neglect, abuse and violence in later life...

NEGLECT, ABUSE AND VIOLENCE IN

LATER LIFE:

INTERSECTIONALITY OF GENDER AND AGE

Competing Paradigms of Elder Abuse: Learning from Intimate Partner Abuse, Active Aging, and Vulnerable Older Adult Research (Emphasis on Older Women)

From an International Perspective

Patricia Brownell, PhD, Associate Professor Emerita of Social Service, Fordham University, and Immediate Past President, National

Committee for the Prevention of Elder Abuse

Toronto, Ontario, November 22, 2017

Popula'onAgeingandGender

•  Globaltrendchangingeconomicsandsocie3esaroundtheworld

•  In2012,people60+represented11.5percentofglobalpopula3on;by2050willdoubleto22percent.

•  Olderwomenoutnumberoldermen:in2012forevery100womenage60+therewere84men;forevery100womenage80+therewere61men;by2050,over1billionwomen60+.

•  Thefeminiza3onofageing,represen3ngtheintersec3onofageandgender,hasimportantimplica3onsforpolicyandprac3ceastheworldcon3nuestoage

•  Neglect,abuseandviolenceagainstolderwomenremainslargelyinvisible:itmustbecomevisibleinordertoend.

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DifferingTheore,calPerspec,ves

• DifferentResearchFramesbasedondifferenttheore3calbasesusedifferentagecohortdataanddifferentvariables,andresultindifferentandconflic3ngprevalencedata.

• In3matePartnerAbuse:Oldagemaystartat30,40,50or60orolderTypesofabuse:physical,sexual,psychologicalUnderlyingtheory:powerandcontrol 3

In,matePartnerViolence

•  Perpetratorcategories:currentorformerspouse,partnerorda3ngpartner,orstrangerincaseofsexualabuseincludingrape

•  Prevalenceratesforolderwomen:1-3%(withinyear);3-4%within5years

•  Cumula3veprevalencerates:(life3me–22%to27%)

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Ac,veAgeing

•  Agecohort:60yearsoldandover

•  Typesofabuse:physical,sexual,psychological,financialexploita3on,neglect

•  Perpetratorcategories:Spouse/partner,adultchildren,grandchildren,otherrela3ves,neighbors/friends,caregivers

•  Prevalenceratesforoneyearperiod:10%-39%

•  Underlyingtheory:ageism

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VulnerableolderAdultPerspec,ve

•  Ageranges:65yearsandolder

•  Typesofabuse:sameasac3veageingbutsome3mesincludingabandonment,self-neglect

•  Perpetratorcategories:sameasac3veageingbutincludingstrangersandsome3mesself.

•  Generallynotdisaggregatedbygendersonoprevalenceratesgenerallyreported

•  Underlyingtheore3calassump3on:vulnerabilityofvic3m(generallyassumescogni3veimpairment)

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HumanRightsPerspec,ve

• Useslifecourse,notlifestage,perspec3ve

• Broadestrangeofperpetratorstoincludestateactorsaswell

• Seangscanincludeins3tu3onalseangslikecarehomesandprisons,aswellacommunity

• Priori3zesrace/ethnicminoritypopula3onsthataresociallymarginalized

• Typesofabusecanincludesocialisola3on,socialexclusionandpoverty

• Basedonassump3onofolderpersonsasrightsholdersandthestateasdutybearer

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UNOrganiza,onalChangestoPromoteGenderEquality

•  UNWomenfoundedin2010toincludedivisionsfocusingonwomenandhumanrights:DivisionfortheAdvancementofWomen(DAW),Interna3onalResearchandTrainingIns3tutefortheAdvancementofWomen(INSTRAW),UnitedNa3onsDevelopmentFundforWomen(UNIFEM),andOfficeoftheSpecialAdvisoronGenderIssuesandtheAdvancementofWomen(OSAGI)

•  Execu3veDirectors:2010-MichelleBachelet;2013-PhumzileMlambo-Ngcuka

•  ValuePerspec3ve–feminist;shihsbetweenlifecourseperspec3veandolderwomenas“othercategory”

