Enhancement of Canadian Data on the Abuse of Older Persons: An exploratory study

Executive Summary

Contract Information

August 2022

This public opinion research report presents the results of a review of scientific literature, individual interviews with Canadian and international researchers as well as representatives of Canada’s provincial and territorial governments, and a group interview with members of the Canadian Network for the Prevention of Elder Abuse, conducted by the Université de Sherbrooke on behalf of the Department of Justice Canada. Interviews were conducted between June 2021 to July 2021, and then from November 2021 to March 2022.

Cette publication est aussi disponible en français sous le titre : Enrichir les données canadiennes sur la maltraitance envers les personnes aînées : Une étude exploratoire.

This publication may be reproduced for non-commercial purposes only. Prior written permission must be obtained from the Department of Justice Canada. For more information on this report, please contact the Department of Justice Canada at: rsd.drs@justice.gc.ca or at:

Research and Statistics Division
Department of Justice Canada
East Memorial Building
284 Wellington Street
Ottawa ON K1A 0H8

Catalogue Number: J4-118/2022E-PDF
International Standard Book Number (ISBN): 978-0-660-45029-2

Related publications (registration number: POR 004-21):
Catalogue Number: J4-73/2022F-PDF (Final report, French)
ISBN: 978-0-660-45030-8

© Her Majesty the Queen in Right of Canada, as represented by the Minister of Justice and Attorney General of Canada, 2022

Research organization and funding

This study was conducted by the Research Chair on the Mistreatment of Older Adult team at the Université de Sherbrooke, which is home to the Research Centre on Aging. The Research Chair was established and funded in 2010 as an enabling action to counter mistreatment through the adoption of the Quebec government’s Plan d’action gouvernemental pour contrer la maltraitance envers les personnes aînées 2010-2015 [2010-2015 government action plan to counter elder abuse]. Its current funding comes from the second action plan covering the 2017–2022 period.

The specifications for this study, funded by the Department of Justice Canada, were approved by the Comité d’éthique de la recherche Lettres et sciences humaines [arts and humanities research ethics committee] of the Université de Sherbrooke on June 28, 2021 (/Ref. No. 2021-2995/Beaulieu).

Study and report drafting

Marie Beaulieu, PhD, Lead Researcher in the Study Holder of the Research Chair on the Mistreatment of Older Adults (hereafter, the Chair), Université de Sherbrooke (U de S) and Research Centre on Aging of the Centre Intégré Universitaire de Santé et de Services Sociaux de l’Estrie-Centre Hospitalier Universitaire de Sherbrooke (CIUSSS Estrie-CHUS) [Integrated university health and social services centre of the Eastern Townships – University of Sherbrooke Hospital].

Kevin St-Martin, Masters of Social Work student, U de S, and Chair Co-Coordinator.

Study

Julien Cadieux Genesse, Master of Social Work, Chair Coordinator (during a large part of the research)

Jacob Hamelin-Lucas, Master’s student in Social Work at U de S, Research Assistant to the Chair

Vanessa Daigle, Master’s student in Social Work at U de S, Research Assistant to the Chair

Editing and formatting

Marie-Chantal Falardeau, Ph. D., Post-doctoral student in gerontology at U de S, Chair Co-Coordinator

Annabelle Maheu, Master’s student in International Strategic Communication at U de S, Chair Intern

Political neutrality certification

I hereby certify, as senior officer at the U de S, that the deliverables fully comply with the political neutrality requirements of the Government of Canada stated in the Policy on Communications and Federal Identity and the Directive on the Management of Communications.

Specifically, the deliverables do not contain any reference to electoral voting intentions, political party preferences, standings with the electorate, or ratings of the performance of a political party or its leader.

Marie Beaulieu, PhD, Holder of the Research Chair on Mistreatment of Older Adults, Université de Sherbrooke and Research Centre on Aging of the CIUSSS Estrie-CHUS [integrated university health and social services centre of the Eastern Townships – University of Sherbrooke Hospital].

Executive Summary

Research purpose and objective

Although it has been studied since 1970, combatting abuse of older persons poses numerous issues and challenges around the world in terms of how it is defined, measured or tracked and given priority in policy, and in terms of practices recognized to be effective. This Canadian exploratory study sought to explore the feasibility of filling national data gaps in the area of abuse of older persons in effort to respond to the Minister of Justice and Attorney General of Canada’s mandate letter commitment to improve data collection on “elder abuse”. The study has four specific objectives that were contractually agreed upon between the University of Sherbrooke and the Department of Justice Canada (contract value = $38,420) : 1) to obtain information on the challenges and gaps in data collection on abuse; 2) to document the differences between abuse and neglect in data collection; 3) to design pragmatic approaches to successful research/data collection; and 4) to identify important data points to collect on the mistreatment of older persons. The results of this study will help further our knowledge and understanding of the data gaps in the production of data on abuse of older persons, and provide up-to-date scientific elements to inform decision-making.

