Abuse of Older People

by Shirley Cummins

The aim of this article is to explore what constitutes elder abuse, the care settings in which it may occur and its prevalence here in Ireland.  Perhaps the most insidious form of abuse against the elderly lies in the negative attitudes towards and stereotypes of, older people and the process of ageing itself. Old age remains a deviant state in a society that celebrates youth and has not yet accustomed itself to the demographic revolution (Laslett, 1989). As long as older people are devalued and marginalised by society, they will suffer from a loss of self-identity and remain highly susceptible to discrimination and all forms of abuse. A predominant theme in the literature on elder abuse is the finding that much abuse goes unrecognised and is hidden from public awareness. A 1992 Council of Europe Report on elder abuse states that a problem common to all European countries is the absence of a policy for monitoring and recording statistics on violence within the family in general and specifically violence against older people. A widespread lack of awareness, together with a slowness to accept its existence is further exacerbated by the ‘veil of silence which too often surrounds this phenomenon’ (Council of Europe Report, 1992). In the past fifteen years or so, this has begun to change, partly because of the recognition and acceptance of other forms of abuse, namely child abuse and domestic violence, as social problems.

Defining Elder Abuse

A recurring theme in the literature on elder abuse is the difficulty in defining the terms abuse and neglect. Difficult issues include the intentions of the abuser, the type of actions and effects that warrant the term abuse and the issue of self-abuse and neglect. Ogg and Bennett (1992) put forward the argument that we should not become obsessed with attempts to provide definitive statements on elder abuse to the extent that this quest precludes any action. It should be remembered that the definition of child abuse also posed similar difficulties. What is required is an explanation between what is normal and culturally acceptable behaviour, from what is abusive.The concept of elder abuse is an evolving one and responses to it are part of a very complex scenario in which “abusers and victims, but also those who wish to intervene or legislate, are jointly enmeshed” (Sprey and Matthews 1989: 59). Abuse in any sense is a very emotive subject. What may seem abusive to one person may not seem so to another. While abuse comes in many guises, the net effect is the same. Abuse creates potentially dangerous situations, feelings of worthlessness and isolates the older person from people who can help.

Power Relations between Caregiver and Receiver

One consequence of the present community care policies is a greater reliance on the support of families in caring for dependent people in their own homes. The living arrangements of older people, in particular co-residence with a relative, may raise pressures pertinent to elder abuse (Stearns, 1986). This is particularly true of older women who, because of their tendency to outlive their spouses, may be more likely to spend some part of their old age residing with their children. To rely on others for help can inevitably means a loss of choice and control. When both elders and carers perceive themselves as having no choice in continuing the relationship, the person with the power advantage develops a monopoly on rewards and has little to loose by being unjust (Biggs, Phillipson and Kingston, 1995). Obligation might actually increase the likelihood of mistreatment. The phenomenon of family violence has always been rooted in the norms and conditions surrounding family care and this may be especially true in the case of groups such as older people. It may be that the emergence of abuse as a social issue has coincided with increased uncertainty about the way in which care relationships are to be handled.  Many older people in the community rely on domiciliary care, which involves help with personal care tasks.  Elder abuse by paid carers is beginning to receive attention (O’Loughlin and Duggan, 1998). The growing home care industry is a sector that has given rise to some reports of abuse in an unregulated area of service provision.  The isolation of such workers, “coping with difficult client behaviour, demanding and critical families and lack of training and support are issues to be addressed” (Aitken and Griffin 1996:101).  Notwithstanding the latter, when a carer has responsibility for an elderly person, the dependency relationship does not authorise the excess exercise of power, except for their benefit.

Institutional Abuse

Research often focuses on the characteristics of the perpetrator and the victim and on the interpersonal dynamics within the family unit. Locating mistreatment within families avoids consideration of other forms, which may be as common. Phillipson (1992) has noted that the identification of elder abuse as a form of family violence has led to an additional problem: the failure to give proper weight to abuse in institutional settings. Elder abuse in institutional settings has received less attention in previous research than abuse in the community. Elders living in institutions are notoriously reluctant to criticise the care they receive. A number of reasons militate against residents or staff blowing the whistle on malpractice, including power politics within establishments, denial or fear of reprisal. The elderly themselves are in the most vulnerable of positions, often being reliant on others to write, telephone or even articulate their experience as one of abuse or neglect. Mistreatment in institutions spans a continuum from petty abuses in human relationships through to the excess of our own Lea’s Cross. Institutional cultures that have become abusive both permit and perpetuate individual acts of cruelty and exploitation.The permission that underlies individual acts of abuse means that it is not always self-evident that something is seriously wrong. Evidence is often of an indirect nature, covering management methods and patterns of systematic poor practice that have become commonplace within that organisation.

