Download - Elder Abuse – an issue not to be ignored
Ed i to r ia l
Elder Abuse – an issue not to be ignored
In the past, abuse of the elderly has largely been
ignored or considered a problem that only took
place on a small number of occasions and usually
under mitigating or special circumstances. In many
instances, other carers or health care professionals
chose to turn a blind eye to these ‘one-off ‘
occurrences and no action was taken to protect the
individual subjected to abuse and they were cer-
tainly not recorded. This allowed a culture to
develop that in certain situations this form of
behaviour was almost regarded as the ‘norm’ to
deal with unruly or ungrateful people. Nearly
20 years ago, various organisations tried to raise
the issue of elder abuse and attempted to define its
meaning. A definition was provided by the orga-
nisation, Action on Elder Abuse and the WHO has
proposed this as a means of recognising the situa-
tion. On 17 November 2002, the Toronto Declara-
tion on Global Prevention of Elder Abuse was
devised at an expert meeting involving the WHO,
the International Network for the Prevention of
Elder Abuse (INPEA) and the University of Toronto
and Ryerson University, Ontario, Canada. They
stated that elder abuse was a universal problem and
was to be found in both the developed and the
developing world and its prevention was relevant
to all and could not be ignored. This declaration has
subsequently been adopted by many countries
around the world.
The accepted definition of elder abuse is:
‘A single act or repeated act or lack of appropriate
action, occurring within any relationship where there
is an expectation of trust, which causes harm or dis-
tress to an older person.’
It has to be recognised that abuse can take place
in a whole range of environments, including hos-
pitals, nursing homes, residential care homes, day
centres and even the person’s own home, perhaps
the one place where the older person might feel
safest. What is also more frightening is that the
abuser may be someone well known to the abused,
such as a close family member or relative, perhaps
the one person whom the older person would feel
they could trust to have their welfare at heart.
Other abusers include care professionals such as
health or social workers, friends, neighbours, and
the gender of the abuser or abused is not a factor as
it manifests itself in all ways. Unfortunately the
abuser sometimes does not recognise that what
they are doing is a form of abuse and it may be
unintentional as they fail through their own
inadequacies to appreciate the plight of the elderly
person under their care. They may be exploiting
their position of trust to their own advantage – a
type of ‘payment’ for services rendered, seeing no
fault in what they are doing.
The National Centre on Elder Abuse (NCEA) has
described seven categories of elder abuse. These are
physical, emotional or psychological, financial or
material, neglect, sexual, self-neglect and aban-
donment. Unfortunately, different organisations
still use different terminology, have different defi-
nitions and there are even discussions as to the age
at which a person can be considered to be ‘elderly’.
This causes significant issues with researchers as it
makes it more difficult to compare the outcome of
various reports with the inconsistencies in the def-
inition of abuse in older adults, as one is not com-
paring like with like. However, NCEA has attempted
to define the different categories with physical abuse
being acts of violence which could also include re-
straint or medication; emotional or psychological
abuse which could involve the use of threats or
intimidation; financial or material abuse which
could involve exploiting an older person’s ‘wealth’
for personal gain; neglect in its broadest sense; sex-
ual abuse encompassing non-consensual relation-
ships; self-neglect where an individual’s behaviour
is putting them at risk; and finally abandonment
where an elderly person is left to their own devices
by the supposed ‘responsible’ carer.
One of the other main difficulties with elder
abuse is recognising the symptoms or making sure
that serious consideration is given to an older per-
son’s concerns. It is a well-known fact that many
carers hide abuse behind the signs and symptoms of
dementia and although they may overlap, there is a
need to carefully explore any changes in behaviour
of the cared for or carer as well as perceived tension
between these individuals. In some cases, there are
obvious signs such as injuries or broken bones that
cannot be easily explained, unusual or rapid weight
loss, changes in financial records or wills, or items
missing from an elder’s home. Although many
carers find their role very rewarding, there are also
risk factors for them as well. These can include
being unable to cope with stress, suffering from
depression, taking of drugs or increasing alcohol
consumption, feeling isolated or lacking in any
physical or mental reward.
Other factors can play a major role in the under-
reporting of elder abuse such as shame, guilt,
� 2010 The Author
Journal compilation � 2010 The Gerodontology Society and John Wiley & Sons A/S, Gerodontology 2010; 27: 83–84 83
ignorance and fear of both the abused and the
abuser. In addition, many studies could be consid-
ered incomplete as certain population groups are
excluded; these may be those who have mental
illness or disorders such as dementia where com-
munication is challenging. However, that being
said, with the increasing number of people living
longer, the numbers subjected to some form of
abuse has every chance of increasing and recent
evidence would suggest that abuse victims are
more likely to visit emergency medical departments
more often. Therefore, health professionals work-
ing in these areas are at the forefront in identifying
those at greatest risk as the vast majority of abused
elderly will not report their own situation. A report
published in the USA by the National Research
Council in 2003 suggested that up to two million
people aged 65 years and older could have been
abused by someone whom they trusted or de-
pended on for support and the researchers raised
grave concerns for the future. For each of these
cases reported to the authorities, it is believed that
there could be at least another 12 that are not.
Therefore it becomes all the more important that
the incidence of potential elder abuse is reduced. It
has been suggested that other care professionals
must listen carefully to what the carers and the
cared for say, not be afraid to intervene when there
is a suspicion of elder abuse, and most importantly
educate others to recognise the signs and
symptoms.
On a slightly different note, Mary Warnock re-
ported in The Observer newspaper (18.04.10) on the
Christies Care survey that one in eight adults had
not been in touch with their parents for a year or
longer. However she states that the report almost
misses the point as the other seven don’t have that
problem, for which many are eternally grateful.
Unfortunately in the same article she has the view
that ‘society’ discriminates against older people and
this appears to start at around the age of 58 years,
beyond which it may be impossible to be usefully
employed. There is the notion that older adults
often don’t receive the care that would make a
substantial difference to their quality of life, are
required to deal with their ‘ageing ailments’ and
that these attitudes can easily end up being the
views of the younger generation. Who can blame
this latter group in not wanting to face the possi-
bility of caring for parents or relatives with
dementia as this could become a long-term com-
mitment to the detriment of their own. Perhaps
only those of us who have been there and ‘bought
the T-shirt’ really understand the issues in caring
for older parents and relatives.
‘It was once said that the moral test of Government is
how that Government treats……… those who are in
the twilight of life, the elderly; and those who are in
the shadows of life, the sick, the needy and the
handicapped.’
Hubert H. Humphrey (1911–1978)
James P. Newton
Editor
� 2010 The Author
Journal compilation � 2010 The Gerodontology Society and John Wiley & Sons A/S, Gerodontology 2010; 27: 83–84
84 Editorial