Upload
others
View
1
Download
0
Embed Size (px)
Citation preview
NEGLECT, ABUSE AND VIOLENCE IN
LATER LIFE:
INTERSECTIONALITY OF GENDER AND AGE
Competing Paradigms of Elder Abuse: Learning from Intimate Partner Abuse, Active Aging, and Vulnerable Older Adult Research (Emphasis on Older Women)
From an International Perspective
Patricia Brownell, PhD, Associate Professor Emerita of Social Service, Fordham University, and Immediate Past President, National
Committee for the Prevention of Elder Abuse
Toronto, Ontario, November 22, 2017
Popula'onAgeingandGender
• Globaltrendchangingeconomicsandsocie3esaroundtheworld
• In2012,people60+represented11.5percentofglobalpopula3on;by2050willdoubleto22percent.
• Olderwomenoutnumberoldermen:in2012forevery100womenage60+therewere84men;forevery100womenage80+therewere61men;by2050,over1billionwomen60+.
• Thefeminiza3onofageing,represen3ngtheintersec3onofageandgender,hasimportantimplica3onsforpolicyandprac3ceastheworldcon3nuestoage
• Neglect,abuseandviolenceagainstolderwomenremainslargelyinvisible:itmustbecomevisibleinordertoend.
2
DifferingTheore,calPerspec,ves
• DifferentResearchFramesbasedondifferenttheore3calbasesusedifferentagecohortdataanddifferentvariables,andresultindifferentandconflic3ngprevalencedata.
• In3matePartnerAbuse:Oldagemaystartat30,40,50or60orolderTypesofabuse:physical,sexual,psychologicalUnderlyingtheory:powerandcontrol 3
In,matePartnerViolence
• Perpetratorcategories:currentorformerspouse,partnerorda3ngpartner,orstrangerincaseofsexualabuseincludingrape
• Prevalenceratesforolderwomen:1-3%(withinyear);3-4%within5years
• Cumula3veprevalencerates:(life3me–22%to27%)
4
Ac,veAgeing
• Agecohort:60yearsoldandover
• Typesofabuse:physical,sexual,psychological,financialexploita3on,neglect
• Perpetratorcategories:Spouse/partner,adultchildren,grandchildren,otherrela3ves,neighbors/friends,caregivers
• Prevalenceratesforoneyearperiod:10%-39%
• Underlyingtheory:ageism
5
VulnerableolderAdultPerspec,ve
• Ageranges:65yearsandolder
• Typesofabuse:sameasac3veageingbutsome3mesincludingabandonment,self-neglect
• Perpetratorcategories:sameasac3veageingbutincludingstrangersandsome3mesself.
• Generallynotdisaggregatedbygendersonoprevalenceratesgenerallyreported
• Underlyingtheore3calassump3on:vulnerabilityofvic3m(generallyassumescogni3veimpairment)
6
HumanRightsPerspec,ve
• Useslifecourse,notlifestage,perspec3ve
• Broadestrangeofperpetratorstoincludestateactorsaswell
• Seangscanincludeins3tu3onalseangslikecarehomesandprisons,aswellacommunity
• Priori3zesrace/ethnicminoritypopula3onsthataresociallymarginalized
• Typesofabusecanincludesocialisola3on,socialexclusionandpoverty
• Basedonassump3onofolderpersonsasrightsholdersandthestateasdutybearer
7
UNOrganiza,onalChangestoPromoteGenderEquality
• UNWomenfoundedin2010toincludedivisionsfocusingonwomenandhumanrights:DivisionfortheAdvancementofWomen(DAW),Interna3onalResearchandTrainingIns3tutefortheAdvancementofWomen(INSTRAW),UnitedNa3onsDevelopmentFundforWomen(UNIFEM),andOfficeoftheSpecialAdvisoronGenderIssuesandtheAdvancementofWomen(OSAGI)
