Program : New Horizon for Seniors Program (NHSP)
Overall objective:

To increase awareness of ageism and the
abuse of older persons in a context of care
relationships.

Ageism

Abuse or ill-treatment

Ageism in the care relationship

Abuse in care, the risk factors

The portrait of the abuser and the victim

Under-reporting

The consequences

Remedies

A process by which persons are stereotyped
and discriminated against on the basis of age
in a manner similar to that of racism and
sexism (Dr. Robert Butler, 1975).
It is…. possible that ageism and discrimination on the
basis of age are, in our societies …. the most invisible
forms of discrimination…and the best tolerated
…. (Pellissier, 2009, p. 5.).

To avoid marginalisation

To increase awareness

To prevent abusive behaviours
To change the social
outlook on ageing
To ensure the quality
of the care relationship

Stereotypes that only present a negative or alarmist view of
undeniable facts: «demographic tsunami»;

Standardisation : assigning certain characteristics –
psychological, social, economic – to all persons of a certain
age;

Scape-goating : accused of being responsible for most of
society’s socio-political ills.
Pellissier, J. (2009). Âgisme et stéréotypes. http://www.aqg-quebec.org/docs/Revue/Vie_vieillissement _o9_vol_7_no2-bonifieEricSedent.pdf

dependant, vulnerable, costly, weak, useless, deaf,
uncompromising, sick, technophobes, babblers, etc.

wise, rich, always available, constantly traveling, etc.

good mentors, transmitters of history, etc.

fond of children and wonderful grandparents
Des exemples précis d’âgisme. http://www.aqg-quebec.org/262/Des-exemples-precis.gerontologie


“I’m lucky to be still here…”
“I think I’m getting Alzheimer …..”
Birthday cards:

“Happy Birthday, it’s amazing that you’re still fit… “

“At 60, you have the combined wisdom of 6 ten-year-old
children , the intelligence of 3 twenty-year-old youths, the wits of
2 thirty-year-old persons, and the memory of 60 one-year-old
babies.”
“an isolated or repeated
the
, or
of appropriate intervention,
that occurs in a relationship of trust
and causes
or
to an older person.”
(WHO, excerpted from the Toronto Declaration of 2002)
http://www.medileg.fr/Maltraitance-envers-les-personnes
http://maltraitanceaines.gouv.qc.ca/
abuse

abuse


abuse



http://maltraitanceaines.gouv.qc.ca/
violations
abuse
Physical abuse
Assaultive behaviours, the older
person is:
Telltale signs:

struck

pushed

bruises

roughed-up

weight losses

made to wait for help

evasive answers

behavioural changes
http://maltraitanceaines.gouv.qc.ca/
http://www.radiocanada.ca/regions/ontario/2013/05/19/005maltraitance-personnes-agees-residence-stjoseph.shtml#top
Psychological abuse
Assaultive behaviours, the older
person is:
Telltale signs:

humiliated

threatened

dependence upon others

infantilized

depression

ignored

absence of hygiene

isolated

alcohol or medication
consumption

loss of cognitive functions (rapid
decline)
http://www.youtube.com/watch?v=TT-wlkA90Do
http://maltraitanceaines.gouv.qc.ca/
Sexual abuse
The older person is:
Telltale signs:

a victim of touching, assault or
exhibitionism

ridiculed for their need to live their
sexuality


compelled to listen to suggestive
language
non respect of their intimacy
http://maltraitanceaines.gouv.qc.ca/

lesions in the genital area

sleep disorders

aggressive behaviours

distrust of others

anxiety at bath time
Rights violations
Rights are violated when the
older person:

is a victim of ageism

is made to accept others’
decisions when he or she
has the capacity to
decide for him- or herself
Telltale signs:

non-observance of the
confidentiality of their personal
information

non-observance of their capacity
to intervene in a discussion

deprivation of freedom of choice
in daily activities
http://maltraitanceaines.gouv.qc.ca/
http://www.suretequebec.gouv.qc.ca/aines/la-surete-vous-conseiles lle/situations-abus-aines.jsp
Negligence
The older person is a victim of
negligence when someone around
them:

fails to do something necessary
for their wellbeing
N.B. intentionally or through
ignorance…
Telltale signs

neglected hygiene

malnutrition

social isolation

etc.
http://www.suretequebec.gouv.qc.ca/aines/la-surete-vous-conseiles lle/situations-abus-aines.jsp
Fraud, theft and deception
The older person is a victim of material or financial
abuse when he or she is subjected to:

emotional blackmail to obtain their money

theft of possessions, jewelry

pressures to bequeath their property

fraud through identity theft

fraud by telemarketing

etc.
Benevolence/ Beneficence
Benevolence : a feeling by which
one wants the good of another
person.
Beneficence : a principle of
medical ethics in which one
must do good to or cause
good to be done to others
Ageism
A process by which people
are stereotyped and
discriminated against on the
basis of their age in a manner
similar to that of racism and
sexism (Dr. Robert Butler, 1975)

Old age: sleepless nights, less reliable memory, stiffer joints,
etc.

