1Elder Abuse in Japan:
An Innovative Approach toPrevention and Evaluation

Akemi Soeda, MA (Professor, Department of Sociology, Kanto
Gakuin University, Japan)
Hanae Kanno, Ph.D. (Assistant Professor, Division of Social Work,Valdosta State University)
Hazuki Naganuma, Ph.D. (Associate Professor, Department ofSocial Work, Tokyo Metropolitan University, Japan)

2Contents• 1. Introduction• 2. elder abuse in Japan• 3. A new intervention approach• 4. The results of the approach• 5. A brief conclusion

3Part 1Introduction

4Example

5Background• Cases of elder abuse in Japan on the rise
• Refusal to communicate with socialworkers• Lack of skilled social workers• The need for a new approach

6Purpose• Proved usefulness of this approach• Possibility for not only Japanese cases
but also non-Japanese families in asimilar situation• Possible application for Americans living
together with or without financialpressure7Part 2elder abuse in Japan
Hanae Kanno

8

A Rapidly Aging Society in Japan• The greatest longevity in this world• The population over 65 years oldAbout one-fifth of the total

9Population Trends with in Japan（1,000 people）
2008

Average life expectancy
year• 1947• 1950• 1960• 1970• 1980• 1990• 2000• 2009menwomen

50.06
58.00
65.32
69.31
73.35
75.92
77.72
79.59

53.96
61.50
70.19
74.66
78.76
81.90
84.60
86.44
10

11

Trends of Population Aging(Population 65 and over, Medium variant)(%)

2005
１９７０

１９９４

12

Elder Abuse in Japan• Elder abuse has not received much attention
untill the end of the 1980’s.
In 1987, a groundbreaking study documented
elderly abuse (Kaneko, 1987).
• In 1990’s, more elderly abuse cases werediscovered by researchers.
• In 2006, the “Act on Elderly Abuse
Prevention and Support for Caregivers ofthe Elderly etc” (Elderly Abuse Prevention Act)

13

“Act on Elder Abuse Prevention and Support forCaregivers of the Elder etc” (Elder Abuse Prevention Act)• The first national law regarding elderly abuse
prevention in the world• “Support for caregivers of the elderly” isvalued and looked on as equal to “elderly abuseprevention”.
• The intended beneficiaries: people over 65
years old.

14

Total number of reports andresults of investigation
26,000Total number ofreports
Result ofinvestigation24,000
22,00020,00018,00016,00014,00012,00010,000

2006

2007

2008

2009

2010

15

Definition of Elder Abuse in theJapanese Law• The following five acts by caregivers orworkers in nursing homes:
1. Physical violence: Inflicting an injury on elder
body or an assault which may lead to injury
2. Neglect: Preventing the elder from nutritional
eating; leaving the elder body as it is for a longtime so that it becomes weakened
3.Psychological abuse: Remarkable violent
language, remarkable negative response to theelder, or giving the elder injurious speech orbehavior

16

Definition of Elder Abuse in Japanese
Law
4. Sexual abuse: Committing an act of obscenity
toward the elder or forcing the elder to commit
an act of obscenity
5. Economic abuse: An improper distribution ofelder property by caregivers or relatives of theelder or unjustly obtaining benefits of property
from the elder

17Types of abuse( multiple answer)
11000
10000

Physical abuse

9000
8000

Neglect

7000
6000

Psychologicalabuse
Sexual abuse

5000
4000
3000

Exploitation

2000
1000
0
2006

2007

2008

2009

2010

18

Main Factors of Elder Abuse in Japan
1. Family Caregiver’s Stress Due toFamily Belief System
2. Pathological Issues between the
Elderly and Family Caregivers

19

Types of household
7000

single6000

couple5000
4000

with unmarriedson /daughterwith marriedson/daughter
others

3000
2000
1000
0

2006

2007

2008

2009

2010

20

Perpetrator
9000
8000
7000
6000
5000
4000
3000
2000
1000
0

2006

2007

Husband
Daugther

2008

2009

Wife

Son

Son's spouse

Others2010

21

Intervention
20000
18000
16000

other

14000

under investigation

12000

both due to two
perpetrators
separatedtemporary

10000
8000
6000

not separated

4000
2000
0
2006

2007

2008

2009

2010

22

The Current Trends of Elder Abusein Japan• The number of reports are increasing.
• The most common type of abuse –physical abuse.
• The most common type of household– with unmarried son or daughter• The most likely perpetrator – son

23

24

Part 3A new intervention Approach

Akemi Soeda
Hazuki Naganuma

25

AAA
• AAA- a new intervention approach• AAA- Ansinzukuri Anzensagasi
Approach; translated in English,
Security and Safety Approach• AAA- leading improvement of social
worker’s coping-efficacy andimprovement of perpetrator’smotivation

26

Way of thinking• 1. The belief that earlyintervention and support for thefamily as well as for the elderly
person is essential.
• 2.Making a partnership between
clients and social workers is key.

