Researchers and service providers first expressed concern about elder abuse in the late 1970’s after a seminal paper about ‘granny battering’ was published (Baker, 1975). Recognition of the problem was largely related to the development of concern for family violence in general, as well as the dramatic increase in the aging population (Dunn, 1995). Until this time issues relating to older people focused on crime against the elderly, exploitation and intimidation within residential care facilities and abuse of older people by those they are unfamiliar with (Biles, 1983).
The dramatic growth of the elderly population has made it necessary to understand the needs of older adults and the impact they have on our social welfare, justice and economic systems. In June 2012 there were 420,300 people aged 85 years and over in Australia. This age group is projected to more than double within 20 years to 842,500 people in 2031 and double again by 2045 to 1.7 million. The growing number of elderly people in the population also means there will be more people at risk for abuse and neglect. Developing appropriate responses to elder abuse and prevention strategies has been an important focus among carers and health professionals. However, varying definitions used in elder abuse studies makes it difficult to make comparisons and estimate prevalence.
The World Health Organisation defines elder abuse as ‘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’ (World Health organisation, 2008). Elder abuse can be divided into distinct categories:
- Physical abuse: Physical force or violence that results in bodily injury, pain or impairment. It includes assault, battery and inappropriate restraint.
- Sexual abuse: Non consensual sexual contact with an elderly person. It includes rape, molestation or any sexual conduct with a person who lacks the mental capacity to exercise consent.
- Psychological abuse: The wilful infliction of mental or emotional anguish or distress by threat, humiliation or other verbal or non-verbal conduct.
- Financial abuse: Illegal or improper use of an older person’s funds, property or assets. It may include things such as taking an older person’s social security money or tricking them into deeding property over to another person.
- Domestic violence: An escalating pattern of violence or intimidation by an intimate partner, which is used to gain power and control. Domestic violence against elderly people can be split into two categories: domestic violence started earlier in life that persists into old age and domestic violence that begins in old age.
- Neglect: The refusal or failure of a caregiver to fulfil their responsibilities to provide need care to an older person. Active neglect refers to caregivers who intentionally withhold care or necessities. Passive neglect refers to situations in which the caregiver is unable to fulfil his or her care responsibilities due to illness, disability, stress, ignorance, lack of maturity or lack or resources.
- Self-neglect: Situations in which neglect is the result of the older person refusing care. This excludes situations in which a mentally competent older person who understands the consequences of his or her decisions makes a conscious and voluntary decision to engage in acts that threaten his or her health or safety.
Although figures vary, it is generally believed that as many as 46% of elderly people are abused. A National Incidence study on elder abuse conducted in 1996 found that approximately 450,000 elderly people experienced abuse nationwide. Research has shown that older people are rarely victims of just one type of abuse. Similar to spouse abuse, the type of abuse older people experience may progress from less to more serious types (Walker, 1984). For example, psychological abuse or neglect may be precursors of physical abuse.
Elder abuse is associated with devastating personal losses such as the loss of independence, their homes, life savings, health, dignity and security. Abuse and neglect can often lead elderly people to experience worry, depression or anxiety. Some will feel shame, guilt or embarrassment that someone close to them has harmed them. These feelings can sometimes lead older people to eat less, use more medications or drink more alcohol to help them cope with their emotional and physical pain. Some abused or neglected elderly people may lose interest in life, become withdrawn or have suicidal thoughts. In some situations elder abuse can lead to serious injury and even death. One large longitudinal study of elderly people found that elderly people who were mistreated were 3 times more likely to die during a 3 year period than those who did not experience abuse, even after adjustment for co-morbidity and other factors associated with mortality were factored in.
There is no one reason for elder abuse, however experience suggests that certain situations, behaviours, relationship issues or health issues place older adults at a greater risk for elder abuse. Both the demands of the caregiver and the needs of the elderly person can create situations in which abuse is more likely to occur. Risk factors for elder abuse include elderly people who:
- Have memory problems such as dementia
- Have physical disabilities
- Are depressed, lonely or have a lack of social support
- Live is a shared living situation
There are also risk factors which increase the likelihood that a caregiver will engage in elder abuse. some of these factors include caregivers who:
- Feel overwhelmed or resentful
- Have a history of substance abuse or a history of abusing others
- Are dependant on the older person for housing, finances or other needs
- Have a criminal history
- Have mental health problems
With increasing numbers of elderly people in our communities it is imperative that issues relating to old age, including elder abuse are better understood so that health and social services can more appropriately cater to their needs. Elderly people are not only at risk health and social problems they are also an asset to our communities and they deserve to be respected and supported.
Australian Bureau of Statistics. (2013). Population Projections, Australia, 2012 (base) to 2101, (cat. no. 3222.0). Retrieved from www.abs.gov.au
Baker, A. A. (1975). Granny battering. Modern Geriatrics, 5, 20–24.
Biles, D. (1983). Crime and the elderly. Australian Journal of the Ageing, 2 (4), 22-23.
Dunn, P.F. (1995). ‘Elder Abuse’ as an Innovation to Australia: A Critical Overview. In J. Kosberg & J. Garcia, (Eds.), Elder Abuse: International and Cross-Cultural perspectives, p.p. 13-31. New York: Haworth Press.
Lachs, M. S., Williams, C. S., O’Brien, S., Pillemer, K. A., & Charlson, M. E. (1998). The mortality of elder abuse. JAMA, 280(5). 428–43.
National Elder Abuse Incidence Study. 1998. Washington, DC: National Center on Elder Abuse at American Public Human Services Association.
The National Committee for the Prevention of Elder Abuse. (2008). What is Elder Abuse? Retrieved from www.preventelderabuse.org
Walker, L. E. (1984). The Battered Woman Syndrome. New York: Springer.
World Health Organisation, (2008). A Global Response to Elder Abuse and Neglect: Building Primary Health Care Capacity to Deal with the Problem Worldwide: Main Report. World Health Organisation: Geneva.