We live in an ageing society. People the world over are living longer. They are in better health, are more visible, more active, and more independent than ever before. But as the aged population grows, so does the problem of elder abuse, neglect andexploitation.  

Abuse in any form is unacceptable, but there is something about elder abuse, much like the abuse of children, that hits home particularly hard. Whether we like it or not, elder abuse is amongst us, and the time to recognise it for what it really is and take action is long overdue. When we think of elder abuse we tend to imagine it happening in hospitals, nursing or care homes and other institutions responsible for taking care of the elderly, or even to older people living alone. But whilst sadly that can occur, it is not the most common type of elder abuse. The majority of elder abuse takes place in the home, with relatives and caregivers the most likely abusers.

The plain and simple fact is that many older people grow frail and depend increasingly on others for meeting their basic needs. Within the home setting, abuse is often subtle, and yet still falls within the World Health Organisation’s definition of “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." The key phrase in this particular definition is that there is an "expectation of trust" of the older person toward the abuser. In other words, the  abuser, as well as perpetrating an unconscionable act, is betraying the trust placed in the spouse, partner, family member, friend or neighbour, by the older and invariably weaker person.

Other definitions refer to “the infliction of physical or emotional harm, financial exploitation or neglect of an older adult by the family or caregiver” and “any knowing, intentional or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult.”

What are the different kinds of elder abuse?

Abuse may take a remarkable variety of forms including, but not limited to:

Physical abuse is the use of force to threaten or physically injure a vulnerable elderly person, or deprive them of a basic need.

Emotional abuse can be verbal or non-verbal attacks, threats, rejection, isolation, or belittling acts that cause or could cause mental anguish, pain, or distress to an elderly person.

Sexual abuse refers to sexual contact that is forced, tricked, threatened, or otherwise coerced upon a vulnerable elderly person, including anyone who is unable to grant consent for whatever reason.

Neglect refers to a caregiver’s failure or refusal to provide for a vulnerable elderly person’s basic needs, whether in relation to their safety, physical or emotional needs, or other life necessities.

Abandonment is the desertion of a frail or vulnerable elderly person by anyone with a duty of care or custody. It also applies to the ‘dumping’ of elderly people at hospitals.

Financial or material exploitation is defined as the illegal or improper use of an elder's funds, property, or assets. This includes cashing an elderly person's cheques without their knowledge or permission; forging an older person's signature; misusing or stealing an older person's money or possessions; coercing or deceiving an older person into signing documents like contracts or wills, and the improper use of power of attorney. It also includes the sharing of an elderly person’s home without paying a fair share of the expenses whether or not requested by the older person.

In extreme cases, which could constitute theft and fraud, the elderly person will have been committed to an institution, or otherwise evicted from their property, and members of the family will profit from the rental of the property with no intention of using the funds for the benefit of the elderly relative.

How can you recognise elder abuse?

The first step towards protecting elders is to be able to recognize the warning signs that some form of abuse is taking place. Some of the signs can be very difficult to detect, but if you have suspicions, it is important to keep a watchful eye on the person and enlist help and support if necessary. Don’t leave it until it is too late and then wish you had acted sooner.

Physical abuse will often result in the presence of bruises or grip marks around the arms or neck, pressure marks, broken bones, abrasions, unexplained injuries or burns, and a refusal to go to the same medical facility for repeated injuries.

Emotional abuse can result in the elderly person being uncommunicative, unresponsive, and evasive, with unexplained withdrawal from normal activities, a sudden change in alertness, being suspicious, fearful, lacking social contacts and displaying unusual distress or passive responses to a family member, friend or caregiver.

Sexual abuse is indicated by unexplained vaginal or anal bleeding, bruising around the breasts or genital area, vaginal infections or venereal diseases, torn, stained or bloody underclothing and the report of sexual assault by the elderly person.

Financial or material abuse is indicated by signatures on cheques and documents which don’t match the elderly person’s signature; large withdrawals from bank accounts, ATM activity inconsistent with the elderly person’s expected needs, fund transfers out of the elderly person’s accounts, confusion about new legal documents like a new will or a new loan, mortgage or other inappropriate purchase. Other signs of financial or material abuse might include family members or others moving into the elderly person’s home and appearing to take over, consigning the elderly person to a smaller room, excluding them from normal social activities and mealtimes and leaving them to fend for themselves during the day or night. Other signs include the insufficiently explained absence of the elder person from their home and others moving in.

Neglect may result in loss of weight, thirst, dehydration, poor nutrition or poor hygiene, sunken eyes, confusion, anxiety, depression and a general and visible deterioration of the elderly person.

Why does elder abuse happen?

Whilst elder abuse can never be justified, one of the first steps in dealing with it is to try to better understand the many and varied reasons that it can happen, even in the most well adjusted families, regardless of race or class.

In some cases, elder abuse is synonymous with bullying in that the abuser invariably has control and power over the older person and derives a perverse sense of satisfaction by intimidating, isolating, dominating or controlling the older person. In many situations of elder abuse, the abuser is either dependent upon, or sees the older person as an easy source of money, food and shelter.

