How to better tackle Elder Abuse in Belgium?

SCIENTIFIC REPORT 30 -- CHAPTER 1: INTRODUCTION 30 -- 1 CONTEXT AND PROBLEM DESCRIPTION 30 -- 2 SCOPE, OBJECTIVES AND RESEARCH QUESTIONS 32 -- 3 METHODOLOGY 33 -- 4 DEFINITIONS 33 -- 4.1 Elder abuse 33 -- 4.2 Older person 34 -- 5 DIFFERENT TYPES OF ELDER ABUSE 35 -- 6 INFORMAL CAREGIVERS AND DERAILED CARE 37 -- 7 CAUSE AND RISK FACTORS OF ELDER ABUSE 38 -- 7.1 Risk factors related to the person 38 -- 7.2 Risk factors related to the family environment 39 -- 7.3 Risk factors related to the society system 39 -- 7.4 Risk factors related to the institution 40 -- 7.5 Protective factors 40 -- 8 CONSEQUENCES OF ELDER ABUSE 40 -- 9 PREVALENCE OF ELDER ABUSE 41 -- 9.1 In general 41 -- 9.2 In Belgium 41 -- 10 DIFFERENT STEPS IN THE TACKLING OF ELDER ABUSE 44 -- 10.1 Prevention 44 -- 10.2 Detection 44 -- 10.3 Intervention 44 -- 11 EVIDENCE ON ELDER ABUSE INTERVENTIONS 45 -- CHAPTER 2: BELGIAN CONTEXT 47 -- 1 INTRODUCTION 47 -- 2 METHODOLOGY 48 -- 3 POLITICAL AUTHORITIES INVOLVED IN POLICIES AGAINST ELDER ABUSE 48 -- 3.1 Health care and social security competences 48 -- 3.2 Justice competences 49 -- 3.3 Security competences 49 -- 3.4 Welfare competences 50 -- 4 LEGAL FRAMEWORK PROTECTING ELDERS AGAINST ABUSE 50 -- 4.1 Repressive responses 51 -- 4.2 Preventive measures 62 -- 5 DUTY TO PROVIDE AID AND PROFESSIONAL SECRECY 68 -- 5.1 Everyone has a duty to assist a person in great danger… 68 -- 5.2 ….even holders of a professional secrecy 70 -- 5.3 Professional secrecy … 70 -- 5.4 ….and exceptions thereto 71 -- 6 DESCRIPTION OF THE SERVICES INVOLVED IN ELDER ABUSE MANAGEMENT 82 -- 6.1 The main actors involved in the management of elder abuse in Flanders 83 -- 6.2 The main actors involved in the management of elder abuse in Wallonia 94 -- 6.3 The main actors involved in the management of elder abuse in Brussels 98 -- 6.4 The main actors involved in the management of elder abuse in German-speaking community 106 -- 7 ACTION PLANS, GUIDELINES AND GOOD PRACTICES RELATED TO THE PREVENTION OF ELDER ABUSE IN FLANDERS, WALLONIA AND BRUSSELS 109 -- 7.1 Awareness campaigns for the public 109 -- 7.2 Professional awareness and training 109 -- 7.3 Informal caregiver support 110 -- 7.4 Policies and practices in residential care facilities and home care 115 -- 7.5 Programmes to decrease societal attitudes and stereotypes towards older people: empowerment of older people. 