Elder abuse is generally understood in terms of the types of abuse that older people can be subjected to – financial, physical, psychological, sexual, and neglect. However, these definitions often fail to take into account the broader social context in which elder abuse is allowed to occur. Older people are rarely asked about what elder abuse means to them but when they are, they define it in societal terms – social exclusion, the belittling of their views and contribution, and violation of their rights. An effective approach to elder abuse requires intervention at a societal level to combat ageism and age discrimination.
Much progress has been made in identifying and attempting to prevent elder abuse since the concept was first described in the 1970s (Baker, Reference Baker1975), and these efforts have resulted in wider recognition, understanding, and regulation of the issue. In recent years there has been greater recognition of the complexity of elder abuse as a social problem (van Bavel et al., Reference van Bavel, Janssens, Schakenraad and Thurlings2010). There is an increasing understanding that elder abuse needs to be approached on a societal level, not just an individual one, and a move towards a public educative approach that encourages social cohesion and solidarity across generations (O'Brien et al., Reference O'Brien2011; WHO, 2011) is required. However, government responses still mainly focus on the individual and familial aspects of the problem (van Bavel et al., Reference van Bavel, Janssens, Schakenraad and Thurlings2010), and there is only limited research examining possible links between societal ageism and elder abuse as experienced by individuals (Phelan, Reference Phelan2008; O'Brien et al., Reference O'Brien2011).
The most widely accepted definition of elder abuse or maltreatment is “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” (WHO/INPEA, 2002). It is usually seen as having various manifestations including psychological, physical, financial, sexual, and social abuses, as well as neglect. Regulatory bodies and policy-makers in countries such as Australia, the UK, and the USA use the above definitions (with slight variance) when considering how best to identify and prevent incidents of abuse, and to support those who are victims of maltreatment.
Defining elder abuse as the occurrence of specific acts has encouraged better regulation and, in many cases, more direct support, but it risks limiting responses to being only interventions at an individual or family level. At this level, the focus is mainly on carer stress or family dysfunction and thereby fails to address the systemic context in which elder abuse is allowed to occur. This focus also encourages an acceptance of the victim–perpetrator dichotomy, and does not take into account the complexity of relationships between two adults, or the societal pressures and assumptions that affect individuals. The danger of limiting understanding of abuse to include only those actions that are perpetuated at the individual level upon vulnerable elders is that it runs the risk of also limiting our view of older people. Rather than seeing older people as having distinct identities and a variety of valuable roles that they fulfill in society, elders are seen only in regard to the aspects of their self that may be protected from or suffer abuse. In a circular manner, this serves to promote negative stereotypical beliefs that society holds about older people, which manifest as ageism and are felt in the withdrawal of respect and recognition deemed abusive by older people (O'Brien et al., Reference O'Brien2011).
Biggs and Haapala (Reference Biggs and Haapala2010) note that elder abuse always involves interpersonal relationships negotiated between adults where the abuse is directed at someone over a certain age (generally 65 years, or the age of retirement). However, the circumstances surrounding each individual occurrence of elder abuse can be very different. The circumstance of a person experiencing dementia and their carer (Cooney and Mortimer, Reference Cooney and Mortimer1995; Sadler et al., Reference Sadler, Kurrle and Cameron1995; Cooney et al., Reference Cooney, Howard and Lawlor2006; Selwood et al., Reference Selwood, Cooper, Owens, Blanchard and Livingston2009) is very different to that of an older person facing the continuation of family violence experienced at earlier life stages (Penhale, Reference Penhale1999; Reference Penhale2003; Lundy and Grossman, Reference Lundy and Grossman2004). It would be a mistake, considering the complex and ambiguous nature of the care relationship, to assume that elder abuse is a consequence of dependency. It is important to note that elder abuse occurs in only a minority of care relationships and not only those older adults who are in a position of direct care dependency experience elder maltreatment. The view of dependency as negative, and as a failure of autonomy and independence, must be challenged (Nolan, Reference Nolan2001). A broader response to elder abuse should highlight the interdependency of people over the life course, acknowledging the value and contribution of the older person being cared for, and should not allow a person's increased need for assistance to be perceived as directly inverse to their worth as a person.
