World Elder Abuse Awareness Day: SOCIOLOGICAL PERSPECTIVE: Theories and measures of elder abuse

Relevance: Sociology: Social Changes in India: Emerging issues: ageing, sex ratios, child and infant mortality, reproductive health. & G.S paper I: Society and social issues 

CONTEXT

The UN designated World Elder Abuse Awareness Day is observed every year on June 15. What comes as a surprise to many is that this day was officially recognised as recently as 2011. Reports state that in the next 10 years, the number of people above the age of 60 is estimated to grow by 38 per cent, reaching a total population of 1.4 billion elders across the world. A large section of this demographic will inhabit developing countries, according to Parul Kamra, programme manager, Wishes Blessings NGO.

The COVID-19 pandemic is causing untold fear and suffering for older people across the world. Beyond its immediate health impact, the pandemic is putting older people at greater risk of poverty, discrimination and isolation. It is likely to have a particularly devastating impact on older people in developing countries.

INTRODUCTION

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”. Elder abuse can take various forms, including financial, physical, psychological and sexual, and can also be the result of intentional or unintentional neglect.

During the COVID-19 pandemic, there have been numerous reports of abuse and neglect of older people living in long-term care facilities and other community settings, but also of those living with family members or in their own homes with caregivers.

Prior to the pandemic, a total of 9 studies in 6 countries based on staff self-reports on perpetrating abuse were analysed together. Findings indicated that 64.2% of staff – 2 out of 3 – perpetrated some form of abuse in the past year.

There is concern that ageism and gender inequalities have worsened during the pandemic, increasing the risk of abuse and violence against older women. At the same time, quarantine and lockdown measures have limited access to essential services, putting many older people at risk of increased neglect.

ANALYSIS

As the population ages, it is imperative to pay more attention to the issues affecting older adults’ quality of life and psychological well-being.1–4 A pervasive phenomenon across the world with devastating effects, elder abuse is associated with decreased quality of life and increased morbidity and mortality rates.5 Although it is not a new phenomenon, awareness of elder abuse and interest in examining the problem are relatively new.

International studies estimate that 1–5% of community-dwelling elderly people aged 65 years and older suffer from abuse or at risk of being abused.6 According to the World Health Organization, elder abuse is defined 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’.7 The goal of this review article is twofold:

• to provide an overview of the theories might explain elder abuse; and
• (ii) to train healthand social-care providers and researchers about selecting and using existing elder abuse measurement instruments.

THEORIES OF ELDER ABUSE

The first section of this article attempts to theorize the causes of elder abuse and why elderly people are vulnerable to abuse. Thus, theories from different disciplines, such as psychology, sociology, and biology, are presented to explain why elder abuse occurs.

Social exchange theory Social exchange theory supposes that two parties are both giving and receiving items of value from each other and that the interaction between two parties will be positively evaluated if both parties benefit equally from the relationship.

According to this theory, elder abuse may occur because of the victim’s dependence on the abuser and vice versa. First, it is assumed that elder abuse is the result of the elder’s increasing dependence the caregiver. As people age, they become more powerless, vulnerable and, to some degree, dependent on family members for assistance, which may increase the risk of abuse.

A caregiver may resent that the older person is completely dependent on the caregiver; the caregiver may experience anger that leads to abusive behavior.

For example, if the caregiver perceives himself or herself as deserving of rewards for supporting that elderly person, abuse may occur if such rewards are denied. It has also been postulated that elder abuse is the result of a caregiver’s increasing financial dependency on the elderly person. Owing to a sense of imbalance in the relationship and the violation of social expectations concerning independent adult behaviours, the perpetrator tries to restore some sense of control with violence or threats of violence.

Feminist theory

Feminist theory focuses on spousal elder abuse as a significant dimension of elder abuse, wherein older women are more vulnerable to spousal abuse because older women tend to have less power than men. According to this theory, men have more social and financial resources and regard women as their property.

Political economic theory

This theory addresses that elderly people are gradually marginalized in their families and society. Therefore, they lose their role and depend on others. According to political economic perspective, the changing role of the elderly removes them from the workforce and reduces their independence, which may lead to elder abuse.

Psychopathology of the caregiver theory

This theory examines the role of the caregiver with a mental health problem and how that puts elders at risk for mistreatment. According to this theory, the abuser’s behavioural characteristics contribute to elder abuse. Caregivers who consumed alcohol and experienced depression and anxiety are more likely to use physical and verbal abuse against the elder.

