World Elder Abuse Awareness Day (#WEADD)

Kathy Greenlee,
Vice President for Aging and Health Policy

Why I Am Tired and Inspired

Kathy Greenlee is the Vice President for Aging and Health Policy at the Center for Practical Bioethics. She previously served as the U.S. Assistant Secretary for Aging and Administrator of the Administration for Community Living from 2009 to 2016. She will be the keynote speaker at “A Conference on Elder Rights and Protection” in Maui, Hawaii on June 15, 2017, World Elder Abuse Awareness Day.

The United Nations recognizes June 15 as World Elder Abuse Awareness Day. Started in 2006 by Elizabeth Podnieks of the International Network for the Prevention of Elder Abuse, the day has become an international opportunity to highlight the global problem of the abuse of older people.

During my tenure as U.S. Assistant Secretary for Aging, I had the honor of observing “World Day” in venues as exotic as the White House and the United Nations Headquarters in New York City. The problem of abuse of the aged is ubiquitous. It happens in every corner of the world, in every culture. Unfortunately and outrageously, it happens to one out of every 10 older adults in the United States.

The impact of abuse can be immediate, such as a sudden punch or a sexual assault. It can develop over time, as is the case with older adults who are neglected and allowed to languish, decline and die from the horrible circumstances that accompany the failure to receive care. Elder abuse can be caused by family members who strike out because of stress, anger or greed. It can be perpetrated by strangers who befriend older people on the telephone or through the internet or who come through the front door. Criminals prey on the cognitive decline associated with advancing age and the presence of dementia.

Reasons to Be Tired 

I became aware of the scourge of elder abuse over 25 years ago when I worked in the Office of the Kansas Attorney General as a young lawyer. In many ways, I have grown up with this issue as a professional. Four aspects of the issue – euphemisms at best and excuses at worst -- continue to motivate and anger me.

1. I am tired of calling elder abuse “scams.” I have not set out to banish the word. But it’s simply not strong enough. These aren’t scams, they are crimes. Older people aren’t tricked, they are exploited. They aren’t stupid, they are scared. By referring to the targeting of older people as scams, we fail to warn sufficiently. We need to do a better job of telling people: When you get old, people will target you and some will try to hurt you. Be aware, be informed and be careful.

2. I am tired of ageism. One of the root causes of abuse is the societal devaluing of old people. Older adults are dismissed, talked down to, ridiculed and, most tragically, ignored. Despite the overwhelming presence of older people in society, on an individual level, older people become invisible. We stop seeing them and we lose them. And in the shadows of their isolation, criminals prey.

3. I am tired of talking about older adults when we should be working with them. I feel strongly that the greatest deficit in the field of aging is the lack of presence of older people themselves. In 1984, I was trained as a volunteer in a domestic violence program. The domestic violence movement in this country was started by formerly battered women. The same can be said about the work against sexual assault. Rape survivors lead the way by bravely speaking out. This is not the case with the work to end elder abuse. The champions in this work are people just like me, professionals who are angered to the point of action and have been for years. We need to provide support and seek opportunities for older people to address the problem of abuse directly and publicly.

4. I am tired of calling them victims, yet we must hold onto this language. It is a crime to hit, slap, rape, abandon, neglect, drug and steal from older adults. Even and especially when the perpetrator is a member of the family. We need adult protective services, law enforcement, prosecutors and judges to recognize these crimes. We need to stop dismissing these crises as family matters.

Reasons to Be Inspired

I am ready to call them survivors. The most hopeful part of the work to end elder abuse is starting to emerge. We need to understand resilience. What does it mean to survive abuse in old age? How does “trauma informed care” relate to these issues? How does a person who needs functional support continue to thrive? How do victims set their own course and live the rest of their lives as survivors?

World Elder Abuse Awareness Day is a day to reflect, focus and applaud. We need this day. We need to shout and talk and listen. We need to tell each of you in the community, “We have a serious problem.” Older people are not safe. For every year we recognize World Day, each of us has taken another lap toward our own old and older age. On this day, we join the world in the sobering acknowledgement of an international epidemic. I am inspired by this work. Inspired by older people. Inspired by survivors. Inspired by our determination to bring this epidemic out into the open and fight together for it to end.

