Introduction
The abuse of elders in society dates back to ancient times. However, until the last quarter of the 20th century, it remained a private matter, hidden from the public (Teaster, Lindberg, & Zhao, 2020). The advent of initiatives to address child and domestic abuse brought the issue of abuse of the elderly to the limelight, making it a public health and criminal justice concern. The public health and criminal justice determine how the abuse of the elderly is viewed, analyzed, and how it dealt with. Elder abuse is defined 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 (Alves, & Coralie, 2017). Based on this definition, the abuse can be classified as either an intentional or unintentional act of commission or omission (neglect). The abuse might be different, including physical abuse, psychological abuse (involving emotional or chronic verbal aggression), material abuse, financial exploitation, or violation of rights. Regardless of the type of abuse, it certainly leads to decreased quality of life for older persons.
Categories of Elder Abuse
According to the National Center on Elder Abuse, physical abuse involves the act of inflicting pain or physical coercion to an elder, which may or may not cause injuries. Physical abuse involves at least one act of violence, such as hitting, slapping, cutting, physical restraint, or intentional over-medication (Alves, & Coralie, 2017). On the other hand, psychological abuse involves the use of verbal or non-verbal action to inflict emotional pain, anguish, or distress. In light of this, therefore, psychological abuse comprises verbal assaults, threats, harassment, intimidation, and humiliation. Some actions that can be classified as psychological abuse include treating an elder like a child, social isolation, silent treatment, etc.
Financial abuse comprises exploitative behaviors such as inflating prices of cheaper goods, fraud, theft, and forgery (Alves, & Coralie, 2017). In its severe form, financial abuse may involve selling of properties belonging to elders without their consent, forcing them to change their will, stealing their pension money, etc. Sexual abuse of the elderly refers to any kind of non-consensual sexual contact, such as intimacy, rape, touching sexually, etc. Finally, neglect of the elderly, which is the most common type of abuse and hardest to prove, involves failing to provide the older people with their needs, including proper nutrition, clothing, and hygiene care.
Risk Factors
Several factors may increase the chances of abuse of an older person. These factors can be classified under individual characteristics of a victim of abuse, individual characteristics of the perpetrator, the interaction between the older person and the caregiver, and broader societal risk factors for elder abuse.
Individual Characteristics of Victim of Abuse
At the individual level, older persons are prone to several risks concerning their gender, age, marital status, difficult behavior, Social isolation and loneliness, Presence of cognitive disorders, Presence of mental or emotional illness, and Substance abuse. Studies have shown that older women are more prone to elder abuse and neglect as compared to men (Rahman & Gaafary, 2012). However, in another study by World Health Organization on community-based prevalence, it was found that men are equally at risk of being abused by the children, spouse, or other members of their family (Ramalingam, Sarkar, Premarajan, Rajkumar, & Subrahmanyam, 2019). This means that men and women have a risk level of abuse. However, in some cultures, where women are viewed as inferior, elderly women are at increased risks of abuse and neglect, especially in cases where they are widowed or divorced (marital status).
Besides, regardless of the gender, chances of being abused increases with increase in age as a result of physical and psychological deterioration. The risks are even higher in cases where the elderly have a serious health condition. In such a case, the elderly fully depend on the caregiver, which may result in stress, which may eventually culminate in abuse and neglect. Elderly people suffering from cognitive disorder or dementia may have a violent tendency towards their caregiver, which increases the risk of being abused. This is the same case with the elderly under substance abuse; older people under the influence of alcohol and drugs may risk physical abuse because they may behave verbally abusively towards others.
Individual Characteristics of Perpetrator of Abuse
In most cases, the perpetrator of elder abuse is the caretaker, mandated with the responsibilities of taking care of the elderly. The risk factors in such a case are determined by the gender, Chronological age, Psychological and emotional problems of the caregiver, and Substance abuse by the caregiver. Research has shown that the male caregiver may not have the emotional quotient required to provide care to the elderly, this, therefore, increases the risk of abuse to the older people under their care Glauser, & Hustey, 2016). The situation is even worse in cases where the caregiver is young male, who according to Rahman and Gaafary (2012), are likely to commit acts of elder abuse and neglect as compared to older caregivers.
The risk factor of elder abuse and neglect is higher in cases where the caregiver is suffering from physical or mental illness. Although such caregivers may have good intentions, they are not competent enough to provide proper care to the elderly, which may ultimately result in abuse. Also, drug addiction and substance abuse among the caregivers hinders proper decision making, which may result in neglect and misuse of finances meant for the older people. In essence, the perpetrator of elder abuse could be a male or female suffering from a psychological or emotional problem and is a substance abuser.
Interaction between the Older Person and the Caregiver
How the elderly person interacts with the caregiver may also present a specific level of risk to the older people. For instance, a caregiver with no experience or who is reluctant to offer service to the elderly may have a feeling of inadequacy and hostility, which may lead to abuse. Besides, such a caregiver might be unable to make financial, social, emotional, and physical sacrifices required when caring for the elderly. An inadequate formal and informal support system to the caregiver may also result in abuse or the elderly due to the overwhelming nature of the caregiving task. Other risk factors concerning the interaction between the older person and the caregiver include the level of dependency, financial difficulties, caregiver’s ability to handle stress, living arrangements, and the past relationships between older persons and caregivers.
Broader Societal Risk Factors for Elder Abuse
The rate of elder abuse and neglect is also determined by social, economic, and political factors. Older people without resources and living in impoverished conditions are more prone to incidences of elder abuse as compared to elders with resources. This situation is made even worse in cases where there is inequality as a result of gender, race, and ageism (Pillemer, Burnes, Riffin, & Lachs, 2016). Pillemer et al. add that widespread unemployment and lack of income also influence intergenerational relations and family harmony. In other words, ageism, rights of the elder people, gender roles, and societal ideas of individual and families play a vital role in elder abuse at the broader societal level.
Prevention of Elder Abuse
Some several measures and strategies have been put in place to prevent and handle incidences of elder abuse. These measures include awareness campaigns, professional screening of potential victims, introduction of intergenerational programs, caregiver support system, including stress management and respite care, development of policies aimed at defining and improving the standard of care to the elderly, and training of caregivers on various aspects of handling the elderly. Some of the efforts that have been put in place to respond to and prevent further abuse include helplines for providing information and referrals, safe houses for the abused elderly, mandatory reporting of incidents of abuse to authority, and caregiver support intervention measures.
The study has shown that caregiver support after the abuse has occurred helps in reducing the chances of its reoccurrence. Also, intergeneration programs have proved to reduce the negative attitude and stereotype towards the elderly. This has helped in reducing the occurrence of elder abuse, as has the creating of awareness. The collaboration between different sectors has also contributed to the reduction of elder abuse. This collaboration includes the social welfare sector in providing legal, financial and housing support, the education sector in creating awareness, and the health sector, which has been in the frontline in detecting and treatment of victims of elder abuse.