Role accumulation theory

This theory argues that elderly people may be abused by family members including their spouse, adult child(ren), or son- or daughter-in-law. According to the role accumulation theory, family members with conflicting role obligations are not able to manage the stress of their own lives. These stressed family members may abuse an older adult as a way to cope with their stress.

Situational theory Situational theory is one of the earliest and most widely accepted explanations of elder abuse. This theory focuses on the role of stress and the burden of caregiving in elder abuse. According to this theory, an overburdened caregiver who cannot cope with caring demands creates an environment for abuse. Overall, this theory supports the idea that stressed caregivers may become abusive towards their vulnerable seniors.

Social learning theory

Social learning theory, also called the transgenerational theory, postulates that violence is a learnt behaviour that may be passed down from generation to generation. When children observe violence as a response to stress, they then internalize this behaviour as acceptable. In the case of elder abuse, an abused child may abuse her or his parents in the future. In addition, when an abusive spouse becomes ill or disabled, the previously abused partner may abuse him or her. Thus, the child or spouse who was abused by the parent or spouse continues the cycle of violence as a caregiver.

Stratification theory

Within this theory, elder abuse is particularly inflicted by caregivers. According to stratification theory, jobs at the bottom of the stratified system are not desirable because of their low status and pay, but they are needed in order to survive. Caregivers for the elderly receive low pay, and their job title has little prestige, regardless of where the job is done. It can be expected that elder abuse occurs when the caregiver tries to control the older person. When the caregiver must override the elder’s wishes, which could be influenced by dementia, the elderly person may resist the caregiver. With little status, the caregiver may feel the need to gain control over the elder. Within the stratification theory, it can be assumed that a caregiver’s low job satisfaction and low levels of education may contribute to elder abuse.

Symbolic interactionism theory

Symbolic interactionism is the way people react and view the world through their interactions with others.

This theory can be used to explain why elder abuse takes place and how culture plays an important role in the perception of abuse. According to this theory, every object has different meaning to each person, and everyone has his or her own way to find meaning. Therefore, perception and interpretation of an object is not always same for all people. According to this perspective, cultural values and expectations influence what conduct is considered to be elder abuse.

For example, in some cultures, sending elderly individuals to nursing homes is considered to be a form of abuse, whereas other cultures define it as a sign of caring.

Causes of abuse

More research is needed on the role of stress among caregivers, originally considered a primary cause of elder abuse. With the increasing prevalence of Alzheimer disease worldwide and the greater level of abusive behaviour found in families where a family member suffers from the disease, more attention should be given to the relationship between the caregiver and the care recipient.

While it may be obvious that social isolation or lack of support can contribute to abuse or neglect, the sufferers of abuse in these situations are generally unwilling to join programmes that encourage social interaction, such as centres for the elderly or day-care activities. Research on who these victims are and on their situations might produce better solutions. The role of ageism – discrimination against and stigmatization of older people – as a possible cause of elder abuse has yet to be properly investigated, although some specialists in the field have suggested that the marginalization of the elderly is a contributory factor. Cross-cultural studies would probably be helpful in understanding this effect.

Clearly there are certain social and cultural factors in some developing countries that are directly linked to abuse, such as a belief in witchcraft and the abandonment of widows. Other practices, which are also often quoted as being important causal factors, need to be examined, since there has been no research to confirm the claims. Other cultural and socioeconomic factors, such as poverty, modernization and inheritance systems, may be indirect causes of abuse. The use of the ecological model to explain elder abuse is still new and more research is needed on the factors operating at different levels of the model.

What can be done to prevent elder abuse?

The impact that physical and psychological violence have on the health of an older person is exacerbated by the ageing process and diseases of old age. It is more difficult for the elderly to leave an abusive relationship or to make correct decisions because of the physical and cognitive impairments that usually come with old age.

In some places, kinship obligations and the use of the extended family network to resolve difficulties may also lessen the ability of older people, particularly women, to escape from dangerous situations. Often, the abuser may be the abused person’s only source of companionship.

Because of these and other considerations, preventing elder abuse presents a whole host of problems for practitioners. In most cases, the greatest dilemma is how to balance the older person’s right to self-determination with the need to take action to end the abuse.

Responses at national level Efforts to galvanize social action against elder abuse at a national level and to develop legislation and other policy initiatives are at varying stages of development around the world. Some authors  have used Blumer’s model of social problems to describe the stages of the process: — emergence of a problem; — legitimization of the problem; — mobilization of action; — formulation of an official plan; — implementation of the plan.

 

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