118 -- 7.6 National, subnational or local policies and/or action plans related to elder abuse 121 -- 8 CONCLUSION 125 -- CHAPTER 3: ELDER ABUSE PREVENTION 128 -- 1 RATIONALE AND CONTEXT 128 -- 2 METHODOLOGY 129 -- 3 LIMITATIONS 129 -- 4 CATEGORIES OF PREVENTIVE ACTIONS 130 -- 5 PREVENTIVE ACTIONS AT THE INTERNATIONAL AND EUROPEAN LEVEL 130 -- 5.1 Elder abuse preventive strategies worldwide 130 -- 5.2 Elder abuse preventive strategies in Europe 136 -- 5.3 Summary of the international data about the preventive strategies 146 -- 6 OVERVIEW OF PREVENTIVE ACTIONS IN 3 DIFFERENT COUNTRIES 149 -- 6.1 The Netherlands 149 -- 6.2 Québec (Canada) 153 -- 6.3 France 159 -- 7 INTERNATIONAL COMPARISON 167 -- 7.1 EA prevention: power levels and action plans 167 -- 7.2 EA prevention: policies in residential care facilities 168 -- 7.3 EA prevention: training professionals 169 -- 7.4 EA prevention: sensitisation campaigns for a broad public 169 -- 7.5 EA prevention: support to informal caregivers 170 -- 7.6 EA prevention: fighting ageism and empowering elders 170 -- CHAPTER 4: INTERNATIONAL OVERVIEW OF STEP-BY-STEP PLANS IN CASE OF SUSPICION OF ELDER ABUSE 172 -- 1 INTRODUCTION 172 -- 2 METHOD 172 -- 3 CONTEXT OF STEP-BY-STEP PLANS IN CASE OF ELDER ABUSE SUSPICION IN FOREIGN COUNTRIES 173 -- 3.1 Australia 173 -- 3.2 Canada 177 -- 3.3 France 182 -- 3.4 The Netherlands 183 -- 3.5 UK 185 -- 3.6 USA 185 -- 3.7 Belgium 189 -- 4 SYSTEMATIC ANALYSIS OF THE STEP-BY-STEP PLANS ON SPECIFIC TOPICS 190 -- 4.1 Australia 190 -- 4.2 Canada 191 -- 4.3 France 191 -- 4.4 The Netherlands 191 -- 4.5 UK 191 -- 4.6 USA 192 -- 4.7 Belgium 192 -- 5 CONCLUSION AND DISCUSSION 192 -- CHAPTER 5: CLINICAL TOOLS FOR THE DETECTION OF ELDER ABUSE 194 -- 1 INTRODUCTION 194 -- 2 METHODOLOGY 194 -- 2.1 Search for systematic reviews 195 -- 2.2 Search for primary studies 195 -- 2.3 Psychometric assessment 195 -- 3 SEARCH RESULTS 197 -- 3.1 Systematic reviews 197 -- 3.2 Primary studies 198 -- 4 CLINICAL TOOLS FOR THE DETECTION OF ELDER ABUSE 198 -- 4.1 Comprehensive detection tools 199 -- 4.2 Tools on specific types of abuse 207 -- 4.3 Tools detecting the caregiver as abuser 212 -- 4.4 Tools for specific settings 216 -- 4.5 An example of a full detection procedure 218 -- 5 DISCUSSION 219 -- 6 BELGIAN PERSPECTIVE 221 -- CHAPTER 6: LIME SURVEY 223 -- 1 INTRODUCTION 223 -- 2 METHODOLOGY 223 -- 3 RESULTS 225 -- 3.1 Characteristics of the respondents 225 -- 3.2 Detection of elder abuse 228 -- 3.3 Evaluation of the urgency 245 -- 3.4 Intervention 246 -- 3.5 Good practices 257 -- 3.6 Reference person 257 -- 3.7 Contact 