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DivisionofEconomicandSocial

Affairs

•  FocalPointonAgeing–RosemaryLane

•  Valueperspec3ve:ac3veageing;aginggenderneutral

•  Languagerelatedtoolderwomen:“girlsandwomenofallages”“allwomenandgirls”

•  NGOinvolvement:NGOCommileeontheStatusofWomen(CSW);NGOCommileeonAgeing(IDOP)

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NGOCommunity• NGOCommileeonAgeing(Ac3veAgeing)

• NGOCommileeontheStatusofWomen(Feminist)

• Sub-CommileeonOlderWomen(Intersec3onalityofgenderandage;linkedbothcommileesabove);disbandedinNYCin2016

• In2010,movedfromCSWtoAgeing;in2015disbandedfromAgeinginNY;con3nuesinCommileeslinkedtoGenevaandViennaUNsites

• RoleofNGOswithconsulta3vestatus:twofunc3ons–provideexpertinforma3ontotheUN(ECOSOCaccreditedNGOs;provideinforma3onabouttheUN’sac3vi3estothepublic(DPIaccreditedNGOs) 10

Documentspromo,ngHumanRightsof

OlderWomen:SoKLaw

• Madrid2002Interna3onalPlanofAc3ononAgeing(non-binding);5and10yearreviews

•  Conven3onfortheElimina3onofAllFormsofDiscrimina3onAgainstWomen(binding),GeneralRecommenda3onNo.27,HumanRightsofOlderWomen(non-binding)

•  SpecialRapporteuronDomes3cViolence:ReportonOlderVic3ms(RashidaManjoo)

•  IndependentExpertonHumanRightsofOlderPersons:ReportonOlderWomen(RosaKornfeld-Male)

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WORLDELDERABUSEAWARENESSDAY

• WorldElderAbuseAwarenessDay(WEAAD)becameaUNDayinDecember2010,whentheUNGeneralAssemblyvotedtoaddWEAADtotheUNCalendarofspecialdays

• June15isthedesignateddaytoreflectontheneglect,abuseandviolenceexperiencedbyolderpeopleasahumanrightsviola3on

• WEAADwasfirstproposedbyDr.ElizabethPodniek,ofToronto,Canada,whoservedasVicePresidentoftheInterna3onalNetworkforthePreven3onofElderAbuse(INPEA)andwasoneofitsfoundingmembersin1997

• INPEAwasrecognizedasanNGOwithSpecialConsulta3veStatusbytheUNin2004,andistheonlysuchNGOthatfocusessolelyonpreven3onofelderabusefromaninterna3onalperspec3ve

NEGLECT,ABUSEANDVIOLENCEAGAINST

OLDERWOMEN

InanumberofUNdocuments,olderwomenareiden3fiedasespeciallyvulnerabletohumanrightsabusesrelatedtoneglect,abuseandviolence.Theseinclude:•  Madrid2002Interna3onalPlanofAc3ononAgeing;

•  CEDAWGeneralRecommenda3onNo.27;

•  SustainableDevelopmentGoals(SDG);and

•  DiscussionPaperandFollow-uptotheExpertGroupMee3ngonNeglect,AbuseandViolenceAgainstOlderWomen.

OlderAdultAbuseinThreeFrames:Implica,onsforOlderWomen-fragmenta,on

Neglect,abuseandviolenceagainstolderwomencanbeunderstoodas:• In3matePartnerAbuse(UNWomen)(USDVsystem)

• Ac3veAgeing(DESA)(USAgingsystem)

• VulnerableOlderAdult(HighCommissionforHumanRights–rightsbasedapproach)(USAPSsystem)

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Imaginethenext3slidesdepictwomen

age74years

•  Whenwethinkaboutdomes3cviolencewethinkohenthinkaboutwomenofreproduc3veage;

•  Whenwethinkaboutabuseofolderwomeninthecommunityweohenthinkaboutoldermotherswhoarehomeboundanddependent,leadingtocaregiverstress;

•  Whenwethinkaboutelderabuse,weohenthinkabouttheelderlyinnursinghomes.

