Elder abuse is a growing public health and social problem worldwide, but it remains neglected and ignored.
According to the World Health Organization (WHO), approximately one in six people aged 60 and over have experienced some form of abuse in the past year.
However, this figure is likely to be seriously underestimated, as many cases of elder abuse are often not reported due to fear, shame or helplessness.
Elder abuse is defined as single or repeated acts, negligence or failure to take appropriate action against an older person aged 60 years or older, that causes actual harm or suffering to the health, dignity or well-being of the older person in any relationship.
This abuse can occur in the family, community, nursing home, or even medical setting, and the abuser may be a relative, friend, caregiver or a stranger.
This can be divided into the following six categories, each with its own unique manifestations and harms.
Additionally, many forms of abuse often occur together.
1) Physical abuse
Physical harm to the elderly, including beating, pushing, kicking, shaking, hitting, slapping, burning, tying and other violent acts.
Signs:
> Unexplained bruises, skin scratches, cuts, bite marks, fractures, rope marks, broken spectacles
> Local body burns or abrasions
> Common falls with unclear causes
> The elderly show fear of caregivers.
2) Psychological/emotional abuse
Inflicting emotional harm or psychological stress on an elderly person by insulting, threatening, humiliating, devaluing, ignoring, etc.
In addition, forcibly isolating the elderly, including limiting contact with family, friends and help services, not allowing visitors or attending social activities, restricting the elderly from participating in cultural activities or using services, and opening the elderly’s emails or blocking phone calls without permission.
Signs:
> The elderly person shows anxiety, depression, withdrawal, distress, shame, great stress or powerlessness
> Sleep disorders, loss of appetite
> Social withdrawal, unwillingness to interact with others
> Sudden silence or over-compliance.
3) Sexual abuse
Any form of non-consensual sexual behaviour against the elderly, including forced touching, exposure of sexual organs, sexual harassment, etc.
Signs:
> Bruise or abrasions on the breasts, genitals or buttocks
> Unexplained vaginal or anal bleeding
> Torn or bloody underwear
> Extreme fear of physical contact by the elderly
> Sudden emotional trauma or withdrawal behaviour.
4) Financial exploitation
Illegal or unauthorised use of an elder’s money, property or resources.
Signs:
> Unexplained expenditures from bank accounts
> Loss of personal property
> Unauthorised signatures or property transfers
> Forcing an older person to change his will
> Inability to pay for basic living expenses.
5) Neglect
The caregiver fails to provide the elderly with basic living needs, such as food, water, clothing, shelter, medical care, medication, personal hygiene and other necessities.
Signs:
> Thinness, dehydrated and dry skin and mouth, malnutrition
> Poor body hygiene
> Dirty bedding, severe bedsores
> Missing essential equipment such as glasses, hearing aids, walkers or dentures
> When the elderly’s illness is significantly worse, they may miss doctor’s appointments or not receive appropriate care.
6) Self-neglect
Elderly people are unable to take care of themselves due to physical limitations or mental conditions and refuse to accept help from outside.
Signs:
> Significant weight loss
> Dirty and messy home, full of garbage
> Bad smell due to lack of cleanliness or hygiene, untidy clothing
> Medication piles up, not taking medicine on time
> Worsening physical illness but refusing to seek medical treatment.
The causes of elder abuse are complex and involve multiple levels:
> Family stress
Long-term care pressure causes caregivers to lose control of their emotions.
> Intergenerational conflict
Conflicts caused by the generation gap, such as property distribution, lifestyle and other issues.
> Economic dependence
Family members rely on the elderly’s pension or property, leading to exploitative behaviour.
> Mental health issues
Caregivers suffer from mental problems such as depression and addiction.
> Social isolation
Old people lack social support and are manipulated by abusers.
These risk factors for elder abuse include:
> Victim-related
Old age, female, mobility impairment, functional dependence/disability, poor physical/ mental health, cognitive impairment/dementia, communication difficulties, social isolation, etc.
The greater the age gap between the elderly couple (e.g., an older man and a younger wife), the greater the chance that the older spouse will be abused.
> Caregiver stress
The caregiver has his own physical/mental illness, alcoholism, drug addiction, substance abuse, financial difficulties, etc.
The caregiver is often overwhelmed, not fully prepared, lacks skills or resources, sees no hope, and suffers from caregiver burnout.
These people have increased social loneliness and sometimes, growing resentment often prompts abuse.
In fact, most caregivers do not intend to abuse the elderly, and do not even realise that they are doing so.
> Environmental
Tension between family members, social isolation and insufficient resources.
Elder abuse, if not detected and intervened in time, can lead to a series of serious physical and mental health effects, and even threaten life.
These effects include:
Deterioration of physical health
> Physical abuse can lead to infection and worsening of chronic diseases
> If bruises and fractures are not treated in time, they may cause complications such as sepsis and even death
> Decreased functional ability and increased dependence
> Malnutrition
> Bedsores.
Psychological trauma
> Old people who have been abused often suffer from depression and anxiety
> Increased despair or stress
> In severe cases they may develop post-traumatic stress disorder.
Social isolation
> Old people may actively distance themselves from their family and friends due to shame or fear
> Isolation further exacerbates their vulnerable situation.
Increased risk of death
> Studies show that the mortality rate of elderly people who have experienced abuse is two to three times higher than that of those who have not been abused
> Malnutrition, neglect, etc. can weaken the immunity of the elderly and accelerate the deterioration of their health.
The management of elder abuse requires the cooperation of an interdisciplinary team, including medical, legal and social services.
Medical intervention
> Physical examination
The doctor should comprehensively assess the physical condition of the elderly, including the location of the injury, nutritional status, etc
> Psychological assessment
Provide psychological counseling services for emotionally or sexually abused older people
> Trauma treatment
For fractures, burns, etc. caused by physical abuse, timely treatment is provided and the injuries are recorded as legal evidence.
Legal protection
> Notify the relevant authorities
Medical staff, social workers, etc. have the responsibility to report to the relevant departments immediately when one suspects abuse has occurred
> Application for protection order
Help the victimised elderly apply for a temporary protection order to restrict the abuser from contacting the victim
> Legal consultation
Assist the elderly to understand their legal rights, such as property protection, guardianship, etc.
Social support
> Arrange temporary placement
Arrange safe accommodation for abused elderly people, such as nursing homes or relatives and friends’ homes
> Contact social workers for follow-up
Ensure that the elderly receive regular visits and psychological support
> Rebuild social circles
Encourage the elderly to participate in community activities to reduce isolation.
Family intervention
> Psychological counselling
Arrange professional psychological counselling for conflicts and pressures between family members
> Financial assistance
Assist in applying for social welfare or financial counselling for cases of abuse caused by financial difficulties
> Education and training
Teach caregivers how to manage stress, communicate effectively with the elderly, etc > Provide care services
Provide help to caregivers to reduce the burden of care.
The elderly should not suffer any form of bullying, abuse or neglect.
We should create a non-violent and non-discriminatory environment for them through education, legal protection, social support and other multi-pronged approaches.
They should feel warmth and care in their later years.
Most importantly, we should encourage the elderly to break the silence and let them know that they are not alone and the whole society supports them.
Dr Tay Hui Sian is a consultant geriatrician. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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