Under Reporting of Abuse of Older Adults in the Canadian Prairie Provinces

This tri-provincial mixed methods study explores the reasons for under reporting abuse of older adults in the Prairie Provinces of Canada. Abuse of community-residing older adults, and specifically the reasons for not reporting such abuse, is poorly understood. This paper discusses the findings of the qualitative arm of the study that collected data through interviews with older adults having histories of abuse, their family members and service providers from related sectors. Content analysis was employed to identify three key themes: (1) recognizing and naming abuse; (2) barriers to disclosure; and (3) facilitators of reporting. Recommendations are made to improve awareness, education, and service provision in prevention and treatment of the abuse of community-residing older adults.


Introduction
Abuse of community-residing older adults and the reasons for not reporting are poorly understood. This paper discusses the findings of an exploratory qualitative study that collected data in the Prairie Provinces in Canada, through interviews with older adults who identified as having histories of abuse, family members of abuse victims, and service providers working in related sectors. Reporting abuse of community-residing older adults to police is not mandatory in Canada. The use of the word "reporting" in this study refers to that action, but given the data that emerged in this study, encompasses a continuum of actions including seeking help from a neighbor, friend, or family member, seeking support from a community organization, and reporting abuse more formally to the police. Understanding the barriers and facilitators of abuse disclosure is critical to better inform the development of recommendations to improve disclosure activities, facilitate help-seeking behaviors, benefit service development, and inform practices related to formal reporting, when required.
Under reporting of abuse of older adults is linked to how families, communities, and societies understand abuse against older adults, and the role that ageism plays in our society (Préville et al., 2014;Roger & Ursel, 2009;Walsh, D'Aoust, et al., 2011). There is a paucity of research in the area of under reporting and abuse as it occurs against older adults in the community (Roger et al., 2015). As reporting abuse is key to accessing appropriate services, understanding the many reasons and contexts why older adults, their family, and service providers may not report abuse of older adults, is critical. Gender, race, or ethnicity, sexual orientation, health status, language of origin, or other socio-demographic factors, places some older adults at greater risk for under reporting abuse (Matsuoka et al., 2012;Roger et al., 2015;Walsh, D'Aoust, et al., 2011). Findings on the barriers and facilitators of reporting and disclosure can be used to develop recommendations to improve existing strategies or develop new approaches for intervention, and when appropriate, reporting abuse in the Canadian Prairie Provinces of community-residing older adults. The Prairie Provinces, Manitoba, Saskatchewan, and Alberta, are characterized by cold and long winters, large grain, and cattle farms in rural places, as well as geographically distant towns and cities. Characterized by a rich diversity, the Prairie Provinces are home to a relatively large proportion of Indigenous peoples as well as immigrants from around the world, with pockets of strong cultural and faith communities in smaller towns and urban settings (Canadian Museum of Immigration Pier 21, 2020), as well as an increasing presence of the LGBTQS2 community (Noorani, 2019).

Background
According to 2019 Canadian population data, 17%-or 6.5 million Canadians-are 65 and older (Statistics Canada, 2020). With unprecedented growth in Canada's older population (Novak et al., 2014), the abuse of older adults is expected to rise and is increasingly recognized as a public health crisis (Castle et al., 2015;Walsh, D'Aoust, et al., 2011;Walsh & Yon, 2012;Wang, Brisbin, et al., 2015). The World Health Organization (2018) defines elder abuse as, "a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person. Elder abuse can take various forms such as financial, physical, psychological, and sexual. It can also be the result of intentional or unintentional neglect." Applying definitions in practice can be challenging, given the contextual nuances that influence the relationships older adults inhabit within their families and communities.