A recent study identified that the research and literature pertaining to elder abuse rarely solicits the views of older people themselves (O'Brien et al., Reference O'Brien2011). Some studies have presented older people with a number of scenarios and asked them to identify incidents of abuse (Helmes and Cuevas, Reference Helmes and Cuevas2007; Hempton et al., Reference Hempton2010), comparing older people's perceptions to those of other groups such as medical students, caregivers, and health professionals, but these questionnaires operate within the definition of elder abuse as discussed above; older people have rarely been asked open-ended questions about what they see as constituting elder abuse. In a series of peer-led focus groups, O'Brien et al. (Reference O'Brien2011) found that many older people see elder abuse or maltreatment as being more wide ranging than individual acts involving a perpetrator and a victim. They identified societal concerns such as the withdrawal of respect and recognition, and the reduction of the roles and opportunities for participation, as being elder abuse. These findings were reflected in the World Health Organization's 2002 report Missing Voices: Views of Older Persons on Elder Abuse, which found that older people's perceptions fall under three main areas: neglect, including isolation, abandonment, and social exclusion; violation, of human, legal, and medical rights; and deprivation of choices, decisions, status, finance, and respect.
The above studies show that older people's views of elder abuse are closely linked to ageism. Ageism devalues older people and leads to prejudiced attitudes, actions, and social marginalization, with the negative views expressed against older people making elder abuse and neglect more tolerable to society (Phelan, Reference Phelan2008; Peri et al., Reference Peri, Fanslow, Hand and Parsons2009; WHO, 2011). Negative attitudes towards any group in society serve to dehumanize the members of that group, and the view that people become physically weak and dependent on others as they age makes it easier for older people to be maltreated and exploited. The agist stereotypes used in the media, families, and the workplace, encourage and allow elder abuse to occur, as they strip away the dignity and humanity of the individual and encourage the process of “othering.” An individual's sense of self plays a large part in the creation of a personal identity and the maintenance of well-being, and self-worth is often measured in relation to the perceptions others form in view of the societal roles an individual inhabits (George, Reference George1998; Siebert et al., Reference Siebert, Mutran and Reitzes1999). Therefore, an attack on the self – such as happens when an older person is continually exposed to agist attitudes, or their role in society is seen as limited and valueless – can have a detrimental effect on well-being. This can lead to a loss of confidence and increased vulnerability, and research has demonstrated the self-fulfilling nature that negative agist stereotypes have on older people (Levy, Reference Levy1996; Whitbourne and Sneed, Reference Whitbourne, Sneed and Nelson2002).
Little information is available on how the community context can affect the occurrence of elder abuse, and more research must be done. There is strong evidence to support the view that social isolation is a key risk factor, with older people who experience abuse often lacking social connection (WHO, 2011). Again, it is not just the lack of interaction on a personal level that can cause feelings of isolation and disconnection, but also the lack of recognition of personal worth in the eyes of society. This lack of recognition of personal worth also affects those engaged in the care of older people, and in this way elder abuse is indicative of the lack of societal support for carers, and the lack of choice in care options. On the other hand, treating older people with respect and improving the public's understanding of the aging process can act as preventative factors of elder abuse (Peri et al., Reference Peri, Fanslow, Hand and Parsons2009), and there is strong evidence to show that programs that facilitate intergenerational relationships improve participants’ attitudes to older people (WHO, 2011).
In light of the above, it is clear that current responses to elder abuse do not adequately address the issue from the point of view of older people. While our current understanding of elder abuse, with its focus on individual and familial factors, allows some of the above concerns to be addressed, it does not cover all. A more effective understanding of elder abuse is necessary – one that directly addresses the societal and individual risk factors of elder abuse and the concerns of older people, and that acknowledges the detrimental effects of ageism. In this way, elder abuse services can more ably support those who are experiencing maltreatment, while developing more effective preventative methods.
Any response to elder abuse must encompass a broad, societal approach that empowers older people by recognizing their inherent value and the contribution they make to society, and by acknowledging that as we age we maintain vibrant identities and a variety of roles. This will only be possible by recognizing the detrimental effect of ageism experienced at the societal level, which can manifest as elder abuse at the personal level, and by working to combat age prejudice and agist stereotypes. A response to elder abuse must recognize the ambiguity and emotional ambivalence of familial care situations and acknowledge older people's right to self-determination (Biggs and Haapala, Reference Biggs and Haapala2010).
Elder abuse is a human rights issue (van Bavel et al., Reference van Bavel, Janssens, Schakenraad and Thurlings2010), and any response must be framed by the understanding that people have a right to freedom from violence and exploitation, and the right to dignity and respect, regardless of age. A comprehensive response to elder abuse must address ageism in society, and while this broader approach is more difficult to implement and evaluate than a focus on elder abuse at an individual level, this does not mean it should be evaded.
Conflict of interest
None.
