Elder Maltreatment: Need For Effective Strategies To Prevent It (Essay).

Foundations of violent behaviour and raised awareness of interventions and prevention strategies

Question:

At this point in time you have an understanding of the foundations of violent behaviour through your preparation of your report, and through your policy analysis/outline development you will now have a raised awareness of interventions and prevention strategies that can be used in violence prevention in your chosen area.

According to World Health Organization (WHO), violence is intentional use of power or physical force, actual or threatened against another person or oneself, community or group resulting in harm, injury, death, deprivation or maltreatment (Devries et al. 2013). Globally, death due to violence is estimated to be 1.28 million increased from 1.13 million since 1990. Among all the categories of violence, self-harm or suicide accounted for roughly 842,000, 405,000 interpersonal violence and 31,000 war or collective violence (Butchart and Mikton 2014). Elder abuse is another form of violence that is causing harm to older people and violation of human rights. There is psychological, physical, emotional, financial and material abuse resulting in neglect, harm, abandonment and loss of respect and dignity of older people (Dillon et al. 2013). There is little information about the extent of elder maltreatment as older people are scared to report to others. Therefore, the following essay involves the discussion of elder maltreatment understood through the lens of elder abuse case study and policy analysis of Elder Abuse Policy Australia.

In the given case study, a 78 year old man with Parkinson’s disease is being cared by his 82 year old wife who is weak and delicate. The wife fell and fractured wrist, however, she was insisted to continue with her husband’s personal care. When the outpatient Physiotherapy (PT) attended her fracture, PT saw bruises on her arms and face saying that she has fallen or ran into a door. On insisting, eventually she admitted that her husband gets angry and often hit her. This case study is elderly maltreatment and the chosen category of violence is interpersonal violence (Moyer 2013). It is divided into categories like intimate partner violence and family between partners and family members that take place in home. Interpersonal violence is one of the commonest violence forms against women including sexual, physical, emotional and psychological abuse and dominating behaviour by the intimate partner. In the given case study, the wife is being physically violated by her husband despite of the fact that she is taking care of him suffering from neuro-degenerative disorder. There is fear of retaliation, lack of economic support and social support from family and friends are some of the barriers that the wife is facing and eventually unable to leave her partner. The main risk factors involved in abuse of the wife in the case study is impaired capability of the husband along with physical health issues. She is subjected to physical abuse and violence by her intimate partner having a huge impact on her health as a result of elderly maltreatment. According to WHO report, about 19-51% women are physically harassed by their intimate partners and have serious health consequences. There are immediate physical, behavioural and mental health consequences persisting long after the violence (Devries et al. 2013).

Elder maltreatment and types of violence

Every one in ten individual of the age of above 60 years being older live at home experience abuse and neglect where maximum cases remain hidden as reported by Centres for Disease Control and Prevention (CDC) (Spivak et al. 2014). There are physical consequences of elder maltreatment that are immediate including wounds, welts and injuries. In the given case study, the woman is bruised on her face and arms and is subjected to persistent physical pain due to broken wrist and soreness. She is aged and there is exacerbation of pre-existing health condition due to this maltreatment affecting her health and mental status. There are psychological effects due to this elder abuse affecting her mental health due to helplessness and increased risk for anxiety and fear reactions that might have stopped her from revealing to the PT.

The above discussion suggests that physical elderly maltreatment has a greater link to adverse behavioural and mental health outcomes, but independently associated with morbidity and premature mortality. According to Dong, Chen and Simon (2014) psychological abuse estimates ranging from 27.9% to 62.3% is highly prevalent among elderly population and physical abuse affecting 3.5% to 23.1%. In Australia, population based studies provided some insights into extent of elderly women subjected to abuse. The research was conducted by Australian Longitudinal Study of Women's Health (2014) to study the random sample of women regarding older women abuse (Loxton et al. 2015). The findings suggested that around 8% are vulnerable to physical abuse and neglect. This result depicts that elderly abuse is happening; however there is lack of reporting and therefore, this policy provides responses to elderly maltreatment. This policy is framed with an aim to support and promote elderly people for equal participation in the society and protection of older people against advantage or misuse taken by intimate partners, informal or formal supporters or representatives.

To safeguard the elderly maltreatment and provide elderly protective services, there should be mandatory reporting of elder abuse and need for health policy research directions dealing with this pervasive issue. There is need for effective strategies for detecting, treating and preventing elder abuse increasing diversely in the elderly population. Health policy comprises of plans, decisions, actions that need to be undertaken for the achievement of specific goals in healthcare in elder abuse (Bodenheimer and Grumbach 2012). This health policy advancement and collective advocacy would help to create a national infrastructure in Australia for the protection of vulnerable elder population.