Although relatively common, research suggests that less than one-third of cases of abuse against older adults get reported to authorities (Ziminski Pickering & Rempusheski, 2014). Thus, accurate estimates of the prevalence of abuse against community-residing older adults remain elusive. A large-scale meta-analysis of 52 studies in 28 countries estimated that 15.7% of people aged 60 years and older, or 141 million people annually, were subjected to some form of abuse (Yon et al., 2017). In Canada, the most recent prevalence estimates of elder abuse among community dwelling older adults was 8.2% (McDonald, 2015). McDonald cautions against comparing the rates of elder abuse in Canada to other nations due to methodological differences.
Abuse of older adults has many different causes, risk factors, and interventions depending on each individual situation (Wang, Brisbin, et al., 2015). Risk factors for abuse have been identified at individual, family, community, and societal levels (World Health Organization, 2018) and commonly include: stress related to caregiving, increasing dependency, social isolation, limited cognitive ability, mental illness, shared living accommodations, poverty, ageism, and the overuse or misuse of drugs and/or alcohol (Peterson et al., 2014;Roger et al., 2015).
Perpetrators of abuse of older adults are most often adult family members, but can also include acquaintances, service providers, and strangers, as for example financial abuse perpetrated via online and telephone scams (Spencer & Gutman, 2008). Individuals who experience abuse earlier in their life are more likely to be victims of abuse as they age-and when it is in the form of spousal abuse, it is sometimes considered to be abuse grown old (Harris, 1996;Wang, Brisbin, et al., 2015). Older adults who have experienced traumatic abuse throughout their lives may have a difficult time trusting any service provider, leading to under reporting (Wang, Brisbin, et al., 2015).
In addition to concerns associated with naming or talking about abuse as such, older adults may not report abuse for various reasons. For instance, women may under report elder abuse because of traditional gender roles; women are expected to be submissive and may be motivated to protect the family due to their high investment in the family unit (Souto et al., 2019). Under reporting for older women may also be associated with their poorer health and higher unemployment rates compared to their male counterparts (Souto et al., 2019). Immigration status and other factors related to culture have been implicated in reporting abuse for newcomer populations (Roger et al., 2015) and testimonies from Canada's Truth and Reconciliation Commission of Canada (2015) highlight silences accompanying long standing histories of and current abuses suffered by Indigenous Peoples.

Methods
A mixed methods approach (Corbin & Strauss, 2014;Creswell, 2018) was used to provide a detailed and contextualized understanding of older adults' experiences in relation to reporting abuse experienced in old age. Led by a social scientist in Manitoba (Community Health Sciences), the research team included academics in Saskatchewan (Medicine), and Alberta (Social Work), and an Advisory Committee consisting of a community-based service providers from each province which included several adults over the age of 55, a cut-off point qualifying "aging," as noted by our ethics protocol. Members of the research team were also over 55, and both advisory committee and academic team members included people with many years of research and professional experience in abuse of older adults, as well as in some cases personal knowledge. Annual reports made available from over 10 years from partner community organizations were reviewed while conducting qualitative interviews, as well an environmental scan and a media scan. The environmental scan identified communitybased resources available across the three primary provinces in the study; the media scan included examples of online news articles, focusing on reporting of issues of abuse of older adults over a 10 year period. A virtual workshop was hosted in November 2020 with approximately 100 participants from the community across all three provinces and related stakeholders, to share preliminary findings of the study.
This paper focusses on the qualitative arm of the study. After securing ethics approval from the each of the three institutions, a convenience sample (Corbin & Strauss, 2015) of service providers working in the field of elder abuse, and family members and older adults who had experienced abuse, were recruited via community organizations, e-newsletters, and word of mouth in 2019. Adults over the age of 55 were recruited for the study, consistent with the age cut-point for many age-specific services offered to older adults in the Prairie Provinces (e.g., A & O: Support Services for Older Adults Inc.). Interested people had to identify as an older adult (55+) and self-identify as having experienced some kind of serious harm, disrespect, assault, or abuse as an older adult in the last 10 years. Service providers were eligible if they were a person who works professionally with older adults in the Prairie Provinces. Participants provided written informed consent before face-to-face, or phone or other virtual technology mediated interviews, were conducted in a private setting at a time convenient for the participant. Interviews, which lasted between 1 and 2 hours, were audio-recorded and subsequently transcribed verbatim. Study participants were either assigned or chose pseudonyms to ensure anonymity and all transcripts had any identifying information removed.