• Execu3veDirectors:2010-MichelleBachelet;2013-PhumzileMlambo-Ngcuka
• ValuePerspec3ve–feminist;shihsbetweenlifecourseperspec3veandolderwomenas“othercategory”
8
DivisionofEconomicandSocial
Affairs
• FocalPointonAgeing–RosemaryLane
• Valueperspec3ve:ac3veageing;aginggenderneutral
• Languagerelatedtoolderwomen:“girlsandwomenofallages”“allwomenandgirls”
• NGOinvolvement:NGOCommileeontheStatusofWomen(CSW);NGOCommileeonAgeing(IDOP)
9
NGOCommunity• NGOCommileeonAgeing(Ac3veAgeing)
• NGOCommileeontheStatusofWomen(Feminist)
• Sub-CommileeonOlderWomen(Intersec3onalityofgenderandage;linkedbothcommileesabove);disbandedinNYCin2016
• In2010,movedfromCSWtoAgeing;in2015disbandedfromAgeinginNY;con3nuesinCommileeslinkedtoGenevaandViennaUNsites
• RoleofNGOswithconsulta3vestatus:twofunc3ons–provideexpertinforma3ontotheUN(ECOSOCaccreditedNGOs;provideinforma3onabouttheUN’sac3vi3estothepublic(DPIaccreditedNGOs) 10
Documentspromo,ngHumanRightsof
OlderWomen:SoKLaw
• Madrid2002Interna3onalPlanofAc3ononAgeing(non-binding);5and10yearreviews
• Conven3onfortheElimina3onofAllFormsofDiscrimina3onAgainstWomen(binding),GeneralRecommenda3onNo.27,HumanRightsofOlderWomen(non-binding)
• SpecialRapporteuronDomes3cViolence:ReportonOlderVic3ms(RashidaManjoo)
• IndependentExpertonHumanRightsofOlderPersons:ReportonOlderWomen(RosaKornfeld-Male)
11
WORLDELDERABUSEAWARENESSDAY
• WorldElderAbuseAwarenessDay(WEAAD)becameaUNDayinDecember2010,whentheUNGeneralAssemblyvotedtoaddWEAADtotheUNCalendarofspecialdays
• June15isthedesignateddaytoreflectontheneglect,abuseandviolenceexperiencedbyolderpeopleasahumanrightsviola3on
• WEAADwasfirstproposedbyDr.ElizabethPodniek,ofToronto,Canada,whoservedasVicePresidentoftheInterna3onalNetworkforthePreven3onofElderAbuse(INPEA)andwasoneofitsfoundingmembersin1997
• INPEAwasrecognizedasanNGOwithSpecialConsulta3veStatusbytheUNin2004,andistheonlysuchNGOthatfocusessolelyonpreven3onofelderabusefromaninterna3onalperspec3ve
NEGLECT,ABUSEANDVIOLENCEAGAINST
OLDERWOMEN
InanumberofUNdocuments,olderwomenareiden3fiedasespeciallyvulnerabletohumanrightsabusesrelatedtoneglect,abuseandviolence.Theseinclude:• Madrid2002Interna3onalPlanofAc3ononAgeing;
• CEDAWGeneralRecommenda3onNo.27;
• SustainableDevelopmentGoals(SDG);and
• DiscussionPaperandFollow-uptotheExpertGroupMee3ngonNeglect,AbuseandViolenceAgainstOlderWomen.
OlderAdultAbuseinThreeFrames:Implica,onsforOlderWomen-fragmenta,on
Neglect,abuseandviolenceagainstolderwomencanbeunderstoodas:• In3matePartnerAbuse(UNWomen)(USDVsystem)
• Ac3veAgeing(DESA)(USAgingsystem)
• VulnerableOlderAdult(HighCommissionforHumanRights–rightsbasedapproach)(USAPSsystem)
14
Imaginethenext3slidesdepictwomen
age74years
• Whenwethinkaboutdomes3cviolencewethinkohenthinkaboutwomenofreproduc3veage;
• Whenwethinkaboutabuseofolderwomeninthecommunityweohenthinkaboutoldermotherswhoarehomeboundanddependent,leadingtocaregiverstress;
• Whenwethinkaboutelderabuse,weohenthinkabouttheelderlyinnursinghomes.
