Prevention and detection of physical and

Prevention and detection of physical and

PREVENTION AND DETECTION OF
PHYSICAL AND ECONOMIC ELDER
ABUSE IN THE BASQUE COUNTRY
Involvement of the Provincial Council of
Bizkaia
Lourdes Zurbanobeaskoetxea Laraudogoitia
Assessment and Guidance service. Provincial Council of Bizkaia
Social and Health Coordination. Basque Country Government
INDEX
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Flash of Bizkaia
Previous: Elderly abuse as an object of study
Design of a tool for detecting situations of abuse
Metodology
The tool
Conclusions
Recommendations
The implementation
In Bzkaia
FLASH SHOT FOR AN AGEING
TERRITORY
• Inhabitants over 65:
Biscay
Global population:
1.150.000 inhabitants.
76% in Bilbao area.
112 municipalities.
Socio-economic figures:
GDP per capita 32% over EU27
AROPE 22,7% (EU27 18,5%)
Unemployment 15,98%
2011
2025
2050
Biscay
20%
26%
37%
EU27
17,4%
22%
28,7%
• Life expectancy at birth:
Biscay
EU27
Women
85,1
82,5
Men
78,2
76,7
Data: The 2012 Ageing Report (EU Commision, 2012)
Basque Health Survey (Basque Government, 2013)
PREVIOUS
Elderly abuse as an object of
study
INTERNATIONAL STUDIES
Pillemer y Finkelhor (2008)
3,2%
 Objetive: prevalence and types
 Sample: 2020 persons in
comunity
 Telephone and personal
interviews





Comijs et al., Holanda 1998,
5,6%
National Center on Elder
Abuse, EEUU, 1998; 2,36%
Vida et al. Canadá, 2002;
16%
Cooney et al. Irlanda, 2006
caregivers of elderly with
dementia; 52%
O´Keeffe et al. Reino Unido,
2007; 2,6%
STUDIES IN SPAIN
Pérez Cáceres et al.(2008)
44,6%
 Women older than 75
Sample: 460 elderly of health
centrers
 Questionnaire
Pérez Rojo, Izal y Montorio (2008)
12%
EASI Community level (health and social
services)
In the absence of cognitive impairment
Reina Sofía center; Iborra (2008)
Surveys of elderly people (0,8%)
and caregivers (4,5%)
PREVALENCE
•
•
Very disparate rates
0,8 % to 52,6%. CAUTION
– PROBLEM:
• the fragility of the elderly persons in most of the research
• the lack of consensus in terms of concepts and definitions
• the major obstacles that research faces in institutional ambits
The bulk of the studies rates of abuse of between 4% and 12% among
people over the age of 70.
LANDMARKS
Since 2002: World Health Organization (WHO)
Encourages the study of elderly abuse conciding whith the Second World
Assembly on Ageing, as it propounds :
• the importance of awareness, education and legislation
• recommends the development of detection and welfare programmes
• creation of the International Network of the Prevention of Elder Abuse (INPEA).
In 2013: The United Nations Secretary- General, Ban Ki-Moon
Urged governments across the world to adopt more effective
prevention strategies and stricter laws and policies
15 June being established as WORLD ELDER ABUSE
AWARENESS DAY.
Basque Country
STUDY OF PREVALENCE OF ELDERLY ABUSE
IN BASQUE COUNTRY (2010-2011)
PREVALENCE
 Perceived by elderly 0,9%
 Perceived by interviewer 1,5%
1207 individuals >=60
años  72.6% women

