Elder Abuse: Emotional & Psychological

Elder abuse can often be invisible because nobody wishes to talk about it, least of all, elders themselves. Emotional & psychological abuse can be even more so, as many times it could be unintentional but with serious repercussions. Here’s a guide to emotional & psychological abuse of elders and what we could do to stay aware.

Mr Pal (name changed on request) 80, no longer calls his daughter, a busy working woman at random hours. Their conversation wasn’t pleasant the last time and his daughter, driving to pick up her child in between business calls, berated her father for unnecessarily disturbing her. Mr Pal was quite upset, says his wife. “Yes, he too is at fault for not remembering how busy she is or what her schedule is like but she could have been a bit gentle with him,” says Mrs Pal, who finally made both sides see where they had gone wrong.

A situation like this, where nobody, neither Mr Pal nor his daughter, is at fault, can be an unintentional form of emotional abuse. We have all probably been guilty of it with the elders in our lives at some point or the other. And while we may really not mean and even regret our harsh words, the elder at the receiving end can feel upset and humiliated, says Malavika Chatterjee, Psychological Counsellor and partner, Caveo, with special experience in geriatric counselling.

The definition of Elder Abuse adopted by the International Network for the Prevention of Elder Abuse states 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 olderperson.’’ Such abuse is generally divided into the following categories:

 * Physical abuse: the infliction of pain or injury, physical coercion, or physical or drug-induced restraint.

* Psychological or emotional abuse: the infliction of mental anguish.

* Financial or material abuse : the illegal or improper exploitation or use of funds or resources of the older person.

* Sexual abuse: non-consensual sexual contact of any kind with the older person.

* Neglect: the refusal or failure to fulfil a caregiving obligation. This may or may not involve a conscious and intentional attempt to inflict physical or emotional distress on the older person.

(SOURCE: Abuse of the elderly – World Health Organization)

What is emotional and psychological abuse of elders?

Any form of insult, humiliation or harassment through words or actions can be psychological abuse. While it can be unintentional in some cases, it can also be intentional in many situations. E.g., the perpetrator may hit at the older person’s self-esteem repeatedly, humiliate them or berate them constantly and lead them to believe they are at fault.

Abuse can also happen when finances are involved, in the form of children pressuring parents to help them monetarily. The financial difficulties can lead to stress, which in turn leads to abuse, when the adult child may be dependant on the parents for financial support whether to start a business or even for daily living. “Children constantly and emotionally asking parents for money can create tremendous pressure on elders. It starts off on a subtle note always and slowly becomes a form of emotional abuse,” Chatterjee says.

Elders not being allowed to meet their loved ones, such as grandchildren or constantly moved from one child’s family to another without their consent can also affect them emotionally. Institutionalising elders without their consent is also a form of psychological abuse. Elders are often left behind in care homes or old age homes and the promises by children to visit them is often never fulfilled, though it raises their hopes.

Chatterjee also points out some real life common situations where neglect of an elder can have far reaching implications, even if not intended. “Often children employ a hired caregiver to take care of ailing parents as they need to work. The caregiver may ignore instructions like giving the medicine at a particular time or delaying the diaper change of an ailing elder because she/he is either not trained enough to know the importance or simply being careless without supervision. Many a times, the elder may repeatedly ask for something basic such as water, a request that the caregiver pretends not to hear. Can you imagine how helpless an ailing older person can feel in this case, especially someone who has been in charge of the same household earlier?”

Emotional and psychological abuse of elders can also happen intentionally or unintentionally by caregivers of an ailing older adult.

“Often abuse by caregivers is because they are so emotionally drained,” says Chatterjee, adding, “Sometimes it is lack of knowledge, such as a maid not knowing the importance of medication timings. Sometimes, the caregiver doesn’t know the correct way to carry an elder who is immobile and it may actually hurt them.”

