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Elder Abuse
Information about this social concern

The 1960s and 70s saw a rise in the public’s awareness of child abuse in Canada. Spousal abuse began to be widely studied in the 70s and 80s. Now a third category, elder abuse, is in the spotlight.

What is elder abuse?

The following definitions help to identify the problem:

• Elder Abuse is any action or lack of action a person in a position of trust uses to risk the health or well-being of an elderly person.
• Physical abuse is any rough treatment causing injury or physical discomfort. Use of restraints may be included in this.
• Psychological or emotional abuse is any act that diminishes a person’s identity, dignity and self-worth. A person who is confined or isolated, spoken to cruelly or harshly, humiliated, or treated like a child is abused by this definition.
• Financial abuse is the misuse of an elderly person’s funds, assets or property without that person’s knowledge and consent. If the elderly person is not mentally aware, financial management must be in that person’s best interests.
• Sexual abuse is sexual assault, sexual harassment or use of pornography directed towards an elderly person.
• Medication abuse is the misuse of an elderly person’s medications and prescriptions.
• Violation of civil or human rights is the denial of an elderly person’s basic rights according to the Canadian Charter of Rights and Freedoms, or the United Nations. Declaration of Human Rights. This includes withholding information, denying privacy, denying visitors, restricting liberty, and censoring mail.
• Neglect may be active or passive.
• Active neglect is withholding basic needs or care intentionally.
• Passive neglect is not meeting basic needs and care because of lack of experience or ability.

How can someone tell if an elder person is being abused?

The following are some of the common indicators of abuse and neglect.

Physical abuse

• unexplained injuries such as bruises, burns, swellings
• injury for which explanation does not fit evidence
• delay in seeking treatment
• injury to scalp indicating hair pulling
• grip marks indicating shaking

Psychological or emotional abuse

• fear
• withdrawal
• low self-esteem
• extremely passive attitude
• fear of elderly person when around the caregiver

Financial abuse

• unexplained difference between income and standard of living
• signed document such as a will or property deed by elderly person without person’s full understanding
• possessions disappearing
• unexpected overdrawn or low bank balance of an elderly person, or unusual transactions on behalf of an older person

Sexual abuse

• pain, bruises, bleeding in genital area

Medication abuse

• reduced mental or physical activity
• depression
• reduced or absent response to medications

Denial of civil or human rights

• difficulty visiting, calling, or otherwise
• contacting an elderly person
• excuses by elderly for social isolation

Neglect

• poorly nourished, dehydrated
• missing dentures, glasses, hearing aid
• unattended for long periods or tied to bed or chair
• uncared for appearance - dirty or inappropriate clothing
• untreated medical problems

Elder abuse in Canada

The National Survey on Abuse of the Elderly in Canada: The Ryerson Study (1989) found that four per cent of the elderly people living in private dwellings had recently been abused. This study looked at financial abuse, verbal aggression, physical violence, and neglect. Just over one half of the abuse was financial, one third was verbal aggression and about one-tenth was physical violence.

About the same number of men as women are abused. However, because women live about seven years longer than men, more women are subject to elder abuse. The abuser is most often the spouse, then sons and sons-in-law, and then daughters and daughters-in-law.

Causes of elder abuse

Elder abuse usually involves more than one of the following factors:

• history of family violence
• abused and abuser(s) too dependent on the one another.
• abuser with mental problems or developmental handicap, or with a substance abuse (most often alcohol abuse)
• abuser under stress from the demand on personal resources
• family socially isolated making it hard for outsiders to learn about the abuse
• abuse in an institution when staff have a negative attitude toward the elderly, lack proper training, or lack job satisfaction. The abused resident is either not alert enough to recognize the abuse or remains quiet out of a fear.

Our society’s value of youth and not of older persons reinforces the chance of elder abuse. Magazine articles focus on youth and the elderly as 'us' against 'them.' This is a dangerous way to look at the relationships between younger and older generations. Some abusers may try to justify the elder abuse when they perceive older generations as a threat. For instance, 'Longer-living Canadians called threat to health care,' (Jan 24, 1995, The Globe and Mail) is the type of headline that can fuel fear.

