Consultation on a federal policy definition of senior abuse: What we heard

4.1.1 Why the issue of senior abuse is important

Many participants across all roundtable sessions talked about the importance of the issue of senior abuse. They valued the chance to provide feedback and hope to move towards collective action to prevent and respond to senior abuse. A variety of main points emerged during discussions.

• Seniors are the fastest growing age cohort in Canada. They deserve dignity, safety and respect at any age. Yet more seniors are coming forward with experiences of serious incidents of harm (being taken advantage of, harassed, not being adequately cared for)
• Senior abuse violates basic rights and freedoms and is a human rights issue. It often stems from ageism.^{Footnote 2} The rights of older persons are at times overlooked or dismissed, despite aging being a natural process that affects us all. They may experience discrimination or be dismissed when they seek help
• Senior abuse is a serious, but preventable public health issue. Some participants described it as a "silent epidemic", known to be under-reported. Older persons who experience abuse may feel ashamed to ask for help or powerless to change their state of affairs. They may interpret it as their fault. Perpetrators of abuse or neglect are most often a family member (partner, child, grandchild) or someone who is in a position of power. The person facing abuse may not come forward out of fear of being abandoned or to protect their loved one from consequences
• Some seniors may be targeted because of social isolation or other vulnerabilities such as diminished physical and cognitive resources. They may not be aware of their rights. Perpetrators may see them as an "easy victim", assuming they would not be believed by others or that they would not fight back. As a society, there is shared duty to protect those who are vulnerable to abuse
• The COVID-19 pandemic has seriously impacted seniors. To reduce their exposure to the virus, they have become more isolated, increasing their vulnerability to abuse. Some seniors living in long-term care were neglected, confined to their rooms 24/7, or not allowed visitors for extended periods. In some cases, seniors died from starvation, dehydration or lack of care
• Telephone fraud and internet scams disproportionately affect seniors. Pandemic isolation has made them more vulnerable to this type of abuse
• There are little or no consequences for those who carry out the abuse. However, there can be serious consequences for the older person who experiences abuse and their family
  • Due to stage of life, seniors who experience abuse may have a limited ability to bounce back financially (in cases of financial abuse or fraud)
  • Physical, emotional/psychological, spiritual and sexual abuse can have harmful health impacts (limiting physical/cognitive abilities, guilt, shame, embarrassment, depression/suicide, loss of hope)
  • Senior abuse affects the whole family, not just the older adult
• Policy inaction to prevent different types of senior abuse results in hefty societal costs, for example, to the health care and social service systems, the justice system, housing, insurance, and financial bodies

4.1.2 How senior abuse is different from other forms of abuse

Some participants commented on how senior abuse is different from other forms of abuse. The main factors related to additional complexity, for example, compared to child abuse, and increasing vulnerability with age, including:

• issues of spirituality, sexual orientation, gender identity
• possibility of declining cognitive abilities or inability to speak for themselves (barrier to meaningful access of support if facing abuse)
• possibility of declining physical health and disability^{Footnote 3} (may rely on others to get out of bed, use the phone, including someone who may be abusing them)
• experience of ageism (lack of credibility given to seniors reporting abuse or neglect)
• limited knowledge of how to access services or low computer literacy

4.1.3 Why the federal policy definition is important

Some roundtable participants focused their feedback on why the federal policy definition of senior abuse is important. They said a consistent definition is important because it can help determine policy actions:

• who gets counted (who is included as a person experiencing senior abuse)
• what related legislation will cover^{Footnote 4}
• where to direct prevention efforts
• where to intervene and with whom

4.2.1 Rights of seniors and the role of ageism

The impact of ageism on senior abuse was one of the clearest, loudest themes from roundtable sessions. Many participants across all roundtable sessions talked about how ageism feeds abusive conduct and can rob seniors of respect, dignity and their basic rights. Society loses the contribution of older adults who could be participating and involved in their communities.