Lack of financial support can also have a draining effect on a caregiver who has to take care of the bills and lead to situations where the caregiver can be short-temped or roughly behaved with the elderly person they are caring for. “I was working two jobs when my mother was ill and really stressed and tired. I’ve been guilty of it at times with my late mother, though I checked myself as much possible,” says Mala, a mediaperson from Delhi. In many cases, says Chatterjee, if a parent had been abusive towards a child earlier, it can even come out in the form of abusive behaviour on the child’s part towards the parent, once the tables are turned. The same applies to a spouse, who has not had a very cordial relationship with his or her better half.

The After Effects Of Emotional Abuse

Elder abuse is often an invisible thing. Emotional & psychological abuse can be more so. The repercussions of emotionally abusive behaviour by their loved ones, hired help or even strangers in public places can be invisible but have huge impact on an elder, who is already feeling helpless because of their ill health or other factors. “Their self esteem can go down, they can sometimes get hyper vigilant and extra sensitive, where every issue becomes a battle,” Chatterjee adds.

Are there signs to look out for?

“The warning signs could be a chirpy person gone quiet, an elder who has stopped talking or has become hyper vigilant about their things. An elder who has suddenly become suspicious and protective about their things is another sign. Some of the physical signs could be trembling while talking or tearing up for simple things,” says Chatterjee. She however adds a cautionary note: “I would also advise people to take this with a pinch of salt. Not everything could be a sign of emotional abuse as with deterioration of mind and body with age, some of the above mentioned changes may happen in any case.”

What should we keep in mind to avoid unintentional abuse?

“One of the simplest things is to answer their phone calls, when an elder calls you,” says Chatterjee. “Even if you are out and busy, just answer the call and say you will call back. Remember how you answer the call, your tone, the way you say I’m busy, make a lot of difference to an elder.After all, many times the older person just wants to know where you are and is anxious!” Mala recommends checking in on the hired caregiver if you are out the whole day and your parent’s welfare is largely in their hands. “Just because outwardly everything is fine doesn’t mean it actually is. I realised much later that a trusted family help, hired to take care of my mother, was actually rationing her fruit intake and taking the rest home!”

Abuse Can Happen Anywhere

Psychological and emotional abuse of elders can happen anywhere. At a nursing home, at the grocery store, in a mall, or even on the road. “Just because you are old, you are looked at differently. There’s a huge difference between sympathy and empathy and not all elders want sympathy,” says Chatterjee.

She also adds that in India, social conditioning is also at play. Older people are expected to behave in a certain way, dress in a particular way and often receive curious looks if it is any different than the norm. Chatterjee calls it a form of bullying and it results in many elders becoming defensive and agitated. It can lead to retaliation and friction with the younger generation.

“For example, if an elderly person is driving we often comment on their driving skills. Just because somebody is on the the other threshold of life, our reactions to them need not be different,” she says, adding that all these could have a psychological impact on the elder.

When are elders are more vulnerable to emotional abuse?

Psychological and emotional abuse of elders is a widespread thing that is prevalent in every class and every society. In many homes you will find instances of the elderly person being given one meal a day or being left in complete isolation. From the instances she has seen in her work with the geriatric population, Chatterjee feels it can happen to people who become weaker emotionally, physically and financially, as they age.

What could elders do to stop emotional abuse?

Prevention can start at a younger age. “Start building yourself to maintain emotional stability. It is also important to have an intergenerational circle of friends as with friends just in your age group, degeneration can set in around the same time. Keep yourself engaged in activities. When your cognition is stable, manage your own finances and make sure your pension comes in your bank account. Try to keep a lot of things in your hand as long as you have the cognition. Stay engaged in some activity,” comes Chatterjee’s advice.

If an elder realises they are being emotionally abused, the best thing to do is open the channels of communication. Meet or pick up the phone to talk to someone close to you; Get yourself educated and informed about what abuse is.

What can we do as a society

Emotional & psychological abuse of elders is a sensitive issue and not a blame game. In cases where it is unintentional, both the elders and younger people need to work on a mutual respect basis. “The most effective way is to spread awareness and create platforms through which you can do so,” says Chatterjee.