Make Addressing Ageism, Elder Abuse and Social Isolation
Setting the Context
Ageism
Older Canadians are valuable members of their communities, yet many are vulnerable to various forms of ageism, abuse, mistreatment, and isolation. Ageism is commonly understood to be, “the stereotyping of, and discrimination against, individuals or groups because of their age”.[1] While this can include those who are young or old, ageism appears to be a more significant issue for older members of society. Indeed, many have come to remark that this form of discrimination still appears to be the last acceptable ‘ism’ in our society.
Ageism manifests itself in multiple ways, such as prejudicial attitudes towards older people, old age, and the ageing process; discriminatory practices against older people; and institutional practices and policies that perpetuate stereotypes about older people.[2],[3] Ageism still remains a significant problem. In a Canadian survey, 63% of respondents 66 years of age and older indicated that, “they have been treated unfairly or differently because of their age”.[4] Comparatively, 80% of Canadians agree with the statement, “older adults 75 and older are seen as less important and are more often ignored than younger generations”; while 51% agree that, “ageism is the most tolerated social prejudice when compared to gender or race-based discrimination”.[5]
Negative attitudes regarding older Canadians can have a significant impact on their health, well-being, and involvement within their communities. Indeed, ageism can influence the way decisions are made about older people. Within health care, for example, a person’s age, rather than their overall health status, can influence medical decisions about the diagnostic tests or treatments provided to an older person. Resources and treatment options may be withheld from an older person that wouldn’t be withheld from a younger person. Ageism in the workforce is manifested when, for example, a person’s age, rather than their experience and abilities, influences hiring decisions. Mandatory retirement was ended in Canada in December 2011 when the federal government officially repealed the section of the Canadian Human Rights Act that permitted it.[6] Nevertheless, according to a poll, 74% of Canadians still consider age discrimination to be a problem in the workplace.[7]
Two specific consequences often linked to ageism are elder abuse and social isolation.
Elder Abuse
The World Health Organization defines the abuse of older adults as “a single or repeated act, or lack of appropriate action, occurring in any relationship where there is an expectation of trust that causes harm or distress to an older person.”[8] Elder abuse can destroy an older person’s quality of life, and significantly increase their overall risk of death. Elder abuse can take several forms, including physical abuse, psychological or emotional abuse, financial abuse, sexual abuse, and neglect. Table 1 provides a description of the different forms of elder abuse.
Table 1 Understanding the Several Forms of Elder Abuse[9]
Financial Abuse |
The most common form of elder abuse, financial abuse, often refers to the theft or misuse of money or property like household goods, clothes or jewelry. It can also include withholding funds and/or fraud. |
Psychological (Emotional) Abuse |
The willful infliction of mental anguish or the provocation of fear of violence or isolation is known as psychological or emotional abuse. This kind of abuse diminishes the identity, dignity and self-worth of the older person. Forms of psychological abuse include a number of behaviors, for example: name-calling, yelling, ignoring the person, scolding, shouting, insults, threats, provoking fear, intimidation or humiliation, infantilization, emotional deprivation, isolation or the removal of decision-making power. |
Physical Abuse |
Any physical pain or injury that is willfully inflicted upon a person or unreasonable confinement or punishment, resulting in physical harm, is abuse. Physical abuse includes: hitting, slapping, pinching, pushing, burning, pulling hair, shaking, physical restraint, physical coercion, forced feeding or withholding physical necessities. |
Sexual Abuse |
Sexual abuse is understood as contact resulting from threats or force or the inability of a person to give consent. It includes, but is not limited to: assault, rape, sexual harassment, intercourse without consent, fondling a confused older adult, intimately touching an older adult during bathing, exposing oneself to others, inappropriate sexual comments or any sexual activity that occurs when one or both parties cannot, or do not, consent. |
Neglect |
Neglect can be intentional (active) or unintentional (passive) and occurs when a person who has care or custody of a dependent older adult fails to meet his/her needs. Forms of neglect include: withholding or inadequate provision of physical requirements, such as food, housing, medicine, clothing or physical aids; inadequate hygiene; inadequate supervision/safety precautions; withholding medical services, including medication; overmedicating; allowing an older adult to live in unsanitary or poorly heated conditions; denying access to necessary services (e.g., homemaking, nursing, social work, etc.) or denial of an older adult’s basic rights. For a variety of reasons, older adults themselves may fail to provide adequate care for their own needs and this form of abuse is called self-neglect. |
Systemic Abuse |
The society, and the systems that develop within it, can generate, permit or perpetuate elder abuse. Most prevalent is discrimination against older adults, due to their age and often combined with any of these additional factors: gender, race, colour, language, ethnic background, religion, sexual orientation, ability, economic status or geographic location. |
Box 1. NIA Definitions of Caregivers
‘Unpaid caregiver’ refers to an individual who provides care to another person primarily because a personal relationship exists and can include family, friends, and neighbours of care recipients. Unpaid caregiver is henceforth also referred to as ‘caregiver’.
