The abuse of older people, also known as 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 older person. This type of violence constitutes a violation of human rights and includes physical, sexual, psychological, and emotional abuse; financial and material abuse; abandonment; neglect; and serious loss of dignity and respect.
The abuse of older people is an important public health problem. A 2017 review of 52 studies in 28 countries from diverse regions estimated that over the past year 1 in 6 people (15.7%) aged 60 years and older were subjected to some form of abuse. Although rigorous data are limited, the review provides prevalence estimates of the proportion of older people affected by different types of abuse. Data on the extent of the problem in institutions such as hospitals, nursing homes, and other long-term care facilities are scarce. However, a review of recent studies on abuse of older people in institutional settings indicates that 64.2% of staff reported perpetrating some form of abuse in the past year.
There are many types of abuse:
- Physical abuse happens when someone causes bodily harm by hitting, pushing, or slapping. This may also include restraining an older adult against his/her will, such as locking them in a room or tying them to furniture.
- Emotional abuse, sometimes called psychological abuse, can include a caregiver saying hurtful words, yelling, threatening, or repeatedly ignoring the older adult. Keeping that person from seeing close friends and relatives is another form of emotional abuse.
- Neglect occurs when the caregiver does not try to respond to the older adult’s needs. This may include physical, emotional, and social needs, or withholding food, medications, or access to health care.
- Abandonment is leaving an older adult who needs help alone without planning for his or her care.
- Sexual abuse involves a caregiver forcing an older adult to watch or be part of sexual acts.
- Financial abuse happens when money or belongings are stolen from an older adult. It can include forging checks, taking someone else’s retirement or Social Security benefits, or using a person’s credit cards and bank accounts without their permission. It also includes changing names on a will, bank account, life insurance policy, or title to a house without permission.
The main reasons for elderly abuse are emotional and economic dependence and changing ethos in society. “Emotional dependence of the abused (46%)” has emerged as the major reason for the prevalence of elder abuse followed by “economic dependence of the abused (45%)” and “changing ethos (38%)”.
In 2013, “lack of adjustment”, “economic dependence of the abused” and “increasing longevity” were the main reasons for elderly abuse. In 2015 from the point of view of youth, the main reasons behind elderly abuse are property and inheritance disputes and financial problems in the house (53.2% and 46.6% respectively). In the society, “Attitudinal and relationship issues” (35.7%) have also emerged as the major reason for the prevalence of elder abuse followed by “Lack of time and patience on the part of the abusers (29.4%)”, “Health/addiction problems of abusers (26.9%)” and “Health/addiction problem of the abused (22.8%)”.
It was reported at the national level that 46% of elderly have been facing abuse for three to five years, 25% of elderly reported for one to two years, and 21% stated that the duration is approximately six to ten years. About 4% of the abused elders have been facing the same situation for more than fifteen years and an equal percentage of elderly (4%) have been facing the abuse for eleven to fifteen years. The abused elders also stated that 35% of them are abused at least once a week, 20% elderly face it once a month, 17% said that they encounter with abusing almost daily, while 15% reported that they come across abuse very rarely and only 13% of them face the abuse once in few months.
You may see signs of abuse or neglect when you visit an older adult at home or in an eldercare facility. You may notice the person:
- Stops taking part in activities he or she enjoys
- Looks messy, with unwashed hair or dirty clothes
- Has trouble sleeping
- Loses weight for no reason
- Becomes withdrawn or acts agitated or violent
- Displays signs of trauma, like rocking back and forth
- Has unexplained bruises, burns, cuts, or scars
- Has broken eyeglasses/frames, or physical signs of punishment or being restrained
- Develops bed sores or other preventable conditions
- Lacks medical aids (glasses, walker, dentures, hearing aid, medications)
- Has an eviction notice for unpaid rent, notice of late mortgage, or home eviction
- Has hazardous, unsafe, or unclean living conditions
- Displays signs of insufficient care or unpaid bills despite adequate financial resources
If you see signs of abuse, try talking with the older adult to find out what’s going on. For instance, the abuse may be from another resident and not from someone who works at the nursing home or assisted living facility. Most importantly, get help or report what you see to adult protective services. You do not need to prove that abuse is occurring. Professionals will investigate.
Many strategies have been tried to prevent and respond to abuse of older people, but evidence for the effectiveness of most of these interventions is limited at present. Strategies considered most promising include caregiver interventions, which provide services to relieve the burden of caregiving; money management programs for older adults vulnerable to financial exploitation; helplines and emergency shelters; and multi-disciplinary teams, as the responses required often cut across many systems, including criminal justice, health care, mental health care, adults protective services and long-term care (5).
In some countries, the health sector has taken a leading role in raising public concern about the abuse of older people, while in others the social welfare sector has taken the lead. Globally, too little is known about elder abuse and how to prevent it, particularly in developing countries.
The Maintenace and Welfare of Parents and Senior Citizen Act 2007 is popularly known as the Senior Citizen Act. It got enacted in the year 2007. The legislation aims to provide adequate maintenance and effective welfare to old parents and senior citizens.
