Elder Abuse and dementia Sirkka Perttu MSc Health

Elder Abuse and dementia Sirkka Perttu MSc (Health Care), RN WHOSEFVA 2016 -2018/WLF Co-funded by the Rights, Equality and Citizenship (REC) Programme of the European Union under Grant Agreement no JUST/2015/RDAP/AG/VICT/9320

This training material has been produced with the financial support of the Rights, Equality and Citizenship Programme (2014 -2020) of the European Union. The contents of this training material are the sole responsibility of WHOSEFVA consortium and can in no way be taken to reflect the views of the European Commission.

Abused women - dementia • Progressive conditions that develop as a result of degenerative changes in the brain • Primarily affects older people and is characterised by – the loss of cognitive, social and behavioural functions that impacts a person’s mood and personality – the ability to think, speak, understand, communicate, remember – perform basic self-care functions like dressing and eating Downes, C. , Fealy, G. , Phelan, A. , Donnelly, N. A. , Lafferty, A. (2013) Abuse of Older People with Dementia: A Review. NCPOP, University College Dublin.

Relationship between elder abuse and dementia • Older adults with dementia are particularly vulnerable to abuse • As the world’s population ages, the number of people with dementia is predicted to increase from 35. 6 million in 2010 to 115. 4 million by 2050 • Estimates of the prevalence of abusive behavior toward older adults with dementia who live in the community range from 5. 4 percent to 62. 3 percent • Abuse of older adults with dementia is underreported older adults may be reluctant to disclose abuse because they fear retaliation or losing support

Relationship between elder abuse and dementia • Common physical signs of and reactions to abuse, such as withdrawal from communication or increased dependence, may be difficult to distinguish from dementia symptoms • Psychological abuse was the most common form of abuse among older adults, with estimates of its prevalence ranging from 27. 9 percent to 62. 3 percent. • Physical abuse was estimated to affect 3. 5– 23. 1 percent of older adults with dementia. Downes, C. , Fealy, G. , Phelan, A. , Donnelly, N. A. , Lafferty, A. (2013) Abuse of Older People with Dementia: A Review. NCPOP, University College Dublin.

Relationship between elder abuse and dementia • A study of 284 sexual abuse cases reported that 60 percent of the elderly victims suffered from cognitive impairment or dementia • 35 percent of eighty-two caregivers of patients with dementia reported experiencing mutual verbal abuse with the care recipients, and 6 percent reported experiencing mutual physical abuse with them Downes, C. , Fealy, G. , Phelan, A. , Donnelly, N. A. , Lafferty, A. (2013) Abuse of Older People with Dementia: A Review. NCPOP, University College Dublin.

Risk factors of elder abuse due to dementia Victim factors: • Older adults with dementia often have psychological or behavioral symptoms such as agitation and aggression, which may intensify caregiver-recipient conflicts and result in elder abuse • older adults with dementia may experience a higher burden of chronic illness and physical impairment, which further increases their risk of abuse Downes, C. , Fealy, G. , Phelan, A. , Donnelly, N. A. , Lafferty, A. (2013) Abuse of Older People with Dementia: A Review. NCPOP, University College Dublin.

Risk factors of elder abuse due to dementia Perpetrator factors: • Caregiver burden and stress are among the most common risk factors associated with elder abus • Depression, anxiety, alcohol abuse, social isolation and poor relationships with the victim prior to the occurrence of dementia are also associated with higher risk of abuse by caregivers • In long-term care facilities, a lower level of job satisfaction and a higher level of burnout rate may lead to increased risks for abuse Downes, C. , Fealy, G. , Phelan, A. , Donnelly, N. A. , Lafferty, A. (2013) Abuse of Older People with Dementia: A Review. NCPOP, University College Dublin.

Intervention models of elder abuse designed for older people with dementia • Improvement of multiagency collaboration in the management of elder abuse • Core elements: – screening tools and referral protocols – handbook for caregivers for identification of elder abuse risk factors – community resource supports and services for the caregivers – training of staff and volunteers Anetzberger et al. 2000

Intervention models of elder abuse designed for older people with dementia • Reducing abusive behaviour of the demented person: – medication to help the care-recipient’s memory – written advice on understanding memory problems and what to do – more information from professionals caring for the person with dementia Selwood et al. (2009) • Caregivers of older people with dementia need to receive adequate information and education about the clinical course of dementia and the care-recipient’s needs (Hansberry et al. 2005).

Intervention models of elder abuse designed for older people with dementia • Home care and respite care services can prevent abuse (Selwood et al. 2009) • Strategies aimed at reducing caregiver isolation and enhancing social support may be effective in reducing elder abuse of people with dementia (Hansberry et al. 2005) • However, Cooper et al. (2010) suggest that outside help may be experienced as stressful for family caregivers and thus it may not result in a reduction of caregiver abuse