As more adults reach the point where they need help with personal care, finances, health and other basic needs of day-to-day living, the potential for them to become vulnerable and in a position to be abused is also rising.
Abuse affects between four and 10 per cent of older adults in Canada, but it’s estimated only one in five incidents is reported to someone who can help (1).
And it doesn’t just happen in care facilities where residents can be emotionally, physically or sexually abused by non-family caregivers, with the most egregious incidents often making media headlines. Family members who are caring for aging relatives can also be the perpetrators, sometimes without even realizing it.
The World Health Organization 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” (2).
So does anyone really know how big the problem is, or the best ways to address it?
Many countries have recognized and acted on the need to protect vulnerable older adults, much in the way that they recognized decades ago that vulnerable children needed protection. In Canada, federal, provincial and territorial governments are investing in efforts to deal with elder abuse. Quebec recently passed an act to combat maltreatment of seniors and other persons of full age in vulnerable situations (3).
However, addressing elder abuse is significantly different from addressing child abuse, and developing a clear description of elder abuse – and ultimately how it should be addressed - has been the subject of much debate.
There has been a great deal of research in the past decade looking at the prevalence of elder abuse, victim profiles, types of abuse, and the initiatives to prevent or stop it.
But what do the potential victims think of all this? Despite the volume of research on the subject, most of this work is professionally-driven, and little is known about older adults’ understanding of the term abuse, or what behaviours they consider to be abusive.
A recent systematic review analyzed 15 studies that focused on how older adults conceptualize abuse (4). This review provides insight on how perceptions of abuse can vary between victims, those providing care, and those who develop policies related to protection.
The 15 studies used a range of methods such as interviews and focus groups to gather the views and perceptions of participants. Most of the studies involved small numbers of participants, but there were two large surveys that compared the perceptions of older adults and professionals.
What the research tells us
Older adults can have complex and diverse perceptions about abuse, some of which are related to their personal experiences, such as age, gender, family relationships, cultural background and living conditions. And while their views generally align with professional definitions of abuse - emotional, financial, or physical abuse, as well as neglect – there are subtle but important differences in how older adults view the severity of such abuse, compared to professionals.
For example, older adults who are vulnerable are perceived to experience abuse more severely, and older adults tend to view elder abuse as a more serious challenge than caregivers and healthcare providers.
The review also noted that while concepts of abuse tended to focus on the family unit, the research also identified broader themes related to society’s attitudes towards family, gender, race and age that contributed to the way people view abuse and the abuse itself.
Another key finding in the review is that some older adults do not understand the concept of abuse, particularly sexual and emotional. The review noted that raising awareness of elder abuse, both among the general public and the older population, is essential.
The varied findings presented through this research illustrate the need for greater efforts to ensure the voices of older adults are heard and acted upon when it comes to addressing the problem of abuse. The way older adults view abuse – based on their backgrounds, beliefs and life experiences – must be taken into account by those who can help them.
Prevention and protection services will only be effective if those receiving such services have a clear understanding of why these services are needed and how they work.
With that information, policymakers will be better able to develop adult protection services that are based on a clear understanding of the needs and wishes of victims.