258 -- 3.8 Involvement of the elder in decision-making 266 -- 3.9 Personal stories 267 -- 3.10 Ideas to improve the management of elderly abuse 267 -- 4 DISCUSSION 272 -- CHAPTER 7: POLICE AND JUSTICE 275 -- 1 OPINIONS OF THE POLICE AND JUSTICE SECTORS IN PREVENTION, DETECTION AND MANAGEMENT OF ELDER ABUSE: AN EXPLORATORY QUALITATIVE STUDY BY INTERVIEWS 275 -- 2 METHODS 275 -- 3 RESULTS FROM THE INTERVIEWS 276 -- 3.1 Police stakeholders’ opinion 276 -- 3.2 Justice stakeholders’ opinion 287 -- 3.3 Chain approach and Family Justice Centers 303 -- 4 CONCLUSION 306 -- 4.1 Key messages 308 -- CHAPTER 8: STAKEHOLDERS AND EXPERTS CONSULTATION ON SPECIFIC ISSUES 314 -- 1 INTRODUCTION 314 -- 2 METHOD 314 -- 2.1 Experts and specialised stakeholders consultation in discussion groups 314 -- 2.2 Acceptability on and feasibility of solutions according to experts and specialised stakeholders 314 -- 3 PROBLEMATIC POINTS FROM PREVIOUS CHAPTERS 315 -- 4 EXPERTS AND SPECIALISED STAKEHOLDERS CONSULTATION IN DISCUSSION GROUPS 316 -- 4.1 Groups description 316 -- 4.2 Statements 317 -- 4.3 Conclusion about the opinion of experts and specialised stakeholders 317 -- 5 ACCEPTABILITY ON AND FEASIBILITY OF SOLUTIONS ACCORDING TO EXPERTS AND MAJOR STAKEHOLDERS 322 -- 5.1 Survey responses 322 -- 5.2 Characteristics of the respondents 324 -- 5.3 Step-by-step plan in case of suspicion of elder abuse 325 -- 5.4 Centralised contact point 330 -- 5.5 Professional secrecy and inter-sectoral consultation 334 -- 5.6 Decisional autonomy 337 -- 5.7 Training 339 -- 5.8 Awareness 342 -- 5.9 Quality of care 344 -- 5.10 Detection tools 347 -- 5.11 Reference person 348 -- 5.12 Coordination and interaction during the long-term management of elder abuse 350 -- 6 CONCLUSION 352 -- 6.1 Complying with the obligation to follow a step-by-step plan in case of suspected abuse 352 -- 6.2 Centralised contact point in case of elder abuse 352 -- 6.3 Professional secrecy and inter-sectoral concertation 353 -- 6.4 Decisional autonomy and involvement of the older adult 353 -- 6.5 Training 354 -- 6.6 Awareness and prevention 354 6.7 Quality of care 355 -- 6.8 Detection tools 356 -- 6.9 Reference person 356 -- 6.10 Coordination and interaction during the management of elder abuse 356 -- 6.11 Role of eerste lijn zone and SISD 357 -- 6.12 Emergency accommodation 357 -- APPENDICES 358 -- CHAPTER 1: INTRODUCTION 358 -- APPENDIX 1. DEFINITION OF ELDER ABUSE IN THE LITERATURE 358 -- APPENDIX 2. STRENGTH OF EVIDENCE FOR THE RISK FACTORS 360 -- APPENDIX 3. DETAILS ON THE BELRAI 361 -- APPENDIX 4. EVIDENCE-BASED DATA ON ELDER ABUSE UP-DATED TILL APRIL 2020 BY THE RESEARCH CHAIR ON ELDER ABUSE, UNIVERSITY OF SHERBROOKE, QUÉBEC. 