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