Exploring the Role of Elder Mediation in the Prevention of Elder Abuse

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Section 5: Implications for the reduction of elder abuse

A. The Problem of Elder Abuse and Neglect

As Canada's population ages, the number of citizens over 65 years of age will outnumber the number of citizens under the age of 15 by 2015. This shift means that an increasing number of people will be put into the position of caregiver for their parents even as they may be caring for their own family. Juggling these responsibilities involves, by necessity, a great deal of stress that potentially can lead to elder abuse. It is widely known and an accepted fact that abuse is underreported and often not identified. It is also believed that psychological abuse is seldom reported. The reality is that abuse and neglect often goes unrecognized. We can, however, gain access to police reported family violence against older adults. The following statistics are provided by Statistics Canada (2009):

• In 2007, 1,938 incidents of family violence against seniors were reported to police, representing more than one-third of all violent incidents committed against older adults.
• The rate of family violence for seniors (48 per 100,000) was much lower than for those in younger age groups. Compared to seniors, the family violence rate was twice as high for adults aged 55 to 64 (104 per 100,000).
• Senior men (163 per 100,000) had a higher overall rate of violent victimization compared to senior women (114 per 100,000). However, senior women had higher rates of violent victimization by a family member (52 per 100,000) compared to senior men (43 per 100,000).
• Spouses and adult children were the most common perpetrators of family violence against senior women, while adult children were most often the accused in family violence against senior men.
• Just over one-half of police-reported family violence incidents against seniors were common assaults.
• Half of police-reported incidents of family violence against seniors did not result in physical injury. When physical injuries were sustained, the vast majority (91%) were minor.

Family homicides against older adults:

• The overall homicide rate was lower among adults aged 65 years and older (9 per million population) compared to persons under 65 years of age (23 per million population). However, rates of family-perpetrated homicide for seniors (3.8 per million population) and non-seniors (4.5 per million population) were comparable.
• Senior female victims killed by a family member were most commonly killed by their spouse (40%) or adult son (36%). In nearly two-thirds of family homicides of senior men, an adult son was the accused killer.
• Most often, frustration, anger or despair was the apparent motive for family-perpetrated homicides against seniors. In contrast, financial gain was the most commonly identified reason behind senior homicides committed by non-family members.

According to the U.S. Bureau of Justice Statistics in the year 2000, 121,000 seniors age 65 and over experienced a violent victimization (Rennison, 2001). Another study determined that two-thirds of the abusers were the victims' children and grandchildren (Davis, 2001). They found that many of these abused elders were trapped in dependent relationships with their abusers because of their total dependence on them emotionally, psychologically, financially, and physically.

As far back as 1994 and earlier a British pioneer in elder mediation was asking whether or not "elder mediation could contribute to the prevention of elder abuse and the protection of the rights of older people and those who care for them" (Craig, 1994). There are many factors that can lead to elder abuse or neglect, often interacting with one another. Many of these factors, if recognized early enough, can be addressed and brought to a standstill before harm is done.

I'm not sure people understand what elder abuse is. I think things are happening that are elder abuse, but people think they are normal (CHPNA, 2010).

As the number of older people continues to rise, so too will the number of health issues, and other issues of aging, that will require special supports. Caregiving for mental or physical impairments is highly stressful and families are not trained for the job. Unintentional though it may be, abuse and neglect is sometimes perpetrated by people who had previously acted loving, supportive and caring. Elder mediators are often called in desperation when the caregiver is totally stressed and "burnt out". Caregivers report feeling guilty because they just can't take it anymore and express their concerns with comments like: "I had nothing left in me and didn't feed Dad dinner three times this week"; "My husband yelled at me so I left him to sleep in his "attends" for two days". Even when impairment is not present and there is only minimal dependency, a grieving and guilt-ridden caregiver's patience can still be short, resulting in outbursts of anger and resentment directed at the older person. In addition, caregivers who are financially dependent on an older family member are also more likely to perpetrate abuse (Woolf, 2009).

Doris is an eighty-year-old widow who lives with her adult son, Dan and his family. A few years back, Doris sold her house, gave her son the money, and moved in with him. Doris has her own room. Dan often tells Doris that she is a burden to him and his family. He jokes that she will probably be dead soon. Doris is not allowed to invite her friends to visit. At the same time, she is discouraged from going out. Her daughter-in-law took down family photographs that were hanging on the walls in Doris' room. Doris has not been able to find them since (CHPNA, 2010).

In 2008, Cooper and Livingston suggested that around 25% of vulnerable, older adults will report abuse in the previous month, totaling up to 6% of the general older population. Though research is limited there have been some consistent themes beginning to emerge from studies with older people who have been abused. Work undertaken in Canada suggests that approximately 70% of reported elder abuse is perpetrated against women, and this is also similar in the UK, supported by evidence from the Action on Elder Abuse Helpline that identifies women as victims in 67% of calls. Domestic violence in later life may be a continuation of a long-term partner abuse or may begin with retirement or the onset of a health condition (Abuse and Violence, BC 2001). This is an important point because domestic violence within older couples is often not recognized, and consequently strategies, which have proven effective within the domestic violence arena, have not been routinely transferred into circumstances involving the abuse of older people.

The likelihood of abuse and neglect increases with age. As people get older, and especially for those who become more dependant, the likelihood of being taken advantage of increases. Abuse increases with age, with 78% of victims being over 70 years of age (Hidden Voices, 2005). As men live longer they are also subject to abuse and neglect and the reality is that men are less likely to report being abused. In 2002, 430 Canadians 65 years of age or older (361 men and 69 women) died as a result of "intentional self-harm" (Statistics Canada, 2002). Older men are at especially high risk for suicide. Elder mediation, when utilized to build family and community supports for these abused, neglected and often isolated older adults, shows promise for reducing these tragic numbers.

