ELDERLY ABUSE

The conventional belief was that elder abuse was confined to developed nations. However, due
to the processes of modernization and urbanization, it is now recognized that elder abuse is
prevalent in India, characterized by distinct features. The dissolution of the joint family system, a
significant force in consolidating various age groups under one roof, has given way to the
nuclear family system. This shift has posed challenges to the traditional respect and support
elders once enjoyed, now confronted by the capabilities and peculiar behavior of the younger
generation. Although such behavior may seem unconventional for elders, it remains
unidentifiable (Abira Basu, 2008).
In the 21st century, there is a noticeable increase in concern for the well-being of the
elderly. The rapid rise in the elderly population corresponds to the decline of the joint family
system. Limited living spaces contribute to psychological stress among the elderly, resulting in
issues such as a lack of social interaction, isolation, communication gaps, and depression. Elder
abuse manifests as intentional actions causing suffering and pain, such as caregivers failing to
meet the basic needs and provide a secure living environment for the elderly. Various forms of
abuse, including physical, mental, financial, and sexual abuse, contribute to the challenges faced
by the elderly in contemporary Indian society (Miri Cohen et al., 2006).

Elderly Abuse
The term “Elderly” encompasses all individuals aged 60 or older (Hall et al., 2016).
Elder Abuse: The definition of elder abuse involves "the reoccurrence of inappropriate
actions in any relationship that contain high expectation can lead to great distress among elders
and disrupts their well-being and rights" (Working Group on Elder Abuse, 2002).
 Elder abuse is described 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" (Daly et al., 2011, p. 1). Also known as elder mistreatment or elder
maltreatment, it encompasses physical abuse, sexual abuse, psychological abuse, neglect, and
financial exploitation of individuals over the age of 60, involving a reasonable expectation of
trust (Dong & Simon, 2013). The National Council on Aging (NCOA, n.d.) additionally defines
elder abuse as confinement and willful deprivation.
Elder maltreatment, as defined by Ayalon et al. (2016), includes physical and emotional
mistreatment, sexual abuse, neglect, and negligent treatment of the elderly.
Elder Mediation: Proposed as a problem-solving process facilitated by a neutral third
party, elder mediation aims to assist older adults during guardianship processes as an alternative
to the court making decisions for them (Crampton, 2013). It focuses on three specific recurring
issues: future financial and care planning, decision-making, and disputes over estate matters
(Crampton, 2013).
Elder Mistreatment: Also known as elder abuse or elder maltreatment, elder mistreatment
is characterized as "Intentional actions that cause harm or create serious risk of harm" (Fulmer &
Caceres, 2012, para. A), or the failure of someone in a position of trust to provide the elder’s
basic needs.
Elder Neglect: Caregiver neglect is described as the failure to provide an older adult with
the essentials required for daily living, such as food, clothing, shelter, or medical care (Dong &
Simon, 2013). It also involves the neglect of basic needs, including hygiene, necessary medical
care, and safety for individuals aged 60 or older (Hall et al., 2016).

Origin of the Term

As the global population experiences rapid growth, incidents of elderly abuse are also increasing
rapidly (Rajini Sooryanarayana, 2013). The awareness of elder abuse first emerged in the 1970s
in the United Kingdom, where the term "granny battering" was coined. However, the United
States took the lead in exploring studies on elder abuse and neglect (Aravanis S.C et al., 1993).
The term "elder abuse" or "elder mistreatment" gained prominence only recently, with societal
attention shifting from discovering child abuse in the 1960s and marital violence in the 1970s to
the final form of violence, elder abuse (R S Wolf, 1989). Various types of ill-treatment or abuse,
such as physical, verbal, and social abuse, are on the rise in society.
Types of Elder Abuse
Elder abuse can take various forms resulting from deliberate intent, negligence, or ignorance, and
individuals may experience more than one form simultaneously. According to the National
Centre for the Protection of Older People, the types of elder mistreatment include:
1. Physical Abuse: Non-accidental infliction of physical force causing bodily injury, pain, or
impairment, including actions like hitting, slapping, pushing, kicking, misuse of medication, and
inappropriate restraint.
2. Psychological Abuse: Persistent use of threats, humiliation, bullying, intimidation, isolation,
swearing, and other verbal conduct leading to mental or physical distress.
3. Financial Abuse: Unauthorized and improper use of funds, property, or resources, involving
theft, coercion, fraud, misuse of power of attorney, and failure to contribute to agreed-upon
household costs.
4. Sexual Abuse: Acts to which an older person has not or could not consent, including
inappropriate talking to or touching.
5. Neglect: Repeated deprivation of assistance needed for important activities of daily living,
such as ignoring or refusing to help with physical care needs, failing to provide access to health
services, or withholding necessities like adequate nutrition and heating.
6. Discriminatory Abuse: Involves racism, ageism, discrimination based on disability, and other
forms of harassment, slurs, or similar treatment.
7. Institutional Abuse: Occurs within residential care and acute settings, including nursing
homes and acute hospitals, involving poor standards of care, rigid routines, and inadequate
responses to complex needs.

