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Rossini. Damned nuisance, all those windows…. What, then, is time? If no one asks me, I know what it is. If I wish to explain it to him who asks me, I do not know. Augustine, Confessions, Chapter XIV. Aspects of aging in later life. Positive Inter-individual variability more complex

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all those windows….

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What, then, is time? If no one asks me, I know what it is.

If I wish to explain it to him who asks me, I do not know.

Augustine, Confessions, Chapter XIV

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Aspects of aging in later life

  • Positive

  • Inter-individual variability

    • more complex

  • Reduced reserve/homeostasis

    • homeostenosis

…, in a word, COMPLEXITY!

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Madrid Action Plan on Ageing

Older persons and development

Advancing health and well-being into old age

Ensuring enabling and supportive environments


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Madrid - 3 Priority Directions

Older persons and development

8 Issues, 14 Objectives, 107 Actions

Advancing health and well-being into old age

6 Issues, 13 Objectives, 81 Actions

Ensuring enabling and supportive environments

4 Issues, 9 Objectives, 51 Actions

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Ensuring enabling and supportive environments

Neglect, abuse and violence

Eliminate all forms of neglect, abuse and violence at older persons

Creation of support services to address elder abuse

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Primary Care

Practical, scientifically sound and socially acceptable

Train primary healthcare worker in gerontology and geriatrics

Article 70

Article 75

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Specialist Needs

Health care designed to need the specialist needs of older people must be made available, taking into account the introduction of geriatric medicine and gerontology into relevant university curricula and healthcare systems

Article 59

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Domestic violence



Child abuse


Changing care


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Research, research, research….

Less than 50 empirical studies in the peer-reviewed literature

NAS, 2002

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  • 25, 355 Domestic Violence

  • 1,108 include older people

  • 96 IPV and older people

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  • Lancet 2002, 2006

  • Limited to ages 15-49

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Elder abuse

  • First formal report 1975

    • First Irish reports 1990

    • NCAOP report 1998

    • Working Group 1999

    • Report accepted as health policy 2002

    • National implementation group 2003

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Working group

  • Older people

  • Health Boards

  • Social workers

  • Public Health Nurses

  • Residential care

  • Police

  • Family doctors

  • Geriatric Medicine

  • Psychiatry of Old Age

  • Psychiatry


Social Work




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Elder Abuse not a legal issue…it is a health and social care issue

Gordon Ashton

Gordon Ashton

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  • Care context

  • Good practice

  • Training

  • Appropriate staffing

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‘‘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 or violates their human and civil rights.’’

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  • Psychological

  • Financial

  • Physical

  • Neglect

  • Sexual abuse

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UK Prevalence Study

  • Neglect1.1%

  • Financial0.7%

  • Psychological0.4%

  • Physical0.4%

  • Sexual0.2%

  • 6% of those abused within previous year report 2 types of mistreatment

  • Underestimate - no nursing homes, none with significant dementia

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Changes with age

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  • Women

    • Financial increases with age for men

    • Advanced age, more men than women

  • Poor health

  • Rented Accomodation

  • Loneliness

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  • 51% partner/spouse

  • 65% living in house

  • Interpersonal

    • 80% men

  • Financial

    • 56% men, overall younger

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Alleged perpetrators

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Main Abuse Allegations

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Abuse in institutions

  • Institutional abuse

    • poor care standards, lack of a positive response to complex needs, rigid routines, inadequate staffing and an insufficient knowledge base within the service

  • Individual abuse

    • In particular, restraints

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  • Draft policies, procedures, guidelines

  • Pilot projects: accepted two areas

  • Training brief, tender, evaluation

  • Evaluation brief, tender, evaluation

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  • Implement current government policy on health and social care for older people

  • National Implementation Group - DoHC

  • National Centre for Study of Elder Abuse

  • Legislative

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  • Regional

    • Steering Groups

    • Training

  • LHA

    • Senior Case Worker

    • Manager

    • Clerical

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Senior Case Worker

  • Positive experience with two disciplines

  • Did not specify discipline

  • Outlined competencies

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  • 2-day for a small group of key personnel

    • 74

  • One session for as many other healthcare personnel as possible (abbreviated by Foot and Mouth outbreak)

    • 198

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Process themes

  • Formality of procedures and signing one’s name

  • Need to go through a line manager before making a referral

  • ‘Fit’ between the procedure advocated and current practice in some work settings

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Resource themes

  • Access to safe therapeutic environment

  • Wider range of options

  • Out-of-hours service

  • Budget

  • Access to counselling services

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What has happened?

Law Reform Commission

HSE implementation group

Steering Groups

Funding for 32 case workers

Funding for National Centre

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Lifetime history IPV

CDC. Behavioral Risk Factor Surveillance System 2005

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Willingness to disclose by current age: “would not be willing to disclose if abused in future” (SAVI, 2002)

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  • More joint working between domestic violence and elder abuse constituencies

  • Skills and options complementary

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Goya, age 80

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  • Ma se in vece fossimo riusciti ad annoiarvi, credete che non s'è fatto apposta.

Manzoni, I Promessi Sposi

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