[Report] Preventing and responding to the mistreatment of older adults: Gaps and challenges exposed during the pandemic

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Executive summary

People who have fought pandemics know it: things never go perfectly. In the turmoil, successes are unnoticed and the losses leave scars.

(Free Translation, Alec Castonguay, 2021)

There are those who will be looking for villains—politicians, care home operators, workers who walked off the job. But the real villain in this tragedy is society’s profound and long-standing neglect of elders. A reckoning is in order.

(André Picard, 2021)

Mistreatment of older adults (MOA) is a pervasive issue in our society that carries serious consequences. Approximately 1 out of every 10 Canadian older adults living in the community experiences some form of MOA each year. The scope of this problem is increasing in accordance with older adult population growth. MOA victimization is associated with detrimental individual consequences, such as:

• premature mortality
• physical or mental health morbidities
• financial hardship

It is also associated with societal costs such as increased rates of healthcare utilization.

The COVID-19 pandemic had a profound impact on the issue of MOA, as well as efforts to prevent and respond to MOA. The pandemic triggered a set of circumstances that magnified known MOA risk factors, such as social isolation and dependency on others. In turn, both the prevalence and severity of MOA increased substantially during the pandemic. The elevated rates and intensified levels of MOA during the pandemic highlighted a need to identify the gaps and challenges that exist in our systems of MOA prevention and intervention response. An understanding of these gaps and challenges will inform future work that is focused on the development of effective prevention and response strategies.

The objective of this project was to identify gaps and challenges in preventing and responding to MOA in Canada, more specifically, gaps and challenges that were exposed or exacerbated during the pandemic. This project undertook the following 2 strategies to meet this objective:

1. a comprehensive review of the literature focusing on MOA prevention and response during the pandemic
2. a survey of stakeholders across Canada directly involved in MOA prevention or response throughout the pandemic

The comprehensive literature review examined peer-reviewed articles from several databases and grey literature sources such as government and non-governmental organizational reports. The review was conducted in both English and French. Informed by literature review findings, the stakeholder survey followed a mixed-methods, computer-assisted self-interviewing approach with a final analytic sample of 249 stakeholders across provinces and territories in Canada. In both the comprehensive literature review and stakeholder survey, findings about gaps and challenges were organized according to the following categories that represent key phases or considerations in MOA prevention and response:

• primary prevention (preventing the initial occurrence of MOA)
• identification and detection (identifying older adults at risk of or experiencing MOA)
• response and support intervention (direct response intervention designed to support older adults experiencing MOA)
• centralized systemic or structural supports

Based on the comprehensive literature review and stakeholder survey, a summary of key gaps and challenges related to MOA prevention and response exposed during the pandemic (detailed throughout the report) are as follows:

• MOA awareness-raising efforts targeted toward the general public or professionals who work with older adults were insufficient throughout the pandemic. This includes training to recognize signs of MOA. Awareness-raising initiatives would have benefited from a more tailored approach that accounted for the varying needs and experiences of older adults from diverse communities
• older adults experienced levels of social isolation above and beyond the social distancing requirements affecting the entire population. This substantially elevated their risk of mistreatment. Older adults experienced these heightened levels of social isolation and MOA risk while simultaneously facing barriers in accessing protective connections with informal supports in their:
• social networks
• community social gatherings
• formal support services (for example, social services, healthcare services)
• MOA perpetrators throughout the pandemic could more easily:
• mistreat older adults
• leverage social distancing protocols to exert a heightened level of power and control over victims
• obstruct attempts by informal supporters or formal service providers to detect and support victims
• the availability of frontline MOA response programs was severely lacking in communities across Canada. This left many older adults at risk of or experiencing MOA without appropriate forms of formal support. Considerable attention is needed around the development of community-based MOA response systems across Canada, including:
• coordinated referral pathways
• specialized response programs
• identification and scaling of evidence-based practices
• social distancing requirements and restrictions to in-person services made it challenging to connect with, identify and detect, or respond to and support older adults at risk of or experiencing MOA during the pandemic. Our current understanding of service delivery through remote or virtual forms of interaction (for example, video-conferencing, telephone, email, chat) was not a fully adequate replacement for in-person interactions in terms of effectively identifying and detecting or providing responsive support for older adults at risk of or experiencing MOA
• dependence on remote or virtual mediums of interaction for social connection or to receive formal service delivery represented an inequitable new standard for many older adults who:
• lacked access to the necessary technology or internet connectivity
• lacked sufficient digital literacy to navigate technology
• were living with physical (for example, vision, hearing), functional or cognitive challenges that impeded their capacity to use such technology
• Internet and technology access barriers were exacerbated for older adults from communities who experienced disadvantage on the basis of their social-cultural identity, socio-economic status, or geographic location
• community-based MOA networks experienced challenges maintaining a collaborative and coordinated effort among partner agencies and organizations throughout the pandemic in order to provide supports at the local level
• organizations responsible for the prevention, identification and detection, and response and support of at-risk older adults experienced workforce instability, shortages in personnel, and resource constraints. These factors impeded their capacity to effectively implement MOA prevention and response objectives
• knowledge of and mechanisms to disseminate and share best practices about MOA prevention and response during the pandemic were underdeveloped. This inhibited organizational capacity to pivot and effectively adapt service delivery

Based on the findings synthesized across the comprehensive literature review and stakeholder survey, a set of recommended future directions are provided. These future direction recommendations represent key opportunities and actionable steps to address the identified gaps and challenges in preventing and responding to MOA that were exposed during the pandemic.