Many participants said ageism is a main contributor to senior abuse and should be central in any discourse on the issue. Some suggested including ageism in the definition as a form of senior abuse. Others said ageism is an underlying reason that senior abuse happens, but should not be confused with abuse itself in the definition.

Specific suggestions for the policy definition included:

• clearly "call out" ageism and its role in senior abuse
• frame senior abuse as a violation of the rights and freedoms
• use language that respects the dignity of older persons and empowers them rather than identifying them as "a weakened person", for example, use vulnerable "circumstances" instead of vulnerable "person"

4.2.2 Intersection of age with other vulnerabilities

Many roundtable participants across all sessions talked about the complexities of understanding senior abuse. They encouraged thoughtful analysis using:

• an intersectional lens to better understand who faces abuse
  • This means recognizing that people have multiple and diverse identity factors that intersect to shape their perspectives, ideologies and experiences.^{Footnote 5} For example, an immigrant woman senior with a disability is considered as a whole person with experiences related not only to her identity as a senior, but also as a woman, immigrant and person living with a disability
• a public health framework to:
  • identify prevalence, risk and protective factors (individual factors; environmental, social, economic and cultural factors)
  • understand systemic inequities and forms of oppression that increase vulnerability (ageism, sexism, racism, colonialism, ableism, homophobia, transphobia, poverty)
  • identify targeted interventions that work
• principles focused on inclusion, choice and self-determination, diversity, safety and security

4.2.3 Historical and current trauma of Indigenous peoples

The historical and current trauma experienced by Indigenous peoples in Canada adds to senior abuse. Indigenous roundtable participants talked about having a very different perspective and definition of senior abuse given:

• geographic, economic and social contrasts
• the legacy of the residential school system

They noted that viewpoints may not be attuned with an agreed federal policy definition. They suggested that the definition capture specific dimensions of senior abuse related to:

• overcoming the legacy of residential schools
• social isolation
• the marginalization of Indigenous peoples

Other participants shared similar challenges related to social determinants of health that contribute to senior abuse. Some examples are:

• lack of access to culturally-appropriate long-term care close to home or other housing options
• financial abuse by family members

4.2.4 Discrimination based on sexual orientation and/or gender identity

Participants in several roundtable sessions talked about abuse experienced by LGBTQ2S+^{Footnote 6}  seniors as a result of homophobia or transphobia. They shared examples of abuse experienced by seniors moving into long-term care or senior residences:

• historical trauma may be triggered in an institutional setting, for example, trauma of coming out/not coming out in the past; living through the period before decriminalization (fairly recent, 1967) or the HIV/AIDS crisis
• the senior may choose to go back into the closet out of fear of discrimination based on their gender identity or sexual orientation
• the senior may experience micro-aggressions causing psychological harm or physical abuse where a culture of discrimination is present

4.2.5 Violence against older women

Several participants across the roundtable sessions raised the issue of violence against older women. They stressed that senior abuse is not gender neutral and not just personal/interpersonal. Gender determines women's role, status in society and shapes social relationships.

Older women make up a higher proportion of the vulnerable older adults and they are more likely to experience certain kinds of abuse. They also may face barriers to accessing services, compounded by the effects of ageism and sexism.

For this reason, these participants said the federal policy definition should:

• recognize gender-specific implications of aging and women's experience of violence
• use language that specifically names violence against older women and femicide^{Footnote 7} as types of senior abuse and intimate partners/ex-partners as common perpetrators
• apply an intersectional framework to understand who is facing senior abuse, considering all forms of systemic oppression that increase risk
• develop policies that target prevention and response to those most at risk

4.2.6 Consideration of minority language rights

Separate from the terminology itself, some participants talked about the challenges of aging in a community where the senior is part of an Official Language Minority Community (OLMC). This includes English-speakers within Québec and French-speakers outside Québec.

Seniors with limited access to services in their first language may be at increased risk of abuse. Their wishes and needs may not be understood or disregarded. If they are facing abuse or neglect, they may not be able to self-advocate or seek help.