Old age and disease are not synonymous, nor is one
inevitably brought on by the other.

To negate the concepts of progress and compensation in the
aging person = ageism
Guinchard-Kunstler, P., & Renaud, M-T., (2006), p. 105
Stereotypical equation: aging = decline
Caregivers who internalise negative images on aging
The quality of the care relationship in jeopardy
“You know, she’s still quite bright!”
Compliments or the admission of the incompetence of the person
to still have at that age, opinions, reasoned impressions, founded,
potentially contestable… like any other opinion…
Guinchard-Kunstler & Renaud, (2006), p. 105

“Let’s change your little bandage”

“You know, at that age, they’re like babies”

“It’s time to change your
diaper”

“We shall go on our walk”
“ …change your incontinence
briefs or protective undergarment”
“I’ll accompany you, Mrs... on your
walk”
Every word has a specific meaning,
each word can be helpful or harmful......
1

“Isn’t she cute”

“It’s amazing how young you are…!” (Pellissier, 2012)

“At your age, it’s unbelievable...!” (Pellissier, 2012)

“He/she’s a special case”
http://www.aqg-quebec.org/docs/Depliantexposition_versionfinale.pdf
The words to say it:
“Not now”
“Hurry up”
“I don’t have the time”
“Make an effort”

use of overly familiar language

exaggerated intonations

volume too high or too low

numerous repetitions

sighs
“Here, everybody’s the same”
Empathy and willingness to listen
A luxury
The words to say it:

taking charge of: in taking, there is to take (to confiscate)

to prolong home maintenance is sometimes to lock up

institutionalization: connotation of locking away
Guinchard Kunstler & Renaud, (2006), p. 179.
http://books.google.ca/books?id=VZzkkCvLmOoC&pg=PA173&lpg=PA173&dq=La+vieillesse+maltrait%C3%A9e&source=
bl&ots=bEGeVFyY6I&sig=SBXaGLxcY5mxUK3cf5euRJ4b5qo&hl=fr&sa=X&ei=bNo4UrrsNoLfiALE4HICQ&ved=0CHIQ6AEwCQ#v=onepage&q=La%20vieillesse%20maltrait%C3%A9e&f=false

doing it instead of the older person (cocooning)

making them wait unduly

compelling them to eat, to go to bed early…

compelling them to wear incontinence briefs (“just in case”)

giving medication improperly or withholding it

speaking only to the accompanying person…
The first major abuse
that we inflict upon older persons
is to give them the help
that
they need.

abusive rules and rigid schedules

sudden room changes

breach of privacy

non-compliance with treatment (e.g. medication, dressings, etc.)

threats of expulsion

insufficient or improperly trained staff

unsafe facilities
http://tremintin.com/joomla/index.php?option=com_content&task=view&id=545&Itemid=85
Let us house the elderly in prisons. They will be entitled to
a shower every day, video surveillance in case of
problems, three meals a day, access to a library, a
computer, TV, cable, a gym.
Let us house criminals in nursing homes. They will be
entitled to cold meals, lights out at 8 pm, one bath per
week, will live in a small room and pay $1500 to $2000 a
month.

Biomedical approach?

Timed care interventions (overly technical procedures)

Caregivers’ approach regarding disabilities (association young =
autonomy; older persons: disabilities = loss of autonomy) Morbidity in the hospital

Contribution to the stigmatisation of older persons

Contribution to loss of autonomy

Etc.

productivity and independence

fear of dying (old age – loss of autonomy - death)

Distancing
Ageism
Older persons’ potential /
perceived primarily as declining
Bourbonnais, & Ducharme (2010). Sous la direction de Lagacé
https://www.google.ca/search?hl=fr&site=imghp&tbm=isch&source=hp&biw=1366&bih=543&q=medecins&oq=medecins&gs_l=img.12..0l10.7252.17826.0.20437.27.20.5.1.1.3.549.4289.
1j8j7j2j0j1.19.0....0...1ac.1.35.img..9.18.2695.6NWg3b_6zao#hl=fr&q=personnes+%C3%A2g%C3%A9es&tbm=isch
Workers have:

practiced harsh or rough handling

laughed at and insulted patients or residents

made embarrassing comments

pushed residents

Mr. Joly has had very little to drink for
several days. The doctor is worried
about dehydration and asks that he be
encouraged to drink.
Why do you think he refuses to drink?
http://www.nurseone.ca/Default.aspx?portlet=StaticHtmlViewerPortlet&ptnme=Elder%20Abuse&plang=11
Mrs. Fox