15
First,IPV
16
Ac,veAgeing
17
VulnerableOlderAdult
18
Whatdothesethreewomenhavein
common?Whatisdifferent?
• Theyareallthesameage• Theyareallvic3msoffamilyabuse• Theyareallvic3msofphysicalabuse• Theyareallwomen
Whatisdifferent?! Theirhealthstatusdiffers! Theyappeartohavedifferingcogni3vestatus! Theyrepresentdifferentstereotypesofolderwomenandabuse
19
Defini,onsofOlderAdultAbuse:IPV
• In3matepartnerabuseisdefinedasviolenceagainstwomenthat“incorporatesin'matepartnerviolence(IPV),sexualviolencebyanyperpetrator(spouse/partner;da,ngpartner),andotherformsofviolenceagainstwomen,suchasphysicalviolencecommiCedbyacquaintancesorstrangers”(Saltzmanetal.,2002).
• Thisdefini3onwasdevelopedbyanexpertpanelconvenedbytheUnitedStatesofAmerica(USA)CentersforDiseaseControlandPreven3onin1996toformulateauniformdefini3onandrecommendeddataelementsforgatheringsurveillancedataonin3matepartnerviolence.
• ThisformsthebasisofIPVresearchglobally20
Defini,onsofolderadultabuse:
Ac,veAgeing
IntheTorontoDeclara3onontheGlobalPreven3onofElderAbuse(2002),elderabuseisdefinedas“asingleorrepeatedact,orlackofappropriateac'on,occurringwithinanyrela'onshipwherethereisanexpecta'onoftrustwhichcausesharmordistresstoanolderperson.Itcanbeofvariousforms:physical,psychological,emo'onal,sexual,andfinancialorsimplyreflectinten'onaloruninten'onalneglect”(WHO/INPEA,2002).
21
Defini,onofOlderAdultAbuse:
VulnerableElders
Abuseofvulnerableolderadultsrefersto“inten'onalac'onsthatcauseharmorcreateaseriousriskofharm(whetherornotharmisintended)toavulnerableelderbyacaregiverorotherpersonwhostandsinatrustrela'onshiptotheelder,orfailurebyacaregivertosa'sfytheelder’sbasicneedsorprotecttheelderfromharm”(NRC,2003,p.40).
• Thisdefini3onofelderabusewasdevelopedbyanexpertpanel(PaneltoReviewRiskandPrevalenceofElderAbuseandNeglect)convenedbytheNa3onalResearchCounciloftheUnitedStatesNa3onalAcademyofScience.Thisinformsresearchinthemedicalmodel
• Caredependencyonthepartofthevic3misassumed.22
FormsofAbuseAgainstOlderWomen
• Physical• Sexual• Emo3onalorpsychological• FinancialExploita3on• Neglect• Abandonment• Harmfultradi3onalprac3ces• Femicide
23
AbuseAgainstOlderWomenasa
HumanRightsViola,on
• Madrid2002Interna3onalPlanofAc3ononAgeing:“Olderwomenfacegreaterriskofphysicalandpsychologicalharmduetodiscriminatorysocietalaatudes.”
• UnitedNa3onsPrinciplesofHumanRightsforOlderPersons:“Livingalifeofdignity,freeofabuse,isanimportanthumanrightforallolderpeople,includingolderwomen.”
• Conven3onfortheElimina3onofAllFormsofDiscrimina3onAgainstWomen(CEDAW):“Violenceagainstwomenisrootedinhistoricalandstructuralinequityinpowerrela3onsbetweenmenandwomen”.
24
PrevalenceofAbuseAgainst
OlderWomen
• Prevalencees3matesrangefrom1-2%ofolderwomenupto38%ofolderwomenage60+.
• Discrepanciesareduetodifferencesintheore3calframeworks,measuresusedandsamplesdrawn.
• Es3matesoflife3meexperiencesofabuseremainfairlystableat20-23%.
25
In,matePartnerAbuseandOlderWomen
• IPVstudiesthatincludeolderwomeninstudysamplesshowthelowestprevalenceofabuse.
