In preparation for World Elder Abuse Awareness Day (15th June every year), Ciara O’Dwyer, Co-ordinator of ENNHRI’s Project on The Human Rights of Older Persons and Long-term Care attended a workshop in Brussels on 14th June 2017 hosted by AGE Platform Europe, the Council of Europe, the European Commission and Victim Support Europe. The workshop provided valuable information on detecting and supporting victims of elder abuse – useful in particular for care providers and anyone monitoring care for older persons, including NHRIs.

What is elder abuse?

Elder abuse is defined as “a single or repeated act or lack of appropriate action which causes harm or distress to an older person or violates their human and civil rights”.

Prevalence, causes and main offenders

Statistics on the prevalence of elder abuse vary – according to a global study carried out in 28 countries in 2017, around 1 in 6 older people experienced some form of abuse in the past year. The study estimated the proportion of victims affected by each different type of abuse:

• psychological abuse: 11.6%
• financial abuse: 6.8%
• neglect: 4.2%
• physical abuse: 2.6%
• sexual abuse: 0.9%

European research suggest that approximately, 3% of older Europeans suffer maltreatment, and up to 25% of those with high care needs.

Prevalence rates vary both because different studies use different methodologies but also because elder abuse is significantly under-reported – with some estimates suggesting this can be as low as one in five cases.

How to detect elder abuse?

Older persons suffering abuse too often experience feelings of shame, resignation and powerlessness that prevent them from seeking protection. Under-reporting makes elder abuse difficult to detect.

Many informal carers and care practitioners have difficulty in identifying or recognising elder abuse (particularly where there is no act of overt physical violence). In fact, often, older persons themselves fail to recognise mistreatment as elder abuse or violence, perhaps because they are afraid of intimidation or reprisal.

Risk factors

While providing care to a family member of friend can bring a lot of personal satisfaction, it also has a cost. Being a carer is often associated with poverty, physical and mental health problems, isolation, work/care balance issues and financial worries. However, not all family carers become abusers – other factors are usually at play.

• Alcoholism, substance abuse or mental health problems on the part of the offender
• Older women are at higher risk of neglect, physical and financial abuse (such as seizing their property), particularly when they are widowed.
• A shared living situation between offender and victim
• An abuser’s dependency on the older person (often financial).
• Social isolation of offender and victim, and a lack of social support
• Complex caring needs of the victim with inadequate support for the offender

Within institutions, abuse is more likely to occur where:

• standards for health care, welfare services, and care facilities for elder persons are low;
• where staff are poorly trained, remunerated, and overworked;
• where the physical environment is deficient; and
• where policies operate in the interests of the institution rather than the residents.

Tell tale signs that someone is being abused include:

• Injuries (particularly those not fully explained)
• Lack of financial independence
• Little choice in everyday matters (diet, clothes, lifestyle)
• Lack of opportunity for independent speech
• Withdrawn and/or subservient behaviour
• No independent participation in social activities
• Misuse of drugs (including prescription) and/or alcohol

What to do?

An approach based on empathy, reliability and respect is more likely to result in a victim feeling confident enough to talk about a difficult or distressing situation.
Anyone who uncovers elder abuse should consider how they can best help the victim seek further support and assistance, such as contacting the police or specialist services on their behalf, while also respecting their wishes. Click here to download a handbook for trainers.

Preventing and combating elder abuse

Victims’ rights

It is possible that elder abuse is so diffuse is because the rights of victims is something of a grey area.

Within international human rights legislation, the right to be free from torture and cruel and degrading treatment is strongly protected in international human rights treaties, albeit with a high threshold, while neglect, violence and abuse are less well protected. Instead, the right to protection from abuse has become inferred from related, broad standards, such as the right to dignity, to the highest attainable standard of health, liberty and freedom of movement, legal capacity, equality before the law, and privacy. International bodies have inferred a number of positive obligations on states to protect individuals who are vulnerable to abuse by private actors.

In Europe, the Victims’ Rights Directive offers protection for victims of any crime. However, whether elder abuse is a crime depends on national legislation. Click here for more information.

Prevention strategies

Interventions to prevent abuse include:

• public and professional awareness campaigns
• screening (of potential victims and abusers)
• school-based intergenerational programmes
• caregiver support interventions (including stress management and respite care)
• residential care policies to define and improve standards of care
• caregiver training on dementia.

Photo: Jonas Boni/Flickr