Understanding & Preventing Elder Abuse

In 2021, 43.1 per cent of elders said that elder abuse is prevalent in society. Here’s a deep look at what is elder abuse and how could it be prevented.

There is an interesting perspective in Helpage India's 2021 report on elder abuse that's focused on the pandemic. 61.4 per cent of older respondents said that the ‘work from home/study from home’ routine of their family members affected their day-to-day routine. It was a sharp contrast with the perspective of their family member/caregiver. 71.6 per cent of them said it did not affect the elder’s day-to-day routine.

Dr NN Prem, Chief Consultant Geriatric Medicine, Department of Geriatric Medicine, Jaslok Hospital, Mumbai, talks of this difference in perspective when talking about the increasing incidents of elder abuse. We need to understand abuse from the perspective of both the caregiver and the elder, he says.

"It's the complexity of relationships.  The younger generation needs to look at the elders' viewpoint. Sometimes the issues come from both sides. Both generations need to understand that there has to be a middle part as sticking to your ground means that the tough situation drags on, there is no open communication and it may lead to an event of abuse." 

What is elder abuse?

Elder abuse is a term referring to any intentional or negligent act, whether by the caregiver (family or paid attendant) or any other person that may cause harm to an older adult. It is not limited to any social strata or class and goes beyond physical abuse. Sometimes both the older adult and the caregiver may not be aware that the behaviour is abusive, a key reason why awareness about elder abuse is important. 

Dr Prem lists out the various types of elder abuse that are common:

Self Neglect: Self-neglect is a state where the older adult neglects every aspect of care. They start living in conditions that can be harmful to their health. It can be a sign of depression, grief or even dementia. Neglecting personal hygiene, failing to seek medical help, avoiding self-harm, and inability to manage activities of daily living, all fall under this. But when does self-neglect get classified as elder abuse? When it is a failure to fulfil a caretaking obligation by the caregiver to ensure the older adult’s overall wellbeing.

Physical abuse: This includes physical assault, restraining or confining the older adult, roughly handling the vulnerable older adult, feeding them forcibly or withholding food from them. "Inappropriate use of drugs is also an abuse," Dr Prem notes. "If they are restless at night, giving them an overdose of sedatives without asking the doctor, for instance.” He cautions that physical abuse can be easily morphed (disguised) and signs of abuse are often passed off as bruises from a fall or self-harm by the person behind the abuse. 

Emotional abuse: Terrorizing an older adult with threats of harm, abandonment, and verbal abuse by yelling, humiliating and ridiculing, all these are signs of abuse. "It is very common to ridicule the older adult as having been a failure and though this often comes out of frustration, it can have a huge emotional impact," Dr Prem adds. "It could also be ignoring the elderly person completely or isolating them from their friends or activities they love." Abuse reports show us that emotional abuse is often the main form of abuse.

Sexual abuse: Apart from sexual assault or inappropriate touch, sexual abuse can also be about exploiting a vulnerable older adult in other physical ways and disrespecting their dignity.

"For example, undressing a person who has dementia without any dignity. Whether the person is bedridden or not, there is still a person inside and everyone needs to respect that. There are times when older adults have been left undressed against their wish or have been changed openly without a cover. All these constitute significant elder abuse," says Dr Prem.

Financial abuse: Exploiting a vulnerable older adult financially is very common. These may include misuse of the older adult's checks, credit cards or cash. Forging the older adult's signature, identity theft, preventing them from accessing their own money or assets. Undue pressure on the older adult to secure loans, forcefully make a will or financial transaction, and any similar coercion related to money, all could be forms of elder abuse.

Prevention & Safeguarding Older Adults

Prevention & Safeguarding Older Adults

Older adults need to secure themselves first, believes Dr Prem. “Make sure you have a home and at no point just name everything to the children. If you make a Will, try to equally distribute whatever you want and make sure you secure yourself and your spouse first.” 

Caregiver stress often contributes to elder abuse. “As geriatricians, we need to understand what amount of stress the caregiver is under. We always talk about prevention and we could do that by addressing caregiver stress at an earlier point.

Here are a few pointers toward caregiver stress that could be looked at to prevent elder abuse at a later stage.

The history between the older adult and the caregiver matters a lot. For instance, in some cases the older adult could have been an abusive parent or spouse to the caregiver and the frustration and anger of that history could turn to abuse.

“It’s important to protect the elder and it is also important to create awareness about caregiver stress and try to prevent it as that often leads to abuse,” Dr Prem notes.

How to notice elder abuse and what to do about it?

Keep checking on the elder, advises Dr Prem, whether you are part of the elder’s home, a friend, relative or a neighbour. Call the elder or visit often if possible so that you become a trusted confidante. Offer to stay with the older adult if they are comfortable so that their primary caregiver may get a break. Watch out for the elder’s state of hygiene, clothes and communication. For instance:

Do they seem happy to live in their home or the care home they are residing in? 

Would they like to live elsewhere? 

Does their condition seem to deteriorate further each time you see them? 

Very few older adults would openly say they are being abused, fearing retribution or out of shame, love or guilt but constant communication could help. If you think the situation demands an intervention, you could speak to a trusted source. Also, look up our guide here on reporting abuse. 

Dr Prem adds a word of caution to this:

If you have established that there is elder abuse, do not try to confront the abuser yourself without gathering support. Find strength in numbers as doing it impulsively might put the older adult in danger. For instance, if you suspect a family caregiver of abuse, other family members need to be aware of the situation and the older adult needs to be convinced that she/he would need alternate care.

If you suspect self-neglect, keep checking in with the older adult and make sure they are always connected to their medical services. If you're an older adult reading this and unhappy with the care you're receiving, try to speak up. Talk to someone you trust. 

For Caregivers

Elder Abuse reports often point out that it begins at home. According to 2021’s report, the main abusers were sons and daughters-in-law. 

It can be exhausting and challenging to care for an older adult. It is especially draining if it is without much help or support or requires you to put your work or activities on the backburner. Since such situations can often lead to abuse, Dr Prem suggests preventive tips if you're a caregiver. 

Take immediate steps to relieve your stress and burnout, whether it's meditation, whether it's doing deep breathing exercises, or Yoga, among these.

Please learn techniques to get your anger under control. 

* Make sure that you get enough rest because the lesser you sleep the more you're susceptible to irritation and anger. 

* Have a healthy diet, get regular exercise, and take care of your own medical needs. 

Find a support group for caregivers for the elderly as sharing your concerns and experiences may be might lead to solutions, which you thought were not there.  

If you're not able to tolerate whatever is happening, you need to seek mental health support as by doing that you will take a step towards providing better care for the older adult. 

Elder abuse is a sad reality in our society. Yet, as we create awareness and empower elders, we could try to address it from the root and take a balanced view on what causes it.

Silver Talkies has written extensively on Elder Abuse through the years. Click here to read.

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