Some participants equated not providing adequate Official Language services to a form of systemic discrimination. They suggested that the federal policy definition mention:

• the provisions of the Official Languages Act of Canada
• the importance of ensuring seniors from linguistic minorities:
  • receive the same standard level of care, access to information, supports and justice in cases of abuse
  • have the same right to express and self-advocate

4.2.7 Consideration of ethnic diversity

Some participants said that greater sensitivity is needed to cultural practices that result in senior abuse. With some cultural groups, where seniors are part of a multigenerational family, different forms of abuse can be more prevalent. 

4.3.1 Crafting a useful definition

Roundtable participants suggested broad points to help craft a definition that can be used for a range of purposes, such as:

• raising awareness among seniors and the general public
• education and training of people on the front-lines (health, social service, justice)
• research, policy and program development

Suggestions included:

• use clear, concise language to make it accessible for everyone (apply plain language principles)
• make the definition flexible enough to be adjusted to regional and cultural contrasts, and changing conditions over time
• ensure the definition is well-understood and consistent in both official languages
• use language that is broad enough to include everyone who experiences senior abuse and all types of abuse and neglect
• operationalize sub-categories of abuse and neglect for purposes of consistent data collection, research and targeted policy development

4.3.2 Preferred definitions

ESDC asked participants about use of the WHO definition of elder abuse or other preferred definitions for senior abuse.

The WHO definition uses the language of "elder abuse":

• elder abuse is 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 (WHO, 2002)

Several participants in the ministerial roundtable (English) and a few participants in other roundtable sessions provided specific feedback on the WHO definition.

Of these participants, most said that the WHO definition of elder abuse is useful. It is viewed to be straightforward and generally covers the major elements of abuse. It is well-known worldwide and within Canada. Some organizations and networks use the WHO definition in their prevention and advocacy work on a regular basis.

At the same time, participants pointed out specific changes they would like to see in the WHO definition to improve it, such as:

• changes to language
• addition of elements
• indicators for monitoring

Some participants said the WHO definition is limited as the basis for measurement. Canada has provided leadership in the past in the area of elder abuse, and could potentially influence revisions to the international definition.

4.3.3 General language and terms

4.3.4 Defining who experiences senior abuse (for example, age, specific groups)

The Discussion Guide highlighted that seniors are not a homogenous group. The seniors population is diverse from many factors, including age, gender, culture, race, health and socio-economic status. Many will continue to function well and/or autonomously long after they reach 65. However, others might experience aging-related changes or life transitions before reaching 65 that leave them vulnerable to mistreatment.

Statements by most roundtable participants in all sessions aligned with the general statements in the Discussion Guide on age and risk of experiencing senior abuse. They said that getting older looks and feels different for different people. It is a combined experience of age and disability that can be compounded by discrimination, isolation or other social determinants of health. Taken together, these factors can put some older persons more at-risk to experience abuse, for example, a person with a developmental disability who is 55 years old and does not have family support.

Many roundtable participants across all sessions suggested that the federal policy definition:

• avoid artificial age cut-offs that could exclude people who experience senior abuse
• consider both age and vulnerabilities to abuse
• use an intersectional lens that goes beyond age or medical vulnerability to include the social and cultural factors built into the experience of aging

4.3.5 Perpetrators of senior abuse

4.3.6 Types of abuse and other elements to include

4.4.1 Common language among the public, researchers, practitioners and policy-makers to support coherent collective action

Many roundtable participants across all sessions said that common, well-defined terms ensure everyone clearly understands the complex issue of senior abuse. Shared understanding of the intersection of aging with other vulnerabilities can improve collaboration and coordinated actions.

They named many people working to prevent and respond to senior abuse, including:

• all levels of government across the country
• partners from many sectors: health care, community and social services, housing, legal and other support services, police and financial services
• researchers, policy-makers, practitioners serving seniors, advocates

Some participants mentioned how common terms can help in the areas of raising awareness, research, policy and program development, and practice.