The health policy development comprising of strategies and plans is a dynamic and complex process conducted by WHO framework comprising of key elements. According to WHO (2014) report, for the protection and support to elderly people, national policy is important that is dedicated to safeguard elder people for any type of violence and abuse (Dong et al. 2013). The literature on elderly abuse suggests that national policy on elderly maltreatment can help in better reporting and treatment of elderly maltreatment (Dong, Simon and Evans 2013). Various policies are formulated in context to elder maltreatment including characterization and prevention. In Australia, the understanding of social dynamics (socio-economic features and demographics) influences elder maltreatment and its prevention. Despite of paucity in evidence on elder abuse prevalence, around 2% to 10% Australians experience elder maltreatment and percentage of neglect is high (Lacey 2014). It is of great concern that elder maltreatment problem will be reaching unprecedented proportions as the population ages by 2050 by the age of 65 years (). For this, WHO policy guidelines provide blueprint for the conduction of policy process. In the given case study, there is need for proper action for safeguarding the wife from elder maltreatment and further physical or mental abuse and neglect.

Psychological and physical consequences of elder maltreatment

 Elder Abuse Policy in Australia was developed with a purpose to identify cases of elderly maltreatment and taking appropriate actions in safeguarding them. The policy is also developed to maintain dignity and protect security and safety of the elderly people and achievement of standardized and integrated approach for the management of elderly abuse. In the given case study, the wife seemed to be scared of reporting abuse due to fear of retaliation, therefore, the policy statement addresses the suspected cases of elder maltreatment for safeguarding and preventing further abuse and neglect (Dow and Joosten 2012). The policy outlines that addressing older people abuse is human rights and they have right to self determination irrespective of their age. From the policy perspective, state, Commonwealth and territory have the responsibility to protect the aging population in Australia and provide services that provide them good quality of life.

Six steps are involved in the development of policy as per WHO guidelines. After the assessment of the situation and raising awareness, it is important to identify the leadership and fostering of political commitment for the initiation of policy development process. The first step is the engagement of stakeholders. The effective implementation of an elder abuse policy can be done through negotiation and inclusive participation between stakeholders along with co-operation from government and non-governmental organizations (NGOs) in safeguarding elders from abuse. In this step, the stakeholders through meaningful engagement and broad consultation work in collaboration for the meaningful policy development dialogue. This is important to build consensus based on the current elder abuse situation in Australia and various goals, values and overall directions of the policy formation guiding elder abuse policy guidelines (Althaus, Bridgman and Davis 2012). The stakeholders include; government and state officials comprising of Ministry in Department of Health, NGOs, community sectors, political parties, councils, committees, local governments and monitoring agencies having centres against violence and statistics bureau. Academics comprising of universities, research institutes and think tanks. NGOs, advocacy groups like victim care groups, community groups, volunteer groups and sponsors like foundations and clubs. Private for profit entities can also be included in the stakeholders like media outlets, professional gatekeepers like trade unions and labour associations. The analysis is required in this step is examination of remit of each stakeholders understanding the relationship between them. There is need for collaboration between them and helping each other bringing together towards the common goal of prevention of elderly abuse.

Situation analysis and priority setting is the second step involved in situation analysis assessing the current situation of elder abuse in Australia for aiding in designing and integrate elements of elder abuse prevention policy into existing legislation or policies. This strong situational analysis would describe the demography, statistics and collection of facts of elderly population subjected to elder abuse. Situational analysis is important as it serves the stage for priority setting need to be addressed in the policy making through inclusive and broad policy dialogue (Dong 2013).

The third step is the bringing together of the stakeholders as disconnected efforts in planning and national processes, lack of communication among stakeholders can lead to fragmented policy implementation. There should be balance and coherence between them for the comprehensive and adequate situation analysis and priority analysis. Funding is an important factor for analysis as it can lead to competition for the available resources (Australian Public Service Commission 2012).

Prevalence of elderly maltreatment and related policy analysis

The next step is to ensure that the policy values and vision are taken into operation. For this, effective planning is important at every level ensuring alignment between expectations and needs of the people and analysis of national priorities. There is also need to link the operational and strategic plans at the local and sub-national levels describing how the national policies on elder abuse can be translated to broad targets and national activities within “off-budget” and “on-budget” resources. In this step, national health goals and strategies need to be translated by stakeholders into feasible plans and appropriate approaches based on the local circumstances (Lawrence and Weber 2014).

The next step is the quantification of resources and budget planning. The priorities need to be translated into resource planning through quantification of needed inputs in regards to equipment, people and infrastructure. This step also determines the budgetary implications being an iterative process. Before proceeding with budgeting phase, the costing is important in planning for the implementation of the policy. The policy makers need to make sound decisions for the available resources being a strategic process. This requires a negotiation consensus between stakeholders for the costing planning (Wampler and Hartz-Karp 2012). The actual expenditure need to match with policy priorities and for achieving it, stakeholders in elder abuse policy should put in realistic inputs that is based on national strategy and policy planning.   