“… they speak to me as if… you didn’t know anything. They
speak to you in a condescending way instead of treating you
with respect… it’s a peculiar sort of person who… might want
to appropriate a part of you in order to reduce your capacity
of being… they are…diminishing you…when they speak to
you as to a child.”
Lagacé, M. (2012)
Lagacé, M. (2012) . Le prisme déformant de l’âgisme. http://www.aqg-quebec.org/docs/Revue/Vie_vieillissement_09_vol7_no2bonifieEricSedent.pdf.

Reduction of services covered by the State: financial issues

Increase of other stakeholders’ role
 insufficient financial resources
 family: insufficient knowledge and training
 facilities: inadequate and unsafe
 Imposition of the high cost related to the care(disadvantaged seniors)
 greater difficulties in evaluating the quality of family care
 failure to provide medical follow-up in the home
 failure to ensure a sufficient number of home care workers
 failure to provide sufficient family respite
 etc.
Lafrenière, (2009)
Violence triggered by:







exhaustion of families or professionals
ignorance of the needs of older persons
greed
Dependence (96% of cases)
Inability to express needs
Isolation
Financial vulnerability
http://www.nurseone.ca/Default.aspx?portlet=StaticHtmlViewerPortlet&ptnme=Elder%20Abuse&plang=11
http://www.video.tv/documentaire/la-vieillesse-maltraitee

Somebody like you and me, who forgot that their job often
depends on older people

A man, a woman, their fellow human…
Guinchard Kunstler & Renaud (2006, 84)
Loved ones

Children: financial abuse and neglect

People hired to help

Grandchildren

Spouses or life partners
(Harvey, 2010)
Journal de Québec, 16 juin. http://vivrevieux.blogspot.ca/2010/06/denoncer-labus-envers-les-aines-du.html

A vulnerable person

A person living alone

Often a woman, 75 and older, who lives alone and
has a disability

A neighbour, your aunt, sister, brother, father or friend

And one day… perhaps you!
https://www.google.ca/search?q=femme+victime&hl=fr&source=lnms&tbm=isch&sa=X&ei=vyHwUtWwPIu8oQStk4GYBA&ved=0CAcQ_AUoAQ&biw=1280&bih=810#hl=fr&q=femme+
%C3%A2g%C3%A9e+triste&tbm=isch
Harvey (2010) http://vivrevieux.blogspot.ca/2010/06/denoncer-labus-envers-les-aines-du.html
Reasons:
… of not being believed
of communications skills
of losing services, of being abandoned, of being
institutionalised or of losing their place in a nursing home
Image : http://www.radio-canada.ca/regions/quebec/2013/03/28/011-campagne-maltraitance-aines.shtml
http://www.radio-canada.ca/regions/quebec/2013/03/28/011-campagne-maltraitance-aines.shtml

Neighbours don’t want to interfere in others’ affairs

Caregivers don’t want to antagonise the family

Families don’t want to lose their home care worker

Older persons are terrified of reprisals

Staff remains silent to avoid trouble with their employer

It isn’t easy to denounce a fellow-worker
In all cases we tend not to believe the older person
Guinchard Kunstler & Renaud 2006, p. 93

Rachel’s story

Serge’s story

Madame Dupuis’ story

Suzanne’s story

Peter’s story
Psychological harm of interiorising ageist stereotypes :

self-inflicted ageist discrimination, the words you hear:

apologies for the trouble they give you

apologies for being a “burden” to others

in short, apologies for existing
(Pellissier, 2009, p. 34)

prone to depressive behaviours: withdrawal, irritability…

will go so far as to refuse to eat, to drink…

will sometimes ask
To change attitudes and
alter the discourse on aging
Older persons are a source of pride and
their contribution to society is important
http://www.lapresse.ca/le-quotidien/opinions/carrefour-du-lecteur/201303/22/01-4633723-combattre-lagisme.php
Lagacé, M. (2012) . Le prisme déformant de l’âgisme. http://www.aqg quebec.org/docs/Revue/Vie_vieillissement_09_vol7_no2-bonifieEricSedent.pdf
The power to act: today and tomorrow (Empowerment)