4.4.2 Strengthened, more consistent data collection across jurisdictions and sectors to support evidence-informed policy

Many roundtable participants across all sessions said that every Canadian jurisdiction has a unique way of defining senior abuse. There is currently no consistency in data collection across jurisdictions. This creates barriers to evidence-formed policy development and coordinated responses. A federal policy definition could help by:

• guiding consistent data collection across jurisdictions and sectors
• helping to assess prevalence and to identify issues and trends across the country. This includes: who is experiencing abuse; who is perpetrating abuse; where is abuse happening; what types of abuse are most common; and what factors are contributing
• shifting policy and program development to target high priority areas and to groups of seniors most at risk of abuse. Policy will not change without evidence
• allowing comparison of information across Canadian jurisdictions and with other countries
• clarifying reporting protocols across jurisdictions and who is responsible for follow-up, that is, which federal, provincial, territorial Ministry keeps the information and who leads follow-up

4.4.3 Coordinated awareness-raising with common messaging to focus attention on how to prevent and respond to senior abuse

Many roundtable participants across all sessions stressed that:

• seniors are facing serious harm across the country
• many are falling under the radar without access to help

Reasons for under-reporting included:

• the stigma/shame of coming forward
• ageism (people may come forward, but are not believed; as a result, no action is taken that would lead to reporting)
• low public awareness of the signs of senior abuse
• no formal reporting mechanisms

Participants said that a federal policy definition could help coordinate awareness-raising. Below are practical benefits that a definition could include.

• Common language and terms to describe what senior abuse looks like
• Possible focus for a coordinated national prevention campaign (partnership of the federal, provincial and territorial governments). The campaign could draw attention to senior abuse and ageism. Some participants said that inter-generational awareness-raising programs that involve youth are critical to preventing abuse and supporting seniors
• Better identification of seniors at-risk through broader awareness of:
  • who experiences abuse
  • conditions that increase vulnerability (the public includes many people who provide services or interact with seniors every day)

Some participants focused on how to increase reporting of cases of abuse. The federal policy definition could provide the foundation for future actions. Participants shared ideas for policy action on awareness-raising and reporting. While outside the scope of this summary report, this input will help inform broader government policy work.

4.4.4 Targeted efforts to raise awareness among seniors about their rights and the resources available to prevent abuse (reduce vulnerability)

Many roundtable participants across all sessions said that the definition could be an important tool to help raise awareness among seniors about their rights. The federal policy definition could:

• equip seniors with language and knowledge to self-advocate (knowing that not everyone has a support network)
• provide organizations with a common tool to focus outreach activities to diverse seniors
• support targeted prevention to diverse groups of seniors

They said that targeted outreach and awareness-raising is essential to protect "at-risk" seniors from abuse, for example, Indigenous Elders (living in urban, Northern and remote communities), other groups who experience language, cultural and other barriers to accessing information and support. Targeted outreach and awareness-raising can help ensure seniors:

• understand their legal rights and how to protect their pension
• are informed of the importance of having signed Powers of Attorney and wills in place and the impact of signing over Powers of Attorney
• know about the patterns of behavior that lead to senior abuse (for example, for seniors moving into long-term care or retirement communities)

4.4.5 Drive policy action at the federal level in key areas that impact senior abuse prevention and response

Many participants focused their feedback on senior abuse strategies and policy actions in areas of prevention, response and enforcement. Suggestions were broad and far-reaching, and beyond the scope of developing the federal policy definition.

Important areas for policy action include:

• coordinated awareness-raising activities
• new senior abuse monitoring and reporting approaches (including tools for detection and reporting; training of front-line and decision-makers)
• actions to address social isolation and social determinants of health
• targeted actions to prevent and respond to abuse experienced by specific groups, such as:
  • older Indigenous peoples
  • older women who experience violence
  • seniors who face access barriers due to gender identity or sexual orientation, race, language, culture, low income or other forms of systemic oppression
• actions to strengthen legal protection and consequences
• actions to strengthen service accountability, standards and training in long-term and community care sectors

4.5.1 Specific data/information required

Participants identified specific data needed to inform their policy work on senior abuse prevention and response.