362 -- CHAPTER 2: BELGIAN CONTEXT 368 -- APPENDIX 5. HIGHLIGHTS ON THE COMPETENCES EXERCIZED BY THE FEDERATED ENTITIES IN BELGIUM 368 -- APPENDIX 6. OVERVIEW OF THE STEPS OF CRIMINAL PROCEDURE 369 -- CHAPTER 3: ELDER ABUSE PREVENTION 374 -- APPENDIX 7. DEFINING EA PREVENTION 374 -- APPENDIX 8. SCIENTIFIC REVIEWS ILLUSTRATING THE LACK OF EVIDENCE IN THE PREVENTION OF EA 375 -- APPENDIX 9. EXAMPLES OF EA PREVENTIVE STRATEGIES 376 -- APPENDIX 10. BELGIUM REPORT ON VIOLENCE PREVENTION 378 -- APPENDIX 11. REVIEW OF VARIOUS CASES IN THE EUROPEAN COURT OF HUMAN RIGHTS 379 -- APPENDIX 12. EXTRACTS FROM THE EUROPEAN CHARTER OF THE RIGHTS AND RESPONSIBILITIES OF OLDER PEOPLE IN NEED OF LONG-TERM CARE AND ASSISTANCE 381 -- APPENDIX 13. DESCRIPTION OF THE ‘BREAK THE TABOO’ PROJECTS 386 -- APPENDIX 14. LAW OF QUÉBEC COMBATTING ABUSE AGAINST SENIORS AND VULNERABLE ADULTS 388 -- APPENDIX 15. LAWS IN CANADA AND QUÉBEC CONCERNING ELDER ABUSE 390 -- APPENDIX 16. BRIEF DESCRIPTION OF THE TOOLS DEVELOPED BY THE STRUCTURES RÉGIONALES D'APPUI À LA QUALITÉ DES SOINS ET À LA SÉCURITÉ DES PATIENTS 394 -- APPENDIX 17. COMPARATIVE TABLE OF PREVENTIVE ACTIONS IN 3 COUNTRIES 396 -- APPENDIX 18. COMPARATIVE TABLE OF PREVENTIVE ACTIONS IN BELGIUM 400 -- CHAPTER 4: INTERNATIONAL OVERVIEW OF STEP-BY-STEP PLANS IN CASE OF SUSPICION OF ELDER ABUSE 405 -- APPENDIX 19. ELDER ABUSE POLICIES AND GUIDELINES IN AUSTRALIA 405 -- APPENDIX 20. AUSTRALIAN NATIONAL PLAN 406 -- APPENDIX 21. ACT STEP PLAN 407 -- APPENDIX 22. NSW STEP PLAN 408 -- APPENDIX 23. QUEENSLAND’S STEP PLAN FOR HEALTH PROFESSIONALS 409 -- APPENDIX 24. QUEENSLAND’S INFO FOR NON HEALTH PROFESSIONALS 410 -- APPENDIX 25. EXAMPLE OF STEP-BY-STEP PLAN IN VICTORIA STATE 411 -- APPENDIX 26. VICTORIAN INTERAGENCY RESPONSE FRAMEWORK 412 -- APPENDIX 27. ELDER ABUSE PROTOCOL OF WESTERN AUSTRALIA 413 -- APPENDIX 28. FACT SHEET TO RESPOND TO ELDER ABUSE CONCERNS IN SOUTH AUSTRALIA 414 -- APPENDIX 29. TASMANIA INTERAGENCY RESPONSE FRAMEWORK 415 -- APPENDIX 30. INTERVENTION AND REFERRAL FRAMEWORK IN TASMANIA 416 -- APPENDIX 31. ADVICES GIVEN TO ELDERS BY THE DEPARTMENT OF JUSTICE OF CANADA IN CASE OF ABUSE 417 -- APPENDIX 32. THE ACT AGAINST ELDER ABUSE IN QUÉBEC 418 -- APPENDIX 33. STEP PLAN IN CASE OF CONCERN ABOUT ELDER ABUSE IN QUÉBEC 419 -- APPENDIX 34. STEP PLAN FOR POLICE