ARTICLE
Issues of elder abuse
MaheshwarNathTripathi, Adya Shankar Srivastava1, RitwijNiketan Oodun2
Senior Resident, 1Associate Professor, 2Postgraduate Trainee, Department of Psychiatry, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
Abstract
Elder abuse as a social concern remains hidden within the domain of family problem. Older people who are victims of abuse are not likely to discuss it with those outside the family as they are very often dependent on those who abuse them for physical and financial support. There is elder abuse or neglect, either reported by older people themselves, or family and professional caregivers or investigated using objective measures. They suffer from financial hardship and social isolation thereby endangering their health. To prevent elderly population from becoming an economic and social problem, adequate, timely and dynamic measures should be implemented at international, national and local levels.
Tripathi MN, Srivastava AS, Oodun RN. Issues of elder abuse. Dysphrenia. 2012;3(1):11-3. Epub 2011 December 19.
Keywords: Ageing. Neglect. Relatives. Family.
Correspondence: maheshwart@rediffmail.com
Received on 14 December 2011. Accepted on 19 December 2011.
Introduction
India is growing old! The stark reality of the ageing scenario in India is that there are around 90 million 60-plus elderly and it is projected that the country will have a population of 142 million old people by 2020. With life expectancy having increased from 40 years in 1951 to 64 years today, a person today has 20 years more to live than he would have lived 50 years back. With this kind of an ageing scenario, there is pressure on all aspects of care for the older persons – be it financial, health or shelter. With more older people living longer, the households are getting smaller and congested, causing stress in joint and extended families.[1]
In 2006 the International Network for Prevention of Elder Abuse (INPEA) designated June 15 as World Elder Abuse Awareness Day, yet elder abuse as a social concern remains hidden within the domain of family problem. Older people who are victims of abuse are not likely to discuss it with those outside the family as they are very often dependent on those who abuse them for physical and financial support. Moreover a study done by HelpAge India shows that the elderly who face such abuse try and justify it themselves due to their dependency.
Definition
Elder abuse is an all-inclusive term representing all types of mistreatment or abusive behaviour towards older adults. This mistreatment can be an act of commission (abuse) or omission (neglect), intentional or unintentional, and of one or more types. The definition developed by Action on Elder Abuse in the United Kingdom and adopted by the INPEA states that: "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."[2,3]
Types of elder abuse
Abuse has been broadly classified into following categories-
1. Physical abuse: This includes like beating, pushing, slapping and sexual abuse.
2. Psychological abuse: This includes verbal threatening to abuse the older person, isolation, moral blackmail, threat of admitting them in old age homes, insulting, ignoring, withholding affection.
3. Financial abuse: This is misappropriating of property through fair or foul means.
4. Denial of rights: Like isolation, preventing one from practicing one’s religion, denying the right to vote.
5. Active neglect: In the form of refusal or failure to undertake a care taking obligation.
6. Passive neglect: This is refusal or failure to fulfil a care taking obligation.
7. Abandonment: Elder abuse can also include deserting an elderly, dependent person with the intent to abandon them or leave them unattended at a place for such a time period as may be likely to endanger their health or welfare.
8. Self-abuse and neglect: Elders can abuse or neglect themselves by not caring about their own personal health and well-being. Elder self-neglect can lead to illness, injury or even death. Elders may choose to deny themselves some health or safety benefits, which may not be self-neglect. This may simply be their personal choice. Caregivers and other responsible individuals must honour these choices if the senior is sound of mind.
Common abusers of older people
Many elders are quietly suffering indignity at the hands of those who they taught to say their first words and take their first steps. It is shocking that the largest perpetrators of elder abuse are their own children. An abuser can be a spouse, partner, a relative, a friend or neighbour, a volunteer worker, a paid worker or a practitioner (e.g. a social worker, bank worker or solicitor). Perpetrators of elder abuse can include anyone in a position of trust, control or authority. Some perpetrators may "groom" an older person (befriend or build a relationship with them) in order to establish a relationship of trust.
The majority of abusers are relatives, typically the spouse/partner or sons and daughters, although the type of abuse differs according to the relationship. In some situations such abuse is "domestic violence grown old," a situation in which the abusive behaviour of a spouse or partner toward another continues into old age. With sons and daughters it tends to be financial abuse, justified by a belief that it is nothing more than the "advance inheritance" of property, valuables and money.