27

Way of thinking of AAA• 3.A balanced perspective ofdangers and risks as well as
safety is important.
• 4.AAA is a solution-based
approach.

28

Process of the Intervention• Step1: Collect informationfrom reporter of the abuse• Step2: Visit elderly person’shome to gather detailed
information and establish arelationship29

Process of the Intervention• Step3: Make another visit towork towards a solution• Step4: Case Conference

30

Tools of the Intervention• Step1:(a)Danger and risk
assessment sheet,(b)Safety assessment sheet• Step2:(c)Time schedule sheet

31

Tools of the Intervention• Step3: (d)Preparation for
Comfortable Living
Environment Sheet• Step4: (e)Case ConferenceFormat

32

Tools; the Danger and Risk Assessment Sheet
the Safety assessment sheet

33(a)Danger and risk assessment sheet★Danger ( the facts of abuse)
Circle for situation ①～⑧-------------------------------------------------------⑤Has there been repeated physical and/or verbal abuse or continued neglect
which may escalate later?
Repeated physical abuse ( how often? how were they
abused? : The son often hits his mother.
）
Repeated verbal abuse(how often? how were they）
abused? : The son often shouts at his mother.
Continued neglect( how were they neglected? :)34(a)Danger and risk assessment sheet★Risk(the factors making the situation
complicated)-----------------------------------------------------------⑦Perpetrator
Length of care: [ 7 ] yearsBurden of care: heavy moderate other( nocomment suspected burden )Skills of care and knowledge about dementia: lack inadequate (force her to color pictures inhopes of restoring her mental function )Personality：impulsive aggressive immature
controlling dependent other()35

Pointers of Danger and Risk
Assessment sheet• In an emergency, contact local
authorities and visit home ASAP.
• Don’t ignore safety even in emergency.
• Not in emergency, collect information
about not only risks but also safety asmuch as possible.

36(b)Safety Assessment Sheet⑨ The elderly person ’s strengths○Support resources[ ]family support aside from perpetrator（）[○]friendship of others （Mrs.Nakano, the otherneighbor ）[○]visits by volunteer （Mrs.Hatano）[ ]visit by a care manager（）[○] other care services（ home helper）[ ] hobbies and interests（）[ ]other（）37(b)Safety Assessment Sheet⑩Perpetrator’s strengths○Private resources[○] ability to care for the elderly[○] signs of intention to care for the elderly[ ] signs of intention to improve care skills[○] concern /desire for the elderly[ ] financial independency[ ]other()38

Advantage of the Safety Assessment
Sheet• Even in the case of ‘Yellow’, you could support
the elderly person at home, providing the elderly
person and the family perpetrator have somestrengths.
• You could have a balanced understanding ofboth the elderly and the perpetrator.
• You could have a chat with the perpetrator
talking about strengths during the visit.

39

How can a social worker communicate with the carer who must
be the perpetrator?
What can a social worker do to build on the positive points?

40(c) Time Schedule SheetTime Schedule Sheetsample

The informants are ( the elderly/ the carer / other ) The informant's name( Kazuo Ise )The client's name（ Hanako Ise） SWr（N.Tsuchiya） Date （ 02/XX/20XX ）We ask how the elderly person and his/her carer live their daily lives.
ChooseThis day is (easystandard

Activities of the elderly person

5:00 wake-up, peehard) for the carer.

Activities of the carer

get up, wash face and get dressed
8:00 have a breakfast
brush teeth
9:00 peeservice useexamples of item

help her to pee and clean up

To help the elde

help her to pee and clean up

pee/bowel moveposition change
Sleeptransfer

6:00
7:00 peeyesterday

help her to get up, wash face,style hair,and get dressed. throw away garbage.

walkmake breakfast, help her to eat
help her to brush her teeth, wash the dishes
help her to pee and clean up
do the clothes and hang them out to dry

eat
drink
change clothes
have a bath41

How can you use this sheet ?
• If you don’t have any clear evidence to provethe carer is the perpetrator.
or• If your team judged that the case was not an
emergency but needed some help.
However the elderly person or the carer
didn’t seem to ask for the help.
• You can use this sheet as an interview guide.