Ageism: A Factor in Elder Abuse and Neglect

Ageism is rampant and a huge factor underlying the abuse and neglect of older people. Wikipedia defines "ageism" or "age discrimination" as "stereotyping of and discrimination against individuals or groups because of their age. It is a set of beliefs, attitudes, norms, and values used to justify age based prejudice and discrimination." Ultimately it refers to a power imbalance. Butler (1969) calls it "bigotry", while Nelson (2005) describes it as "prejudice against our feared future selves". The stereotypical view of all older people as being frail, sickly, useless and a burden to society is clearly inaccurate yet it is espoused by many younger people from all walks of life including both paid and unpaid caregivers.

The Oxford Canadian Dictionary defines "senior" as an "elderly person, especially a person over 65". Palmore (1999) maintains that such simple, outdated definitions of what is old have to change. Ageism is ingrained in our society. Many older adults accept judgmental beliefs and negative definitions about themselves thus perpetuating the various stereotypes directed against them (Butler, 1990). Elder mediators believe that during the process of mediation family members very often begin to see the person at the heart of the care in a new light. They often report not considering the older person in ways they did prior to the mediation. Dr. Judy Lynn Richards (Canadian Association for Gerontology Conference, 2009) promotes elder mediation as a strategy to reduce ageist behaviors by helping families to reconnect with their older loved ones on a more caring level. Increasing sensitivity towards the older family members will serve to reduce elder abuse and neglect.

B. The Contribution of Elder Mediation

Elder mediation can assist families to be more resilient and with early intervention can be preventive, forming a buffer for older people who are vulnerable or at risk of abuse from a particular family member. Bagshaw reported on evaluations of family mediation in family law cases where there is domestic violence (Bagshaw, 2003 & 2009). The premise is that specialized family mediation models for the prevention of financial abuse of older people by a family member may be effective in some cases. That is, if the mediation is voluntary and older-person-centered, victim safety and protection is assured, power imbalances are addressed and advocates and other supports are used to ensure that the needs of the older person are central and the voices of older people, with or without capacity, are heard (Bagshaw, 2009).

To determine whether elder mediation is appropriate in suspected abuse cases, most elder mediators agree that a thorough assessment of the type and extent of abuse needs to be considered. It is generally agreed that in egregious cases elder mediation is not appropriate. Certified elder mediators report an openness to consider mediation—even if abuse or neglect issues has been identified—provided that each party involved in the mediation can be interviewed individually in order to conduct a proper assessment of the abuse or neglect. Whatever model(s) the elder mediator chooses to use, there is a stated bias to protect all parties, to look for the least restrictive option, and to address the constant struggle among the many stakeholders. At the same time the mediator needs to have concern for the older person's well-being and autonomy by promoting self-determination and ensuring informed consent (Kardasis & Trippe, 2009). Mediators have reported that by increasing the number of people involved with the older person, as well as the frequency of contact made by those offering service and support, that the likelihood of reducing abuse and neglect is increased (McIvor, 2008 and Soden, 2010). A further impact is that the family's awareness of what constitutes abuse and neglect is heightened. The mediator can then use this new awareness to craft additional agreements with the participants in order to address the identified concerns.

I think the general population understands the very clear incidents and acts of elder abuse such as assault, but more subtle types of abuse such as financial and emotional are not as easily recognized and accepted. Also, people may tend to minimize elder abuse (CHPNA, 2010).

Elder mediation has been known to reduce the likelihood of elder abuse and neglect in other circumstances including:

• Involvement of children or grandchildren in the control and decision making of financial affairs
• Family, extended family and colleagues wishing to make decisions around business affairs
• Living arrangements that are creating challenges for a variety of reasons
• Disagreements or misunderstandings of the outcomes of a will and its effects on the surviving partner and adult children
• Pressure to move residences and change plans
• The right to die with dignity
• Palliative care costs and dying at home concerns
• Caregiving and health issues
• Social isolation
• Noncompliance with medical regimens and treatment dropouts
• Increased tolerance to illness and discomfort to which older people have adapted
• Older parents parenting their adult children.

Contributions from the research including the Alaska Study, the Cornwall Project, the Australian Project, the British Project and the Atlantic Canada study all demonstrate how valuable elder mediation is in reducing the likelihood of abuse and neglect. Its effectiveness is heightened when such intervention is introduced sooner rather than later. Families reluctant to seek help—for whatever reasons—unwittingly increase the risk of stress and conflict that may in turn lead to incidents of abuse and neglect of older people. Researchers throughout Canada and abroad are becoming more interested in this area particularly to ascertain the ways in which elder mediation may serve to prevent or reduce such abuse and neglect in the future. Researchers will continue their commitment to learn from families as they utilize the service of elder mediation. It is anticipated that the extent of such research will grow as the population ages.

As awareness and use of elder mediation grows so will recognition that the more people that are involved in the day-to-day care, the less likelihood of the often-unrecognized incidences of abuse and neglect. In situations where some level of support or care is required, focused and individualized care can accommodate continued autonomy and self-determination.

Illustrative Vignettes

Elder mediation has been shown to be an effective methodology in resolving elder abuse and has made it possible to resolve many elder abuse cases, with greater client satisfaction (McIvers, 2006; Bagshaw, 2010; Craig, 1998). Through involvement in elder mediation, participants' awareness of what constitutes neglect and abuse is heightened and families are empowered to develop preventative strategies that ensure improved quality of life and commitment to dignity and respect for all concerned. Research in this area continues to be on the rise—in search of verification of the preponderance of anecdotal information and testimonies from both participants of mediation and mediators themselves.

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