The age of abuse
Why mistreatment of our elders is spreading like a virus
OPINION
The restrictions put in place during the coronavirus pandemic are designed to keep people, and particularly vulnerable older adults, safe. However, as clinical geropsychologist and UQ School of Psychology Professor Nancy Pachana explains, they also increase the risk of elder abuse – a hidden and poorly studied challenge.
The coronavirus pandemic and its primary management tools – social distancing and restricting people to their homes – has led to an unintended but very real increase in instances of domestic violence as well as child abuse. But another form of abuse has not to date garnered the same headlines – namely, elder abuse.
Currently, older adults face increased risk of serious or life-threatening health complications should they contract COVID-19 – and plans for flattening the curve have taken both age and health status into account.
But increased social isolation, economic impacts on themselves and their families, and mounting anxiety and stress may put older adults at increased risk of elder abuse during the pandemic.
Elder abuse is defined by the World Health Organization (WHO) 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 (aged 60 years and older)."
"It includes physical, sexual, psychological/emotional abuse; financial and material abuse; abandonment; neglect; and serious loss of dignity and respect."
– WHO
Despite increasing attention from both researchers and the popular press, elder abuse remains a global issue of high concern, with the WHO estimating that 15.7% of people 60 years and older are subjected to abuse.
Although the WHO drafted an international call for action aimed at the prevention of elder abuse in 2002 (the Toronto declaration on the global prevention of elder abuse), rates of elder abuse remain high and under-reported. In fact, reported rates of elder abuse are increasing, while awareness of the issue is not.
The coronavirus pandemic has set the stage for an increase in instances of abuse and a decrease in the ability for such abuse to be detected.
Resources Diverted, Restrictions in Place
In the same year as the Toronto declaration appeared, the WHO stated that “Elder abuse is a violation of Human Rights and a significant cause of injury, illness, lost productivity, isolation and despair… Confronting and reducing elder abuse requires a multisectoral and multidisciplinary approach.”
But while health sectors globally are pouring resources and clinical focus, appropriately, into battling COVID-19, signs of abuse likely will go undetected in most clinical settings, and communication between health practitioners and community agencies about such issues is far down the list of current priorities.
Elder abuse can take the form of physical abuse, sexual abuse, financial abuse, psychological abuse or neglect. Laws between and even within countries vary greatly with respect to reporting channels and obligations, and can be confusing. Healthcare practitioners who do not usually treat older persons may not be aware of the various guidelines and referral options available.
Even without the current pandemic, elder abuse often goes undetected, sometimes for years.
The American Psychological Association reports that for every case of elder abuse and neglect reported to authorities, experts estimate as many as 23 cases go undetected.
COVID-19 restrictions have severely limited the ability for families to visit their loved ones in nursing homes. Family members often provide help with care in such settings – for example, helping with feeding during mealtimes.
Less families in nursing homes helping out means more work and less support for care workers, and less direct observations of any changes in behaviour in residents – behaviours which could indicate health or emotional changes, or possibly abuse or neglect.
Both abuse and neglect in the industry were cited as major concerns by the recent Royal Commission into Aged Care.
Image credit: Goodboy Picture Company/Getty Images
Pressure on Vulnerable Parts of Society
There are multiple risk factors that place an older person at risk for elder abuse (it is important to remember that risk factors do not mean causal mechanisms – risk factors are associated with an outcome (in this case, elder abuse), but do not directly cause the abuse).
Many of these risk factors – psychological difficulties, lower income or poverty, and social isolation – may be exacerbated by strategies to mitigate COVID-19.
Poorer access to health professionals during the crisis may also put the older person at risk for poorer health – and this is yet another risk factor for elder abuse.
Rates of elder abuse are greater in ethnic minority groups, and for those with low social support – two groups that may also be hit hard by the COVID-19 crisis.
Increased fears and financial pressures as a result of COVID-19 can lead to increased carer burden – and can thus mean family caregivers are at a higher risk for abusing those they care for.
A history of poor relationships as well as substance abuse are also risk factors that may be exacerbated by the COVID-19 crisis.
Older persons with cognitive impairment or dementia might not understand the need for staying at home, or changed circumstances in their living situation. This may increase caregiver burden and with that, the risk of abuse. Cognitive impairment and dementia are themselves risk factors for elder abuse, both in communities as well as care facilities.
The intersection of ageism and neglect
Ageism in many places – including Australia – is more likely to be expressed by younger people. Unfortunately, the coronavirus pandemic has led to extremely ageist views expressed, particularly on social media, with the #boomerremover possibly the worst example.
During the pandemic, many organisations have put out statements about ageism in the time of COVID-19. However, ageism can also infiltrate clinical environments, particularly around medical decision-making.
There have been calls to guard against ageism in public health policy and practice guidelines by directly involving older adults in such discussions, particularly those from disadvantaged backgrounds.
COVID-19 worldwide have also ignited conversations about retaining the rights of older adults, even while practising key public health mitigation strategies.
The Gerontological Society of America has a free tool available, Ageism First Aid, that offers education and practical advice suitable for health care professionals, business professionals and those in higher education settings.
Image credit: RUNSTUDIO/Getty Images
What can we do to prevent elder abuse?
The two most researched prevention strategies are education and caregiver support programs. Interventions, however, are very thin on the ground, and the evidence base on their efficacy is poor.
So, what can be done?
Awareness is key – being alert to and following up suspected elder abuse should not cease, even in a pandemic. Referrals to psychologists, social workers and community organisations can potentially avert long-lasting health and emotional consequences of abuse.
Friends and family can help, too, by staying in contact with older loved ones, giving extra support to those in caregiving roles, and being available to support and to listen.
This pandemic is challenging, particularly for older adults. We need to attend to all sources of fear and harm to protect our older populations, and summon help when required.
If you or a loved one is experiencing elder abuse, the Elder Abuse Prevention Unit of Uniting Care offers online help and advice.
Relationships Australia offers similar advice.
If dementia is part of the context of elder abuse, Dementia Australia is available with assistance.
If you need help with other types of violence or mental health issues, text the Crisis Text Line at 741741.
Image credits:
Header: kupicoo/Getty Images
Woman sitting on bed: Fancy/Veer/Corbis/Getty Images
ABOUT THE AUTHOR
Professor Nancy Pachana is a clinical geropsychologist, neuropsychologist and professor from UQ's School of Psychology. She is internationally recognised for her research in geriatric mental health, particularly in late-life anxiety disorders.
Professor Nancy Pachana
Professor Nancy Pachana
Professor Pachana is co-developer of the Geriatric Anxiety Inventory, a published brief self-report inventory in wide clinical and research use globally, translated into over two dozen languages.
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