Sample
A total of 12 older adults, 2 family members, and 23 service providers were interviewed. In Manitoba, two interviews were conducted with older adults, two with older family members of older adults, and seven with service providers. Six interviews with service providers were conducted in Saskatchewan. Ten interviews with older adults and 10 with services providers were conducted in Alberta. Missing demographic information on older adults precluded reporting this data.

Analysis
We used a content analysis approach to data analysis (Corbin & Strauss, 2014). First, the interviews were read by three team members independent of each other for initial overarching content as related to the research question. Emerging themes were reviewed by the same three team members in a subsequent meeting, to ensure that we were considering multiple meanings, as well as what the participants wanted to convey. All emerging themes were retained and subsequently reviewed by the larger research team-some renaming of themes then occurred, redefining content in each theme when agreed upon, and retaining outliers as potential data for subsequent papers. No themes were discarded. Once emerging themes were established, line-by-line coding of selected transcripts was conducted to identify and confirm main and subthemes. These were reviewed again by research team members to identify instances of divergence and convergence, prior to finalizing a list of codes. The final list of codes was then used to code the entire dataset. Transcripts were sent to each participants as a way of member checking (Corbin & Strauss, 2014). One participant did not respond at all to their transcript, and we did not use any quotes from that participant; all other participants approved their transcripts with no changes. Findings were compared with the literature to establish trustworthiness (Braun & Clarke, 2013). We maintained records of how the data led to the categories and overall findings through a "code map" (Anfara et al., 2002). This documents our analysis (e.g., how data led to initial codes, and initial codes to focused codes, etc.), and provides a transparent "audit trail" (Lincoln & Guba, 1985 as cited in Anfara et al., 2002).

Findings
The findings are organized according to the three major themes: (1) issues with recognizing and naming abuse; (2) barriers to disclosure; and (3) facilitators of reporting abuse.

Issues With Recognizing and Naming Abuse
The word "abuse" is not always used. The terms "abuse," "elder abuse," or "abuse of older adults," while commonly used among service providers, was more nuanced among older adults and family members. As a community social worker from Manitoba explains: I think elder abuse is a pretty standard term that we use between us [service providers]. I'm not going to tell my client, 'You're going through elder abuse', I'm not going to say that to a client. I would be like, 'sounds like there may be some issues here', or 'sounds like someone's taking advantage of you', or, 'sounds like someone might not be treating you right'. Asking the question, 'do you feel everything is ok with you', 'is your son treating you the way he should be', or, you know, that kind of thing. We're not going to, we never say 'are you being elder abused', or 'are you being abused'? I feel like abuse is such a harsh word for people to hear, that they don't like. They might just shy away from that word like, 'No way is my son abusing me!' A social worker, Mary from Saskatchewan, explains further complications regarding naming abuse, especially when it came to building trust with victims: So, I am cautious, I would say about calling it 'abuse' unless they name it [first]. In part because if it's a family member, these people matter and you're trying to build a trusting relationship. And if they see you as identifying someone they care about as abusive; they might not want to share with you.
A police constable in Manitoba explains further complexities with the naming of abuse in his work with older adults: Alternately, some older adults were comfortable in naming abuse as such. In Alberta, Ina, a woman in a physically abusive relationship with her partner, readily described her relationship as "abusive." Also, a service provider in Alberta advised that she commonly referenced the term abuse, particularly with respect to cases of physical violence.
Abuse is normalized. Both service providers and older adults identified that some people normalized abusive behavior. A leader of services for crisis intervention, Debrah, in Saskatchewan describes this: And often people are not prepared to disclose. It's the abuse [that] has become the norm. So, something has to change in their view of what's happening for them to reach out or for someone to reach out on their behalf.