Methodology

The research process was based on a review of scientific literature, individual interviews with Canadian and international researchers as well as representatives of Canada’s provincial and territorial governments, and a group interview with members of the Canadian Network for the Prevention of Elder Abuse (CNPEA). In total, 42 people were interviewed. The interviews were conducted and recorded using Teams or Zoom virtual platforms (one interview was conducted over the phone due to a technical issue), and lasted on average between 60 and 90 minutes. It is important to note that this qualitative exploratory study presents valuable information that is, by its nature, not statistically generalizable to the target population.

Summary of key findings

This report includes a review of the issue of abuse of older persons with a focus on conceptual challenges (terms and definitions), the quality of available data, and avenues for further data collection in Canada.

The conceptual challenges related to the abuse of older persons arise from the choice and use of terms and the plurality of definitions. The terms in use differ considerably in Canada’s two official languages. The main terms used in English are "elder abuse", "senior abuse", "mistreatment/maltreatment of older adults" and "abuse of older adults". In French, they are “maltraitance”, “mauvais traitements” and “abus”. None of the terms, other than the French “maltraitance,” are without criticism. Respondents preferred the term "maltraitance envers les personnes aînées" in French and "abuse of older adults/older persons" in English, while considering the term "mistreatment of older adults/persons". Recently, in July 2022, the World Health Organization (WHO) opted to use the term "abuse of older people". In terms of a definition, the Toronto Declaration of 2002 still serves as a reference in many respects, although there is no consensus and it is subject to many nuances and adaptations. It states that: "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.”

Any definition of abuse usually includes two parts: a statement of the problem and a list of recognized types and forms of abuse. A review of legislation, policies and regulations shows the variety of terms used (abuse, mistreatment, violence, domestic violence in English) in Canadian jurisdictions, the diversity of ways in which the problem is framed, and the recognition of various types and forms of abuse. Most of the differences in provincial/territorial definitions of abuse are related to the way in which the ‘trust relationship’ (Hall et al., 2016) dimension is framed. There is no doubt that the definition of abuse must include both violence and neglect. The most common forms and types of abuse recognized in provinces and territories include psychological/emotional abuse, physical abuse, material/financial abuse, neglect and sexual abuse. Some jurisdictions include self-neglect. Several avenues are being explored to recognize other types and forms of abuse in a possible Canadian definition, including organizational abuse, abuse of power by agents, spiritual/religious or cultural abuse, and others.

Data quality is primarily affected by the various modes of data collection and recording. Two types of data collection or recording are used worldwide: population-based surveys, which generally rely on self-reporting by people who have experienced abuse or, less frequently, by witnesses to abuse, and administrative or operational data, which is derived from the application of laws or policies, or from public, private, or community-based care, service, public safety, or other organizations. The first is considered more objective than the second, which only reports on situations known to the organizations. It is important that data collection be representative of various subgroups of the older Canadian population. To this end, special attention is given to cultural minorities, older LGBTQ people and people with physical or cognitive disabilities, three subgroups for which data is limited. Next, data from four settings where abuse may occur are examined: the home, residential facilities, rural and remote areas, and prisons. Although it requires further work, abuse in the home is the best documented. Prevalence studies in residential care facilities are rare worldwide and non-existent in Canada; this is a field that needs to be explored. Studies on the abuse of older persons conducted in Canada are rather silent on rural and remote areas, which makes it difficult to understand what might be specific to these areas. In this regard, an expansion of the prevalence studies conducted in the community would allow for detailed analyses by rurality and region. Finally, much work remains to be done regarding abuse in correctional institutions.

The last point in the section on data quality deals with reporting mechanisms and the levers and obstacles to their use. A reflection is offered on the application of Canada’s Criminal Code in situations of abuse, which often seems marginal compared to the estimated number of cases per year in the country. While some of the consulted experts believe that the Criminal Code responds well to situations of abuse requiring legal intervention, others believe that adding a specific section on the abuse of older persons is necessary and that it could help rectify the state of knowledge on the subject. Experts felt that mandatory reporting of abuse is only appropriate when older persons are under protective custody or living in residential and long-term care settings. Each province has adopted legislation and policies to address abuse and, as with the definitions, there is wide variation. It will be a challenge to find a recording method that will allow all these data sources to be compared with one another. Finally, the obstacles faced by practitioners in recognizing abuse and the many obstacles and levers to seeking help, reporting, and the complaint process that older persons face are outlined in order to highlight the challenges of obtaining complete and quality information.

The final section outlines a series of proposals for a pragmatic Canadian approach to enhancing data collection. It is suggested that Canada align itself with the five priorities identified by the WHO in June 2022 as part of the work for the United Nations Decade of Healthy Ageing. These priorities are: combatting ageism; generating more and better data on prevalence, risk and protective factors; developing and scaling up cost-effective solutions; investing in generating data on the costs of abuse and on the cost-effectiveness of solutions; and, raising funds for both research and intervention (World Health Organization [WHO], 2022) The proposals are then expanded under four additional headings: choice of terminology, adoption of a definition, population-based study data, and administrative or operational data.