Sandwich generation largely a myth

For many years, the popular press and many researchers believed that many people were 'sandwiched' between two pressing forces. One force is the children they are raising and the other, parents needing care. Elder abuse under these conditions can be explained but should not be accepted.

Two recent Canadian studies have shown the 'sandwich' assumption often may be wrong. They reported that a small number of adults is providing care to both children and older parents. More often, older parents are the resource for both their children and grandchildren. This is especially true when grandparents care for grandchildren while the grandchildren’s parents work.

The University of Victoria’s Centre on Aging study (released Feb. 1995) suggests replacing the words 'sandwich generation' with 'serial care-giving' to reflect what occurs most often. Serial care-giving is experienced mostly by women. These women care for their children until they grow up, then care for older parents, and finally begin caring for their aging husbands. The University of Victoria study confirmed some findings of an earlier study, a 1994 Statistics Canada analysis entitled The Sandwich Generation: Myths and Reality.

A caution when thinking of helping

Helping someone who may be suffering abuse can be difficult. Despite anyone’s best intentions, a person who is being abused has the right to refuse help with these exceptions:

• there is justifiable reason to believe the older adult is not capable of making sound decisions
• the Criminal Code has been violated
• the older adult is a risk to others

In these three cases, there are clear reasons to step in. Otherwise, the older adult must agree to be helped. Even then, help should take the form of 'least intrusion and least restriction' to avoid violating the Canadian Charter of Rights and Freedoms. One can be charged with an offense by an older adult who is 'rescued' from an abusive situation if none of the three exceptions listed above exist and the abused older adult does not agree to be rescued.

Often, giving help is a slow process. A family member or helping professional may need to spend several weeks to gain the trust of the abused older adult before a voluntary consent is obtained to involve outside services.

Intervention options

Most cases of elder abuse are not as severe as the sensational ones shown in a made-for-TV movie of the week. The abuse or neglect may simply be lack of awareness of community resources or inability to reach these resources. They include home care, homemaker services, meals on wheels, friendly visiting (some of these offered by seniors groups), and transportation to community services.

Health and social services can offer indirect help by referral to community services or by documenting abuse. Direct intervention means helping resolve conflict by education and counselling about services available to both the abused and the abuser. Direct intervention can also mean assessing the physical and mental abilities of both the abused and the abuser.

Barriers to reporting elder abuse

Many victims of elder abuse choose not to report what is happening to them for the following reasons:

• they are physically or mentally unable to make a report
• they are isolated and completely under the control of the abuser
• they fear backlash from the abuser
• they fear loved ones will suffer
• they fear they will be blamed
• they fear being put in an institution
• they are not aware of the support services or believe that others cannot help them
• they are ashamed to tell anyone about the abuse

Legislation on elder abuse

Depending on the province, as well as the Criminal Code, there is a wide range of government acts that relate to elder abuse. Each of these acts offers protection if abuse or neglect is occurring.

A provincial office of the public guardian can suggest ways to make use of the legislation. Some police forces have the equivalent of a seniors’ liaison officer who has training and experience in dealing with suspected elder abuse. Lawyers who specialize in health law can help interpret a particular piece of legislation.

Judging the abusers

Elder abuse is wrong. However, we need to be careful how harshly we judge the abusers. Few abusers are truly evil people. Most are not much different from you and me. What is different is the abuser’s ability to cope with sometimes demanding and stressful situations. This does not excuse the abuse. It does remind us that each of us, under certain circumstances, could be driven to some degree of elder abuse. If you need outside help to cope with your situation, the longer you wait before seeking it, the greater the risk that elder abuse will occur.

Each of us has a responsibility to ensure resources are available to anyone who needs them. The treatment you receive when you are an older adult may well depend on what you do now to ensure that resources and support programs for family caregivers are developed and sustained.