The 6th Seminar on East Asian Social Seminar

Implications for elder abuse prevention inJapanese elderly care facilities-What makes them effective in protecting elders?-Jeongmi LIM

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Outline
Chapter 1

Research Background

Chapter 2

MethodChapter 3

Results

Chapter 4

Discussion ＆ suggestion2

Research Background■ Elder abuse in facilities is still increasing in Japan（Ministry of Health, Labor and Welfare 2016）- In 2014, 300 cases were reported- It increased by 35.2% compared to the previous year

The effect of existing elder abuse prevention
law and preventive strategy is insufficient3

Characteristics of Elder Abuse■ Not only damages the physical and mental health of the elderly
but also causes permanent disability, depression and even death(Dyer et al 2000; Astrom et al, 2002).

■ Abuse could occur gradually with human rights violation such as
the inadequate care and quasi-abuse behavior(柴尾, 2008; 任, 2014)■ Abusive behavior escalates to inadequate care, then to quasi-abuse,
and ultimately to more harmful and serious abuse(Conrad et al, 2011; 任, 2016).
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Characteristics of the human rights violation■ Since human rights violations occur on a daily basis and repeatedly(柴尾, 2008; 任, 2014), it may cause damage continuously to theelder’s physical and mental health.

■ For this reason, the effects to elderly of human rights violations

may be as serious as the abuse.

■ Sudden environment changes such as disrupted human relations,

impairment of decision-making and violation of privacy in a facility, have impacts on helplessness, depression, and isolation.
(川越, 2004; Walker et al, 2007）5

To prevent abuse effectively,Understanding and breaking the escalation
process among the different levels of
abusive behaviors is important.

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Previous study
Most studies have focused on clarifying the risk factors of abuse

Problems
1. They tend to regard the occurrence of elder abuse
as a simple causal relationship with risk factors,
although the fact that there are facilities where abuse does
not occur even if they have risk factors.
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Problems
2. Previous studies have not analyzed the accumulationof risk factors which have effects on elder abuse.

We cannot accurately understand the mechanism ofabuse without considering the effects of accumulationand chronicity of risk factors.

Current study■ The need for exploration integrally the mechanisms of occurrence and prevention of abuse■ The need for clarification the mechanism of chain
and escalation of abuse

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Purpose
1. To explore the process which quasi-abuse
escalates to abuse, using the Double ABCX
model

2. To examine the effect of preventive strategies
which can break the escalations of abuse

10Abuse, quasi-abuse, inappropriate care
(鈴木1993；柴尾2008；Conrad et al 2011；任 2014；任 2016）■ AbuseBehaviors with definite physical andpsychological damage.
〇 Isolating the elderly〇 Letting go to the toilet with no clothes while otherresidents are watching, which often happens
while bathing11Abuse, quasi-abuse, inappropriate care
(鈴木1993；柴尾2008；Conrad et al 2011；任 2014；任 2016）■ Quasi-Abuse
Behaviors that are not included in the Elder
Abuse Prevention Law but are regarded as such
which violates human rights of the elderly andcauses physical harm or mental stress to them
〇 Lack of Autonomy, behavioral control,
Lack of Interchange, Lack of Dignity〇 Minimizing elderly’s needs, Discounting their feelings,
Not respecting self-determination,
Controls in lifestyle that the elderly wish.
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■ Inappropriate care・Ways of caregiving that are not centered on
the elderly but focused on staff’s duty
・The severity of the problem is smaller thanthat of quasi-abuse
・As a result, it makes elderly feel bad and unsafe
・this can cause problems and anxiety for the elderly〇 Using water that is too hot when washing of the elderly‘sface or skin in the bottom(perineal).
〇 Staffs bath the elderly at maximum 2 times a week.