• Prevalence data on who is experiencing abuse, where the abuse is happening, the perpetrators, and the type of abuse
• Demographic data to allow disaggregated analysis by sub-groups who experience abuse, for example, age, gender, sexual orientation, Indigenous or racialized group, immigrant/refugee status, language, geographic and/or health region, setting (community, long-term care, seniors residences), vulnerability (social isolation, cognitive impairment). Disaggregated, race-based data can illuminate systemic inequalities and injustices that increase risk of abuse
• Information on perpetrators, including the perpetrators relationship to the senior reporting abuse, gender and age of the perpetrator, and contributing factors
• Clear operational definitions naming each type of abuse (and sub-categories of behaviours and conduct). Without naming the types of abuse and sub-categories, those affected will not be counted. In addition, actions will not be taken to prevent and address the form of abuse. Sections 4.3.6 describes participant views on the types of abuse or neglect to include in the definition
• Information on the type of response provided when abuse is reported (for example, health, housing, police, legal or financial support), and the outcomes of reporting, for example, number of charges laid, number of cases prosecuted and outcomes of prosecution

4.5.2 Direct experience of seniors

Several participants encouraged the collection of quantitative and qualitative data on senior abuse to better understand the experience and issues. They encouraged outreach to hear the stories of seniors from diverse communities and provide seniors with ways to directly report experiences of abuse. This should include an alternative to police reporting.

Some Indigenous participants suggested developing restorative justice approaches to senior abuse in their communities. This approach aligns with cultural understanding and practices. It can potentially encourage older Indigenous peoples to come forward who might be concerned about legal consequences to their family member, for example, in cases where a child or grandchild is the perpetrator.

4.5.3 Suggested methods/mechanisms of data collection

Many roundtable participants across all sessions said that consistent data collection across jurisdictions and sectors is needed to develop senior abuse policies. They suggested broad approaches to improve consistency in addition to possible mechanisms or tools for data collection. General suggestions included:

• collaborate with international and Canadian research networks to clarify operational definitions and develop shared indicators to monitor progress on senior abuse prevention and response
• review and build on work already done internationally and in Canada on measuring senior abuse
• work with cross-sectoral agencies across the country to understand what data is currently available and to identify information gaps
• build on the experience of national data collection in other issue areas, for example, through the Canadian Institute of Health Information
• look to other fields that use standardized approaches to data collection and measurement, for example, the child maltreatment field
• consolidate various points of national data collection into a single, measurable study to identify gaps
• use and strengthen existing data collection mechanisms (for example, within health and social service systems, seniors’ networks, criminal justice system, financial system, government administrative and survey systems)
  • Create opportunities for population-based self-reporting
  • Document all forms of abuse reported through crisis calls and surveys
  • Collect institutional data using embedded tools and processes (hospitals, long-term care, senior residences, police reports, etcetera)

Some participants noted their organization’s interest in aligning data collection with the federal policy definition. They shared the types of data they currently collect on senior abuse through their organizations. Some participants suggested using existing systems to collect consistent data across sectors, for example, screening tools in home care, police reporting, residential assessment tools in long-term care.

4.5.4 On-line survey responses

On-line survey respondents were asked about which type of information and/or data they require to develop senior abuse policies. In addition, they were asked how data on the victimization of seniors should be collected.