42

Not only to gather the information
but to build good relationships• Asking them about their activities and use ofservices• Listening to how they feel carefully and politely• Complimenting specific actions• The relationship between you and the family will
be so fragile that you should listen to themcarefully, and become familiar with theirexperiences.
• NEVER BLAME THEM

43

For relaxed communication
Eye contact creates pressure.

Both you and the carer look at thesame sheet. Eye contact andpressure decrease.

44

How does the social worker develop the solution-talk withthem?

45

Preparation for Comfortable
Living Environment Sheet• If the elderly person or the family told you that they
had a problem or a difficulty▫

• If they want to use some services .
• If you want to know more detailed information
about the family• You can share it with the family when you visit theirhome.

46

Preparation for Comfortable
Living Environment Sheet• This sheet has three parts.
1. Identify the problems and exceptions, andcoping strategies of the family
2. Explore the Strengths and Resources from
Background and Support Networks of thefamily
3. What do they hope? What would need tohappen first?

47

Get the whole picture of the family• You can get various types of information
through the conversation about this Sheet• Don’t overlook their problems, but do try to
become familiar with what really happened.
▫ You are not a judge, so you should help the family
as a social worker.

• Keep trying to find their strengths andresources, and to help them to explore theirhopes, dreams, and goals.

48

49

Part4
Results of the Intervention
approachAkemi Soeda
Hazuki Naganuma

50

Training of AAA and brief research
about the effects• To verify the usefulness and effects of AAA▫ We had pilot training workshops for social workers
at Tokyo, Chiba, Toyama, Niigata.

• We began researching AAA training effects withthe view of improving their coping efficacy withelder abuse.
• We collected the data using questionnaires at thepre- and post- workshops at Tokyo, Chiba,
Saitama, Kanagawa (N=311)

51

Fig.1
Checking the Safety
Assessment sheet based ona model case, the Ise family.

Fig.2
Role-playing the scenarios
based on the model case,
the Ise family

52

Fig.3
Pair work; role playing

Fig.4
Group case conference
about the model case

53

54

The trainee’s perception of difficulty decreased.
It is difficult to change the attitude of theelderly person or the family members
PrePost

90.4%
76.5%

If the family refuses help, I haven't beenable to find an alternative way.
Pre
Post

77.5%
67.5%

55

The trainee’s perception of coping ability
improved.
pIf I improve my communication style, I
can find the positive aspects of the familymembers
Pre

88.1%

Post

97.1%

Even if the family members don't
cooperate, I can keep communicating withthem if necessary.
Pre
Post

65.6%
79.7%

56

Results• The trainees were satisfied with the AAA
training workshops• Their coping efficacy improved significantly.
• 10items of 1-2-3-4 likert scale total averagechanged from 25.9(S.D.=3.7) to 28.0(S.D.=3.6)• No significant differences :• areas, type of institution they belong to, type ofspecialty, years of elderly welfare experience, andtheir experience of responding to elder abuse

57

Further development• Need to develop how to maintain these effects▫ More detailed interview technique▫ Case conference format▫ Follow-up training program▫ Consultation system

58

59

Case study• Purpose; to research the effect of AAA on
making a relationship and improvement of theperpetrator’s motivation• Subjects; 13 social workers volunteered to takepart in the AAA training program• Method; filling out the follow-up sheet after
every interview• Term; 6 months

60

Analysis of the data
• Objects – 11 cases• Analysis and method –*Analysis and classification of change patterns
on relationship between social worker and theperpetrator*Analysis and classification of change patterns
in the perpetrator’s motivation* Analysis and classification of relationshipbetween tow patterns

61

Results of the analysis
Case#No1

relationshipmotivation

No3

No5

No6No7

No9

No10 No11

62

Results of the case study• Suggestions– AAA; an efficient approach for establishing
relationships and improvement of perpetrator’smotivation.
– AAA; a useful intervention approach for elder
abuse• Task– Further data to show the effects

63Part 5Conclusion

64

Summary• 1. Abuse by sons - increasing• 2. Designed a solution-based
approach- AAA• 3. Trained social workers andresearched the effects of AAA

65

Summary• 4. Results of the questionnaire suggest
improvement of social workers’ copingefficacy.
• 5. Results of the case study- improvementof not only the relationship but also theperpetrator’s motivation

66

Conclusion• 1. We believe there are benefits to implementing
the AAA• 2. More data must be collected in a wider rangeof environments.

67

Thank you very much for listening
If you want more information, send us in the following E-mail address:

Akemi Soeda: ake.soe@gmail.com
Hanae Kannno: hanaekanno@gmail.com
Hazuki Naganuma: hazmaki@gmail.com