It is well known that abuse knows no limits as it can happen in all types of relationships irrespective of one’s age. Yet, society’s focus on child abuse and intimate partner violence in adulthood has somehow overshadowed research on abuse in later life. Nonetheless, in recent years, research on abuse in later life gained increased interest both internationally and locally.
Apart from unveiling different forms of abuse at this stage in the life course, studies have provided invaluable insights into the dynamics of this multifaceted issue and helped to identify various risk factors and consequences. Moreover, it has been reported that the occurrence of abuse in later life both in the community and in residential care settings soared during the COVID-19 pandemic, indicating that there is still a lot of work to be done. Hence, the consolidation of preventive strategies, timely and accessible interventions have been accentuated.
Abuse in later life encompasses any form of mistreatment, abandonment, neglect, intentional or negligent act that causes harm or distress to older persons. It can take various forms including emotional/psychological, physical, sexual and/or financial. It is crucial to note that these forms of abuse often coexist and overlap.
Emotional, verbal or psychological abuse refers to when someone intentionally or unintentionally causes emotional distress or pain to an older person by shouting, insulting, infantilising, demeaning or by isolating them from friends or family.
An older person may be physically abused when someone employs physical force or action that causes bodily harm, pain, or injury. This can vary from hitting or pushing to beatings and restraining. It includes physical maltreatment of any form.
Sexual abuse occurs when an older person is subjected to inappropriate sexual behaviour or contact. It can take the form of rape, sexual assault, or inappropriate sexual contact.
Financial abuse and exploitation occur when someone takes advantage of an older person’s funds or assets. A family member or carer, for example, may misappropriate an older person’s credit card or bank accounts, steal their money or property, or compel them into amending their will, life insurance policy or other legal documents.
Neglect entails failure to provide the older person with essential needs including the physical, the social and/or emotional needs of the older person such as when older persons are disregarded, and their voice is not heard.
Abandonment denotes the desertion of an older person by an individual who accepted responsibility for the provision of care of the former.
Abuse can occur within various settings, including one’s own home, in community environments, hospitals and residential care settings. Hence, perpetrators can be family members, intimate partners, carers, or strangers.
Risk factors include older persons living with dementia or cognitive impairment, individuals with physical disability, those who are experiencing mental-health issues, older persons who are socially isolated, a history of family violence and/or mental-health challenges experienced by the care provider. Informal and formal carers may experience stress and burnout which can contribute to heighten the risk of abuse.
It is crucial to recognise signs and indicators of abuse in older people such as unexplained injuries, inexplicable sexually transmitted infections, variations in behaviour or mood, social withdrawal, unanticipated financial complications, malnourishment, untreated medical conditions, and distress or apprehension in the presence of certain individuals.
One of the challenges of addressing abuse is that it often occurs in private and hidden spaces, making it difficult to detect and address. Indeed, it has been documented that abuse in later life often goes unrecognised and unreported. Older people may feel uncomfortable, humiliated, helpless and/or afraid of revenge or lack of support, which causes them to stay silent about their experiences. Moreover, cognitive decline may impair the victim’s capacity to reveal what happened/or is happening, or pursue assistance. Dependency on others, a history of trauma or violence and lack of awareness about one’s rights and available resources are other contributing factors to abuse.
The repercussions of abuse in later life can be severe both physically and psychologically
Additionally, stereotypes against older people tend to perpetuate an indifference towards reports of abuse leading to under-reporting and a lack of recognition from the public and authorities. Consequently, this leads to lack of information and data on the prevalence of abuse in later life.
The repercussions of abuse in later life can be severe both physically and psychologically. It has been reported that older persons who experience abuse are more prone to experience mental-health issues, emotional distress, social isolation, increased dependency, financial insecurity, and decline in overall well-being and quality of life.
Abuse in later life is also associated with heightened rates of mortality as those who experience abuse are at a higher risk of premature death in comparison to those who do not, often due to the physical and psychological effects brought about by abusive behaviour.
Additionally, abuse in later life can intersect with other forms of oppression and discrimination. Marginalised older persons may face added barriers to reporting abuse and gaining access to support services.
Cultural factors and beliefs shape how abuse in later life is understood, recounted and tackled. Hence, comprehending cultural norms, values and expectations is fundamental to ensure culturally sensitive interventions and prevention strategies.
Having said this, it is important to recognise that some older persons may also engage in abusive behaviour towards others. For instance, an older person living with dementia may become physically aggressive or verbally abusive towards a significant other or carer. In other cases, older persons may use their position of authority or power to exploit or control others. Therefore, older persons who engage in abusive behaviours need support and assistance to address underlying difficulties such as substance-abuse challenges or mental-health issues that contribute to their behaviour.
It is imperative to enhance societal understanding and recognition of abuse in later life to better identify, prevent and address this issue. Advocating and protecting the rights and well-being of older people requires a collective effort from society.
Advocacy groups, policies, legislation, promoting awareness through campaigns to educate the public, improving reporting mechanisms, strengthening support systems via community outreach programmes, and supportive environments all serve to encourage victims to come forward and ensure their safety. Supportive environments and respite services for carers are essential to prevent abusive situations. Programmes to assist perpetrators to resolve their own issues and identify alternative ways of resolving conflict are important.
Continuing education, specific training and collaboration among social and healthcare providers, and law enforcement personnel to be adequately equipped to recognise the signs of abuse in later life and ensure that they are familiar with interventions and support services available, are essential.
The Department of Gerontology and Dementia Studies, within the Faculty for Social Well-being, University of Malta, offers specialised courses on ageing and dementia. The Master in Gerontology and Geriatrics is opening in October 2023 and the Master of Arts in Ageing and Dementia Studies is going to commence in February 2024. Applications for the former are already open and more information can be found on the university website.
In commemoration of World Elder Abuse Day, the Malta Association of Gerontology and Geriatrics (MAGG) organised a seminar on Abuse in Later Life last Friday, June 9. We invite whoever is interested in ageing and dementia to follow our Facebook page for further information.
Roberta Sultana is a doctoral candidate at the Department of Gerontology and Dementia Studies within the Faculty of Social Well-being at the University of Malta. She is the educational officer for the Malta Association of Gerontology and Geriatrics.