AGENT IN CASE OF ELDER ABUSE IN QUÉBEC 420 -- APPENDIX 35. TOOL ‘EN MAINS’ HELPING THE ETHICAL DISCUSSION AROUND ELDER ABUSE SITUATIONS 421 -- APPENDIX 36. BRISTISH COLUMBIA’S EASY-TOT-USE DECISION TREE 423 -- APPENDIX 37. GUIDE FOR SERVICE PROVIDERS ASSISTING OLDER ADULTS IN BRITISH COLUMBIA 425 -- APPENDIX 38. GENERAL STEP PLAN IN ONTARIO 426 -- APPENDIX 39. STEP PLAN FOR EMOTIONAL ABUSE IN ONTARIO 427 -- APPENDIX 40. STEP PLAN FOR PHYSICAL ABUSE IN ONTARIO 428 -- APPENDIX 41. ELDER ABUSE DECISION TREE IN MANITOBA 429 -- APPENDIX 42. ELDER ABUSE DECISION TREES IN NEW FOUNDLAND AND LABRADOR 430 -- APPENDIX 43. CONCRETE ACTIONS TO DO IN NEW BRUNSWICK 434 -- APPENDIX 44. TIPS TO RESPOND TO ELDER ABUSE IN YUKON 436 -- APPENDIX 45. PROCEDURE TO RESPOND TO ELDER ABUSE IN FRANCE 438 -- APPENDIX 46. FOLLOW-UP OF ELDER ABUSE BY 3977 SERVICE IN FRANCE 439 -- APPENDIX 47. MAIN ACTION POINTS OF THE DUTCH NAP ‘OUDEREN IN VEILIGE HANDEN’ 440 -- APPENDIX 48. IMPROVED ‘MELDCODE’ IN THE NETHERLANDS 441 -- APPENDIX 49. ADAPTED ‘MELDCODE’ FOR THE USE OF DUTCH GP’S 442 -- APPENDIX 50. CONTENT OF THE NHS-UK WEBSITE ON ABUSE AND NEGLECT OF VULNERABLE ADULTS 444 -- APPENDIX 51. STEP PLAN TO REPORT ABUSE TO APS IN CALIFORNIA 446 -- APPENDIX 52. GENERIC FLOW CHART FOR APS WORKER 447 -- APPENDIX 53. STEP-BY-STEP PLAN FROM BELGIAN GUIDE ABOUT VIOLENCE AGAINST OLDER PEOPLE 448 -- APPENDIX 54. CODE FOR REPORTING SEXUAL VIOLENCE IN BELGIUM 449 -- APPENDIX 55. DECISIONAL TREE ON PROFESSIONAL SECRECY ADDRESSED TO BELGIAN PSYCHOLOGISTS 450 -- CHAPTER 5: CLINICAL TOOLS FOR THE DETECTION OF ELDER ABUSE 451 -- APPENDIX 56. SEARCH STRATEGIES PER DATABASE 451 -- APPENDIX 57. OVERVIEW OF SEARCH RESULTS 464 -- APPENDIX 58. SELECTION OF SYSTEMATIC REVIEWS 466 -- APPENDIX 59. SELECTION OF PRIMARY PAPERS 473 -- APPENDIX 60. PSYCHOMETRIC PROPERTIES OF DETECTION TOOLS 476 -- APPENDIX 61. DETECTION TOOLS QUESTIONNAIRES AVAILABLE IN OPEN ACCESS 478 -- SOURCE: CHAPTER 7: POLICE AND JUSTICE 496 -- APPENDIX 62. DESCRIPTION OF POLICE AND JUSTICE SECTORS 496 -- APPENDIX 63. INTERVIEW GUIDE 498 -- APPENDIX 64. CHECKLIST INTRAFAMILY VIOLENCE IN THE POLICE ZONE OF ANTWERP 505 -- CHAPTER 8: STAKEHOLDERS AND EXPERTS CONSULTATION ON SPECIFIC ISSUES 511 -- APPENDIX 65. STATEMENTS DISCUSSED IN THE GROUPS OF EXPERTS AND STAKEHOLDERS 511 -- APPENDIX 66. SUMMARY OF THE DISCUSSION WITH STAKEHOLDERS 515 -- APPENDIX 67. ACCEPTABILITY AND FEASIBILITY OF STATEMENTS 522 -- APPENDIX 68. ANALYSIS OF THE ONLINE SURVEY 550 -- REFERENCES 552