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First,IPV

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Ac,veAgeing

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VulnerableOlderAdult

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Whatdothesethreewomenhavein

common?Whatisdifferent?

•  Theyareallthesameage•  Theyareallvic3msoffamilyabuse•  Theyareallvic3msofphysicalabuse•  Theyareallwomen

Whatisdifferent?! Theirhealthstatusdiffers! Theyappeartohavedifferingcogni3vestatus! Theyrepresentdifferentstereotypesofolderwomenandabuse

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Defini,onsofOlderAdultAbuse:IPV

• In3matepartnerabuseisdefinedasviolenceagainstwomenthat“incorporatesin'matepartnerviolence(IPV),sexualviolencebyanyperpetrator(spouse/partner;da,ngpartner),andotherformsofviolenceagainstwomen,suchasphysicalviolencecommiCedbyacquaintancesorstrangers”(Saltzmanetal.,2002).

• Thisdefini3onwasdevelopedbyanexpertpanelconvenedbytheUnitedStatesofAmerica(USA)CentersforDiseaseControlandPreven3onin1996toformulateauniformdefini3onandrecommendeddataelementsforgatheringsurveillancedataonin3matepartnerviolence.

• ThisformsthebasisofIPVresearchglobally20

Defini,onsofolderadultabuse:

Ac,veAgeing

IntheTorontoDeclara3onontheGlobalPreven3onofElderAbuse(2002),elderabuseisdefinedas“asingleorrepeatedact,orlackofappropriateac'on,occurringwithinanyrela'onshipwherethereisanexpecta'onoftrustwhichcausesharmordistresstoanolderperson.Itcanbeofvariousforms:physical,psychological,emo'onal,sexual,andfinancialorsimplyreflectinten'onaloruninten'onalneglect”(WHO/INPEA,2002).

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Defini,onofOlderAdultAbuse:

VulnerableElders

Abuseofvulnerableolderadultsrefersto“inten'onalac'onsthatcauseharmorcreateaseriousriskofharm(whetherornotharmisintended)toavulnerableelderbyacaregiverorotherpersonwhostandsinatrustrela'onshiptotheelder,orfailurebyacaregivertosa'sfytheelder’sbasicneedsorprotecttheelderfromharm”(NRC,2003,p.40).

• Thisdefini3onofelderabusewasdevelopedbyanexpertpanel(PaneltoReviewRiskandPrevalenceofElderAbuseandNeglect)convenedbytheNa3onalResearchCounciloftheUnitedStatesNa3onalAcademyofScience.Thisinformsresearchinthemedicalmodel

• Caredependencyonthepartofthevic3misassumed.22

FormsofAbuseAgainstOlderWomen

• Physical• Sexual• Emo3onalorpsychological• FinancialExploita3on• Neglect• Abandonment• Harmfultradi3onalprac3ces• Femicide

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AbuseAgainstOlderWomenasa

HumanRightsViola,on

•  Madrid2002Interna3onalPlanofAc3ononAgeing:“Olderwomenfacegreaterriskofphysicalandpsychologicalharmduetodiscriminatorysocietalaatudes.”

•  UnitedNa3onsPrinciplesofHumanRightsforOlderPersons:“Livingalifeofdignity,freeofabuse,isanimportanthumanrightforallolderpeople,includingolderwomen.”

•  Conven3onfortheElimina3onofAllFormsofDiscrimina3onAgainstWomen(CEDAW):“Violenceagainstwomenisrootedinhistoricalandstructuralinequityinpowerrela3onsbetweenmenandwomen”.

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PrevalenceofAbuseAgainst

OlderWomen

•  Prevalencees3matesrangefrom1-2%ofolderwomenupto38%ofolderwomenage60+.

•  Discrepanciesareduetodifferencesintheore3calframeworks,measuresusedandsamplesdrawn.

•  Es3matesoflife3meexperiencesofabuseremainfairlystableat20-23%.

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In,matePartnerAbuseandOlderWomen

•  IPVstudiesthatincludeolderwomeninstudysamplesshowthelowestprevalenceofabuse.

•  Defini3onalcriterialimitperpetratorcategoriestospouse/partners,da3ngpartnersandstrangersininstancesofrape.