‘Care provider’ refers to an individual who provides care because of a financial relationship which may include licensed or unlicensed care providers.
Most instances of elder abuse are committed by family members and caregivers of older people. The prevalence and severity of elder abuse is therefore difficult to ascertain since, in many instances, abuses are often underreported or go unnoticed. This is largely due to many older persons not being willing to report elder abuse because of the social stigma attached to it or their concern regarding the consequences of reporting a loved one or caregiver (see Box 1 for the definition of ‘caregivers’ based on Stall et al. 2019).[10] For instance, reporting abuse could mean the withdrawal of care or the loss of their caregiver, making their decision to report abuse much more difficult. As a result, while up to 10% of older Canadians experience a form of abuse,[11] it’s estimated that only one in five incidents of elder abuse are reported.[12]
Many forms of elder abuse are also on the rise. For example, shortly after the 2008 recession, large Canadians law firms reported seeing a striking increase in the number of challenges to Powers of Attorney, some of which constitute financial abuse.[13] Health Canada notes that financial abuse of older adults tends to be the most common form of abuse (62.5%), followed by verbal (35%) and physical abuse (12.5%), along with neglect (10%).[14] Primary caregiver stress has also been shown to significantly contribute to the incidence of elder abuse, highlighting the need to provide caregivers with increased supports.
In 2018, there were 12,202 cases of police-reported violence against older adults in Canada, 33% of which were victimized by a family member.[15] While older adults are the least likely demographic to suffer violent crime by a stranger, they are the population most at risk of suffering violence at the hand of a family member or relative.[16] From 2009 to 2018, the rate of police reported violence against older adults by family members increased by 11%, while spousal violence and violence against children either plateaued or decreased during the same period.[17]
Elder abuse is also more complicated than abuse in other age categories (e.g. child abuse), since older adults generally have the capacity to, and are expected to, address issues themselves. However, the hidden power imbalances that can occur in relationships of dependency between older adults and their families or caregivers further complicates these situations. The increasing prevalence of older Canadians living with dementia, functional impairments, or poverty, is placing older adults in vulnerable positions that could allow them to become victims of abuse or neglect.
Furthermore, determining when health, social and community care, and public safety professionals have a duty to report elder abuse and neglect (similar to child abuse and neglect) is another aspect that will need to be revisited. Older adults may neglect to take care of their personal health and well-being, often due to declining mental awareness or capability. Some older adults may also choose to deny themselves health or safety benefits, which may not be self-neglect, but a reflection of their personal choice. While difficult, caregivers and other responsible parties must honour an older person’s choice to live at risk, especially if the older adult is capable of making such decisions for themselves.
As Canada’s population ages, elder abuse may also increase unless it is more comprehensively recognized and addressed. At a minimum, increasing awareness among older Canadians and members of the public about elder abuse and neglect, so they can better understand when and how they should provide help is a needed first step.
Social Isolation
There is a growing concern that older Canadians are particularly at risk of becoming socially isolated. Although multigenerational living is once again on the rise, people today have become less likely to live in intergenerational communities, and less likely to participate regularly in traditional faith-based or social groups. Furthermore, the growing presence of physical and cognitive limitations while ageing, along with the fact that older adults also tend to outlive their decision to stop driving by up to decade, may all contribute to limiting one’s ability and or willingness to interact with others.
Increased social frailty can develop with time that puts older Canadians at particular risk of becoming socially isolated, especially if they outlive their spouses or partners, family members, or friends. A report focusing on ageing in rural and remote areas of Canada also emphasized that social isolation can be caused by having a lack of transportation options. [18]
Research shows that about 30% of Canadians are at risk of becoming socially isolated while Statistics Canada estimates that between 19-24% of Canadians over the age of 65 wish they could participate more in social activities. [19] Social isolation can have a significant effect on a person’s overall health and well-being as it can lead to loneliness, elder abuse, and declining mental health. Finding ways to minimize this in communities should be a priority.
