the victim, with son or daughter the most common followed by partner or spouse and other relatives. In most cases, the abuser acted alone.

5%

of older Irish people are victims of elder abuse

2-10%

of over-65s have been victims in the past year

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