Elder Abuse at Global Level

The global population aged 60 and above is expected to double from 900 million in 2015 to 2
billion in 2050, leading to a surge in elder abuse cases worldwide. Statistics from the World
Health Organization in 2018 reveal that 1 in 6 elderly individuals experiences some form of
abuse in community settings. Elder abuse occurs in various settings, including homes,
institutional care systems, nursing facilities, and involves self-neglect at times. Factors
contributing to abuse include high dependency levels, deviations from normal behavior,
caregiver stress, social isolation, intergenerational violence, and reversed dependency. Financial
abuse is prevalent, with elderly women being particularly vulnerable due to limited social
contacts. Caregiving, especially for those with cognitive problems, can turn into abuse, causing
emotional distress, violence, and mental health issues (Rafi & Saif, 2020).

Elderly Status in India

India is witnessing a growing concern for the elderly, with the population aged 60 and above
increasing from 20 million in 1951 to 97.24 million in 2011. This demographic is expected to
expand further by 18% by 2025. The 21st century is termed the "Era of Population Ageing" due
to this significant demographic shift. However, along with advancements in technology and
healthcare facilities, the elderly population faces a 3.09% greater rate of growth compared to the
general population, leading to associated challenges. The perception of old age as a golden phase
with minimal responsibilities has shifted, and caregivers now often perceive caring for their
elders as a severe burden (Rafi & Saif, 2020).

Status of Elderly Abuse in India

The rate of elder abuse in India has risen alongside the growth of the elderly population. Reports
from HelpAge India in 2019 indicate that 15% of caregivers feel a severe burden in caring for
the elderly. Studies conducted in major cities in 2011 revealed that around 60% of elders
experience verbal abuse, 48% face physical abuse, 37% endure emotional abuse, 35% suffer
financial abuse, and 20% self-neglect. The lack of awareness of legal rights, illiteracy, and
economic vulnerability make elderly women more susceptible to abuse. Institutional settings are
not exempt from elder abuse, with mistreatment, illegal exploitation, infliction of pain, verbal
abuse, and sexual abuse being prevalent. Crime rates against the elderly are increasing globally,
with various forms of crimes reported, including murder, molestation, ill-treatment, abduction,
burglary, harassment, torture, kidnapping, cheating, and theft. Fear of crime among the elderly is
evident in many studies and reports.

Signs and Symptoms of Elder Abuse

Initially, signs of elder abuse may go unrecognized or be attributed to symptoms of dementia or
the natural frailty of the elderly person, as caregivers may explain them. While these signs may
overlap with symptoms of mental deterioration, it is essential not to dismiss them solely based on
the caregiver's explanations. General signs of abuse include frequent arguments or tension
between the caregiver and the elderly person, along with changes in the elder's personality or
behavior.
● Physical Abuse: Physical abuse manifests as unexplained signs of injury, such as bruises,
welts, or scars, especially if they appear symmetrically. Other indicators include broken
bones, sprains, or dislocations, reports of drug overdose, broken eyeglasses, signs of
being restrained, and a caregiver's refusal to allow alone time with the elder.
● Emotional Abuse: In addition to general signs, emotional abuse may involve threatening,
belittling, or controlling caregiver behavior witnessed by others. Behavioral changes in
the elder, mimicking dementia-like rocking or mumbling, are also indicators.
● Sexual Abuse: Sexual abuse signs include bruises around breasts or genitals, unexplained
venereal disease or infections, unexplained vaginal or anal bleeding, and torn, stained, or
bloody underclothing.
● Neglect: Neglect is evident through unusual weight loss, malnutrition, dehydration,
untreated physical problems like bed sores, unsanitary living conditions, being left dirty
or unbathed, inappropriate clothing for the weather, and unsafe living conditions.
● Financial Exploitation: Financial abuse involves significant withdrawals from the elder's
accounts, sudden changes in financial condition, missing items or cash from the
household, suspicious changes in legal documents, and unpaid bills despite having
sufficient funds.
● Healthcare Fraud and Abuse: Healthcare-related signs include duplicate billings,
evidence of overmedication or undermedication, problems with care facilities, and
inadequate responses to questions about care.