24.9% over 75
Lack of hygiene
Inhabitability of housing
Dejected, anxiety…
Lack of technical support
Major campaing: ‘Don't let that you happen’
(sept-oct 2012)
La indiferencia
y el ninguneo
Campaña por el buen trato a las personas mayores
Design of a tool for detecting situations of abuse.
At the request of the Basque Parliament (BOPV 22.02.2013 /14/878)
WHAT WE WANT TO?
Develop an instrument
enabling objective assessment of elderly vulnerability in
presences of abuse situations,
assess the seriousness of the risk,
reporting on interventions to be carried out, where appropriate
DESIGNED FOR WELFARE PURPOSES
detection of situations of suffering amongst elderly people
in order to alleviate them.
TERMINOLOGY AND DEFINITION
ABUSE
Any single or repeated ACTION,
or LACK OF SUITABLE
RESPONSE
that harms an elderly person or
causes them distress, within any
relationship in which there is a
duty of trust
INTENTIONAL
OR
UNINTENTIONAL
TYPES
PHYSICAL ABUSE:
 The use of physical force, violence or the omission of the care and
attention to basic needs carried out by other people, and causing as
a consequence damage, pain or physical impairment
ECONOMIC ABUSE:
 Misuse, misappropriation or not authorized AND/OR exploitation of
economic resources or materials of the older person, resulting in a
financial loss for the same
THE FOCUS
Over 65s, which especially are in situations of
dependency, with poor communication and lack of
access to social and health care resources.
ALWAYS in woman, over 80 years
old and with total dependence for
the ADL
APPLICATION CONTEXTS
SOCIAL SERVICES
 Municipal with direct attention
 Secondary social services
(Provincial Council Dependency
Assessment)
 Nursing Homes and Day Centres
HEALTH SERVICES
 Primary Care
 Emergency admissions
SOCIO-HEALTH CARE
FINANCIAL AND NOTARIAL FIELD
JUDICIAL FIELD
 Judicial disability
 Involuntary income
TUTELAGE INSTITUTES
METODOLOGY
ADVISORY TEAM

Zahartzaroa: analysis of scientific evidence
SCIENTIFIC TEAM



Deliberation on risk factors and indicators identified in the
scientific literature
Contrast with the reality
Determination of instrument
PILOT FOR VALIDATION



Agreement with the university of Deusto
Quantitative and qualitative methodology
Final wording of the procedure
MULTIPROFESIONAL / INTERINSTITUCIONAL






Municipal social services,
Bizkaia Dependency
Assessment and Guidance
Department
Bizkaia Department for
Residential Homes
Primary healthcare
Hospital A&E departments
Residential home for the
elderly







Socio-healthcare unit
Basque Institute of Legal
Medicine
Bizkaia Tutelage Institute
Official College of Medical
Practitioners
Collective Movement against the
abuse of the elderly
Bizkaia Ethical Committee for
Social Welfare
University.
Scientific team
Advisory team
 CONSULTANT AND WRITER:
Marije Goikoetxea. Psicóloga.
Universidad de Deusto.
 SECRETARY:José Javier Miguel.
Psicopedagogo. Secretario de la
AVGG Zahartzaroa.
 COORDINATOR: Lourdes
Zurbanobeaskoetxea. Médica.
Coordinadora socio-sanitaria
CAPV.
 SUPERVISOR: Gema Pérez.
Doctora en Psicología. Universidad
CEU-San Pablo. Experta en malos
tratos a personas mayores.
HEKTH SERVICES

Amaia Andrés. Médica. Atención Primaria.

Maite Berasaluce. Enfermera. Atención Primaria.

Itziar Barreña. Médica.JUrgencias. H.U. de Cruces.

Begoña Pablos. Médica. Colegio de Médicos de
Bizkaia.
SOCIAL SERVICES

Iñaki Artaza. Geriatra. Presidente de Zahartzaroa.

Ainhoa Castejón. Médica. S. de Val y Or. DFB.

Elixabete Elordi y Agurtzane Etxezarraga.
Trabajadoras Sociales. S.de Val y Ori. DFB.

Elena Aisa. Trabajadora Social. S.de Centros. DFB.

Karmele de Guinea. Jefe de Sección de Programas
Sociales. Ayuntamiento de Bilbao.

Ignacio Pérez de Mendiguren. Médico. Res.F. Matía.
LEGAL FIELD

Mª Angeles Solano. Médica Forense.

Mª Dolores Etxano. Economista. I.Tutelar de Bizkaia.

Goretti Sagarduy. Abogada. Asociación de lucha
contra el maltrato a mayores. ALMAMA.
TWO STAGES
1.OBSERVATION
1.1.Prevention: assess elderly
person´s vulnerability
– RISK FACTORS
2.ACTION
consistent with the seriousness
of the case
–
1.2.Detection of indicators
apprisal of the seriousness of
the risk
– INDICATORS OF ABUSE
–
–
–
FOR PREVENTION
SERIOUS RISK
VERY SERIOUS RISK
URGENT INTERVENTION
PHASE 1. OBSERVATION
1.1
PREVENTIVE
Risk factors
Assessment of
vulnerability
2 or more risk factors
Elder verbalizes
victimhood
Professional identifies damage
that is not explained
Any professional contact
with the elderly person
1.2
DETECTION OF
WARNING
INDICATORS
ASSESSMENT OF
THE POTENCIAL
RISK
Questionnaire of prevention and detection of risk
OBSERVATIONAL
WHEN?
 Periodically as an instrument of prevention
 Person tells status of damage
 Professional identifies damage that is not explained