A family member from Manitoba, for example, commented that his mother was reluctant to label her longstanding intimate spousal violence as "abuse." Instead, he stated his mother normalized it as "la vida" ("the life" in Portuguese), as a consequence also of her faith, which prioritized the sanctity of her marriage above personal safety. This same woman (and her husband) had also normalized the emotional abuse, according to our participant, that their adult daughter exacted on them in their household. The experience of abuse in this family was quite complex and would require further exploration than one interview would allow.
DMX, an older Chinese adult from Alberta, explained his emotional abuse experience as disrespect from his adult son. He offered that his reluctance to disclose abuse was related to his desire to maintain privacy, and calling it disrespect, in that "older adults might not want to exaggerate things in their personal lives; they don't want to share the private stories with their doctors." In this way, privacy needs and renaming abuse disrespect, became a way to couch abuse for him.

Barriers to Disclosure
Fear of loss of relationships. Fear of losing kinship ties served as a significant impediment to reporting abuse. This, for some, was related to their desire to maintain a connection to their families' cultural heritage-not wanting to lose the traditions and practices associated with their countries of origin. A service provider from Saskatchewan articulated that importance of family ties and cultural connections through the case example of an older Indigenous woman who had been neglected by her children: I have one [client] right now in hospital who really, really wants to be with her children when actually she comes from a difficult background. But the children weren't looking after her and she doesn't remember that. And she's so lonely and she's crying when I talked to her yesterday. She's just saying 'All I wanna' do is go to my kids and if I can't do that, I wanna' go back to the reserve up north and die where I'm comfortable.' But you know there's nobody up there to look after her either, like. And all she wants is to go back -how do you do that, you know? An Albertan service provider explicates this complex reality: So, I think that at times, that is probably one of the biggest barriers that we have to overcome, right? Because the individual is considering the 30-50 years of the relationship, the fear of the retaliation, being isolated, losing connections through that individual, and at the end of the day, not wanting that individual to be in trouble I find is by far one of the biggest things that we have to work through with clients. They may also have bad experiences previously with the court systems in place for their adult son and daughter, and there hasn't been either an outcome that has been desirable, or at times it may be viewed that this is a mental health consideration -and not something that's like punishable.
Bill, an older adult from Alberta, expressed that he wanted to maintain a relationship with his female partner who had physically abused him, by still sending her Christmas card and maintaining a friendship.
Dependence on the perpetrator. Some older adults in the study identified that they were reluctant to disclose abuse as it could disrupt their caregiving arrangements, such as relying on the perpetrator for basic needs-transportation to medical appointments, grocery shopping, housekeeping, or financial support. Pedro, a family member in Manitoba who was reflecting on the abusive situation his parents are in perpetrated by his sister, described that while providing caring for their aging parents, she took control over the household to such an extent that other family members and service providers were prohibited from entering the home. Not only were the parents dependent on the sister for daily help, they were barred from seeing others in their home. Pedro speculated that his sister was likely in financial need, as she had been unemployed for many years, and was also potentially gaining monetarily from living in this situation. He was reluctant to report this situation to authorities as it could disrupt care for his parents. Others were reluctant to report abuse in relationships that met some of their emotional needs. A female participant from Alberta, for instance, acknowledged sending a man she had met over the internet funds each month totaling thousands of dollars as a way to maintain companionship.
Shielding abuser from the law. In some cases, although they understood their experiences as abusive and wanted them to stop, participants did not want to disclose to authorities and have their loved ones face dire consequences. For example, an Albertan service provider shared that her client stated, "I don't want to get my grandson in trouble, but I want this to stop." Similarly, an older adult male living with his adult grandson in Manitoba described his fear of escalation of physical abuse, further explained that he was shielding his grandson from consequences by not reporting or evicting his grandson.
