Elderly people need security. Pic: Abhishek Angad

Our nation is facing a crisis in ageing as we attempt to understand and prepare to meet the needs of millions of older adults, current and future. Public and private sectors are engaged in a dialogue to address the needs of a diverse ageing population; to promote their dignity and independence, and expand opportunities for current and future generations of older persons.

In India, over 90 million people are above 60 years of age. This is about 7.4% of the total population. The fear is that by 2021 it is estimated to grow to a whopping 140 million. In the state of Karnataka, 7.2% of the population is aged making it one of the top states in the country in this focus area. (Source: Situation Analysis Of The Elderly in India, June 2011).

The National Policy on Older Persons 1999 has set an agenda about what it proposes to do. The policy envisages state support to ensure financial and food security, healthcare, shelter and other needs like equitable share in development, protection against abuse and exploitation and availability of services for their well being, and has called for stakeholders, including the public, to decide what is sustainable and relevant, and what issues need addressing in the next decade. In the current scenario, issues that loom large are financial security, healthy ageing, long term services and supports, and elder justice. Firm commitment in tackling these pointers will definitely provide a better quality of life to our senior citizens.

In 2006, the United Nations General Assembly declared June 15th as “World Elder Abuse Awareness Day”. There is no beter time than now to discuss ways to combat this social malaise that has crept into our families and communities unchallenged.

What is elder abuse?

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.

In many parts of the world, elder abuse occurs with little recognition or response. Until recently, this serious social problem was hidden from the public view and considered mostly a private matter. Evidence is accumulating, however to indicate that elder abuse is an important public health and social problem.

Data shows that 50% of seniors in Indian experience abuse. Among Tier 1 cities, Delhi has the lowest (22%) and Bangalore has highest (75%). (Source: Report on Elder Abuse in India 2014)

All cases of abuse are not reported and the extent of elder mistreatment is unknown; however its social and moral significance is obvious. As such, it demands a global multifaceted response, one which focuses on protecting the rights of older persons.

Where does the abuse take place?

Elder abuse tends to take place where the senior lives; mostly at home. Abusers are children, son/daughter in law, spouses or caregivers. Abuse can also take place in institutional settings, especially in long term care facilities.

The different types of elder abuse

Abuse of elders takes many different forms, some involving intimidation or threats against the elderly, some involving neglect, and others involving financial chicanery. 41% of elders in India have reported verbal abuse, 33% have reported disrespect and 29% reported neglect. The most common findings are defined below.

Physical abuse: Physical elder abuse is non-accidental use of force against an elderly person that results in physical pain, injury, or impairment. Such abuse includes not only physical assault such as hitting or shoving, but also the inappropriate use of drugs, restraints, or confinement.

Emotional abuse: In emotional or psychological abuse, people speak to or treat elderly persons in ways that cause emotional pain or distress. These can be verbal or non-verbal. Verbal abuse involves intimidation using yelling or threats, humiliation and ridicule. Non-verbal psychological abuse can be ignoring or isolating the elderly person or terrorising them.

Sexual abuse: Sexual elder abuse is contact with an elderly person without the elder’s consent. Such contact can involve sexual acts, or vulgarity.

Neglect or abandonment by caregivers: Elder neglect, failure to fulfill a caretaking obligation, constitutes more than half of all reported cases of elder abuse. It can be intentional or unintentional, based on factors such as ignorance or denial that an elderly charge needs as much care as he or she does.

Financial abuse: This involves unauthorised use of an elderly person’s funds or property, either by a caregiver or a relative. It involves misusing the elder’s accounts or credit cards, stealing cash, forging signatures, and investment frauds.

Signs and symptoms of elder abuse

At first, you might not recognise or take seriously the signs of elder abuse. They may appear to be symptoms of dementia or signs of the elderly person’s frailty. In fact, many of the signs and symptoms of elder abuse do overlap with symptoms of mental deterioration, but that doesn’t mean you should dismiss them on the caregiver’s say-so.

General signs of abuse

• Frequent arguments or tension between the caregiver and the elderly person
• Changes in personality or behavior in the elder
• Unexplained bruises or injury marks on the body
• Unsanitary living conditions
• Isolation, neglect or confinement of the elder
• Threatening, belittling or control by the abuser
• Unusual weight loss, malnutrition or dehydration
• Sudden changes in the elder’s financial condition

Ways to prevent abuse

• Listening to seniors and their caregivers
• Intervening when you suspect elder abuse
• Educating others about how to recognise and report elder abuse

Reporting elder abuse

Residents at the Nightingales Centre for Ageing and Alzheimer’s gather around on the lawn for a support session.

• If you are an elder who is being abused, neglected, or exploited, tell at least one person. Tell your doctor, a friend, or a family member whom you trust. Or call one of the help lines available.
• If you see an older adult being abused or neglected, don’t hesitate to report the situation. Don’t assume that someone else will take care of it or that the person being abused is capable of getting help if he or she really needs it.
• Many seniors don’t report the abuse they face even if they’re able. Some fear retaliation from the abuser, while others believe that if they turn in their abusers, no one else will take care of them. When the caregivers are their children, they may be ashamed that their children are behaving abusively or blame themselves.

Addressing elder abuse

Approaches to define detect and address elder abuse need to be placed within a cultural context and considered alongside culturally specific risk factors. For example, in some traditional societies, older widows are isolated and not allowed to socialise. 

From a health and social perspective, unless both primary health care and social service sectors are well equipped to identify and deal with the problem, elder abuse will continue to be under diagnosed and overlooked.

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