So, the Act made it a legal obligation for adult children and heirs to provide a monthly allowance for parents. The act provided inexpensive and speedy procedures to claim monthly maintenance for parents and senior citizens. The act also makes it necessary for the children and relatives of senior citizens to maintain their parents and grandparents. So, it lays down provisions to protect the life and property of senior citizens.
A senior citizen unable to maintain himself from his earnings or the property he owns can receive maintenance under Section 5 of the Senior Citizen Act.
It becomes the duty of the children, grandchildren, or relatives to maintain senior citizens or parents to fulfill their needs. A relative has to pay maintenance if he has possession or will inherit the senior citizen’s property.
If more than one relative is entitled to inherit the senior citizen’s property, the maintenance gets payable in the proportion they will inherit the property.
If they don’t take care of the senior citizen, senior citizens have the right to seek assistance from the Tribunal. The claim is raised regarding maintenance or any other relief.
The rights of a senior citizen under the Senior Citizen Act are as follows:
- A childless senior citizen can claim maintenance from any relative who would inherit his property.
- The state government has to constitute a tribunal to hear the case regarding maintenance.
- The State Government specifies the maximum maintenance that can be allowed. The amount of maintenance should not exceed the amount of Rs. 10000/- per month.
- If a person defaults in payment of the maintenance, he should be liable for imprisonment as per the provision of the Senior Citizen Act.
- A senior citizen has the right to cancel the transfer of his property by will or gift.
- A legal practitioner is not required to represent any party before a maintenance tribunal or appellate tribunal.
- The Senior Citizen Act provides the establishment of at least one old age home in every district. Such old-age homes should have the capacity to shelter 150 senior citizens.
Section 19 of the Senior Citizen Act deals with the establishment of old age homes, and according to this section, the state government must establish at least one old age home in one district. The old age home should be made to accommodate one hundred fifty senior citizens.
The State Government can prescribe schemes for managing old age homes, including the standards and types of services provided by the old age homes. The services include medical care and means of entertainment.
Section 20 of the Senior Citizen Act provides provision for Medical Support for Senior citizens.
According to this Section, the State Government should ensure that:
- The fully or partially funded hospitals by the state government should be provided with beds for senior citizens.
- There should be separate queues for the senior citizen.
- Facilities for treating chronic, terminal, and degenerative diseases gets provided for the senior citizen.
- The research for chronic elderly diseases and aging gets expanded.
- There are facilities for geriatric patients in every district hospital. The hospital gets headed by a medical officer with experience in geriatric care.
Section 22 of the Senior Citizen Act states that the State Government confers powers and imposes duties on District Magistrate. The State Government should ensure the proper execution of the Maintenance and Welfare of Parents and Senior Citizen Act provisions.
The District Magistrate has the power to specify the officer subordinate to him. The person subordinate to him can exercise power and perform the duties conferred to him and the local limits within which the officer carries the powers or duties as prescribed.
The State Government prescribes a plan to protect the life and property of the senior citizen.
If a senior citizen has transferred the property (i.e. movable or immovable) after the commencement of the Senior Citizen Act in the form of a gift or any other way where the condition is such that the transferee provides the basic amenities and physical needs to the senior citizen.
If the transferee refuses or fails to provide basic amenities to the senior citizen, the tribunal can declare such transfer void under section 23 of the Senior Citizen Act.
Elder abuse is an intentional or negligent act by any person that causes harm or a serious risk of harm to an older adult. It is a term used to describe five subtypes.
• Physical Abuse
• Psychological Abuse
• Financial Exploitation
• Neglect and Abandonment
• Sexual Abuse
The trauma of elder abuse can result in premature death, the deterioration of physical and psychological health, destruction of social and familial ties, devastating financial loss and more. Older adults are being mistreated in multiple settings (homes, nursing homes, assisted living facilities) by family members, friends and neighbors, professionals, and strangers. The EJI provides several scenarios and red flags to help the public understand the five types of abuse.
An elder abuse case has many stages from the incident through investigation, prosecution, and victim recovery. The EJI seeks to improve outcomes at each stage by providing resources, training, and information, and by promoting a multidisciplinary response to elder abuse.
Abuse of older people can have serious physical and mental health, financial, and social consequences, including, for instance, physical injuries, premature mortality, depression, cognitive decline, financial devastation, and placement in nursing homes. For older people, the consequences of abuse can be especially serious and recovery may take longer.
Individual-level characteristics which increase the risk of becoming a victim of abuse include functional dependence/disability, poor physical health, cognitive impairment, poor mental health, and low income. Individual-level characteristics which increase the risk of becoming a perpetrator of abuse include mental illness, substance abuse, and dependency – often financial – of the abuser on the victim.
On 15 June 2022, World Elder Abuse Awareness Day, WHO and partners published “Tackling abuse of older people: five priorities for the UN Decade of Healthy Ageing (2021–2030)”. These five priorities, arrived at through wide consultation, are:
- Combat ageism as it is a major reason why the abuse of older people receives so little attention.
- Generate more and better data to raise awareness of the problem.
- Develop and scale up cost-effective solutions to stop the abuse of older people.
- Make an investment case focusing on how addressing the problem is money well spent.
- Raise funds as more resources are needed to tackle the problem.
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