Many sides of financial abuse. Participants expressed concern regarding financial abuse. Carmen, from Manitoba, explained that her father-in-law's financial abuse perpetrated by a longlost nephew only came to light through her and her husband's designation as power of attorney, and while their role increased as a result of her father-in-law's serious physical health decline, they felt quite powerless in finding the appropriate kind of help. She further explained in the interview that verification of the abuse through financial records could have been confirmed quite easily. Although she named it as abuse, sought help from the legal system, the perpetrator was not held accountable. Carmen expressed frustration with the apparent fraud, the lack of support from formal reporting agencies in the rural area (the jurisdictions were sending her back and forth) and being unable to obtain justice for the wrongdoing.
A common scenario related to financial abuse is described by Denise, a social worker in Manitoba. She explains the complexity of joint bank accounts for her clients: But if it -say it's the joint bank account, and where, you know, the older person's putting money in, but the abusive individual has been using up all the money. They've not been putting their own money into it. We would suggest that they cancel that joint bank account, but sometimes, what we've been finding is that banks are saying well, 'the other joint account owner has to sign off on it'. . .and it's like, why? It's not their money going in, for one thing. They're using this older person's money, they're taking advantage, financially.
Older adults expressed reluctance to report or leave an abusive situation when they were tied financially to the perpetrator. Older adults commonly identified they had savings and investments, houses, vehicles, and joint accounts with the perpetrators. Samantha, an older adult in Alberta, describes the financial abuse in addition to physical and emotional abuse perpetrated by her husband: My Canada Pension Disability, he was taking it. Also thinking that, you know if I had extra money, he would take it to make sure there's no money in the account, in our joint account, just so I couldn't leave.
Bill, an older adult in Alberta, describes the complex financial situation between him and his female partner, at whose hands he had experienced physical abuse, most notably pushing him down a flight of stairs in this senior's housing complex: We were contributing money towards -an automatic amount of money comes out of her bank account every month. Guaranteed Income Supplement's with [name of banking institution], and it's not a lot but it adds up over the years. . . .I didn't want charges laid against her. I know she feels remorseful for what she did, alcohol was involved. . . and I want to be civil for her because of the financial stuff that we have together. I mean, I want some money in the summertime and the only way I can get that money is that I have to get her to agree with it. I've already been to the bank; I went to the bank yesterday and asked them about it and they said that there is nothing they can do about it -it is a two-signature thing.
Ina, an older adult in Alberta, describes the financial abuse she experienced in addition to physical, sexual, and emotional abuse: I didn't have to stay in the relationship for that, but I depended on him for a while because I quit working and he was a provider for me, I mean he was paying the bills. I mean, initially it started with me, and then it kind of switched over.
In some situations, the perpetrators were either intimate partners, or sons, and daughters of the victim, all of which further made their departure from the abusive situation more complex.
Other systemic factors preventing reporting. Other factors were identified by study participants linked to preventing disclosure of or reporting abuse. In particular, it appeared that some participants were less likely to want to talk about abuse for a number of reasons, such as "wanting privacy." John, an Albertan, shared that his victimization by his male partner led to a double jeopardy. He was both vulnerable to discrimination related to his sexuality and the context of gender norms and expectations: . . . being a man is very difficult for men. Because we don't like to show emotion, we don't like to, uh, let others think that we are weaker than they are. We don't like to cause trouble, like I don't anyways.
Another factor expressed by service providers, most often in Manitoba, was the complexity of the legal system. Specifically, the barriers an older adult might experience in attempting to lay charges or obtaining a protection order. Service providers attested that their role in reporting in a more formal sense (e.g., police and legal system) was essential because they were trained to understand and work within these specific parameters. As explained by Louise a social worker in Manitoba, who works very closely with police: Just getting the protection orders, it's a process! Like it's a process, and if you're no good at writing or you don't really understand the questions they're asking you, its stressful. And I mean, you're also being questioned by a judge and like it's kind of, you need guidance and you need support and help. . .. They [the judge] might just say the threats that have happened, they might be very general instead of very specific about what's happened. So, all those things can kind of like they take away from the severity of the situation and so the judge might say this isn't really what these [protection orders] are for. It sounds to me like this is like not severe enough to be wanting this type of order. And then they think like if you're by yourself and then it gets rejected then you're just left to think this is it.