Risk Factors for Elder Abuse

Caring for a senior with diverse needs is challenging, and the experience of aging comes with its
own set of vulnerabilities and dependencies. The intersection of caregiving demands and the
unique requirements of the elderly can create circumstances that elevate the risk of abuse.
● Risk factors among caregivers: Many informal caregivers, including spouses, adult
children, and other relatives or friends, derive satisfaction and enrichment from caring for
the elderly. However, the increasing demands of elder caregiving as the senior's condition
deteriorates can be overwhelmingly stressful. The strain of elder care often leads to
mental and physical health issues, resulting in caregiver burnout, impatience, and a
 propensity to lash out against those under their care. Key risk factors among caregivers
include:
○ Inability to cope with stress (lack of resilience)
○ Common occurrence of depression among caregivers
○ Lack of support from other potential caregivers
○ Perception that caregiving for the elder is burdensome and lacks psychological
reward
○ Substance abuse
Caregivers in institutional settings may also face stress levels that contribute to elder
abuse. Nursing home staff, lacking adequate training, burdened with excessive
responsibilities, unsuited to caregiving, or working in suboptimal conditions, may be
prone to engaging in abusive behavior.
● The elder’s condition and history: Several factors related to the elderly, while not
excusing abuse, influence their vulnerability to mistreatment:
○ The severity of an elderly person’s illness or dementia
○ Social isolation, wherein the elder and caregiver spend significant time alone
together
○ The elder's past role as an abusive parent or spouse
○ A history of domestic violence within the home
○ The elder’s inclination toward verbal or physical aggression

Consequences of Elder Abuse

Elder abuse has profound and far-reaching health consequences, affecting various aspects of an
older individual's well-being. The repercussions of elder abuse are extensive and include a
cascade of detrimental effects:
● Declining Functional Abilities: Elder abuse contributes to a gradual deterioration in the
older person's physical and cognitive capabilities. This decline may affect their ability to
perform daily activities independently, compromising their overall functional abilities.

● Increased Dependency: Victims of elder abuse often experience an escalation in their

dependency on others for assistance. The abuse may compromise their autonomy and
force them to rely more heavily on caregivers or support systems.
● Heightened Sense of Helplessness: Elder abuse induces a profound sense of helplessness
in victims, as they may feel powerless to escape or stop the mistreatment. This emotional
burden can exacerbate the overall impact on their mental and emotional well-being.

● Elevated Stress: The experience of abuse places a significant psychological burden on

older individuals, leading to heightened stress levels. The persistent fear, anxiety, and
uncertainty associated with abuse contribute to a chronic state of stress that can have
cascading effects on physical health.

● Worsening Psychological Decline: Elder abuse is closely linked to a decline in mental

health, contributing to worsening psychological well-being. Victims may experience
increased symptoms of anxiety, depression, and other mental health conditions as a direct
result of the abuse they endure.

● Premature Mortality and Morbidity: Perhaps most alarmingly, elder abuse is associated
with premature mortality and morbidity. Victims of abuse face a three times higher risk of
death compared to those who are not subjected to mistreatment. This heightened
mortality risk underscores the gravity of the consequences of elder abuse.

● Depression and Dementia: Elder abuse can significantly contribute to the development or
exacerbation of depression and dementia in older individuals. The psychological toll of
abuse may accelerate cognitive decline and contribute to the onset of these serious mental
health conditions.

● Malnutrition: The neglect and mistreatment associated with elder abuse often result in
inadequate nutrition. Elders may experience malnutrition, which can further compromise
their physical health and exacerbate existing health issues.

● Bed Sores: Victims of elder abuse, particularly those subjected to neglect or confinement,
may develop bed sores due to prolonged immobility. These painful sores can lead to
further complications and compromise the individual's overall health.

● Death: In the most severe cases, elder abuse can lead to premature death. The cumulative
impact of physical, emotional, and psychological abuse can contribute to life-threatening
conditions, ultimately resulting in the death of the abused individual.
Therefore, elder abuse is a multifaceted issue with severe health implications, impacting both the
physical and mental well-being of older individuals. The heightened risk of mortality
underscores the urgent need for prevention, intervention, and support systems to safeguard the
well-being of the elderly population.

