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Sahar Takshi photoEquity and Older Adults: How Systemic Inequities Affect Elder Abuse and Adult Protective Services

by Sahar Takshi, JD, Staff Attorney, Justice in Aging

The last two years have highlighted deep-rooted systemic racism in our country and exposed the gaps in addressing such inequities. Advancing equity aims to guarantee fair treatment, access, and opportunity for historically marginalized communities. Equity goes a step further than equality by recognizing that not everyone starts from the same place, and to achieve equity we must also identify and eliminate barriers that prevent full participation by marginalized communities. This post will introduce the connection between equity and older adults, and provide some tools—including definitions, resources, and promising practices—to apply equity principles to adult protective services (APS).

Equity and Older Adults

Racial and other systemic inequities are not reduced by aging, and in fact can be increased. Discrimination and the impact of discrimination magnify as one ages—such as increased risk of chronic illness when experiencing racism. However, experiencing oppression at a younger age can result in different types of disparate impacts at an advanced age. For example, institutionalized racism and ableism in the criminal-legal system result in the incarceration of people of color and people with disabilities including at a younger age, and a formerly incarcerated older adult will continue to face barriers in securing housing at an advanced age due to having a criminal record.
Older adults can experience inequities based on multiple identity markers—for example, a Black woman may face discrimination based on both race and gender. These identities do not exist independently, but rather intersect and overlap. Intersectionality is a concept that recognizes this complex, cumulative way that the effects of multiple forms of discrimination combine and overlap especially in the experiences of marginalized individuals or groups. Older adults may experience intersectional inequities including by age, race, gender identity, sexual orientation, immigration status, language proficiency, and disability.
Because inequities persist in older age, older adults experiencing abuse continue to face barriers in accessing services that can prevent or mitigate the impacts of abuse—such as legal assistance, health care, long-term care, and financial planning. By centering equity in their work, APS professionals and others who work with older adults experiencing abuse can build a relationship of trust and a culture that recognizes the role of systemic inequities for historically marginalized people. Awareness of these inequities is the first step in reaching a diverse population of older adults and reducing barriers to services.

Promoting Equity in Person-Centered Practice

Older adults with personal or community experiences of discrimination—for example by health providers, law enforcement, and government programs—may be resistant to reporting abuse or accepting help. For example, given the high rates of police brutality and disparate treatment in the criminal-legal system, older adults of color may be hesitant to self-report to APS once they learn that law enforcement can become involved.
Person-centered practice focuses on the wishes of the older adult as opposed to what the professional might believe is in their best interest. Centering equity is part of person-centered advocacy. It includes recognition that choices related to the experience of elder abuse, including hesitancy to report to a government organization like APS or to work with a multidisciplinary team that includes health care professionals—can be the result of personal or community experiences.
To build trust, avoid trying to rationalize or defend services that the client is uncomfortable with. Instead promote and support the organizations and people that the client trusts—such as faith-based organizations, pride centers, or other intermediaries—and find methods that can help the older adult without compromising their wishes. For example, an APS staff member can highlight services and supports that do not involve law-enforcement if a client is uncomfortable, and can use it as an opportunity to re-examine existing practices  and enhance training around restorative practices for all parties involved. Embracing a wide range of responses to abuse and partners in intervention is key to providing solutions that many older adults may accept. Some APS programs are required to cross report to law enforcement. If this is the case, APS programs may consider providing shared training opportunities for both APS and law enforcement partners to continue education on cultural humility and trauma-informed practices, discussed in more detail below.

Understanding Implicit Bias in Trauma-Informed Practice

When the individual’s internal or external resources are inadequate to cope effectively with traumatic experiences—such as abuse, poverty, racism, or a combination—an older adult may feel afraid, helpless, or avoidant in response. Individuals who are traumatized multiple times are more likely to experience exacerbated trauma related symptoms; this is also true for individuals who have experienced intergenerational or cultural trauma. Trauma-informed services aim to educate on the role of trauma on a person’s life, create a sense of safety for all recipients and providers of the services, and to reduce re-traumatization. Re-traumatization is often unintentional, for example resulting from one’s internal biases (i.e., attitudes towards groups and stereotypes that affect our reasoning without our conscious knowledge). By identifying implicit biases (such as through the Implicit Association Test) and creating an environment that fosters trust and choice for the older adult, APS professionals can mitigate re-traumatizing older adults who have experienced both racial- and abuse-based trauma.
Exposure to a client’s trauma can also lead to feelings of vicarious trauma experienced by advocates. When the effects of vicarious trauma are not mitigated, professionals lean into unsustainable coping mechanisms, including service rationing (e.g., prioritizing work based on the easiest cases or most complaint clients), to maintain a sense of satisfaction in the work. An example of service rationing would be an APS worker who is more sympathetic to a compliant client who is willing to accept help, rather than one who is belligerent or hesitant. Professionals may begin to rely on their implicit biases when making decisions about which older adults to direct their attention to. Clients who have experienced the most trauma, both as a result of abuse and in systemic discrimination, are also most likely to feel the harmful effects of service rationing.
Practicing “trauma stewardship” allows APS professionals to navigate vicarious trauma without engaging in service rationing behaviors that can further systemic inequities. At its core, trauma stewardship involves being fully present with the client, their pain, trauma, and suffering without taking it on as one’s own. Professionals in healthy work environments—where they feel supported, not overworked, and can practice self-care—are more likely to embody positive trauma stewardship behaviors.

Practicing Cultural-Responsiveness Within APS

Older adults of any identity can experience abuse, and some research suggests that certain groups have a higher risk for experiencing abuse. Therefore, it is vital for APS professionals to recognize cultural differences and mitigate implicit biases and power dynamics. Some scholars recommend that professionals brainstorm the similarities and differences between themselves and the older adult—including, race, age, and language—to recognize “less obvious similarities and differences that may enhance or interfere with understanding.” Identifying our own characteristics in comparison with the older adults we work with allows us to view the older adult holistically, with lived experiences, and bring our implicit biases to the forefront. The next step after identifying similarities and differences is outlining how they influence client interactions, potential communication problems, and planning for corrective action if such hinderance occurs. Exposure to older adults with different backgrounds and/or with lived-experiences also improves cultural competency; APS can work to partner with diverse organizations (including those with self-advocates) on projects, outreach, and trainings.

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