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What is Double ABCX model?
(McCubbin & Patterson 1983)■ This was developed to explain changes andimpacts of stress that occurs over time.
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What is Double ABCX model?
(McCubbin & Patterson 1983)■ This model can explain not only the crisis ofsystem caused by piled-up of stress but theprocess in respond to that.
■ This can examine the process of quasi-abuse
escalating into abuse

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What is Double ABCX model?
(McCubbin & Patterson 1983)

Positive or negative result (xX) to a crisis- by the accumulation of stressors(aA), the resources(bB)
and meaning for stress situation(cC).
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What is Double ABCX model?
■ Most research have focused on the second postcrisis segment of the model, measuring thecomponents on a single occasion(Minnes et al, 2007).

〇 Crisis(X) - the occurrence of quasi-abuse.
〇 Post-crisis- composed as the quasi-abuse (xX),risk management, training of care skills (bB)
and caregiving stress(cC).
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Previous studies■A hierarchy of abuse (Conrad et al, 2011).
■Abuse occurs on gradual process of humanrights violations such as quasi-abuse（柴尾2008；任2016).
■Risk management and training of care skills
can prevent the occurrence of abuse(堀米 2015, 2016；Anetzberger 1993).

■The more care staffs are exposed to stressful
situations, the higher risks of abuse(Pillemer et al 1988；Anetzberger 2000；Schiamberg et al, 2011).

■Supports for risk management and training ofcare skills relieves caregiving stress.
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Research question

1. Does abuse occur as a result of escalation ofquasi-abuse?
2. Can training of care skills and risk management
mitigate the occurrence of abuse?
3. Does caregiving stress influence the occurrenceof abuse?

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Method■ Participants
6,000 nursing care staffs working at nursing homes
and group-homes with dementia across Japan■ Method of Research
Stratified two-stage random sampling■ Data analysis
1516 responses (response rate 27.78%)→ 1473 responses (valid response rate 22.9%)■ Analytical method
Path analysis
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Result
Characteristics of respondents

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Result

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Discussion
1. Does abuse occur as a result of escalation ofquasi-abuse?
Quasi-abuse - a positive influence on abuse.

〇 Quasi-abuse is a risk factor of abuse〇 Supports the research done by Conrad et al,which suggests the hierarchical abuse〇 Proves empirically Shibao's claims on escalationof the abusive behavior
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Discussion
２．Can training of care skills and risk management
mitigate the occurrence of abuse?

■ Risk management and training of care skills
had a negative impact on abuse■ They also had a negative impact on caregiver stress■ Risk management was the strongest factor〇 Risk management and training can mitigate caregiving stress and abuse〇 Intervention in risk management is quite usefulcompared to the other factors.

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Discussion
３．Does caregiving stress influence theoccurrence of abuse?

■ Caregiving stress positively impacted on abuse〇 Care stress is a predictor of abuse occurrence25

Suggestion for the intervention
1. Intervention of quasi-abuse leads to theprevention of abuse〇 Necessary to define clearly a concept for quasiabuse and conduct investigation to clarify its
actual condition〇 Important to devise the strategies to focus on
the prevention of quasi-abuse, before level ofabusive behaviors get more serious

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2. Risk management must be implemented priority
among other preventive strategies〇 necessary to identify risk factors that elder peop-le potentially have and take measures againstthem〇 necessary to build a system that allows all
employees to share information about the lives
and small changes of the elderly at all times27

3. Training on care skills should be strengthened
that stops abuse and quasi-abuse from occurring〇 Training skills that do not control the behaviorsof the elderly〇 Expansion of training about how to support
elderly with dementia who is difficult torespond〇 If it is not possible to eliminate risk factors
such as quasi-abuse, - to enhance thepreventive strategy against abuse

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Suggestion
4. Efforts to reduce caregiving stress should be
implemented〇 Enhancing the risk management and training〇 Building a care environment that reduces theexposure of employees to stress〇 Improving skills to cope with stress〇 Eliminating barriers to implementing stressmanagement in facility〇 Necessary to reflect the implementation of stress management on the assessment of facilities. 29

Thank you!

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