Vulnerable Populations: Increasing Awareness & Preventing Elder Abuse in Ontario
Canada's population is aging. Statistics Canada reports that the senior population (aged 65 and older) has been steadily increasing over the past 40 years (Statistics Canada, 2018). The proportion of seniors in our population grew from 8% to 14% from 1971 to 2010 (Statistics Canada, 2018). Based on population projections, it is expected that by 2036 the number of seniors could reach between 9.9 and 10.9 million people and represent 25% of the total population (Statistics Canada, 2018).
For the first time ever there are more seniors aged 65 and older than children aged 0-14 years in Canada. (Statistics Canada, 2016).
Image Source: Statistics Canada
Given the significant growth increase of seniors and population projections, it is crucial we take immediate action to help prevent and assist seniors at risk of experiencing abuse.
There is still little known about the prevalence of elder abuse because most cases are unreported, however it is estimated that 1 in 6 older adults worldwide have been abused in the past year (World Health Organization, 2018).
What Is Elder Abuse?
According to the World Health Organization (WHO), elder abuse can be defined 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. Elder abuse can take various forms such as financial, physical, psychological and sexual. It can also be the result of intentional or unintentional neglect" (World Health Organization, 2018).
Elder abuse is an important public health problem that requires immediate attention (World Health Organization, 2018). Abuse against elders is often perpetrated by people of trust (e.g. health care providers or family members) and can take place at home, in other residential settings such as nursing homes and retirement homes, or in the community .
Elder abuse incidences continue to be on the rise, but only 4% of elder abuse is reported (World Health Organization, 2016). For every one case of abuse that is reported, it is estimated that approximately 23 cases remain hidden (Centres for Disease Control and Prevention, 2017). Abuse cases are often under reported because older people may fear retaliation, worry about the abuser getting in trouble, be mentally incapable, feel ashamed or embarrassed (World Health Organization, 2016).
Why are Seniors at Increased Risk of Experiencing Abuse?
There are many factors that contribute to the vulnerability of seniors including:
Cognitive Impairment
Conditions such as Dementia, Alzheimer's or Delirium. Limited knowledge of these cognitive conditions can cause staff members of long-term care facilities or family members to see seniors behaviour as purposeful and can lead to "retaliation" by caregivers.
Inability to Express Wishes
Communication difficulties such as expressive aphasia, or hearing difficulties.
Physical Impairment
Dependancy on other people for assistance with Activities of Daily Living (ADL) such as bathing, toileting, and dressing.
Social Isolation
Having limited contact with other people inside or outside their place of residence.
(Canadian Nurses Association, 2018).
Caregiver Stress
Caregiver stress can also increase the risk of elder abuse.
The duties and responsibilities that are associated with providing care to the elderly can place overwhelming demands on the care provider. Dealing with behaviours by the elderly person "such as alcohol or drug abuse, frequent falls, wandering, incontinence, disrobing, or violent verbal behaviour, the caregivers become exhausted or antagonized to the point of violence" (Jones & Holstege, 1997).
Respite Care Ontario
If you are a caregiver for someone with a health condition, disability or who requires help associated with aging, the government of Ontario offers respite care services so that caregivers can have a break.
Learn more about respite care in Ontario at:
Signs of Abuse
Health care providers play an important role in screening for cognitive deficits and mistreatment of vulnerable older adults. The presence of certain indicators should raise concern about potential abuse or neglect including:
Repeated ER visits or hospital admissions
Poor grooming or hygiene
Unexplained weight loss or failure to thrive (e.g. malnutrition and dehydration)
Infestations (e.g. lice, bed bugs)
Lack of follow-up appointments
Unexplained physical injuries
Decline in financial status or threat of eviction
Inappropriate or soiled attire
Refusal of needed assistance (e.g. home care, meal delivery)
Non-compliance with medication
Acute deterioration in ADL or cognition
(Culo, 2011)
Preventing Elder Abuse
The goal is to stop elder abuse before it starts. There are several steps we can take to prevent it:
Listen to older adults, treat them with respect and dignity
Educate oneself and others about how to recognize the signs of abuse
Learn when, how and where to report elder abuse
Implement better staff training programs in long-term care facilities on how the signs of elder abuse differ from the normal aging process
Increase public awareness
Educate health care providers and family members on cognitive conditions such as Delirium, Dementia and Alzheimer's
Improve quality of working environments, and address staffing issues in acute care hospitals and long-term care facilities
Provide over-burdened caregivers with better support (stress management and respite care)
Check in often on seniors who may have few friends or family members
(Centres for Disease Control and Prevention, 2016), (World Health Organization, 2018), (Elder Abuse Ontario, 2018)
Public Awareness
Elder Abuse Ontario (EAO)
Elder Abuse Ontario (EAO) is a provincial, non-profit, charitable organization that is dedicated to the prevention of elder abuse and neglect.
