They separated me from my books, I kept silent/ Then they kept me away from my wife, I still kept silent/ They put me away from my home, I had to keep silent/ My daily medicines provided me the only company/ My ‘age’ was a ‘burden’ and I lived in silence.” This excerpt was from the diary of a retired 78-year-old school teacher, who spent the last years of his life in an old-age home, far from his family and his self-built world.
These incidents of suffering are, however, not uncommon in old age and as a practicing geriatric psychiatrist, I encounter such stories frequently. Be it at home, in the streets, or old-age care facilities and hospitals, the elderly face various forms of emotional, physical, psychological and social abuse. It might range from neglect to physical trauma, food refusal to financial deprival, a casual insult to separation from the spouse.
But no matter what the form is, the impact is manifold and creates sustained mental trauma to the person, already shackled down by the grip of age. Being old is an experience of wisdom, but it also brings in vulnerability. Unfortunately, our surroundings exploit that part, rather than protecting them.
India is graying fast; a report by the Ministry of Statistics and Programme Implementation mentions that in 2016, the elderly (above 60 years of age) form 8.5% of our population.
With the WHO estimating that the elderly population is increasing by 3.5% per year, by 2050, around 20% of our country will be seniors. What these numbers do not predict is the consistent struggle the elderly have to face daily in the community. Historically, Indians are perceived as familial beings with young-old coexistence. In reality, it is a myth, as the International Network for Prevention of Elder Abuse (INPEA) in its 2016 report mentions India as the leading Asian country in terms of elder exploitation and abuse.
The WHO 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/senior person”. Needless to say, expectation of trust forms an important part of the definition, as most perpetrators of the abuse are families or care-givers in old-age facilities. Besides financial exploitation of the elderly, casual humiliation, ridicule or criticism on grounds of age are such a common practice that it has almost become our lifestyle.
It reminds me of how insulted one of my friend’s grandfather had felt while travelling by bus when he was ridiculed with a sexual comment for sitting down next to a young lady as he felt sick. These are definitely not stray incidents; they occur daily, at perhaps every corner of life. It is just that we choose to stay silent about it and our daily neglect keeps reinforcing this abuse. Sadly, most elders in our country are unaware of senior citizens’ rights, legislative options and the right forums to approach at times of serious abuse. That adds to the burden, perpetuating this wrong behaviour towards them.
Abuse results in the elderly leaving their homes, overdosing on pills, refusing food and self-neglect. Mostly they lose self-esteem and mental strength, eventually giving rise to disorders like depression, anxiety and insomnia. The National Mental Health Survey (NMHS) 2015-16 mentions abuse as an important risk factor for suicide, and the overall risk of death by suicide in the elderly is double that of the younger population.
Abuse at times is subtle and chronic, and difficult to recognise. However, certain warning signs of elder abuse are multiple injuries or fractures, poor appearance, frequent infections, isolation, multiple bruises at inaccessible parts of the body, unexplained weight loss, refusal to feed or speak, signs of dehydration (dry skin, lips and sunken eyes) and apparent lack of cleanliness. These signs often do not need a doctor but can be picked up by a sensitive family member or a care-giver leading to early detection and consequent prevention of abuse.
During the present Covid-19 times, entrapment for prolonged periods has increased the rates of both domestic and institutional abuse of the elderly. This is a worrying social evil. The INPEA designated June 15 as World Elder Abuse Awareness Day, mainly due to the increasing number of public-awareness events held by the WHO on this day for elder abuse prevention. However, like any other day, it will be lost if we do not give it appropriate relevance. Elder abuse is a social evil and reflects badly on our mental health as well. Many countries like the UK, US, Australia and Canada have strict laws for restricting elder abuse and it is high time our policymakers come up with necessary legislation.
The Maintenance and Welfare of Parents and Senior Citizens Act, 2007, created an excellent impact on care for the elderly but fell short of combating elder abuse. Laws are confined mostly to paper and the inherent challenges in their implementation need to be handled. “No one asks, no one bothers, so no one tells…,” was mentioned by one of the old-age home staff, which cannot be overemphasised. Awareness is the need of the hour and all forms of medical, nursing, and senior care facilities need to be sensitive to this issue. Whatever the context is, it is preventable if detected and dealt with early. Ultimately, graying awaits all of us and the question we need to ask is: “Do we want ourselves to be treated the same way?”
Eleanor Roosevelt once said, “Beautiful old people are works of art!” There is still time for us to help the ‘art’ that is our beautiful elders. (dr.djan88@gmail.com)
Dr Debanjan Banerjee
Geriatric psychiatrist, NIMHANS, Bengaluru