Another social worker in Manitoba, Denise, further describes being an advocate for older adults when they do want to press charges and police have not followed through with their wishes: When that older person actually does want police involved, and does want the police to charge, sometimes police don't. And then we, as an agency, or as staff in the agency, have to contact police to inquire why charges weren't laid. . . .And so, we then have to advocate on behalf of that older person, when it's obvious that there has been a certain type of abuse that has taken place, whether it's an assault, or whether it's a theft, or uttering threats, or you know. . . If an older person comes to us and says: Well, I called the police, this is what happened, I expected that they would charge my son or my daughter, and they didn't. They just said it was a family matter and they left. So, then with the permission of the older person. . .what we do is contact the police to find out what happened, and to inquire as to the reasons that charges weren't laid. If the older individual wanted charges to be laid, advocate on their behalf, then we see if the police would then go ahead.

Facilitators of Reporting
While police intervention is being considered, small steps matter. Reporting abuse to the authorities was considered by many older adults and their family members. In the case of prolonged physical violence, for instance, some reported the abuse to police, some relocated to a shelter for abused older adults without reporting to the police, while others indicated that reporting to the police was not helpful. In some cases, others reported the incidence to the police, and so the individual was not the one who initiated.
Several participants noted that small steps in disclosing abuse mattered most such as being able to talk to someone about their experience, without being told what to do or having the pressure to report. Kelly from Alberta mentioned: . . .one of the things that was major for me is that as I'm trying to explain the situation, being told 'you need to do this' -that just really shuts me down. Rather than saying 'well, this is available, this is available, maybe you might try this. . .'. It's hearing someone say, 'you need to do this'. Like, I'm sorry, but do you have the answer? Are you experiencing it? That's your answer. It sounds the same as 'just throw him out'.
A service provider from Saskatchewan acknowledged that while reporting to police was an option, support from a professional was also valued: So, it's a very large power over relationship and so I think they need a safe space to say, 'You know what it's okay for you to report if this is what happened, we'll look into this'. We'll help support you, you've got-whether it's PTSD [post-traumatic stress disorder] or it's counselling or if it's-I don't know. I think it's just about feeling safe. And knowing that somebody's actually going to do something about it.
Denise, a social worker from Manitoba, explained: "When they're reporting [older adults], usually they're asking for help with that situation, they would like some relief from the mistreatment, but not necessarily, through a legal approach." Having autonomy to call the authorities if needed, was noted by study participants as helpful, as a family member from Manitoba articulates: So, I did consider police, I have a key to their [parents'] house. I considered entering their home, with police, but the more I thought about it, the more I felt that that was just to appease me, and to know that I'm doing something to help, versus is this the help that she wants or needs. And the conclusion I came to, mostly from speaking to a psychiatrist, is unless they ask for your help, are you really helping them? Or are they really going to change? Tracy, a social worker from Saskatchewan, shared the types of supports they might recommend to an older adult instead of more formal reporting agencies: . . .Get in touch with any other kinds of support networks that they [older adults] can have, whether it's in their church, whether it's with their community association, whether it's in an exercise class. It's just breaking that isolation and then getting the information that they need; directing them to information where they can find help. Even places where they can get a definition of what abuse is.

Discussion
Study findings highlight recognizing and naming abuse, barriers to disclosure, and, facilitators of reporting abuse, together which demonstrate the complex contexts and reasons that shape the reality of under reporting of abuse of older adults. Mysyuk et al. (2016) state that we know little about how older adults themselves conceptualize abuse, in that the voices of older victims remain scant in the research conducted on abuse of older adults. Ziminski Pickering and Rempusheski (2014) similarly suggest that barriers to selfreporting are an issue related to whether an older adult perceives a situation to be abusive or not.
