Elder Abuse – what do we know about it?

Judith Davey 19/7/21

Elder abuse and neglect in all its forms detracts from the health and wellbeing of older people. It creates mental and physical harm and distress, and can strip them of their voice, their rights, and their possessions. Despite evidence that elder abuse has occurred throughout history and across social groups and cultures, it has only recently been studied and named as a social problem. Tackling this problem is hampered by the lack of clear definitions of what it is; by the difficulty in obtaining data on its extent and characteristics; and the lack of initiatives to avoid and address elder abuse.

Definition

There is no single internationally accepted definition of elder abuse and neglect. New Zealand and many other countries use the definition adopted by the World Health Organisation in 2002: “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”.

Within this statement are elements which, in their turn, require definition and which highlight the complexity of the problem. Firstly, what is an “older person”? Many organisations, including Age Concern New Zealand, which has been very active in providing elder abuse and neglect prevention services, defines “older person” as 65 years or older. What sort of harm is involved? It may be physical, psychological/emotional, material/financial, or sexual. Not all of these are crimes in the legal sense.

The phrase “where there is an expectation of trust” means that “stranger” crimes against older people would not be covered by the WHO definition. These would include criminal activity, such as burglary, assault by strangers, fraud and “scams”. And where does institutional abuse come in?

What about neglect, where” lack of appropriate action” causes harm? Self-neglect by older people is an important issue, seriously threatening wellbeing. Definitions also require consideration of the cultural context. Interpretations of what constitutes abuse, and the appropriateness of responses will vary. For example, disrespect, dishonour, lack of esteem shown to kaumatua/elders may be seen as abuse in the Maori and Asian communities.

Types of abuse and neglect

Abuse, neglect and violence against older persons take many forms and occur in different settings (private homes, residential care, etc). Several types can happen at the same time. The following categories are roughly in order of prevalence.

Psychological abuse refers to behaviour that causes the victim anguish, stress, or fear. It includes verbal abuse, intimidation, humiliation, harassment, removal of decision-making powers and control of choices, and threats of damage to property or physical abuse.

Material/financial abuse is the illegal or improper exploitation and/or use of older people’s funds or resources. Examples include theft of money or property, appropriation of assets by people with legal powers over them (such as Power of Attorney). For example, a family keep an old man with multiple health issues at home because paying rest home fees would erode his assets – their inheritance.

Physical abuse is the infliction of pain or injury, physical coercion and restraint. including medication abuse (deliberate misuse of prescriptions that sedate or result in harm) and inappropriate use of restraint or confinement. For example, an older woman has been giving her son cash. When she doesn’t have enough to spare, he pushes her, twists her arm and forcibly takes her handbag with her purse. Physical abuse could also be a continuation of partner abuse which has been a life-long issue.

Sexual abuse is non-consensual sexual contact of any kind; forced, coerced or exploitive sexual behaviour or threats, especially where a person lacks mental capacity to give consent or understand.

Institutional abuse arises from the policies or practices of an organisation that impinge on the rights and well-being of older people (institutional racism is a comparable concept). This may occur within a residential care facility, hospital, or other public or private sector agency, including financial and social service organisations. It may arise where there is insufficient staff or where practice focuses more on organisational convenience than client needs.

People in residential care may be subject to abuse from their family and visitors or by staff. Examples include neglect, forced feeding, rough handling, inappropriate use of restraints, or cultural insensitivity. There are also cases of stealing from residents.

Neglect is when another person fails to meet the physical and emotional needs of a person. Passive/unintentional neglect may arise from carers’ inadequate knowledge, illness or lack of trust in prescribed services. Active/intentional neglect is the conscious and deliberate deprivation of care.

So why does elder abuse and neglect happen?

Some of the theories about the nature and causes of elder abuse and neglect relate to the vulnerability of older people, who may be dependent on others. Social isolation from family and friends and from supportive services increases the potential for abuse, because it offers opportunities, and the ability to conceal it.

Elder abuse and neglect are predominantly perpetrated by family members, making it an intergenerational issue, especially where there is a history of family conflict and issues of power and control. Alcohol and drug abuse, psychological and behavioural problems may be involved as well as financial stress and unemployment. The older person may be dependent on others, making them vulnerable to abuse. Or the abuser may be financially and emotionally dependent on the older person.  Older people may choose to remain in a living situation which is not physically, psychologically, or financially safe for them out of loyalty to family.

In the case of older people with significant disabilities, carer stress can lead to abuse, but this is not seen as the dominant cause. Dementia or other medical conditions may produce behaviour which is abusive of carers. Both victims and their carers may be isolated older people, in a powerless and dependent position.

The ‘ecological model’, links elder abuse and neglect with broader social issues, instead of focussing solely on individual and family contexts, associating it with older people’s relatively low status in society and lack of economic power.  This suggests that to the need to explain why and how elder abuse and neglect occurs needs an exploration of social structures and ageist attitudes^. 

Because of the problems of definition and reporting, reliable statistics on the prevalence of elder abuse and neglect are difficult to find. As with other forms of family violence, elder abuse and neglect is likely to be under-reported. This may be due to a lack of awareness of the problem or reluctance to report suspected cases. Older people especially may be reluctant to report abuse by their closest relatives.

Research by the Family Centre Social Policy Research Unit used data from the New Zealand Longitudinal Study of Ageing in 2012 to measure the prevalence of elder abuse in New Zealand[1]. This used self-reporting and aimed to identify types of elder abuse and neglect; to calculate prevalence and produce future projections. Associations with gender, marital status and ethnicity were tested alongside a range of health and wellbeing measures.

This study demonstrated that elder abuse was prevalent for at least 10% of participants aged 65 and over. It gave insights into the extent of different types of abuse. Other broad findings included:

• Psychological abuse was more frequent than coercion and physical abuse.
• Women were more likely to experience interpersonal and financial abuse than men, but men were significantly over-represented in coercion and more likely to have property taken without their permission.
• Māori experienced significantly more elder abuse compared with non-Māori.
• Divorced, separated and widowed older people experienced a greater level of sad and lonely feelings than partnered people and were more likely to have property taken without their permission.
• Married people had the lowest elder abuse scores.
• Statistical correlations were found between elder abuse and lower levels of health and wellbeing, and higher levels of depression and loneliness.

The authors concluded that, if nothing is done to reduce elder abuse and neglect, there could be substantial increases in the percentage of older people experiencing abuse. The projections show that it is essential to address these matters sooner rather than later, because of the personal distress to many older people and the increasing costs to government.

For more information about elder abuse, you can go to our website www.ageconcern.org.nz or phone 0800 652 105

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[1] A summary of this research was published by the Office for Senior Citizens in 2015 – “Towards gaining a greater understanding of Elder Abuse and Neglect in New Zealand”.