Acknowledging Irish Elder Abuse

Abuse of the elderly can occur anywhere, in their own home, in the community, in hospital or in a residential setting. Abuse can be perpetrated through abusive actions, attitudes and practices. Although the vast majority of older people enjoy the benefits of family life, there has been a growing awareness during the past twenty years in particular, that older people are sometimes abused, neglected or mistreated. Little Irish research on this subject has been carried out, although a few pioneering studies have established the existence of cases in Ireland. Demographic change, the growth of community care policies and the growth of professional groups concerned with older people have been significant factors in the emergence of elder abuse as a social concern. Until relatively recently the abuse, neglect and or mistreatment of older people, was not recognised as a problem in common with other forms of abuse and maltreatment. According to O’Loughlin and Duggan “we do not know the prevalence of elder abuse in Ireland but it does happen and is likely to occur to the same extent as it has in other developed countries” (1998:8).  This means that in Ireland between twelve and twenty thousand people living in the community may be suffering from abuse, neglect and or maltreatment.

In Ireland, the message that physical, sexual and mental abuse of women and children in their own homes by those known to them is unacceptable is only beginning to become part of the public agenda. In October 1999, the Minister of State at the Department of Health and Children, with special responsibility for older people, established the Working Group on Elder Abuse. This was following on from the publication of the report Abuse, Neglect and Mistreatment of Older People (O’Loughlin and Duggan, 1998), by the National Council on Ageing and Older People. The role of the Working Group was to advise the Minister on what was required to address effectively and sensitively the issue of elder abuse in general. That report was called Protecting our Future.The implementation of the report in full and in a timely fashion would according to O’Neill (2002) enable our society to come to terms with a very real problem, not only for older Irish people of the present generation but also for ourselves as we age.  While many older people in Ireland have a positive experience of later life, there is growing evidence that some are exposed to ill treatment. The problem of elder abuse cannot be properly solved if the essential needs of older people are not met.

Conclusion

We need to create an environment in which ageing is accepted as a natural part of the life cycle. The goal for work in this field should be to ensure that older people could enjoy a life free of violence and mistreatment, where anti-ageing attitudes are discouraged, where older people are given the right to live in dignity and are given opportunities to participate fully in educational, cultural, spiritual and economic activities.  The route to achieving this goal is complex and difficult. It will involve the development of social policy that recognises, rather than colludes with, ageist assumptions that form a backdrop to abuse and neglect. As elder abuse begins to find its way into public consciousness the caution highlighted by Buckley (1996) in an article about child abuse guidelines in Ireland is very relevant. There is a danger that a narrow focus on elder abuse might channel resources away from the wider issues of promoting the welfare of older people, deny a service to those people who do not conform to the designated definition of abuse and lessen the recognition of the many other social issues affecting older people in our society. In 1789, William Wilberforce concluded his three-hour abolition debate to the Houses of Parliament saying, ‘You may choose to look the other way, but you can never again say you did not know’.

Elder abuse in Ireland has suffered from us choosing to overlook that which we find upsetting or as Steinmetz (1988) refers to it as “selective inattention”.  There are many adversities suffered by older people.  Elder abuse must be part of the debate about the causes and consequences of violence in Irish society.  The social conditions that permit abusive behaviour in the family and in the institutional setting can only be transformed by a political climate committed to eliminating them.

Shirley Cummins BBS, BA, MA works as a telephone counselor and in the areas of policy and advocacy for the Dublin Rape Crisis Centre.

References

Aitken, L. and Griffin, G. (1996)  Gender Issues in Elder Abuse. London: Sage.

Biggs, S. Phillipson, C. and  Kingston, P. (1995) Elder Abuse in Perspective. (Rethinking Ageing).  Buckingham: Open University Press.

Buckley, H. (1996) Child Abuse guidelines in Ireland: for whose protection? Administration, Vol. 44. no. 2: 37-56.

Council of Europe (1992) Violence against Elderly People. Strasbourg: Council of Europe Press.

Laslett, P. (1989) A Fresh Map of Life: The Emergence of the Third Age. London: Weidenfeld and Nicolson.

Ogg, J. and Bennett, G. (1992) Elder Abuse in Britain.  British Medical Journal, Vol. 305: 998-999.

O’Loughlin, A. and Duggan, J. (1998)  Abuse, Neglect & Mistreatment of Older People: An Exploratory Study.  Dublin: National Council on Ageing and Older People.

O’Neill et al. (2002)  Protecting our Future: Report of the Working Group on Elder Abuse. Dublin: Stationery Office

Phillipson, C. (1992) ‘Family Care in Great Britain’ in J. Kosburg  (ed) Family Care for the Elderly in a Changing World.  New York: Sage.

Sprey, J. and Matthews, S. (1989) ‘The perils of drawing implications from research: the case of elder mistreatment’ in R. Filinson and S. Ingman (eds.) Elder Abuse: Policy & Practice. New York: Human Sciences Press.

Stearns, P. (1986) ‘Old age family conflict: the perspective of the past’ in K. Pillemer and R. Wolf (eds.) Elder Abuse. Dover: Auburn House.

Steinmetz, S.K. (1988) Duty Bound: Elder Abuse and Family Care. London: Sage.