Our study shows that some older participants did not recognize or name abuse, and as such, this had implications for reporting. Roger et al. (2015) previously found that recognizing or naming abuse was a challenge for some older adults, especially immigrant women. Our findings demonstrate that the context in which recognition and naming of abuse occurs by older adults is complex. While some service providers in the current study rarely used the term "abuse," saying they were following the lead of their clients; some used the term primarily when they were referring to physical abuse. Some service providers opted to use the term "mistreatment," but recognized the broadness of the term. One constable stated that "elder abuse" was not a term recognized by law, further complicating reporting. Fraga Dominguez et al. (2021) identified that, since most older adults face abuse behind closed doors and by family members, there is an assumption of the obstacles they face when considering disclosure or reporting.
Relational priorities emerged as a key finding in this study. Mysyuk et al. (2016) similarly found that older adults with strong family ties, and those who depended on family members for support, were more vulnerable to staying in abusive situations and not reporting. Predominantly, fear of losing kinship ties was key in our study, in which relational priorities led to an acceptance of untenable situations for a range of reasons. Study findings also demonstrated that cultural belonging could be a significant motivation for maintaining kinship ties, where individuals feared losing access to their families and thereby their culture, if they were to report abuse. For some adults, there was a recognition that broader familial and cultural networks would be impacted or severed if they reported the abuse, and this could lead to a decision to live with the harm and suffering of abuse instead. The tension of protecting themselves, while maintaining a range of kinship ties, was profound. Mysyuk et al. (2016) speak to the power and imbalance of control in similar familial contexts, in which lonely older adults stayed and felt vulnerable to their abusers.
On the other hand, some participants spoke extensively about seeking help from a range of public officials, but reporting was not an option for them in part due to the power of familial ties. Our data shows that some family and older adults who saw the abuse for what it was, and had sought help extensively, had not found the kind of help they wanted (e.g., moving the abuser out into supportive housing vs. charging them with assault). This lack of options for some who sought help, placed the onus on them to decide the best course of action now, based on limited resources and external supports.
Study findings also show that some participants wanted to protect the abuser from coming into contact with the law, at the price of protecting themselves from the abuse. Fear of abuse, but also the inevitable possibility of breaking family ties based on one's reporting, was a complex decision that led to not reporting. Jackson and Hafemeister (2014) reported that the majority of victims did not want law enforcement involved in their case, and our data shows this as well. Participants who were older adults feared negative consequences for the abuser, negative consequences to themselves, and for some, feelings of privacy, shame, or embarrassment. One participant in Manitoba actively spoke about his fear that his grandson would be reported to the police, contact he was protecting his grandson from despite the emotional abuse and escalating fear of physical violence. This participant expressed concern that evicting his grandson could lead to his grandson's spiraling into homelessness, and the further escalation of his grandson's long-standing mental illness. He was shielding him from contact with the law, the risk of homelessness and overall abandonment, as well as losing his own close ties to a family member who was simultaneously helping him around the house.
Financial abuse emerged as a topic for some of our participants. Pillemer et al. (2016) found that financial abuse of older adults now ranks amongst the top three types of abuse, although little is still known about it. According to Pillemer et al. (2016) interestingly, financial abuse (and physical abuse) was easier to talk about than other forms of abuse. In one case of financial abuse in the current study, the participant identified that professional support and knowledgeable advice was not available to her. She further noted that finding the right kind of help was the biggest challenge in her situation. In other cases, participants sought help and despite the help made available to them, were unwilling to press charges, move out, or unwilling or unable to evict the perpetrator, deciding instead not to make major changes. For others, participants, remaining private about the abuse whether it was financial or not, and not wanting others to know, was a key influence in their decision-making about not reporting.