Staying autonomous… in decision making

Self-stimulation through active participation in society

Creating an effective communications network

Reminding others that to live without being able to choose or
taking chances… is to vegetate while waiting for death
It’s better to get involved than to demonstrate
that you are useless to society
Guinchard Kunstler,& Renaud,(2006). Mieux vivre la vieillesse : 100 réponses aux questions des personnes âgées et de leur entourage. Éditions de l'Atelier.
Re-examining support in the care relationship

Change your outlook on old age (ageism)

Use the expertise of older persons

Don’t forget: older persons still have desires, needs and
expectations

Respect the person’s values and right to make their own decisions

Obtain the person’s assent or agreement

Be aware of your protective role (Advocacy)

Recognise that abuse can occur everywhere…
http://www.nurseone.ca/Default.aspx?portlet=StaticHtmlViewerPortlet&plang=11&ptnme=Other%20Resources%20-%20PEACE%20sites
Harvey (2010) http://vivrevieux.blogspot.ca/2010/06/denoncer-labus-envers-les-aines-du.html
http://www.aqg-quebec.org/264/Pistes-d-action.gerontologie
Guinchard Kunstler,& Renaud,(2006). Mieux vivre la vieillesse : 100 réponses aux questions des personnes âgées et de leur entourage. Éditions de l'Atelier.
Objectives

Develop an intervention policy regarding the abuse of older persons
and their abusers

Ensure the dissemination of information (public awareness campaigns,
networking between agencies)

Develop training programs and showcase training

Promote the quality of life of older persons and the quality of services
offered

Raise ageism awareness

Increase community awareness of the aging phenomenon
Hébert, Craig et & Douglas (2012) et AQG (2011)
Le guide pratique En mains (2010). Chaire de recherche et de maltraitance envers les personnes aînées http: //www.maltraitancedes aines.com/fr
http://www.aqg-quebec.org/docs/Depliant_AQG_2011.pdf
Association québécoise de gérontologie ( 2012). Avez-vous tendance à faire de l’âgisme ?
Campagne de sensibilisation.
Association québécoise de gérontologie ( 2012). Des exemples précis d’âgisme. http://www.aqgquebec.org/262/Des-exemples-precis.gerontologie.
Association québécoise de gérontologie (2012). Sensibiliser vos milieux de travail à
l'âgisme! http://www.aqg-quebec.org/298/Milieux-de-travail.gerontologie.
Beaulieu, M. & Bergeron-Patenaude, J. (2012). La maltraitance envers les personnes âgées.
Changer le regard. Les presses de l’université Laval.
Bourbonnais, A. & Ducharme (2010). L'âgisme. Comprendre et changer le regard social sur le
vieillissement, Laval (CAN) : Les Presses de l'Université Laval, pages 155-174.
http://www.aqg-quebec.org/docs/Revue/Vie_vieillissement_09_vol7_no2bonifieEricSedent.pdf
Guinchard Kunstler, P., Renaud, M-T ( 2010) Mieux vivre la vieillesse 100 réponses aux questions
des personnes âgées et leur entourage. Éditions de l’Atelier.
Hébert, M., Craig, J., & Douglas, A. (2012). Collaboration interprofessionnelle. Stratégies
pour lutter contre les mauvais traitements à l’égard des personnes âgées. Association
canadienne des ergothérapeutes. Présentation Ppoint.
Harvey, D. (2010). Dénoncer l’abus envers les aînés du Québec. Journal de Québec, 16 juin.
http://vivrevieux.blogspot.ca/2010/06/denoncer-labus-envers-les-aines-du.html
Hugonot, R. ( 1998 ). Violences invisibles. Reconnaître les situations de maltraitance envers
les personnes âgée.
Hugonot, R. (1998). ). La vieillesse maltraitée.
Janvier Lafrenière, R. (2009) Soutien à domicile des personnes âgées en perte d’autonomie et
questions éthiques. Vie et Vieillissement. Vol. 7, no2.
Lagacé, M. (2012) . Le prisme déformant de l’âgisme. http://www.aqgquebec.org/docs/Revue/Vie_vieillissement_09_vol7_no2-bonifieEricSedent.pdf
Lagacé, M. (2010). L’âgisme. Comprendre et changer le regard social sur le vieillissement.
Presses de l’université Laval.
Pellissier, J. (2009). Âgisme et stéréotypes. http://www.aqgquebec.org/docs/Revue/Vie_vieillissement _o9_vol_7_no2-bonifieEricSedent.pdf.
Vézina,J.(2010). L'âgisme. Comprendre et changer le regard social sur le vieillissement.,
Laval (CAN) : Les Presses de l'Université Laval, 2010, pages 133-153.
http://www.bdsp.ehesp.fr/Base/436632/