Elder Abuse: The Canadian Experience

ABSTRACT

Abuse and neglect of older adults occurs in all Canadian communities and solutions require the coordinated efforts of society at large. Amelioration entails more than a legislative approach. Prevention of this growing problem is a social responsibility that requires networking and collaboration between different disciplines in all sectors of the community. This article will discuss elder abuse in Canada from a historical perspective, as well as current legislation, model programs, and research initiatives. It is intended to allow for comparison from the various countries presented in this volume. Hopefully, readers will find some models, or ideas, they may wish to explore or even replicate within their own jurisdictions.     

Change and Inertia in the New York State Medicaid Personal Care Services Program: An Institutional Case Study

This study analyzes how competing logics (belief systems) of stakeholders have influenced patterns of change and inertia in the development of the New York Medicaid Personal Care Services (PCS) program. A case-study methodology was used to collect documents, statistics, and interview data from four key stakeholder groups: state and city officials, PCS agencies, a labor union, and consumer advocates covering the period 1999 to 2005. The New York PCS program is one of the oldest, largest, and most stable programs in the United States. Its early unionization of workers resulted in relatively generous wages and benefits and made New York number one nationally in PCS spending per capita. In spite of wide support from stakeholder groups, the overall number of participants has gradually declined since 1999. A consumer-directed model of personal care developed in 1995 challenged the status quo and has grown steadily. Resistance by public officials, agency providers, and union representatives to the consumer-directed model has resulted in a small program that is often targeted toward individuals labeled “difficult to serve.” Dominant stakeholders in New York have ensured a stable personal care program that has resisted change and led to program inertia.     

Commentary: Male Osteoporosis—Policy Gaps in Prevention and Treatment

Osteoporosis is a disabling disease affecting 10 million Americans, leading to increased risk of fractures and poor functional ability. Although typically thought of as a women's disease, millions of men are diagnosed with osteoporosis or low bone mass, and the risk for osteoporotic fractures is increasing. To address undetected and untreated osteoporosis among men, public health education should be targeted to males. Insurance programs, including Medicare, should add the heel qualitative ultrasound (QUS) for age-eligible men with follow-up every 2 years. Policy changes should address funding of targeted education and prevention programs for aging males, including coverage of screening tests.     

What Is “Elder Abuse”? Voices From the Margin: The Views of Underrepresented Canadian Older Adults

We know relatively little about the definitions and perceptions of elder abuse held by marginalized groups of older adults in Canada. The current study used focus group methodology to explore perceptions of elder abuse among marginalized groups such as Aboriginal persons, immigrants, refugees, and lesbians. We found both similarities and differences in perceptions of elder abuse across groups. Groups identified traditional forms of elder abuse (i.e., physical, sexual, psychological/emotional, financial abuse, and neglect) as well as less frequently identified types of abuse such as disrespect and government or systemic abuse. Groups also discussed issues related to immigrant sponsorship arrangements and abuse in nursing homes.     

Mapping the Elder Mistreatment Iceberg: U.S. Hospitalizations With Elder Abuse and Neglect Diagnoses

Purpose: This study describes U.S. hospitalizations with diagnostic codes indicating elder mistreatment (EM). Method: Using the 2003 Nationwide Inpatient Sample (NIS) of the Healthcare Costs and Utilization Project (HCUP), inpatient stays coded with diagnoses of adult abuse and/or neglect are compared with stays of other hospitalized adults age 60 and older. Results: Few hospitalizations (< 0.02%) were coded with EM diagnoses in 2003. Compared to other hospitalizations of older adults, patients with EM codes were twice as likely to be women (OR = 2.12, 95% CI = 1.63–2.75), significantly more likely to be emergency department admissions (78.0% vs. 56.8%, p < .0001), and, on average, more likely to have longer stays (7.0 vs. 5.6 days, p = 0.01). Patients with EM codes were also three to four times more likely to be discharged to a facility such as a nursing home rather than “routinely” discharged (i.e., to home or self-care) (OR = 3.66, 95% CI = 2.92–4.59). Elder mistreatment–coded hospitalizations compared to all other hospitalizations had on average lower total charges ($21,479 vs. $25,127, p < .001), with neglect cases having the highest charges in 2003 ($29,389). Implications: Knowledge about EM is often likened to the “tip of the iceberg.” Our study contributes to “mapping the EM iceberg”; however, findings based on diagnostic codes are limited and should not be used to minimize the problem of EM. With the so-called graying of America, training is needed in recognizing EM along with research to improve our nation's response to the mistreatment of our elderly population.     

Supporting Family Carers Through Telephone-Mediated Group Programs: Opportunities For Gerontological Social Workers

ABSTRACT

Telephone-mediated group programs are an important but under-utilized medium for reaching frail or disabled older persons' family carers who are in need of support. The primary purpose and style of group programs can range across a broad spectrum–encompassing educational, supportive and therapeutic types. Gerontological social workers are the members of the multidisciplinary care team whose training, experience and supervision makes them most suitable for facilitating this broad range of group types. Drawing on the experience of training a number of group facilitators, this article provides suggestions for social workers contemplating the use of telephone-mediated groups and highlights groupwork skills peculiar to conducting group programs via the telephone.     

Robust minimum distance inference based on combined distances

The minimum disparity estimators proposed by Lindsay (1994) for discrete models form an attractive subclass of minimum distance estimators which achieve their robustness without sacrificing first order efficiency at the model. Similarly, disparity test statistics are useful robust alternatives to the likelihood ratio test for testing of hypotheses in parametric models; they are asymptotically equivalent to the likelihood ratio test statistics under the null hypothesis and contiguous alternatives. Despite their asymptotic optimality properties, the small sample performance of many of the minimum disparity estimators and disparity tests can be considerably worse compared to the maximum likelihood estimator and the likelihood ratio test respectively. In this paper we focus on the class of blended weight Hellinger distances, a general subfamily of disparities, and study the effects of combining two different distances within this class to generate the family of “combined” blended weight Hellinger distances, and identify the members of this family which generally perform well. More generally, we investigate the class of "combined and penal-ized" blended weight Hellinger distances; the penalty is based on reweighting the empty cells, following Harris and Basu (1994). It is shown that some members of the combined and penalized family have rather attractive properties     

Robust tests for equality of two population means under the normal model

A robust procedure is developed for testing the equality of means in the two sample normal model. This is based on the weighted likelihood estimators of Basu et al. (1993). When the normal model is true the tests proposed have the same asymptotic power as the two sample Student's t-statistic in the equal variance case. However, when the normality assumptions are only approximately true the proposed tests can be substantially more powerful than the classical tests. In a Monte Carlo study for the equal variance case under various outlier models the proposed test using Hellinger distance based weighted likelihood estimator compared favorably with the classical test as well as the robust test proposed by Tiku (1980).     

Bayesian Analysis of Masked Series System Lifetime Data

The problem of analyzing series system lifetime data with masked or partial information on cause of failure is recent, compared to that of the standard competing risks model. A generic Gibbs sampling scheme is developed in this article towards a Bayesian analysis for a general parametric competing risks model with masked cause of failure data. The masking probabilities are not subjected to the symmetry assumption and independent Dirichlet priors are used to marginalize these nuisance parameters. The developed methodology is illustrated for the case where the components of a series system have independent log-Normal life distributions by employing independent Normal-Gamma priors for these component lifetime parameters. The Gibbs sampling scheme developed for the required analysis can also be used to provide a Bayesian analysis of data arising from the conventional competing risks model of independent log-Normals, which interestingly has so far remained by and large neglected in the literature. The developed methodology is deployed to analyze a masked lifetime data of PS/2 computer systems.