The National Seniors Council Report on the Social Isolation of Seniors (2014)[20] determined that older Canadians are at increased risk for social isolation when they:
- Live alone;
- Are 80 or older;
- Have compromised health status, including having multiple chronic health problems;
- Have no children or contact with family;
- Lack access to transportation;
- Have a low income;
- Have a changing family structure, such as where younger family or community members migrate for work and leave older adults behind,
- Live in isolated urban, rural or remote situations; and
- Have experienced a critical life transition (e.g. retirement, bereavement).
Social isolation is considered both a risk factor for as well as a result of elder abuse, representing the complexity and importance of the social network around the health and well-being of older Canadians.[21] While the negative effects of isolation are primarily borne by older adults themselves, communities are also at risk of suffering from the lack of involvement of valued older community members as well. Indeed, missing the contributions of older adults can lead to, “a lack of social cohesion, higher social costs, and the loss of an unquantifiable wealth of experience that older adults bring to families, neighbourhoods and communities”.[22]
Finally, the Canadian government has made concerted efforts to raise awareness around and address issues of elder abuse and social isolation in Canada. Some key initiatives have included:
- Launching of the Elder Abuse – It’s Time to Face the Reality Awareness Campaign on television, print and online in 2009 followed by a public opinion survey that showed 91% of Canadians have a basic awareness of elder abuse.[23]
- Passage of the Protecting Canada’s Seniors Act in 2013 which amended the Criminal Code of Canada so that age is considered an aggravating factor for criminal sentencing purposes.
- Adoption of the Canadian Victims Bill of Rights in 2014 that gives statutory rights to victims of crime.
- Launching of the Government of Canada’s www.seniors.gc.ca website in 2015 as an online awareness and resource center that includes specific sections on elder abuse and social isolation.
- Funding of the New Horizons for Seniors Program (NHSP) in 2018 that provides funding annually to for-profit and not-for-profit organizations to support projects involving older adults with objectives of promoting social participation, mentoring and volunteering to mitigate the risk of social isolation.[24],[25]
Societal ageism manifested itself more recently at the start of Canada’s COVID-19 pandemic experience with disgraceful incidents such as the appearance and widespread use of hashtags on social media, such as #boomerremover[26]Furthermore, consideration of age alone in the allocation of medical treatments, without recognizing the diversity among older adults became a real concern.[27] The pandemic also highlighted the reality of intergenerational complacency and a general disregard for older populations due to early reports that most serious infections and highest risk of death appeared to be occurring amongst older adults.[28] Indeed, analyses by the National Institute on Ageing showed that by the summer of 2020, over 80% of all COVID-19 deaths in Canada occurred amongst older Canadians in nursing home and retirement home settings.
The COVID-19 pandemic also posed new health risks beyond transmission of virus. Due to significant visitor restrictions placed on those wishing to visit others in both nursing and retirement homes and acute care settings to reduce disease transmission, many older adults in these settings experienced additional social isolation, loneliness, and inactivity. Without being able to sustain frequent and meaningful social interactions with others, self-isolation and physical distancing measures can lead to rapid declines in cognitive functioning and increased rates of depression and anxiety.[29],[30]
During the COVID-19 pandemic, elder abuse hotlines were reporting a 10% increase in calls regarding scams and frauds.[31] This highlighted that in times of crisis, perpetrators of financial abuse looked to prey on those most vulnerable, many of whom were older adults. One thing that the COVID-19 pandemic has reinforced is that there is an increased need for a greater awareness of and strategies to address ageism, social isolation, loneliness, and elder abuse.
What Are the Issues?
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Age-Related Social Issues Such as Ageism, Elder Abuse, and Social Isolation Pose Significant Negative Health Risks for Older Canadians
Ageism, elder abuse, and social isolation in all of forms negatively impact the health of older adults. While some forms of elder abuse, including physical or sexual abuse in particular, have more obvious negative health implications,[32] other forms of elder abuse such as emotional and financial abuse have the potential to deprive older adults of basic necessities for health and well-being. Additionally, ageist stereotypes based on perpetuated myths regarding the abilities and competencies of older adults affect their ability to remain active and valued members of society. Similarly, social isolation – whether it is self-imposed or imposed upon by others – is also known to have tangible and significant effects on the health status of older Canadians.