SUGGESTED LINKS

Center for Practical Bioethics
http://www.PracticalBioethics.org
https://www.facebook.com/practicalbioethics/
https://twitter.com/PracBioethics

National Latin@ Network
https://enblog.nationallatinonetwork.org/a-message-from-the-founder-of-world-elder-abuse-awareness-day/

National Center on Elder Abuse
www.ncea.acl.gov
https://www.facebook.com/NationalCenteronElderAbuse/
https://twitter.com/NCEAatUSC

National Committee for the Prevention of Elder Abuse
http://www.preventelderabuse.org
https://www.facebook.com/NCPEA/
https://twitter.com/NCPEA

National Adult Protective Services Association
http://www.napsa-now.org
https://www.facebook.com/NAPSANow/
https://twitter.com/NAPSA_NOW

Elder Justice Coalition
http://elderjusticecoalition.com
https://www.facebook.com/elderjustice/
https://twitter.com/ElderJustice

Speaking for those with diminished decisional capacity

Public ready to serve as surrogate

Gary Pettett, M.D., F.A.A.P.
Fellow, Center for Practical Bioethics

America’s nearly 70 million post-WWII “baby boomers” are now reaching their 60’s and beyond. Estimates suggest that as many as 30% will develop aged-related dementias of which Alzheimer’s Disease is the most common paradigm.

Efforts to prevent or minimize the health burden of dementia will be critical to sustaining a comprehensive and affordable health care system for an aging population.

Unfortunately, our current understanding of the epidemiology and pathophysiology of many of these disorders is incomplete. Clinical research designed to expand our knowledge of age-related disorders and answer many of these questions is essential.

However, much of that research will require the participation of elderly individuals with diminished decisional capacity. Despite years of debate, the absence of clear public policy on the participation of patients with diminished decisional capacity in clinical research leaves much of this work undone. Who will speak for those who cannot speak for themselves?

Interestingly, the public seems to be reasonably comfortable with the concept of a family surrogate to speak for those who have lost decisional capacity. In the January 13th issue of Neurology, Kim, et al.[1] reported the results from the 2006 Health and Retirement Survey, a biennial survey of a representative sample of Americans aged 51 and older.

Participants were queried specifically as to whether one would want to participate in a research study, whether our society should allow family surrogate consent for participation in clinical research, and whether one would allow surrogates some or complete leeway to override stated personal preferences.

In 2006, the Center for Practical Bioethics published a policy brief, Protecting Research Subjects with Diminished Capacity, providing a series of recommendations that might serve as a template for the development of public policy on clinical research in patients with diminished capacity.

These recommendations addressed the need to ensure that studies involving adult subjects with diminished capacity are conducted on firm ethical ground, that uniform procedures should be established for identifying surrogate decision-makers and defining the extent of their authority when acting on behalf of adults with diminished-capacity, and develop clearly defined criteria for determining the allowable levels and types of research related risks that would be appropriate for adults with diminished capacity.

Never before has research on age-related dementia been more important or more needed. The public seems ready. The ethical issues are not entirely new. Many were debated at length during the formulation of the federal guidelines for protecting human subjects in clinical research in the early 1970’s.

It is time now to focus our efforts on developing meaningful public policies and guidelines that foster clinical research to help us more fully understand and manage age-related dementias. The social and economic cost of ignoring these issues will far exceed the investment required to develop more effective health care for one of the most rapidly growing segments of our population.

Link:

Decide for Me When I Can't, Most People Say
HealthDay News
January 21, 2009

The survey of people age 51 and older found that at least 68 percent believed family surrogates should be able to grant consent for a mentally incapacitated loved one to participate in a research study.

[1] Kim SYH, Kim HM, Langa KM, et al. Surrogate Consent for Dementia Research. Neurology 2009, 72:149-155.