Vision: "Elder Abuse Ontario envisions an Ontario where seniors are free from abuse, have a strong voice and are safe and respected" (Elder Abuse Ontario, 2018).
For more information about Elder Abuse Ontario (EAO) visit: http://www.elderabuseontario.com
World Elder Abuse Awareness Day (WEAAD)
Did you know that June 15th is World Elder Abuse Awareness Day? You can help by getting involved and raising awareness.
For more information about World Elder Abuse Awareness Day (WEAAD) visit http://weaad.elderabuseontario.com
The PEACE Project
The Prevention of Elder Abuse Centers of Excellence (PEACE) initiative is a partnership between the Canadian Nurses Association (CNA) and the Registered Nurses' Association of Ontario (RNAO) which promotes awareness of elder abuse in long-term care. Funding for this project was provided by the Government of Canada's Federal Elder Abuse Initiative.
The PEACE project is focused on increasing awareness and understanding of elder abuse among healthcare providers, and the important role they play on recognizing and responding to elder abuse. There are ten long-term care facilities across Canada involved in raising awareness about elder abuse. Learn more about the PEACE sites across Canada.
Reporting Elder Abuse in Ontario
The Seniors Safety Line is a 24/7, confidential and free resource that provides information, referrals and support in over 150 languages for seniors experiencing abuse.
Reporting elder abuse cases of victims living in long-term care homes or retirement homes is mandatory in Ontario. This obligation to report applies to everyone except for other residents in the home. All professionals under the Regulated Health Professions Act (RHPA) have a duty to report abuse cases. For more information on reporting elder abuse visit:
Nursing Resources
Registered Nurses Association of Ontario (RNAO). (2014). Best Practice Guideline (BPG): Preventing and Addressing Abuse and Neglect of Older Adults: Person-Centred, Collaborative, System-Wide Approaches.
Registered Nurses Association of Ontario (RNAO). (2009).Best Practice Guideline (BPG): Preventing and Managing Violence in the Workplace.
Canadian Nurses Association (CNA). (2017). Code of Ethics for Registered Nurses. Retrieved from
Ministry of Health and Long-Term Care (MOHLTC). (2011). A Guide to the Long-Term Care Homes Act, 2007 and Regulation 79/10. Retrieved from
Canadian Network for the Prevention of Elder Abuse (CNPEA). (2017). Government of Canada's New Horizons for Seniors Programs. Retrieved from
References
Canadian Nurses Association (CNA). (2018). Elder Abuse. Retrieved from
Centers for Disease Control and Prevention (CDC). (2016). Understanding Elder Abuse, Fact Sheet. Retrieved from
Culo, S. (2011). Risk Assessment and Intervention for Vulnerable Older Adults. British Colombia Medical Journal (BCMJ), 53(8)421-425. Retrieved from
Elder Abuse Ontario (EAO). (2018). What is Elder Abuse? Retrieved from http://www.elderabuseontario.com/what-is-elder-abuse/
Elder Abuse Ontario (EAO). (2018). Prevention. Retrieved from http://www.elderabuseontario.com/what-is-elder-abuse/prevention/
Government of Ontario. (2017).Information About Elder Abuse. Retrieved from
Jones, J., Holstege, C. & Holstege, H.(1997). Elder Abuse and Neglect: Understanding the Causes and Potential Risk Factors. The American Journal of Emergency Medicine, 15(6): 579-583. Retrieved from
Statistics Canada. (2018). Seniors. Retrieved from
Statistics Canada. (2016). An Aging Population. Retrieved from
World Health Organization (WHO). (2018). Ageing and Life Course. Elder Abuse, What is Elder Abuse? Retrieved from
World Health Organization (WHO). (2018). Elder Abuse, The Health Sector Role in Prevention and Response. Infographic Fact Sheet. Retrieved from
World Health Organization (WHO). (2018). Elder Abuse. Fact Sheet. Retrieved from
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