Social isolation has been proven to lead to engagement in adverse health behaviours such as: smoking, drinking and maintaining an unhealthy diet.[33] This may help explain why isolated older adults are more likely to experience a fall, coronary heart disease, stroke, suicide and depression. [34],[35] Evidence further suggests that social isolation is a correlate of specific illnesses such as dementia. Specifically, “the lack of supportive social networks has been linked to a 60% increase in the risk of dementia and cognitive decline.”[36] In a meta-analysis of 148 studies, authors demonstrated that social isolation is a significant predictor of death.[37] Further, as a predictor of early mortality, social isolation was also found to be as strong a predictor as smoking over 15 cigarettes a day or excessively consuming alcohol.[38] Importantly, social inclusion is a significantly protective factor against death and dementia.[39],[40]
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Elder Abuse and Social Isolation Have Systemic Cost Implications
The impact of ageism, social isolation and elder abuse on the individual health status of older Canadians also directly results in broader health and social system costs. For example, social isolation has been shown to be a significant risk factor for hospitalizations[41] and hospital readmissions[42] amongst older adults. In fact, socially isolated older adults are four to five times more likely to be admitted to hospital than older adults in general.[43] Disease specific costs known to be correlated to social isolation, such as heart disease, stroke, dementia and depression as well as falls are themselves significant. Finally, social isolation has been identified as one of the top four predictors for placement into more costly nursing home settings.[44]
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Certain Populations Are More Vulnerable to Experiencing Social Isolation and Elder Abuse
Current evidence suggests that there are specific older populations of Canadians that are particularly at risk of experiencing social isolation and elder abuse. The National Seniors Council Report on the Social Isolation of Seniors (2014)[45] highlighted the following specific populations as being at greatest risk:
- Older adults with physical, mental health issues (including older adults with Alzheimer’s disease or other dementia, or multiple chronic illnesses)
- Low income older adults
- Older adults who are caregivers
- Indigenous older adults
- Older adults who are newcomers to Canada or immigrants (language proficiency issues, separation from family, financial dependence on children, low levels of inter-ethnic contact, discrimination); and,
- Older adults who are lesbian, gay, bisexual, transgender, queer, intersex, and/or two-spirit (LGBTQI2S).
Older immigrants currently arriving in Canada under the family class category were highlighted by the Special Senate Committee on Aging as a particularly vulnerable group,[46] mainly because they are subjected to a 10 to 20-year sponsorship period. As a result, sponsored parents or grandparents are not entitled to any form of social assistance even if they become citizens during this time. This means that these older adults will remain ineligible for the Old Age Security (OAS) and Guaranteed Income Supplement (GIS) benefits that other income-taxpaying older Canadians would receive.[47] In addition, many vulnerable older immigrants would not have had any employment history in Canada, thus making them ineligible for the Canada Pension Plan or Quebec Pension Plan (CPP/QPP) unless they come from a country with a reciprocal pension agreement. This also leads to sponsored older adults having limited or no access to certain forms of provincial and territorial long-term home, community, and nursing home care, until after being a resident for ten years. Many of these older adults do not have independent sources of income. As a result, they live in a perpetually dependant state due to their limited options. They are largely dependent on their families, which can place them at increased risk of abuse, exploitation, or neglect.
In 1997, the Government of Canada reduced the period of sponsorship for spouses and partners from ten to three years in recognition of the potential for abuse due to long periods of sponsorship dependency[48]. Therefore, many argue that a similar reduction of the immigration sponsorship period for parents and grandparents could significantly improve the settlement of sponsored older adults in Canada and reduce distress and the potential consequences that they may experience in the process of integration.
Some Forms of Isolation and Elder Abuse Vary by Region
Available data on family violence demonstrates that despite the national awareness efforts mentioned above, rates of family violence against older people can vary significantly by province and territory, with a tendency to occur mostly in rural settings.[49] Police-reported family violence against an older adult, for example, is significantly higher in Canada’s territories compared with all other jurisdictions, while Saskatchewan, Alberta, and Prince Edward Island were the three provinces with the highest reported rates of family violence against older people (See Table 2).[50] Taken together, these findings help point to complex social, geographic and economic factors underlying higher prevalence of this form of elder abuse in certain regions.