• Defini3onalcriterialimitperpetratorcategoriestospouse/partners,da3ngpartnersandstrangersininstancesofrape.
• Typesofabusearelimitedtophysical,psychologicalandsexual.
• Loca3onsofabuseincludehomeandcommunity.
• Agesofsamplepar3cipantsareohenlimitedtowomenuptoage49(Example:WHOstudyonDomes3cViolence).
26
Ac,veAgeingandAbuse
• Studiesintheac3veageingframeworkincludesamplesage60+.
• Generallylimitedtoabuseinthecommunity.
• Abusecanincludephysical,sexual,psychological,financial,andneglect.
• Categoriesofperpetratorscaninclude,inaddi3ontospouse/partners,adultchildrenandotherrela3ves,neighborsandformalandinformalcaregivers.Example:AVOWstudyin5Europeanna3ons
27
VulnerableOlderAdultAbuse• Canincludeabuseinins3tu3onalseangslikecarehomes
andhospitalsaswellascommunitybased.
• Olderadultsubjectsohenage65+andhavephysicalandcogni3veimpairments.
• Perpetratorscanincludespouse/partners,adultchildrenandotherrela3ves,formalandinformalcareproviders,andotherresidentsofcarehomesandins3tu3ons.
• Typesofabusecanincludephysical,sexual,psychological,financial,neglect,abandonment.Example:studiesonnursinghomeabuse.
28
Implica,onsofDifferent
Frameworks
• LowprevalencefoundamongolderwomeninIPVstudies:olderwomenaremorelikelytobewidowed(withoutspouse/partners);lesslikelytoberapedbystrangers(WHO,2005)
• Highprevalencefoundamongolderwomeninac3veageingstudies:olderwomenaremorelikelytolivewithadultchildren,tobevic3msoffinancialabuse,andtobecaregiversforimpairedabusivefamilymembers(Luomaetal.,2010).
• Unknownprevalenceamongvulnerableelderlywomenincarehomesandins3tu3onalseangs:olderwomenintheseseangsaremorelikelytobeunabletoself-reportabuse,tobeunavailableforstudiesthatrequireinformedconsent.29
Implica,onsforPolicyandPrac,ce
• Lawsandservicesbasedonprevailingstereotypeofelderabuse,forexample,adultprotec3veservicesintheUSA.
• Olderadultprotec3veprogramsthatassumecogni3veincapacitynotappropriateforIPVwitholderwomanvic3m.
• DVservicesassumingIPVnotappropriateforolderwomenvic3msofadultchildabuse.
• ConceptandImpactofpolyvic3miza3onnotgenerallyrecognizedinelderabusefield.
30
Whatprofessionalsandpolicymakersneedtoknowaboutinterven,ons:IPV
• IPVinlaterlife:DVsheltersohendon’tofferage-appropriateprogramsforolderwomen;can’tadmitcaredependentvic3ms
• LawEnforcement:olderwomenmayresistrepor3ngabusebyfamilymemberstopolice
• Guardianshipsarenotappropriateforvic3mswhohavecapacity
• Criminalandfamilycourt:mayminimizeabuseofolderwomenalthoughordersofprotec3oncanbehelpfulifusedappropriately. 31
Ac,veAgeingintheCommunity
• Agingserviceprogramscanprovidetemporaryassistancewithmeals,socialprogramslikeseniorcenters,interimhomecare,transporta3ontocourts,linktolawenforcementforseniors
• AdultProtec'veServices(APS)maybeusefulinassessingcapacityandneedforsocialservices;linktoDistrictAlorneyoffices;lawenforcement;localandstateservicestructureinUS
• Community-basedelderabuseprogramswithcounseling,supportgroupsareavailableinsomecommuni3es(notmany)
• FaithCommuni'escanprovideopportuni3esforoutreachandabusepreven3on;limitedcapacityforassistance,interven3onforabuseamongmembersandfamilies.