•  Typesofabusearelimitedtophysical,psychologicalandsexual.

•  Loca3onsofabuseincludehomeandcommunity.

•  Agesofsamplepar3cipantsareohenlimitedtowomenuptoage49(Example:WHOstudyonDomes3cViolence).

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Ac,veAgeingandAbuse

• Studiesintheac3veageingframeworkincludesamplesage60+.

• Generallylimitedtoabuseinthecommunity.

• Abusecanincludephysical,sexual,psychological,financial,andneglect.

• Categoriesofperpetratorscaninclude,inaddi3ontospouse/partners,adultchildrenandotherrela3ves,neighborsandformalandinformalcaregivers.Example:AVOWstudyin5Europeanna3ons

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VulnerableOlderAdultAbuse•  Canincludeabuseinins3tu3onalseangslikecarehomes

andhospitalsaswellascommunitybased.

•  Olderadultsubjectsohenage65+andhavephysicalandcogni3veimpairments.

•  Perpetratorscanincludespouse/partners,adultchildrenandotherrela3ves,formalandinformalcareproviders,andotherresidentsofcarehomesandins3tu3ons.

•  Typesofabusecanincludephysical,sexual,psychological,financial,neglect,abandonment.Example:studiesonnursinghomeabuse.

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Implica,onsofDifferent

Frameworks

•  LowprevalencefoundamongolderwomeninIPVstudies:olderwomenaremorelikelytobewidowed(withoutspouse/partners);lesslikelytoberapedbystrangers(WHO,2005)

•  Highprevalencefoundamongolderwomeninac3veageingstudies:olderwomenaremorelikelytolivewithadultchildren,tobevic3msoffinancialabuse,andtobecaregiversforimpairedabusivefamilymembers(Luomaetal.,2010).

•  Unknownprevalenceamongvulnerableelderlywomenincarehomesandins3tu3onalseangs:olderwomenintheseseangsaremorelikelytobeunabletoself-reportabuse,tobeunavailableforstudiesthatrequireinformedconsent.29

Implica,onsforPolicyandPrac,ce

•  Lawsandservicesbasedonprevailingstereotypeofelderabuse,forexample,adultprotec3veservicesintheUSA.

•  Olderadultprotec3veprogramsthatassumecogni3veincapacitynotappropriateforIPVwitholderwomanvic3m.

•  DVservicesassumingIPVnotappropriateforolderwomenvic3msofadultchildabuse.

•  ConceptandImpactofpolyvic3miza3onnotgenerallyrecognizedinelderabusefield.

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Whatprofessionalsandpolicymakersneedtoknowaboutinterven,ons:IPV

•  IPVinlaterlife:DVsheltersohendon’tofferage-appropriateprogramsforolderwomen;can’tadmitcaredependentvic3ms

•  LawEnforcement:olderwomenmayresistrepor3ngabusebyfamilymemberstopolice

•  Guardianshipsarenotappropriateforvic3mswhohavecapacity

•  Criminalandfamilycourt:mayminimizeabuseofolderwomenalthoughordersofprotec3oncanbehelpfulifusedappropriately. 31

Ac,veAgeingintheCommunity

•  Agingserviceprogramscanprovidetemporaryassistancewithmeals,socialprogramslikeseniorcenters,interimhomecare,transporta3ontocourts,linktolawenforcementforseniors

•  AdultProtec'veServices(APS)maybeusefulinassessingcapacityandneedforsocialservices;linktoDistrictAlorneyoffices;lawenforcement;localandstateservicestructureinUS

•  Community-basedelderabuseprogramswithcounseling,supportgroupsareavailableinsomecommuni3es(notmany)

•  FaithCommuni'escanprovideopportuni3esforoutreachandabusepreven3on;limitedcapacityforassistance,interven3onforabuseamongmembersandfamilies.