Addressing Elder Abuse: Solutions

1. Educating and Training Healthcare Professionals:

Healthcare professionals, including doctors, nurses, and medical personnel, play a crucial
role in assisting elder abuse victims. Despite the average of 13.9 visits per year by elderly
individuals, only 2% of elder abuse cases are reported by physicians. Reasons for this
underreporting include a lack of current knowledge about state laws on elder abuse, concerns
about angering the abuser and damaging the relationship with the elderly patient, potential court
appearances, lack of cooperation from elderly patients or families, and insufficient time and
reimbursement. To address this issue, comprehensive education and training programs on elder
abuse for healthcare professionals are essential.

2. Educating and Training Criminal Justice Professionals:

Extending education and training on elder abuse to those in the criminal justice system,
such as police, prosecutors, and the judiciary, is critical. Increased legislation focused on
protecting elders can contribute to minimizing elder abuse and providing improved assistance to
victims.

3. Community Involvement:
Community participation in responding to elder abuse is key to ensuring the safety of
elderly individuals. Communities can develop structured programs that cater to the needs of the
elderly. For instance, Financial Abuse Specialist Teams, composed of public and private
professionals volunteering their time, can advise Adult Protective Services (APS), law
enforcement, and private attorneys on matters related to vulnerable adult financial abuse.

Preventing Elder Abuse and Neglect:

Preventing elder abuse involves three key actions:
● Listening to Seniors and Caregivers: Actively listening to the concerns of seniors and
their caregivers is crucial in identifying potential signs of elder abuse.
● Intervening When Suspecting Elder Abuse: Taking proactive steps to intervene when
there is suspicion of elder abuse is essential for the well-being of the elderly.
● Educating Others: Spreading awareness and educating others on how to recognize and
report elder abuse contributes to building a protective environment for seniors.

Caregiver Guidelines to Prevent Elder Abuse:

● Requesting Help: Seeking assistance from friends, relatives, or local respite care
agencies to take breaks from caregiving responsibilities is important.
● Utilizing Adult Day Care Programs: Exploring adult day care programs provides relief
and support for caregivers.
● Maintaining Personal Health: Prioritizing one's health and seeking medical care when
necessary is fundamental to effective caregiving.
● Stress Reduction Practices: Adopting stress reduction practices helps caregivers manage
the challenges associated with elder care.
● Counseling for Depression: Seeking counseling for depression is crucial, as mental
health significantly impacts the potential for elder abuse.
● Joining Support Groups: Engaging in support groups tailored for caregivers of the
elderly provides a platform for shared experiences and advice.
● Addressing Substance Abuse Issues: Seeking help for problems related to drug or
alcohol abuse is imperative for maintaining a healthy caregiving environment.

Guidelines for Concerned Friends or Family Members:

● Watching for Warning Signs: Being vigilant for warning signs of elder abuse and
promptly reporting suspicions is crucial.
 ● Reviewing Medications: Checking the elder's medications and ensuring alignment with
prescriptions is a proactive measure to prevent abuse.
● Monitoring Financial Transactions: Observing for potential financial abuse and seeking
permission to review bank accounts and credit card statements is essential.
● Regular Communication and Visits: Maintaining regular communication and visits helps
build trust and ensures the well-being of the elderly.
● Offering Respite Support: Providing respite support by staying with the elder allows
caregivers to take breaks, contributing to a healthier caregiving dynamic.

Protecting Oneself as an Elder:

● Organizing Financial and Legal Affairs: Ensuring financial and legal affairs are in order,
with professional assistance if needed, is crucial for an elder's protection.
● Maintaining Social Connections: Staying in touch with family and friends and avoiding
isolation is vital for an elder's well-being.
● Expressing Concerns About Care: Speaking up about dissatisfaction with the care
received, whether at home or in a care facility, is important. Reporting abuse, neglect, or
substandard care to an elder abuse helpline or long-term care ombudsman is crucial for
immediate action.

Conclusion
Research reveals the challenging life experiences and current circumstances faced by the
elderly in Indian society. Their unresolved issues persist until their essential needs for
nourishment, protection, healthcare, and security are addressed. Many elders find themselves
leading isolated lives without family support. It is imperative to establish an environment that
promotes peaceful and dignified living for the elderly, fostering a positive attitude towards aging.
Providing full rights to live free from mistreatment and creating a suitable atmosphere for them
to enjoy and participate in societal and commercial activities is crucial, as emphasized by the
World Health Organization.
Currently, Article 41 and 46 of the Constitution address the rights of older individuals
concerning sickness, unemployment, social injustice, and various forms of exploitation.
However, given the substantial elderly population, these provisions may not be sufficient. To
ensure their security, there is a need to emphasize the importance of enhancing self-reliance and