The helpline rang. I could never hear the other side! It was only days or months later that we realiSed that the older persons on the ‘other side’ of the calls were either beaten, neglected, abandoned, or denied freedom. Strangely, very few of them sought help. While some were afraid of legal hassles, others had poor digital literacy and limited access to resources. They were continuously abused in different types of ways—it was undetected and led to serious physical and psychological consequences.
The World Health Organization (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 person”. Elder abuse is a common yet neglected social evil. The WHO states that one in six seniors face abuse globally. However, the truth is largely under-reported.
Elder abuse can be emotional, psychological, physical, sexual and financial. Besides physical abuse which is obvious, emotional abuse includes blaming, scapegoating, threatening, scolding, insulting, intimidating, denigrating, humiliating, etc. Theft of the older person’s assets, misuse of an ATM card, chequebook fraud, credit card fraud, power of attorney transfer, etc., come under the ambit of financial abuse.
Another important form of abuse is neglect which also can be physical or emotional. In physical neglect, the older person’s essential physical needs are deliberately not catered to by the formal or informal caregiver or other trusted persons. An example may be a wilful failure to turn a bedridden older person (which will precipitate bedsores). Psychological neglect can be explained as turning a ‘deaf ear’ to the person’s emotions. The perpetrators (those who commit abuse or neglect) may employ force, threat, deception or any kind of manipulation. When it is overt, it is often easier to observe. This holds true for overt physical, sexual or even financial abuse.
Unfortunately, most cases go unreported. The older adults are often seen to have doubts, reluctance, fear of further adversity from the perpetrator, lack of privacy, inability to access a reliable authority and a lack of awareness of their own rights and legal provisions. This makes it all the more important for both the well-wishers (neighbours, family or others without a vested interest) and professionals (medical, police, administrative) to observe keenly for any sign of abuse.
Elder abuse needs prompt detection. Here are a few warning signs: unexplained signs of injury (scars, bruises, broken bones, etc.), damaged daily aids (like spectacles, walking sticks, etc.), malnutrition, unkempt appearance, tattered clothing, poor living conditions, sudden worsening of memory, prolonged sadness, and lack of privacy during doctor-visits. We need to be aware to detect. Older people have a tendency to conceal abuse for various reasons.
“You do not ask, and they do not tell.” The abuse of elders by caregivers is a worldwide issue. In 2002, WHO brought global attention to the issue of elder abuse. Over the years, government agencies and community professional groups all over the world have specified elder abuse as a social problem. The ongoing Covid-19 pandemic has further widened these inequalities among older people. The HelpAge India Report published in 2020 highlights a significant rise in elder abuse and unmet needs of the older persons during the pandemic.
In 2006, the International Network for Prevention of Elder Abuse (INPEA) designated June 15 as World Elder Abuse Awareness Day. An increasing number of events are held across the globe on this day to raise awareness about elder abuse and highlight ways to tackle such abuse. Characteristics which increase the risk of becoming a victim of abuse include functional dependence/disability, poor physical health, memory problems, poor mental health and low income. Risks of becoming a perpetrator of abuse include mental illness, substance abuse and being financially dependent on the elderly victim. Sadly, in most instances, the perpetrator is a family member of the older person.
Normalisation of violence and ageism are social factors which form the root of elder abuse. Equating agEing with negative stereotypes and labelling older persons as “weak and frail” often lead to neglect and abandonment. Decay in intergenerational bonds within families also contribute to abuse of senior citizens. Awareness campaigns, screening of potential victims and abusers, sensitisation of school and college-goers about the issue, caregiver training for dementia, strict regulatory policies to control abuse, mandatory and accessible reporting system for abuse and improving standards of care in the residential care homes—all are effective strategies for preventing abuse. They need to be aware of their rights and uphold legislations available (say, the Maintenance and Welfare of Parents and Senior Citizens Act, 2007). Other pertinent laws are to be modified in an age-sensitive manner to cater to the needs of those with impaired capacity to make their own decisions. Timely media campaigns should be conducted to make the stakeholders aware. Inputs must be taken from older people and caregivers to make the laws more sensitive to them. Support groups will help caregivers open up about their difficulties, thereby reducing the abuse.
Human rights and dignity are universal. Elder abuse threatens these rights and the quality of life. Ageing is an inevitable truth and it needs to be dealt with by using the principles of equality, respect, autonomy and care. The UN Decade of Healthy Ageing from 2021–2030 aims to combat ageism, create an age-friendly environment, and promote integrated care for them. It is a collective responsibility and we need to act now. Let us eliminate the evil of elder abuse by creating and nurturing a world for our senior citizens—a world that we would love to live in when we age!
Dr Debanjan Banerjee
Consultant geriatric psychiatrist, Apollo Multispecialty Hospitals, Kolkata
(dr.djan88@gmail.com)