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VulnerableOlderAdultAbuse

•  Forcommunitydwellingolderwomen:APSservices(interna3onally,SingaporehasbegunanAPS-likeprogram;mostwesterncountrieshavenot–howeversomeprovincialprogramsexistinCanadaandUK)

•  Forins'tu'onalizedolderwomen:OmbudsmanservicesthroughagingservicenetworksinUSA,someAPSservicesinjurisdic3onsthatincludenursinghomesaspartofterritory

•  Forolderwomenwholackcapacity:guardianships;districtalorneyofficesandforensiccentersinUSA

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LifeCoursePerspec,ve

• Somestudieshavefoundcorrela3onbetweenchildabuseandelderabuse(McDonald&Thomas,2014;Podnieks,2000)–UniversityofToronto.

• Includesolderwomeninthelifecoursetrajectory(girls,womenofreproduc3veage,olderwomen)

• Demonstratescumula3vedisadvantagesatintersec3onsofgenderandageforolderwomen

• Dis3nguishesbetweenelitesandotherwomen

• Feministgerontologyprovidesframeworkforunderstandingabuseinlaterlife. 34

HumanRightsPerspec,ve

•  Rightsbearersanddutybearers/rightsenforcers

•  Governmentsresponsibleforenforcinghumanrightsofolderadults.

•  Challenges“residual”approachtosocialwelfarepolicy(charitybyNGOs)

•  Stressesen3tlementapproach,rightsbased;empowerment

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BarrierstoEffec,veElderAbusePrac,ce•  Ageismremainsasignificantbarriertoeffec3veprac3cewitholderwomenand

abuse.Prac33onersandresearchersmustworktogethertoreachabelerunderstandingoftheuniqueneedsofolderwomenvic3msofneglect,abuseandviolence.Researchcaninformprac3ce.AnewlistserveoftheNAPSAandNCPEAallowsprac33onerstoaskques3onsofresearchersaboutprac3ceconcerns(r2plistserv@napsa-now.org).

•  Inatechnicalguideonproducingsta3s3csonviolenceagainstwomenpromulgatedbytheUnitedNa3onsDepartmentofEconomicsandSocialAffairsin2013,readersareadvisedthat

“somecountrieshaveoptedtosetanupperagelimitforrespondents,thereasonsbeingthatolderpeoplearemorepronetomemoryrecallproblemsandtendtohaveageneralreluctancetodiscusssensi8vesubjects…Itisalsolikelythananolderagecategorywillbetoosmalltoallowforseparateanalysis”(UnitedNa3ons,2013,p.15).

•  Misguidedandmisinformedstatementslikethisdiscourageresearchersfromincludingolderwomeninstudiesonviolenceagainstwomen,andseeminglyencouragena3onstoexcludedataonolderwomenfromdomes3cviolencereportsthatinformna3onalandinterna3onalpolicymaking.Fundinglimita3onsdrivechoicesaswell.Lackofresearchonolderwomenandabuselimitpolicymakersandprac33oners’abilitytomakeinformedchoicesaboutneededresourcesandappropriateinterven3ons. 36

CHALLENGESTOTHESTEREOTYPES:Educa,ngprofessionalandpolicymakers

• MissMaryinterview(fromTerraNovaFilms)challengesstereotypethatolderwomenrefusetodiscussabuse.hlps://drive.google.com/drive/folders/0B0xCtCQOe7YuQW90NEFwdjU5UUU

•  Normaninterview(fromTerraNovaFilms)challengesstereotypethatoldermenarenotvic3msofabuse,includingpolyvic3miza3on.However,mo3veforolderwomen’sinvolvementnotexamined.hlps://drive.google.com/drive/folders/0B0xCtCQOe7YuY3RUOE55MTk1dTg

•  Discussionofprofessionalprac3cesinworkwithvic3msfromminoritycultures.