Signs
An older person who is being abused:
i. May seem depressed and withdrawn
ii. Will never accept invitations to spend time away from their family or a caregiver
iii. Seems afraid to make their own decisions
iv. Seems to be hiding something about a caregiver
v. Never seems to have any spending money
vi. May put off going to the doctor
vii. Seems to have too many household "accidents"
The extent of the problem
There has been limited research into the nature and extent of elder abuse, and it is often argued that the absence of such data is a reflection of the low priority given to work associated with older people. One study suggests that around 25% of vulnerable older adults will report abuse in the previous month, totalling up to six percent of the general elderly population.[4]
Domestic setting
Approximately four to six percent of elderly people report incidents of abuse or neglect in domestic settings. The most common forms of abuse are verbal abuse and financial exploitation by family members and physical abuse by spouses. Gender distribution (of victims) is equal and economic status and ages are unrelated to risk of abuse. Importantly, elder abuse is underreported - 450 000 older adults in domestic setting were abused, neglected or exploited in the US during 1996, of which only 70 000 were self-reported.[5]
Institutional settings
No data exist for the extent of abuse within institutional settings. However, one survey of nursing home staff in the US disclosed that 36% of staff had witnessed at least one incident of physical abuse in the preceding year, while 10% admitted having committed at least one act of physical abuse themselves.[5]
Explaining elder abuse
The main risk factors for elder abuse are: dependency and social isolation of the victim; carer has mental or substance misuse problems; absence of a suitable guardian. Factors vary according to the type of abuse; for example, dependency is a risk factor for financial or emotional abuse, but not necessarily for physical abuse. Also the cause of spouse abuse may differ from the cause of abuse by adult offspring.
Indian scenario
According to pan-Indian surveys, 30% of elderly subject to some form of abuse. According to a rough estimate, nearly 40% of older people living with their families are reportedly facing abuse of one kind or another, but only one in six cases actually comes to light (HelpAge India website). Studies conducted recently among old people show that over 35 percent of the elderly in urban areas and 32 percent in rural areas live alone.
According to HelpAge India, most elders are ill-treated by their own children, who have emerged as the largest group of perpetrators at 47.3 per cent. Spouses follow next at 19.3 per cent. Other relatives and grandchildren follow at 8.8 per cent and 8.6 per cent respectively. Neglect is the most common form of abuse at 48.7 per cent followed by emotional/psychological, financial exploitation, physical abuse and abandonment respectively. There is growing number of insecurity, injustice and abuse of elderly in India.
Who Cares in India! An integrative response to elder abuse
Some argue that a good legal regime will help victims of abuse and neglect among the elderly. India, like many other countries in the world, has adult protection provisions similar to those in Europe, the UK, Canada, South Africa and the US. For example: Indian National Policy on Older Persons (NPOP) (formulated by the Govt. Of India, Social Justice and Empowerment Ministry and adopted by the Union Cabinet on 13th February 1999), The Maintenance and Welfare of Parents and Senior Citizen Act 2007, The Protection of Women Against Domestic Violence Act 2005 and Several other Benefits and Facilities by Government of India. The National policy, seeks to assure older persons that their concerns are national concerns and they will not live unprotected, ignored or marginalized. As elderly are the vulnerable sectors of the population, prevention is the best approach and number of measures have proved effective; training and support of carers; reducing isolation of elders; respite care; etc. responding to abuse effectively requires a multidisciplinary approach and a proactive system of assessment of suspicious cases (a number of assessment instrument have been developed[6,7]). It is also essential that each individual understands the legal, social and financial factors that shape their lives throughout their life span, and build the necessary support networks.
References
1. Soneja S. Elder Abuse in India: Country Report for World Health Organization. New Delhi: Help Age India; 2001.
2. Hudson MF. Elder mistreatment: a taxonomy with definitions by Delphi. J Elder Abuse Negl. 1991;3:1–20.
3. Krug EG, Mercy JA, Dahlberg LL, Zwi AB. The world report on violence and health. Lancet. 2002;360:1083-8.
4. Cooper C, Selwood A, Livingston G. The prevalence of elder abuse and neglect: a systematic review. Age Ageing. 2008;37:151–60.
5. Payne BK. An integrated understanding of elder abuse and neglect. J Crim Justice. 2002;30:535-47.
6. Fulmer T. Elder abuse and neglect assessment. J GerontolNurs. 2003;29:8-9.
7. Reis M. Validation of the indicators of abuse (IOA) screen. Gerontologist. 1998;38:471-80.
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