The term “elder abuse” was first documented in 1975 (World Health Organization, 2014). Even though research has shown that abuse of older persons existed prior to such date, such crime was considered as being a family affair, and consequently, discussions on this matter were limited.
Despite the fact that there is no universally accepted definition of elder abuse, an oft-cited definition is that “elder abuse is 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 serious problem in Malta. I think that the available information is an underestimate of the problem because the number of nonfatal injuries is limited to older adults who are treated in emergency departments. The information does not include those treated by other providers or those that do not need or do not seek treatment. Additionally, many cases are not reported because elders are afraid or unable to tell police, friends or family about the violence. Victims often have to decide whether to tell someone they are being hurt or continue being abused by someone they depend upon or care for deeply.
Elderly abuse includes physical abuse, sexual abuse, emotional abuse, financial/material exploitation, neglect, abandonment and self-neglect.
The picture I get from current research is that the primary abusers of the elderly appear to be adult children and other family members, indicating that violence against elderly persons occurs mostly at home. It has been suggested that family stresses, both psychological and financial, may be a contributing factor to elder abuse. If young children are in a home where this form of violence occurs, this experience can have an impact on them. Research has demonstrated that children exposed to violence, whether they are the intended victim or witnesses to violence perpetration, are more likely to have behavioural problems and later become perpetrators of aggression and violence themselves.
Signs of elder abuse can be difficult to recognise or mistaken for symptoms of dementia or the elderly person’s frailty, or caregivers may explain them to you that way. In fact, many of the signs and symptoms of elder abuse do overlap with symptoms of mental deterioration, but that does not mean one should dismiss them on the caregiver’s say-so.
It is difficult to take care of a senior who has many different needs, and it is difficult to be elderly when age brings with it infirmities and dependence. Both the demands of care-giving and the needs of the elder can create situations in which abuse is more likely to occur.
Many non-professional caregivers – spouses, adult children, other relatives and friends – find taking care of an elder to be satisfying and enriching. But the responsibilities and demands of care-giving, which escalate as the elder’s condition deteriorates, can also cause significant stress. The stress of elder care can lead to mental and physical health problems that leave caregivers burned out, impatient and more susceptible to neglecting or lashing out at the elders in their care.
Certain societal attitudes may contribute to violence against older people and make it easier for abuse to continue without detection or intervention. These factors include the devaluation of and lack of respect for older adults and society's belief that what goes on in the home is a private "family matter".
When older people are regarded as insignificant, society fails to recognise the importance of assuring dignified, supportive and non-abusive life circumstances for every older person. The idea that what happens at home is private can be a major factor in keeping an older person locked in an abusive or neglectful situation. Those outside the family who observe or suspect abuse or neglect may fail to intervene because they believe "it's a family problem and none of my business" or because they are afraid they are misinterpreting a private quarrel. Shame and embarrassment often make it difficult for older persons to reveal abuse. They do not want others to know that such events occur in their families.
Education is the cornerstone of preventing elder abuse. Media coverage of abuse in nursing homes has made the public knowledgeable about, and outraged by, abusive treatment in those settings. Because most abuse occurs in the home by family members or caregivers, there needs to be a concerted effort to educate the public about the special needs and problems of older adults and the risk factors for abuse.
The abuse of older adults is everyone’s business. Seniors and community members need to be informed about elder abuse, be able to recognise the signs and be engaged in taking steps to prevent it. It is important to remember that EVERYONE can help and has a role to play to prevent elder abuse.
Knowledge is the key to prevention… it is possible to prevent elder abuse. Specific prevention strategies may be required depending on the situation and type of abuse occurring.
Just as Malta has made inroads and registered progress in its fight against domestic violence, so too must it endeavour to raise more awareness of elderly abuse, which in itself is just a small branch of domestic violence, and counter its dire consequences. None of us will ever grow young again.
Dr Mark Said is an advocate