Na3onalCommileeforthePreven3onofElderAbuse(NCPEA)on-

linecurriculumprovidesanexcellenttrainingandeduca3onalresourceforprofessionalsandpolicymakersonpolyvic3miza3oninlaterlife.ThiscanbedownloadedfromtheUSDepartmentofJus3ceOfficeofVic3msofCrimeswebsite:

hlps://ovclac.gov/views/TrainingMaterials/dspOnline_polyvic3miza3on.cfm

Recommenda,onsonhowtopromoteinterestsofolderwomenattheUN

•  Expanddefini3onofperpetratorsbeyondspouse/partnertootherfamilymembersandtrustedothers;

•  Con3nuetodefinedomes3cviolenceofolderwomenashumanrightsviola3on;

•  Challengemarginaliza3onofolderwomenwithinsocietyandtheinterna3onalwomen’smovement,asageistandunacceptable;

•  Ensurethevoicesofolderwomenareincludedinallforumsanddiscussionsonwomenanddomes3cviolence.

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• Obtaindataatcountrylevelonabuseofolderwomenage60andabove(disaggregatedbyageandgender);

• Includeolderwomenindocumentsondomes3cviolenceandwomen(forexample,TheWorld’sWomen,TrendsandSta3s3cs(DESA,2010),hasnomen3onofolderwomenandabuseinitsDVsec3on);

• Conductoutcomeresearchoninterven3onsforolderwomenvic3msofabuse,includingevalua3onsonlegisla3onintendedtoprotectolderwomenfromabuse;

• WithintheDVmovement,expanddefini3onsoffamilyviolencebeyondphysicalandsexualtoincludeemo3onalabuse,financialexploita3on,abandonmentandneglect;

Recommenda,onsonhowtopromoteinterestsofolderwomenattheUN

GapsinPreven,onandInterven,on•  Interna3onally,na3onallegisla3veini3a3ves,whentheyexist,largely

havebeenbifurcatedbetweendomes3cviolenceandagingorprotec3veserviceapproaches.

•  Olderwomenohenfailtofitintoeitherapproach.Whentheproblemisin3matepartnerabuse,olderwomenmaybereferredtoagingserviceprogramsthatlackcapacitytoaddressdomes3cviolenceamongelderspouse/partners.

•  Olderwomenmaynotmeettheeligibilityrequirementsforprotec3veservicesfortheelderly,suchasguardianships,iftheyarenotphysicallyorcogni3velyfrail.

•  Consequently,olderwomenvic3msofabusearelikelytofallbetweenthecracksofabifurcatedlegisla3veandlegalsystem.

•  Inaddi3on,lawsrelatedtoabuseandneglectofolderwomenbyfamilymembersorformalcaregiversmaybelegislatedbutnotfunded.

•  Policyimplementa3ongaps;policyversusprac3ce.

SummaryandRecommenda,ons

• Thisdiscussionofprevalenceofneglect,abuseandviolenceagainstolderwomenbasedondifferentandsome3mescompe3ngconceptualframeworksdemonstratesthedifficul3esinusingthesedatatounderstandandpromoteolderwomen’srighttolivefreeofabuse.

•  Inordertoaddressthecurrentfragmenta3oninservicestoolderwomenandneglect,abuseandviolence,prac3ceandresearchcommuni3esmustcometogethertoaddressgapsinknowledgeandprac3ce,eliminateageiststereotypes,andreflectamoreholis3cviewofolderwomeninsociety.

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SummaryandRecommenda,ons

•  DVservicesystemshouldacknowledgeolderwomenandplantoaccommodatethem.Sheltersshouldbeculturally,age,andgendersensi3ve.Sheltersshouldbeculturally,age,andgendersensi3ve.APSservicesystemmaybeappropriateforolderwomenwholackcapacity.Nursinghome-basedshelterop3onscouldbeappropriateforcaredependentvic3msofabuse.Agingservicesystemcanworkcollabora3velywithlawenforcementtoaddresscrimesagainstolderwomen,par3cularlythosecommiledbyadultrela3ves.

•  Professionalsshouldbefamiliarwithelderabuseandthevariousservicesystemsthatserveolderwomenvic3msofneglect,abuseandviolence.

•  Interna3onalpolicyinfluencedbyUSandUKsystemsandservices(forexample,Singapore;HongKong).

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Contactmeforreferencesandresources:

Email:brownell@fordham.edu

Also:www.inpea.netwww.ncall.uswww.ncea.acl.govwww.un.org/esa/socdev/documents/ageing/neglect-abuse-violence-older-women.pdf

Thankyou! 43