32
VulnerableOlderAdultAbuse
• Forcommunitydwellingolderwomen:APSservices(interna3onally,SingaporehasbegunanAPS-likeprogram;mostwesterncountrieshavenot–howeversomeprovincialprogramsexistinCanadaandUK)
• Forins'tu'onalizedolderwomen:OmbudsmanservicesthroughagingservicenetworksinUSA,someAPSservicesinjurisdic3onsthatincludenursinghomesaspartofterritory
• Forolderwomenwholackcapacity:guardianships;districtalorneyofficesandforensiccentersinUSA
33
LifeCoursePerspec,ve
• Somestudieshavefoundcorrela3onbetweenchildabuseandelderabuse(McDonald&Thomas,2014;Podnieks,2000)–UniversityofToronto.
• Includesolderwomeninthelifecoursetrajectory(girls,womenofreproduc3veage,olderwomen)
• Demonstratescumula3vedisadvantagesatintersec3onsofgenderandageforolderwomen
• Dis3nguishesbetweenelitesandotherwomen
• Feministgerontologyprovidesframeworkforunderstandingabuseinlaterlife. 34
HumanRightsPerspec,ve
• Rightsbearersanddutybearers/rightsenforcers
• Governmentsresponsibleforenforcinghumanrightsofolderadults.
• Challenges“residual”approachtosocialwelfarepolicy(charitybyNGOs)
• Stressesen3tlementapproach,rightsbased;empowerment
35
BarrierstoEffec,veElderAbusePrac,ce• Ageismremainsasignificantbarriertoeffec3veprac3cewitholderwomenand
abuse.Prac33onersandresearchersmustworktogethertoreachabelerunderstandingoftheuniqueneedsofolderwomenvic3msofneglect,abuseandviolence.Researchcaninformprac3ce.AnewlistserveoftheNAPSAandNCPEAallowsprac33onerstoaskques3onsofresearchersaboutprac3ceconcerns([email protected]).
• Inatechnicalguideonproducingsta3s3csonviolenceagainstwomenpromulgatedbytheUnitedNa3onsDepartmentofEconomicsandSocialAffairsin2013,readersareadvisedthat
“somecountrieshaveoptedtosetanupperagelimitforrespondents,thereasonsbeingthatolderpeoplearemorepronetomemoryrecallproblemsandtendtohaveageneralreluctancetodiscusssensi8vesubjects…Itisalsolikelythananolderagecategorywillbetoosmalltoallowforseparateanalysis”(UnitedNa3ons,2013,p.15).
• Misguidedandmisinformedstatementslikethisdiscourageresearchersfromincludingolderwomeninstudiesonviolenceagainstwomen,andseeminglyencouragena3onstoexcludedataonolderwomenfromdomes3cviolencereportsthatinformna3onalandinterna3onalpolicymaking.Fundinglimita3onsdrivechoicesaswell.Lackofresearchonolderwomenandabuselimitpolicymakersandprac33oners’abilitytomakeinformedchoicesaboutneededresourcesandappropriateinterven3ons. 36
CHALLENGESTOTHESTEREOTYPES:Educa,ngprofessionalandpolicymakers
• MissMaryinterview(fromTerraNovaFilms)challengesstereotypethatolderwomenrefusetodiscussabuse.hlps://drive.google.com/drive/folders/0B0xCtCQOe7YuQW90NEFwdjU5UUU
• Normaninterview(fromTerraNovaFilms)challengesstereotypethatoldermenarenotvic3msofabuse,includingpolyvic3miza3on.However,mo3veforolderwomen’sinvolvementnotexamined.hlps://drive.google.com/drive/folders/0B0xCtCQOe7YuY3RUOE55MTk1dTg
• Discussionofprofessionalprac3cesinworkwithvic3msfromminoritycultures.
