Domestic violence and older people

Aged Care Psychiatry Service
Eastern Sydney Mental Health Association

Wednesday 21 June 2017
Event: 9:00am – 1:00pm
Opening Address: 9:05-9:15am (10min)

Royal Hospital for Women Lecture Theatre
Level 1, Women’s Health Institute, Randwick Hospital Campus
Barker Street Randwick

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Introduction

• Acknowledge traditional owners Bidjigal people of the Eora Nation.
• Thank Elizabeth Abbott for introduction and the Aged Care Psychiatry Service for inviting me to speak at today’s forum on Domestic Violence & Older People.
• I am delighted to see a focus on older people in clinical and health setting at today’s forum. 

The rights of older people

As you may be aware, last Thursday, on World Elder Abuse Awareness Day, the Federal Attorney General launched the Australian Law Reform Commission’s Elder Abuse Inquiry report. It was fantastic to see the Government and public focus their attention on this serious issue of elder abuse. I am determined to ensure that this report does not sit on a shelf and that as many of the recommendations are implemented as possible.

Today we are focussed on domestic violence, in particular the domestic violence against older people. While elder abuse is often discussed in the context of family or domestic violence, there are important differences between partner to partner violence and elder abuse which is often perpetrated by sons and daughters. However, regardless of context, the fundamental human rights of older people remains the same. That is, the universal rights of all people, regardless of age, to be treated with dignity and respect and to be free from violence, abuse, intimidation and neglect.

Domestic violence and older people

Domestic violence of older people tends to sit in a grey area between elder abuse and domestic violence. One of the key issues is the invisibility of older people in the Domestic Violence discussion and serious underreporting of abuse by older people. Shaped by the generational expectations and traditional gender roles of their time, older people, especially older women, may not recognise their experience as abuse.

For many, domestic violence was not criminalised until later in their lives, after many traditional values were already set in concrete. Participants in Norma’s Project, a research study into sexual assault of older women, reflected:
[30 years ago] I don’t think many women thought they had much choice … they spoke to their minister or priest or they spoke to their doctor and none of those professionals had the appropriate response. They gave them advice about how to be a better wife or how to keep the peace … And they were called things like difficult marriages or demanding husbands. There were all sorts of labels around what were obviously very violent and abusive relationships. These older women consequently had very different experiences of trauma, having had no one to go to, no one to tell and having held on for so many years. 

Domestic violence in older people can have more severe consequences due to increased health risks, frailty, caring responsibilities, financial and housing situations.

Two Lives Two Worlds, a study funded by the Office of the Status of Women in 2000, interviewed older female survivors about what stopped them from leaving an abusive relationship.

o I do not want to lose my house.
o I can’t leave because my (adult) children do not want me to break up their inheritance.
o My financial situation stops me leaving because I do not have superannuation and would only have a pension with no house and no other money.
o I am too old and weak to leave now.

The interaction between DV and dementia adds another layer of complexity. The recent Royal Commission into Domestic Violence report quoted the following example:
A disturbing case, involved a 78 year old woman experiencing sexual abuse at the hands of her husband who had Alzheimer’s Disease. When encouraged to speak to her GP, he advised her that this was common and that in any case men with this disease who are exhibiting these behaviours usually pass through this stage “in a year or so”. No support or referral was offered. 

All the issues and examples highlight the need to better understand and better address the unique circumstances of domestic violence in elder abuse.

Rights of older people in clinical and health settings

It is critical that the rights of older people do not become lost between definitions of elder abuse and domestic violence.

The Government recently asked the Australian Institute of Family Studies to conduct a scoping study for a definition of elder abuse. I hope this will assist to some extent in clarifying the parameters between DV and elder abuse. I also hope that if further research is undertaken to understand DV in older people and ways to address it, efforts will be made to translate such research into practice. I have an absolute aversion to research reports that just sit on a shelf. I hope that any new knowledge in this area will be actively used to fill the clinical and service gaps in this field and to inform the community about this serious issue.

In all this, I believe frontline health workers and community service professionals have an important role to play. They are often the first point of contact for older survivors. How they choose to use the tools and resources available to them will have a significant impact on outcomes for the older person.

I won’t delve into the technicalities of clinical systems and present practices (I’m sure my fellow presenters will offer much greater expertise on this) however I do want to highlight two overarching points.

First, it is important for all of us to be aware of our prejudices and assumptions. This is particularly important for those dealing with older people as their first point of contact, including health professionals, social workers, aged care staff and community services.
o For example, do we generally think of DV survivors as younger women? After all, that’s how they are commonly portrayed on DV posters and ad campaigns.
o When we see an older patient do we tend to attribute their symptoms and stories to age-related causes like falls, memory loss, dementia or physical weakness rather than enquiring into all the circumstances?
o How might our assumptions affect the way we deal with older perpetrators, especially those with cognitive impairment?
o Our assumptions can often prove to be correct, but not in all cases, which is why we need to be alert to our age stereotypes and know when to challenge them.

Second, we need to ensure that in health and clinical settings we do not discriminate, dismiss or disadvantage people on the basis of age. Older patients, like everyone else, have the same rights to care, choice and respect regardless of their age and the years they have to live. 

I would like to mention an innovative program being undertaken at St. Vincents Hospital in Melbourne.  A social worker, Megan O’Brien (as part of her PhD), has developed a program which involves all the health professionals from a most senior level down.  They are trained to identify older people at risk of abuse.  In discussions with Megan she told me that in a 4 year period there were, from memory, about 400 cases of which 70%, on further examination, involved elder abuse.  They now have a lawyer on the team who is in the hospital for 3 days a week and they have been able to assist their patients to address the issues they are facing - educating

In the 2015 Quarterly Essay entitled Dear Life: On Caring for the Elderly, the author Dr Karen Hitchcock considers the treatment of the elderly in health, particular those with dementia and facing end of life decisions. She makes a statement that I think should resonate not just with health professionals and community workers but with all Australians. She says:
The elderly, the frail are our society: they gave birth to us, nourished us, protected us, paid their taxes diligently, went to war, ate bread with sugar when there was no butter. They worked and love and live – they continue to do so. They are our parents and grandparents, our carers and neighbours, and they are every one of us in the not-too distant future … [they are] people whose needs require us to change.

I understand that change – reviewing of health models, developing of practice guidelines – can be difficult especially with limited resources and work pressures. But if we all share in this mission – understand that older people including those experiencing DV deserve to be cared for, respected and live lives of dignity – then change is achievable.