The problem of elder abuse should be of concern to all of us. We often fail to recognize the signs of abuse. We may be living next door to someone experiencing some form of abuse and simply be unaware that it is happening. As the proportion of the population over age 65 years increases, it is likely that the problem of elder abuse will also increase.
It is important to know that older people may experience different kinds of abuse. This knowledge will allow us to recognize significant clues that someone is being abused. More importantly, we need to recognize some simple things that we can all do to help identify and prevent elder abuse in our communities.
In this four-part series we discuss all aspects of elder abuse:
- In Part 1 we examine the general definition of elder abuse
- In Part 2 we look at important risk factors associated with elder abuse and different types of abuse
- In Part 3 we compare what Canadians believe about abuse and the evidence on the size of this health problem in Canada and around the world
- In Part 4 we discuss the benefits and possible harms of elder abuse interventions
Why is elder abuse an important issue for seniors' health?
Many of us are aware that elder abuse exists, but question the extent of this problem in Canadian society. Surprisingly, measuring elder abuse is no simple matter. In part, this is because it is not easy to ask people if they are being abused. Fear and shame are some of the emotions that victims of abuse experience, as well as reluctance to disclose that they are being abused. Victims of abuse may fear backlash or worsening abuse if they speak out. They may fear that they will have to leave their home to avoid the abuse. As a result, much of the abuse remains hidden, and abuse becomes a taboo subject. It is, however, a major health problem for the person experiencing the abuse and a societal problem that requires attention.
Although most Canadians are aware of elder abuse, many would not be able to define it precisely. Generally, any action or lack of action that brings harm to an older person can be considered elder abuse. Often this abuse is caused by someone who is trusted by the older adult. The person causing the abuse (known as the perpetrator of abuse) is usually known by the older adult and may be a paid caregiver, friend, or even a family member. In institutionalized care there is the potential for abuse between residents; however, this type of abuse is different in that the perpetrator is not in a position to provide care or assistance to the person experiencing the abuse. Abuse can occur in any number of settings including an individual's own home, acute care hospitals, day centres, and nursing homes. It is troubling to think that these are places where an older person should feel the safest. Elder abuse can occur regardless of gender, age, religion, race or culture; unfortunately abuse has been found in all of these contexts.
Although the definition of abuse has evolved over the last 20 years, we now understand that there are five common types of abuse: physical, psychological or emotional, sexual, financial, and neglect (abandonment). Elder abuse and self-neglect are not the same. When an older person is being neglected, the neglect is due to someone else's actions or inactions. When older people neglect themselves, it is the result of their own actions and behaviours. Self-neglect occurs when people intentionally or unintentionally fail to take care of themselves (like not eating, not taking their medications or not taking care of their basic hygiene).
What is the scientific evidence about elder abuse and health?
While it seems obvious that if seniors are abused, they will experience negative health consequences, there is limited research evaluating this issue. One well-conducted American study showed that older persons being abused had approximately three times the risk for death compared with those who were not mistreated (1). This study followed people forward in time and the researchers took into account a number of other factors that could have added to their risk of dying (e.g., age, gender, having chronic diseases, functional status, social networks, cognitive status, and depression). This study made a very good attempt in estimating the long-term risks linking abuse and mortality. Unfortunately, we do not yet have many good studies exploring the risk between abuse and poor health outcomes. There are a number of reasons for this, and one of these reasons is that we have had differing definitions of abuse over time.
Why do definitions of elder abuse differ?
The study of elder abuse is a relatively new area of research compared to abuse in children or in women (2).The research suggests that part of the problem with studying elder abuse is that it is not defined consistently (3). Sometimes our understanding of elder abuse varies because of differing laws between regions or countries. Our understanding of elder abuse may also differ because of lack of agreement on what activities or actions are considered abuse. Our definition of elder abuse has changed over time and some studies reflect the historical and social context of the era in which it was evaluated. A recent systematic review (4) identified 42 different studies and showed how elder abuse labels changed over time. From the mid 1970s to the mid-1980s elder abuse was characterized exclusively as physical assault on female seniors (called granny-battering). From the mid 1980s to 2003, our understanding of abuse widened to include psychological or emotional and financial abuse. Currently, there is agreement that there are five main types of abuse. However, there is some disagreement as to what actions (and circumstances) within these five categories should be labeled as elder abuse. The specifics of these five categories of abuse are detailed in Part 2 of this series.
What is the bottom line about elder abuse?
As we noted previously, we may be living next door to someone experiencing some form of abuse and simply be unaware that it is happening. We know that being exposed to abuse puts you at greater risk for poor health outcomes such as mortality. The research on elder abuse is limited for a number of different reasons. In part this is related to the social stigma (fear and shame) of people reporting their own abuse. It is also related to differences over time in how we have defined elder abuse. We need more concerted efforts to prevent elder abuse. The first step is recognizing and identifying the signs of abuse (see Part 2 for more details). If you or someone you know may be experiencing abuse, don't be embarrassed to get help.
- Find out more by calling 1 800 O-Canada (1-800-622-6232) or visiting seniors.gc.ca
- Join the Canadian Network for Prevention of Elder abuse (CNPEA); the link to their website is in the references (5)
In Part 2 of this series we review the different types of risk factors and types of elder abuse.
In Part 3 of this series we examine what Canadians believe about elder abuse and the evidence on the size of the problem in Canada and elsewhere.
In Part 4 we discuss the benefits and possible harms of elder abuse interventions.