The Simmering Problem of Elder Abuse

In Ireland we have no legislation governing the abuse of the elderly in spite of repeated promises over the years that this would be enacted.

Is this another case of abuse of vulnerable citizens that will remain under the radar until some other calamity happens and is brought into the public domain screaming and kicking?

The shock that reverberated across the country when a television programme exposed and produced videos of elderly, vulnerable people being abused in a care home made the headlines and some staff were suspended and another such inquiry was established.

According to the Central Statistics Office in the 2011 census,  136,295 people over the age of 65 live alone in Ireland and almost 500,000 people over 65 live in homes with others. 66% of those that live alone are women and that increases to 75% for women aged 85 and over. Between 2006 and 2011 there was an increase of 18% in men over 65 and 12% increase for women,  with an increase of 22% in men and women over 85 years of age.  Living longer is one of the bonuses of modern Ireland, with better health care and nutrition,  but it also increases the problems associated with getting older.

According to the National Council for Aging and Older People, we have at any given time 12,000 older people suffering abuse at the hands of their carers, be that in the home or in institutions.

As little research has been done and records are scant an exact number is difficult to ascertain, as only severe cases come to the attention of the HSE. This problem is being pushed under the carpet, as we are prone to do in this country,  not having learned from the previous abuses which have come to light in the recent past.  But going by statistics in the UK and other countries, from the research that they carried out, shows  that between 3% and  5% of the elderly experience abuse of some form on a regular basis.

Authorities were slow to admit or accept that women and children were abused over decades and both the Government and those in charge of such institutions, mainly religious orders, were in denial until dragged into the public domain and made to make restitution for lost years and broken lives. Older people do not have the time nor the energy to fight this silent abuse  being perpetrated on those who are in vulnerable and dependent positions at this stage of  their life.

We know that physical, mental and emotional abuse is taking place, but it is clear that as a society we are not ready to deal with the problem in an honest and open fashion. In other countries they have a protocol in place to facilitate whistle-blowers and other carers to report such cases to the authority in charge of the elderly.  In 2000 the Department of Health set up a group of people who work with older people, like doctors, public health nurses, social workers, the gardai, psychiatrists and nursing  home representatives, as well as a public campaign to highlight elder abuse and heighten awareness in the public mind. Fifteen years later we are still awaiting for action.

There is a consensus among the experts that a wide range of abuses do exist and anecdotal evidence give credence to that. Abuse can vary between financial, physical, psychological, discriminatory and neglect. Financial abuse is the most common,  followed by psychological, emotional, physical and sexual abuse and a wide range of issues that surround  neglect.  Because family members are the main perpetrators of  abuse and account for 81% of the reported cases to the HSE,  it is difficult to ascertain the full extent of abuse on older people. The elderly are often fearful, ashamed and not willing to complain about an adult child who is abusing them, so much abuse goes  undetected.  If the person  is isolated and have few visitors or other contacts it escalates the problem as the abuser may be the only one to care for them and others may not be in a position to challenge them.

The National Centre for the protection of Older People said that most abuse is perpetrated by a son or daughter as was seen by 45% of complaints, with husband/wife/partner  accounting for 20% and 15% linked to others including relatives. 66% of victims were women and those over 80 years of age were most at risk.

As people grow older they may suffer serious financial abuse as they arrive at their twilight years. They may have amassed savings  or property which was the result of a lifetime of work. When they must through necessity or immobility hand over the responsibility of their financial affairs to others there is always the possibility of theft, fraud, exploitation, drawing down a pension and keeping it or spending it without authority.  There has been numerous high profile cases of misappropriation of  savings, homes, property, especially farms and pressure to change wills to benefit the perpetrator, with no redress for the older person who may be weak and vulnerable. In many of these cases people face daily threats of harm or violence, are regularly humiliated, intimidated or verbally abused. If isolated,  it further escalates the possibilities surrounding abuse and an older person may be unable to trust  another to disclose what is happening.

A garda spokesperson told Irish that there are currently no guidelines in relation to elder abuse similar to that in place for child abuse. Individual cases are usually dealt with by local gardai by an individual guard.  Reports of abuse may sometimes come from the victim themselves or from others with regular access to the victim, like the public health nurse or doctor. But as there is no legislation for implementation it is a useless exercise.

Dr. Des O’Neill consultant paediatrician has spoken out and said that the elderly should be treated with respect and dignity and that changes need to be made in the way society treats people as they grow older. Government policies with the withdrawing of benefits and their affects  treat people as if they are a burden on the state, and on the health system.  Like cuts to the home help hours, the withdrawing of rural transport, a reduction to the  benefits that made life more tolerable as old age creeps in, even discrimination like screening of over 70’s for a drivers licence, all confirms what Dr.O’Neill has said.  Dr. O’Neill has also stated that many families with the best will in the world,  undermine their elderly relative’s desire to retain their independence and control of their affairs.

Definition of abuse

Physical abuse may include physical force, hitting, slapping, pushing, kicking, pulling hair, pinching, inappropriate restraint, burning or ro  ugh handling.

Psychological  abuse include the persistent use of threats, humiliation, bullying, intimidation, isolation, swearing, shouting and other verbal conduct that result in mental and physical distress.

Financial abuse include the unauthorised and improper use of funds, pressure to change wills, demanding the handing over of property or any other resources belonging to an older person, theft, coercion, fraud, misuse of power of attorney and using funds for the perpetrators use.

Neglect refers to repeated deprivation of assistance needed for daily living or withholding necessities such as adequate hygiene, food or heating.

Discrimination include racism, ageism, discrimination based on disability, harassment, slur or similar treatment.

Institutional abuse may occur in care settings and involve poor standards of care, rigid routines, and inadequate responses to complex needs. Any of the above abuses may also take place in institutions. Already highlighted in care homes were psychological maltreatment, physical assault, not answering calls for toilet facilities or drinks, not ensuring meals were adequately taken, ignoring calls for assistance by bedridden people and the taking and withholding of pensions by the institutions involved.

The tell tale signs according to the American National Centre for elder abuse and to watch out for,  include unexplained injuries such as cuts, bruises, or burns for which strange and inconsistent explanations are given, unkempt appearance like soiled clothes, bad odour, dirty bed linen, bed sores or pressure sores, evidence of confinement such as being strapped into a chair or locked into a room, dehydration and  malnutrition  without a medical cause.  A person  being fearful,  withdrawn,  depressed or full of anxieties and worry.  A hesitation to talk  openly or being defensive where close family members are

involved.   An air of silence and hopelessness.

In today’s world the enormous financial losses suffered by families and their security at risk, may mean an escalation of abuse on elderly relatives. Their welfare must be  more closely monitored by those in authority and those whose duty it is to care for elderly and vulnerable people. Carers may take out their frustration and anger at their own problems on an older and weaker person. People who suffer addictions with drugs, alcohol, gambling or are in severe debt, are more likely to be abusive and require money on a regular basis. Instilling fear and being verbally or physically abusive are ways of commandeering an older person’s assets.

The rights of the elderly in Ireland as well as the rest of the Western world are being eroded on a daily basis. In Western countries there is a cultural stigma around aging and dying.  In countries  like China, Korea, Japan and Greece all honour and celebrate respect for their elders and is the root of how they operate as families. 75% of Japanese parents live with their adult children and are considered valuable assets in rearing and passing on their wisdom to the next generation.

Aging is a personal journey for all of us and we are conditioned by events and opportunities and changes throughout our lives. Those of us lucky to be cared for with love and kindness by our children have much to be grateful for and remembering in the final up we will all reach, if we are lucky, old age to be lived out in productivity and fulfilment.