Na3onalCommileeforthePreven3onofElderAbuse(NCPEA)on-
linecurriculumprovidesanexcellenttrainingandeduca3onalresourceforprofessionalsandpolicymakersonpolyvic3miza3oninlaterlife.ThiscanbedownloadedfromtheUSDepartmentofJus3ceOfficeofVic3msofCrimeswebsite:
hlps://ovclac.gov/views/TrainingMaterials/dspOnline_polyvic3miza3on.cfm
Recommenda,onsonhowtopromoteinterestsofolderwomenattheUN
• Expanddefini3onofperpetratorsbeyondspouse/partnertootherfamilymembersandtrustedothers;
• Con3nuetodefinedomes3cviolenceofolderwomenashumanrightsviola3on;
• Challengemarginaliza3onofolderwomenwithinsocietyandtheinterna3onalwomen’smovement,asageistandunacceptable;
• Ensurethevoicesofolderwomenareincludedinallforumsanddiscussionsonwomenanddomes3cviolence.
38
• Obtaindataatcountrylevelonabuseofolderwomenage60andabove(disaggregatedbyageandgender);
• Includeolderwomenindocumentsondomes3cviolenceandwomen(forexample,TheWorld’sWomen,TrendsandSta3s3cs(DESA,2010),hasnomen3onofolderwomenandabuseinitsDVsec3on);
• Conductoutcomeresearchoninterven3onsforolderwomenvic3msofabuse,includingevalua3onsonlegisla3onintendedtoprotectolderwomenfromabuse;
• WithintheDVmovement,expanddefini3onsoffamilyviolencebeyondphysicalandsexualtoincludeemo3onalabuse,financialexploita3on,abandonmentandneglect;
Recommenda,onsonhowtopromoteinterestsofolderwomenattheUN
GapsinPreven,onandInterven,on• Interna3onally,na3onallegisla3veini3a3ves,whentheyexist,largely
havebeenbifurcatedbetweendomes3cviolenceandagingorprotec3veserviceapproaches.
• Olderwomenohenfailtofitintoeitherapproach.Whentheproblemisin3matepartnerabuse,olderwomenmaybereferredtoagingserviceprogramsthatlackcapacitytoaddressdomes3cviolenceamongelderspouse/partners.
• Olderwomenmaynotmeettheeligibilityrequirementsforprotec3veservicesfortheelderly,suchasguardianships,iftheyarenotphysicallyorcogni3velyfrail.
• Consequently,olderwomenvic3msofabusearelikelytofallbetweenthecracksofabifurcatedlegisla3veandlegalsystem.
• Inaddi3on,lawsrelatedtoabuseandneglectofolderwomenbyfamilymembersorformalcaregiversmaybelegislatedbutnotfunded.
• Policyimplementa3ongaps;policyversusprac3ce.
SummaryandRecommenda,ons
• Thisdiscussionofprevalenceofneglect,abuseandviolenceagainstolderwomenbasedondifferentandsome3mescompe3ngconceptualframeworksdemonstratesthedifficul3esinusingthesedatatounderstandandpromoteolderwomen’srighttolivefreeofabuse.
• Inordertoaddressthecurrentfragmenta3oninservicestoolderwomenandneglect,abuseandviolence,prac3ceandresearchcommuni3esmustcometogethertoaddressgapsinknowledgeandprac3ce,eliminateageiststereotypes,andreflectamoreholis3cviewofolderwomeninsociety.
41
SummaryandRecommenda,ons
• DVservicesystemshouldacknowledgeolderwomenandplantoaccommodatethem.Sheltersshouldbeculturally,age,andgendersensi3ve.Sheltersshouldbeculturally,age,andgendersensi3ve.APSservicesystemmaybeappropriateforolderwomenwholackcapacity.Nursinghome-basedshelterop3onscouldbeappropriateforcaredependentvic3msofabuse.Agingservicesystemcanworkcollabora3velywithlawenforcementtoaddresscrimesagainstolderwomen,par3cularlythosecommiledbyadultrela3ves.
• Professionalsshouldbefamiliarwithelderabuseandthevariousservicesystemsthatserveolderwomenvic3msofneglect,abuseandviolence.
• Interna3onalpolicyinfluencedbyUSandUKsystemsandservices(forexample,Singapore;HongKong).
42
Contactmeforreferencesandresources:
Email:[email protected]
Also:www.inpea.netwww.ncall.uswww.ncea.acl.govwww.un.org/esa/socdev/documents/ageing/neglect-abuse-violence-older-women.pdf
Thankyou! 43