Monitoring and evaluation is the last step in policy making. For effective outcomes, more focused and increased investment is required in the monitoring and evaluation process on how the plans, strategies and policies need to be implemented. This step requires assessment of progress, performance as per the agreed benchmarks, indicators and scope for improvement within monitoring and evaluation framework. This step also allows scope for continuous improvement, learning and improvement in planning process with timely corrections contributing to proper documentation of policy reform. Better documentation and support from networks can help to guide and drive better implementation of elder abuse policy, plans and strategies in Australia (Tsui, Hearn and Young 2014).

From the above discussion, it can be concluded that elderly abuse is at alarming stage in Australia. Violence is divided into various categories like self-directed, collective, non-physical, interpersonal violence, targeted or everyday violence. The elderly maltreatment falls under the category of interpersonal violence as per WHO guidelines. Policy considerations are important to prevent elderly population from abuse with better reporting and safeguarding them from further health and violence. WHO provides guidelines for the step wise formulation of policy development. Elder abuse policy in Australia is developed with a purpose for identifying elder abuse cases and provides appropriate action against it. This policy development in conjunction with concerned stakeholders can help to develop elder abuse policy against elderly maltreatment addressing the issue that have devastating physical and mental consequences for elderly population.

References

Althaus, C., Bridgman, P. and Davis, G., 2012. The Australian policy handbook. Allen & Unwin.

Australian Public Service Commission, 2012. Tackling wicked problems: A public policy perspective.

Bodenheimer, T. and Grumbach, K., 2012. Understanding health policy. McGraw Hill Professional.

Butchart, A. and Mikton, C., 2014. Global status report on violence prevention, 2014.

Devries, K.M., Mak, J.Y., Garcia-Moreno, C., Petzold, M., Child, J.C., Falder, G., Lim, S., Bacchus, L.J., Engell, R.E., Rosenfeld, L. and Pallitto, C., 2013. The global prevalence of intimate partner violence against women. Science, 340(6140), pp.1527-1528.

Dillon, G., Hussain, R., Loxton, D. and Rahman, S., 2013. Mental and physical health and intimate partner violence against women: A review of the literature. International journal of family medicine, 2013.

Dong, X., 2013. Elder abuse: Research, practice, and health policy. The 2012 GSA Maxwell Pollack award lecture. The Gerontologist, 54(2), pp.153-162.

Dong, X., Chen, R. and Simon, M.A., 2014. Elder abuse and dementia: a review of the research and health policy. Health Affairs, 33(4), pp.642-649.

Dong, X., Chen, R., Chang, E.S. and Simon, M., 2013. Elder abuse and psychological well-being: A systematic review and implications for research and policy-A mini review. Gerontology, 59(2), pp.132-142.

Dong, X., Simon, M. and Evans, D., 2013. Elder self-neglect is associated with increased risk for elder abuse in a community-dwelling population: Findings from the Chicago Health and Aging Project. Journal of aging and health, 25(1), pp.80-96.

Dow, B. and Joosten, M., 2012. Understanding elder abuse: a social rights perspective. International psychogeriatrics, 24(6), pp.853-855.

Lacey, W., 2014. Neglectful to the Point of Cruelty; Elder Abuse and the Rights of Older Persons in Australia. Sydney L. Rev., 36, p.99.

Lawrence, A.T. and Weber, J., 2014. Business and society: Stakeholders, ethics, public policy. Tata McGraw-Hill Education.

Loxton, D., Powers, J., Anderson, A.E., Townsend, N., Harris, M.L., Tuckerman, R., Pease, S., Mishra, G. and Byles, J., 2015. Online and offline recruitment of young women for a longitudinal health survey: findings from the Australian Longitudinal Study on Women’s Health 1989-95 cohort. Journal of medical Internet research, 17(5).

Moyer, V.A., 2013. Screening for intimate partner violence and abuse of elderly and vulnerable adults: US preventive services task force recommendation statement. Annals of internal medicine, 158(6), pp.478-486.

Spivak, H.R., Jenkins, E., VanAudenhove, K., Lee, D., Kelly, M. and Iskander, J., 2014. CDC grand rounds: A public health approach to prevention of intimate partner violence. Morbidity and Mortality Weekly Report, 63(2), pp.38-41.

Tsui, J., Hearn, S. and Young, J., 2014. Monitoring and evaluation of policy influence and advocacy. London: ODI Working paper, 395.

Wampler, B. and Hartz-Karp, J., 2012. Participatory budgeting: Diffusion and outcomes across the world. Journal of public deliberation, 8(2).