What does elder abuse look like?

A list of signs of what elder abuse is and the mental health impact of it

Aaheli Dasgupta

At the age of 60, Uma lost her husband, her strong pillar of support. She moved in with her adult children, who initially welcomed her warmly. However, things started to take a turn for the worse when Uma found herself staying alone at home. The children expected her to take care of herself despite having a serious medical condition. Her food habits suffered because her children were used to a different kind of a lifestyle. Soon, Uma found herself hesitating to ask for very basic things like being dropped off to the nearest park, lest her children got irritated. They hardly had time to spend with her; she was seldom included in any major family decision. Uma started to feel isolated, lonely and hopeless. She does not know what to do.

This fictional narrative has been constructed to aid the understanding of this issue by placing it in a real life situation.

World Health Organization (WHO) 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". In a recent survey by HelpAge India, 50% elderly persons reported abuse. However, experts suggest that there may be more instances of unreported abuse because of the stigma attached to abuse and reporting about it. Abuse can be emotional, verbal or sexual, and may escalate to physical violence. Neglect too counts as abuse. This study shows that in most cases, the person who was being abusive was a trusted individual —adult children, or family—they are living with.

What are the signs of abuse and neglect?

  • Physical signs of violence – visible bruises or cuts, fractures and dislocation  

  • Signs of malnutrition - due to food deprivation

  • Addressing the elderly by derogatory terms/phrases 

  • Calling the person "a burden”, “good for nothing” or by other phrases that attack their dignity

  • Restricting them financially and refusing to provide comforts that are a necessity

  • Ignoring their consent or not involving them in major familial decisions  

  • Serving food that may not fit into the elderly’s diet and at unsuitable hours

  • Torn clothes and shabby appearance (a serious lack of grooming) that may lead to skin infections or sores

An aging person may already be dealing with deteriorating physical and cognitive ability. Research has shown that most abuse and neglect occurs because caregivers are unaware that these behaviors are abusive and are unsure about how adquate care can be provided. There is also discourse on how a caregiver facing burnout is more likely to abuse the elderly, since they feel unappreciated and burdened. In such instances, caregivers must immediately seek professional help.  

Abuse may also occur because of economic reasons. Perpetrators of abuse often force, manipulate or trick the elderly to give up on property or sources of income. This leaves the elderly in a vulnerable situation as they end up becoming more dependent on the abuser. In extreme cases, the elderly is left to seek refuge elsewhere as they do not have the means left to support themselves.  

It has also been seen that some caregivers abuse the elderly —often a parent—if they have been abused  during childhood.

Why the elderly don't report abuse

The person experiencing the abuse may be in denial, feel ashamed, helpless, and may even blame themselves. They may find it difficult to articulate their experience, and feel low self-worth and self-confidence. This may further develop into symptoms similar to depression, and in certain cases, anxiety. Another very common effect of abuse is a strong sense of guilt and even death wishes. Any form of  abuse of the elderly has a severe psychological impact on the person. It is crucial that one seeks help from a mental health professional and in extreme cases, social workers working with this cause.

If you suspect that you may be facing abuse or if someone you know is facing abuse you can call the Elders Helpline at 1090 run by the Nightingales Medical Trust.

References 
1.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4961478/
2.http://www.sciencedirect.com/science/article/pii/S0140673604171444
 
With inputs from Dr Santosh Loganathan, NIMHANS