WHO?: Any professional contact with the older
person

FOR WHAT?: Assess potential risk
PHASE1.1 RISK FACTORS
Questionnaire for elderly abuse indicators detection and
rating severity alert
IF SO, WHEN?
 2 or more risk factors
 Elder verbalizes victimhood
 A situation of damage is detected
WHO? Always by reference professional (social
worker in social services health primary care team)
FOR WHAT? Assess the seriousness of the risk and
to initiate interventions
Fase
1.2.WARNING
INDICATORS
Fase
1.2. INDICADORES
DE ALERTA
• GENERAL INDICATORS
• INDICATORS OF SOCIAL
RELATIONS
• PHYSICAL INDICATORS
• ECONOMIC INDICATORS
BLUE
YELLOW
RED
SERIOUSNESS OF THE RISK
Serious risk 2-3 blue indicators
 Assessment in 3-6 months
Very serious risk + 3 blue or 2-3 yellow indicators
 Assessment in 1-3 months
Urgent intervention + de 3 yellow or 2-3 red indicators
PILOT AN VALIDATION
BILBAO: CASCO VIEJO
– Profesionales de SAD
– Equipo de AP del Centro de Salud
– Equipo Servicio Social de Base
– Kutxabank
– Urgencia Hospital de Basurto
– Equipo de valoración de dependencia
(casos Casco Viejo)
ZUIA
– Equipo de AP de Centro de Salud
– Equipo Servicio Social de Base
– Kutxabank
HONDARRIBIA
– Equipo de AP de Centro de Salud
– Equipo Servicio Social de Base
– Kutxabank
OTROS:
– Urgencia de H. Cruces;
– Urgencias Valoración DFB
14/07/2014
MAYO-SEPTIEMBRE 2014: DETECCIÓN
FACTORES DE RIESGO

EQUIPOS DE AP

SERVICIOS SOCIALES MUNICIPALES

SUCURSALES BANCARIAS
OCTUBRE: INDICADORES
• EQUIPOS DE AP
• SERVICIOS SOCIALES MUNICIPALES
• URGENCIAS SANITARIAS Y SOCIALES
NOVIEMBRE-DICIEMBRE 2015
ANALISIS DE DATOS
ENERO-MARZO 2016
INFORME Y PROPUESTAS DE IMPLANTACIÓN
CONCLUSIONS

It has developed a simple tool of prevention and intervention
It´s observational, therefore apply also to persons with cognitive impairment
and communication difficulties.
The instrument has been validated as sensitive for its objective

It is equally valid for the health and social fields.





Particularly sensitive in the detection of physical abuse indicators in emergency
health and social services.
Professionals involved value very positively the instrument and consider it
necessary to the implementation of the same in a systematic way.Recomendación
de introducir algunas mejoras para evitar interpretaciones diversas de algunos
ítems.
New proposal of weighted numerical measurement of the indicators
INDICATORS
RECOMMENDATIONS ON INTERVENTIONS




Complete healthcare and social assessment (different
time limits) or intervention of immediate protection if
necessary.
Assessment of the capacity and report to public
prosecutors office if necessary
Socio-Meath coordination, Join intervention plan and
report attached to the history
Injury report, if necessary
ANOTHER RECOMENDATIONS
• TRACEABILITY: When and who made the observation and
evaluation and final report
• ALWAYS ACT ON THE HIGHER LEVEL OF RISK OR DAMAGE
DETECTED
• If there is no intentionality avoiding judicial, though it is
necessary to be the part of injuries if observed
• Take into account in the decisions on intervention if the
elderly person be able.
• Damage as little as possible the CONFIDENTIALITY
AND NOW??
• Create a coordinator team
• Selection of people responsible for implementation
(in organizations)
• Training of managers
• Cascade professional training to advance
implementation
WHAT ARE WE DOING IN THE PROVINCIAL
COUNCIL OF BIZKAIA

Detection of risk factors in women older than 80 years,
being the group most at risk (assessment teams)

Detection of indicators directly administered
questionnaire on indicators to cases classified as urgent

Definition an implementation of a internal procedural
protocol in the event of the detection of situations of
abuse (objective of ISO 9000 standard)
ESKERRIK ASKO
THANK YOU
[email protected]