Table 2. Older Adult Victims of Police-reported Family Violence, by Sex of Victim, Province and Territory[51]
Older adult victims of police-reported family violence and non-family violence, by victim sex and province or territory, 2016 to 2017
| Province or territory | 2017 | |||||
| Female victims | Male victims | Total victims | ||||
| number | rate | number | rate | number | rate | |
| Family violence | ||||||
| Newfoundland and Labrador | 30 | 56 | 38 | 79 | 68 | 67 |
| Prince Edward Island | 14 | 94 | 10 | 78 | 24 | 87 |
| Nova Scotia | 51 | 53 | 43 | 52 | 94 | 53 |
| New Brunswick1 | 54 | 77 | 52 | 83 | 106 | 80 |
| Quebec | 588 | 74 | 421 | 62 | 1,009 | 68 |
| Ontario | 649 | 54 | 402 | 39 | 1,051 | 47 |
| Manitoba | 72 | 72 | 73 | 84 | 145 | 77 |
| Saskatchewan | 102 | 119 | 83 | 110 | 185 | 115 |
| Alberta | 265 | 99 | 208 | 88 | 473 | 93 |
| British Columbia | 316 | 72 | 213 | 53 | 529 | 63 |
| Yukon | 5 | 216 | 8 | 338 | 13 | 278 |
| Northwest Territories | 23 | 1,427 | 16 | 1,027 | 39 | 1,230 |
| Nunavut | 10 | 1,271 | 14 | 1,980 | 24 | 1,606 |
| Canada | 2,179 | 70 | 1,581 | 58 | 3,760 | 64 |
| 1 Excludes data from the Saint John Police Service due to data quality concerns.
Note: Rates are calculated on the basis of 100,000 population aged 65 to 89 years. Populations based upon July 1st estimates from Statistics Canada, Demography Division. Family violence refers to violence committed by spouses (legally married, separated, divorced and common-law), children (biological, step, adopted and foster), siblings (biological, step, half, adopted and foster) and extended family members (e.g., grandchildren, nephews, nieces, cousins and in-laws). Victims refer to those aged 65 to 89 years. Victims aged 90 years and older are excluded from analyses due to possible instances of miscoding of unknown age within this age category. Excludes victims where the sex or the age was unknown or where the accused-victim relationship was unknown. Percentages may not total 100% due to rounding. Based on the Incident-based Uniform Crime Reporting Survey, Trend Database, which, as of 2009, includes data for 99% of the population in Canada. As a result, numbers may not match those presented elsewhere in the report. |
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Evidence-Informed Policy Options
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Improve Awareness around Ageism, Social Isolation and Elder Abuse
The federal government has thus far supported general awareness campaigns around issues of elder abuse. While a general awareness exists around the issue of elder abuse amongst Canadians, specific forms of elder abuse, such as financial and domestic abuse, are on the rise and require a better public understanding of how to identify and effectively mitigate these issues. The widespread issue of ageism is also one that can further contribute towards elder abuse and social isolation and requires increased general awareness to help Canadians better recognize and address it.
The federal government has also funded work that has further identified older populations that are most at risk of social isolation and elder abuse.[52] In particular, rural and Indigenous populations have been identified as being at particular risk of experiencing social isolation as well as violent crimes. Understanding and addressing the complex cultural and societal issues related to ageism, social isolation, and elder abuse, will require a multi-faceted approach. The federal government is in a position to lead the development and dissemination of both general and specifically targeted approaches to raising awareness and preventing ageism, social isolation, and elder abuse in partnership with provinces and territories.
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Address the Higher Rates of Elder Abuse in Rural, Indigenous and Immigrant Populations
Evidence suggests that social, cultural, geographical and economic factors likely play a significant role in regional patterns and presentations of elder abuse. Furthermore, rural dwelling older adults are also increasingly prone to social isolation, neglect and other forms of abuse as access to transportation and/or services are sparse or non-existent in many rural communities. As a result, when older adults in these settings outlive their ability or wish to stop driving, staying connected and accessing support and services becomes challenging. The federal government could provide leadership to prioritize work that helps to understand and address issues of social isolation, abuse, and violent crimes in these communities.
In line with the 2009 recommendation of the Special Senate Committee on Aging,[53] the Government of Canada should reduce the immigration sponsorship period for older relatives and the residency requirement for entitlement to a monthly pension under the Old Age Security Act from ten to three years. In 1997, the Government of Canada made the decision to reduce the period of sponsorship for immigrating spouses and partners from ten to three years in recognition of the potential for abuse in sponsorship arrangements and in line with the time it takes to become a Canadian citizen.[54] Older immigrants remain the only group required to have a 10-year sponsorship period.[55] Aligning all sponsorship periods could significantly reduce the risk of abuse they older adults may experience during their integration process.
References
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