Most respondents (individuals and organizations) agreed or strongly agreed that the many types of information and data are essential to develop senior abuse policies. They suggested the following methods and mechanisms to collect data on victimization of seniors:

• police
• nursing
• senior residence and hospital records
• self-reported victimization reports from seniors
• proxy reporting

6.2.1 Who responded

Total of 588 responses were received:

• 456 individuals (78%)
• 132 organizations (22%)

Language of survey completed:

• 543 English (92%)
• 45 French (8%)

Place of residence of individual respondents:

• Ontario is overrepresented in survey responses (54% of responses compared with 39% of Canadian population)
• Quebec is underrepresented in survey responses (6% of responses compared to 23% of Canadian population)

Individual respondents were predominantly older Canadians:

• 64% of individual respondents were aged 55+

Gender:

• individual respondents were overwhelmingly female (76%)

Indigenous participation:

• a very small number of individual respondents identified as Indigenous (6%)

Disability:

• a very small number of participants identified as a person with a disability (8%)

Caregivers:

• 30% of individual respondents indicated they were caregivers for a relative or friend who they considered to be a senior

Experience of senior abuse:

• 18% of individual respondents indicated they identified as a person with lived experience of senior abuse

Organizations:

• responding organizations predominantly served Ontario (34%) or the West (33%). Organizations serving Quebec accounted for only 7% of responses
• responding organizations worked mainly in the areas of Social Services (30%) or Health (20%)

Limitations of the survey:

• this survey was not conducted as a random sample of Canadians. Because of this, the results cannot be generalized to the Canadian population as a whole
• because the total number of respondents was low (and therefore the numbers in subgroups is much smaller), the amount of analysis of responses of particular subgroups was very limited

6.2.2 Preferred terminology

Of the terms offered in the survey, the preferred term among all respondents was senior abuse (44% of responses), followed by "abuse of older adults" (18%).

However, caution is needed in interpreting these survey results.

• The term "elder abuse" was not an option in the online survey since the term "elder" holds unique meaning in Indigenous Communities. Respondents were able to choose "Other" and write "elder abuse". But, not having "elder" listed could make it less likely for someone to consider the term and take the extra step of clicking "other" in their response
• Many more respondents from Ontario and the West completed the survey than from other regions. The number of individuals responding from other regions was too small for meaningful regional analysis. This means the results are not a balanced representation of diverse views from across the country

In French, the preferred term was "maltraitance envers les personnes âgées" (38% vs. 20% for "mauvais traitements envers les aînés"). While there seems to be a strong preference for this term, caution should be taken in drawing conclusions because of the relatively small number of francophone respondents.

There was some difference in the main reasons why respondents chose the term senior abuse. The most common reason given by Individuals was that it was more inclusive" (33%). Organizations said the term was "consistent with the term used in Canadian organizations" (31%).

For the age group covered by the term senior abuse, there was a range of responses:

• 55+ was the preferred age range for 33% of Individuals and 37% of Organizations
• 65+ was preferred by 36% of Individuals and 33% of Organizations
• individuals from Atlantic had a stronger preference for the 55+ age range (46%) than other regions. West, Ontario and Quebec preferred 65+ (accounting for 38% of responses for each of these regions)
• there were 38 comments that suggested that age range should not be the only factor, and that some combination of age and vulnerability should be considered

There was a high degree of agreement on the part of both Individuals and Organizations to include the elements outlined in Table 2 in a federal policy definition of senior abuse.

6.2.3 Preferred definition of senior abuse

A strong majority of respondents (73% of Organizations and 71% of Individuals) found the WHO definition of "elder abuse" to be acceptable.

• This was consistent across regions with a higher percentage of Quebec respondents (85%) finding the definition to be acceptable.
• Many respondents felt the definition should not be limited to situations "where there is an expectation of trust", since perpetrators could be strangers such as phone scammers.
• A large number suggested including "financial" in the types of senior abuse.

There was a high degree of agreement on types of senior abuse.

A strong majority of respondents (91% of Individuals and 84% of Institutions) agreed that types of senior abuse should be included in the federal policy definition.

6.2.4 Types of data required to inform senior abuse policies

There was a high level of agreement on the importance of gathering data on the factors outlined in Table 4 related to senior abuse.

There was a high level of agreement that data should be collected from all of the sources suggested in Table 5.

Comments suggested other important sources of data:

• community and social service organizations (14 comments)
• family and friends (7 comments)
• banks (5 comments)