It is important to acknowledge that spouses make up a large percentage of elder abusers, and that a substantial proportion of these cases are the result of partnerships in which one member of a couple has traditionally tried to exert power and control over the other through emotional abuse, physical violence and threats, isolation, and other tactics.

The character traits of the elderly person can also play a part in the likelihood that they will be subjected to elder abuse. Elderly people who are argumentative and verbally aggressive, sometimes as a result of their awareness of their loss of independence, are at increased risk, as are those who are naturally submissive and overly trusting of others. In all cases, the greater their needs and reliance on others for providing those needs, the greater their vulnerability to abuse.

The stress and strain of caring for an elderly person with senile dementia or Alzheimer’s disease cannot be overestimated. Even the most loving and well intentioned of caregivers can become so overwhelmed and exhausted by the burden of caring for dependent elders suffering from these most challenging of conditions that they end up losing self-control and striking out, neglecting, or otherwise harming the elder. Lack of appropriate support and training in caring for the elderly, including lack of information and support for balancing the needs of the elderly person and the caregiver, can give rise to abuse.

How can elder abuse be prevented?

The first and most important step towards preventing elder abuse is to recognize that no one, of whatever age, should be subjected to violent, abusive, neglectful or humiliating behaviour. Educating seniors, professionals, caregivers, families and the public on abuse is critical to prevention. On an individual level, there are some simple but vital steps to reduce the risk.

Seniors

Take care of your health. Plan your own future. Having a power of attorney granted to someone you trust implicitly, or a living will, makes it easier for property, financial and health care decisions to be addressed to avoid confusion and family problems if you become incapacitated. Do not sign any documents before you get independent professional advice. Stay active in the community. Stay connected with friends and family. This will help to prevent isolation, which is a factor in elder abuse.

Know your rights. If you employ a paid caregiver, or a family member, you have the right to voice your concerns about treatment given. Attend support groups for spouses and get advice and information on domestic violence services.

Family Members

Ensure that family members, friends and neighbours make frequent checks on elderly people who are living at home, especially those living alone. Find a trusted caregiver, friend, nurse, relative or professional for in-home care. Encourage the caregiver to seek advice from physicians, social workers and nurses who can explain the older person’s medical, emotional and physical needs. Get help especially if you are feeling overwhelmed when taking care of an elderly relative. Arrange for a respite worker to take over for a few hours a week so that you can get time off from taking care of the elderly person.  Some day care centres for the elderly are willing to take seniors for specific time periods. Avoid overworking or overwhelming the caregiver. If the potential for abuse is suspected, help a caregiver to express his or her anger or frustration in ways that do not hurt the elderly person. Offer to help the caregiver to find a support group. Consider attending the support group with the caregiver if he or she agrees.

When living at home has become unsustainable, consider enrolling your elderly relative at a reputable adult day-care centre, retirement or nursing home or other reputable institution and visit them regularly.

How can I help stop elder abuse?

The devaluation of and lack of respect for older adults, as well as the cultural belief that what goes on in the home stays in the home, make it easier for abuse to continue without detection or intervention. You should never use cultural beliefs as an excuse for ignoring abuse. If you do, you are essentially enabling the abuser and are therefore partly responsible for the consequences of the abuse.

Be involved. Join with other volunteers in your community and form the equivalent of a Neighbourhood Watch. Offer to visit elderly members in your community on a regular basis and offer to run small errands for food, toiletries or medication. Contact the National Assistance Board to ensure the elderly person and their needs are known.

Report it. Elder abuse is a crime. Call the police if you know or suspect abuse is taking place. If you have concerns about confidentiality, you can call Crime Stoppers toll free on 1 800 8477. It is completely confidential and you will be able to follow up on any action taken by the police with total anonymity. You may even qualify for a reward! Crime Stoppers is only interested in the information that you have. When you call them, you do not have to give your name or your address. You will never be called upon as a witness or to testify in a court of law because they would never know who you are! You can also visit their website at www.crimestoppersbarbados.com.

Lobby government ministers to increase and strengthen adult protective services. In the summer of 2008, Minister of Social Care, Chris Sinckler indicated that his Ministry has plans for a Department of Elder Affairs. Write to the Minister and ensure that the active prevention of Elder Abuse is one of the new department’s priorities. Both Minister Sinckler and Minister of Health Donville Inniss have also indicated that Government will no longer put up with the practice of relatives ‘dumping’ elderly people at the island’s hospitals and will seek to recover costs from the estates of those who are forcibly put into care by their relatives. Whilst this is excellent news, it is vital not to lose sight of the desperate need for care homes and services for those who are genuinely unable to continue to care for elderly relatives in their homes. In the real world, it is not always practical or even advisable for elderly people to remain at home or in the care of relatives. For those families who are not lucky enough to be able to afford alternatives, government must respond, and quickly.