Ultimately, as described by Lachs and Pillemer (2015), finding a trusted person to disclose to at their own pace was highly valued by our participants as well. They reflected that they wanted to talk with professionals or trusted others outside of their family; and if they trusted them, they would reveal a lot (rather than remain silent and private). Overall, they did not want to report to police, and they did not want to be told what to do, even while they wanted the abuse to stop. According to Fraga Dominguez et al. (2021), older adults might only consider reporting once the abuse had become so severe that they felt they could no longer live with it, in that it was unbearable, and they feared for their safety.
Community awareness was a key player in the aspect of disclosure, according to some service providers in our study, in that greater community awareness about abuse was seen to promote stronger trusting relationships facilitating the ease of disclosure, and down the road the potential of reporting. Here, we see a strong bias in favor of seeking support for disclosure rather than reporting. Disclosure to trusted others, and to those who can help to seek resources for them, was seen as very powerful-participants wanted others to hear their story and to listen, to help find strategies for daily living, or to develop alternatives meaningful to the older adult but different from reporting. Dong and Simon (2014) suggest that a better understanding of the role of community could lead to support for more disclosures to occur.
Fraga Dominguez et al. (2021) recommend that service providers can be helpful in this process, if they are in contact with older adults experiencing abuse, by assisting older adults in naming their experiences as abuse, and helping them to understand their options. Our findings demonstrate that service providers can play a vital role by establishing trusting relationships, whereby older adults and family members are more comfortable to then seek support for these issues. This mirrors what Jackson and Hafemeister (2015) found, in that the relationship between the victim and offender was as important as the relationship between the victim and those to whom they reported. Talking to a trusted other and then deciding to move forward in their life on their own terms, which may mean with no formal police intervention, meant a lot to our participants. Service providers concurred that staying connected to the older adult was important. Following what the older adult wanted to do was key to building trusting collaborations for possible interventions in the future. Pillemer et al. (2016) describe similarly the ways in which good disclosure can occur if there is trust with a range of professionals. Considering the wishes and needs of the older adults was vital for service providers in our study, responding in a dignified manner to their suggestions and approaches, and finding ways to work with those decisions.
Services providers were also aware of the organizational and system related options available to older adults, and their role was key in facilitating the correct paperwork. For example, requesting a protection order would be nearly impossible without the support of a service provider. Many service providers in our study indicated that due to the difficulty in obtaining protection orders or officially pressing charges against a perpetrator, that help from those familiar with or trained in the justice system, were a necessary part of the reporting process, simply to navigate the legal system and help advocate for victims of abuse.
As official statistics underestimate the prevalence of abuse against older adults, policy-makers, practitioners, and the general public may believe that elder abuse is not a pressing issue (Lysova et al., 2019;Roger et al., 2015), and not worthy of the support and attention needed to end the abuse (Castle et al., 2015;Wang, Brisbin, et al., 2015). Increasing resources and support at the provincial level would serve these older populations better. If, for example, a medical professional suspects abuse of an older adult, it may be difficult to determine what is in the best interest of their patient, and where to refer them, since in many cases a family member or loved one are often perpetrators of abuse (Peterson et al., 2014).
This study has demonstrated that while older adults do want to discuss abuse, reporting is not always their preferred option. Considerations for the value of disclosure-how it can happen, when and with whom-should be the priority for the focus on service provision for older adults living with abuse, and community outreach goals. This study's findings suggest that providing opportunities for informal conversations about abuse experiences are key in creating the possibility of disclosure, which can lead to finding trained supports and resources. Policies that support improved public education and awareness, and stronger infrastructure of trained professionals across professions are central recommendations.

Limitations
This was a small qualitative study, and as such the results cannot be transferred or generalized to the wider population. Despite our careful and strategic recruitment efforts, it was challenging recruiting older adults who had experienced abuse. Provinces with more resources available for older adults in general, and abuse more specifically, were more successful in recruiting older adults. In provinces where resources were more abundant and awareness of abuse of older adults greater, the likelihood of calling something abuse increased, therefore also increasing recruitment possibilities for the study.