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Major Issues in the Abuse of Seniors
By Connie Chapman, Consultant
There are a number of issues which distinguish abuse of
seniors from violence against women. The majority of these
issues stem not so much from what is happening to seniors
as they stem from who is defining the issue and how it is
being defined.
Influences
Abuse of seniors has been highlighted as an issue for a
little more than 10 years. The first people to bring the situation
of seniors to public attention were primarily nurses and social
workers, and this continues to be the case. Home care nurses,
home support workers, geriatric social workers, hospital social
workers are among the people who have seen the abuse and have
worked against many odds to do something about it. Because
it is almost exclusively within a medical setting that abuse
of seniors has been seen, understanding of abuse reflects
the medical model. In an attempt to intervene effectively
many professionals, particularly in the United States, have
adapted the child abuse medical model as the appropriate one
for intervention with older people. This model sees the child
or senior as incapable of acting on her/his own behalf and
advocates for laws which allows professionals to intervene
on behalf of the child or senior. This has led to Adult Protection
Laws in most states in the United States and in a few provinces
in Canada (see Gordon & Tomita: 1990 for a critique of adult
reporting laws).
Both feminist and seniors' organizations have been mainly
silent about the topic of abuse of seniors. While many of
the front line nurses and social workers concerned about abuse
of seniors are feminists, feminist organizations such as shelters
for battered women, sexual assault centres and provincial
and national groups have been significantly silent about this
issue. Seniors' organizations have recently started to take
more of an interest and this may very well influence our understanding
of abuse of older people in the coming years.
Definition of Abuse of Seniors
Most of the definitions of abuse emphasize content rather
than process. The definition most used in British Columbia
says that abuse of seniors is any action or inaction which
jeopardizes the health or well-being of an older person. This
includes: acts of physical assault; financial exploitation;
emotional, sexual and medication abuse; violation of civil
and human rights; and withholding care or the basic necessities
of life. Little distinction has been made between a person
who engages in an abusive act and a person who engages in
abusive behavior. For example, there is often no distinction
made between the person who yells at an older person in frustration,
apologizes and change his behavior and the person who continually
yells at an older person and who does not take any responsibility
for his behavior.
Who is Being Victimized?
Most of the literature refers to the "typical victim" as
a woman 75 years of age or older, who has one or more serious
health problems. A great deal has been written about the dependency
and vulnerability of seniors to abuse.
In spite of the fact that most researchers will identify
an older woman as the most likely victim, gender has not been
seen as a critical issue. Some researchers have pointed out
that there are more women seniors in the population than older
men and therefore, men and women are abused at equal rates.
Complicating this issue has been the use of the Conflict Tactics
Scale (CTS) in a lot of the research. This instrument has
been used in several national surveys both in the United States
and Canada. This scale consists of items which measure behaviors
used in conflicts between family members or intimates. The
use of the CTS consistently indicates that men are most often
the recipients of acts of physical violence. While the authors
of the CTS caution that the meaning and consequences of such
results are easily misunderstood, they continue to use the
scale. The CTS measures neither the intent of an act nor the
consequences of it. When these two variables are taken into
account, seniors are the ones who are being controlled by
the violence and are the ones who are most likely to be injured
as a result of the violence. There hasn't been enough quality
research to determine whether the consequences and circumstances
of abuse for senior men and women are different. Anecdotal
evidence suggests that for senior women, the violence is often
more severe and more long term.
The Abuser
Many of the early studies of abuse of seniors focused on
"caregiver stress:" the pressures and strains a caregiver
may experience looking after an older person. This theory
states that without adequate supports and resources, the demands
on family members to look after the frail and the elderly
are often overwhelming and violence has been the result. While
there has been a great deal of research to suggest that this
theory only accounts for a small percentage of abuse of seniors,
researchers and professionals alike continue to refer to abusers
as "caregivers." Recent research has indicated that rather
than the abuser "caregiving" the older person, the abuser
may be dependent in some way on the older person or may have
imposed the caregiving role. This practice of referring to
the abuser as a "caregiver" obfuscates and minimizes the abuse.
Depending on the program or the research collecting the
information, the abuser is most often either the husband or
an adult child (most often son).
Ageism
Although many writers do mention ageism in connection with
abuse of seniors, it hasn't had a central explanatory role.
Almost no writing has looked at how ageism operates to perpetuate
and maintain abuse of seniors. The book by the Ageism and
Battering Project, Old Women Breaking the Silence, is one
of the few that examines the relationship between abuse of
seniors and ageism. This book also examines sexism in the
battering context.
Perhaps one of the reasons so little has been written about
ageism and violence is because so little has been written
about ageism. There are a few noteworthy books, such as The
Fountain of Age by Betty Friedan, which have examined this
concept and how it operates in our society. Perhaps as the
baby-boom generation begins to experience the effects of ageism,
more will be written about it.
Competency
Often a central issue for service providers is whether older
persons are competent to make their own decisions and handle
their own affairs. This issue has acquired more attention
than is warranted by the number of older people in the population
who have actually lost the capacity to make their own decisions.
Also, the ways in which abuse may affect an older person to
give the appearance of incompetence has not been adequately
explored. For example, many practitioners will acknowledge
that depression is a problem for many older people and that
depression can affect a person's competency. However, abuse
as a possible contributing factor to depression has not been
adequately explored. Also, the relationships between crisis,
abuse and competency have not been examined. As a result,
one of the first questions often asked about a senior is whether
they are competent. Since this procedure would not be done
with a woman ten or twenty years younger, this form of institutional
ageism colors both the understanding of abuse and the service
abused seniors are receiving.
Intervention Issues
Services for abused women have, for the most part, either
ignored the situation of seniors or have worked on the assumption
that abuse of all women is the same. While the dynamics may
be the same, the solutions are not. There are several areas
where significant differences exist.
Housing
For many seniors, particularly senior women, housing has
a much more central role in their lives than it does for younger
women. For a younger woman, leaving an abusive relationship
often means leaving her house for a shelter for battered women
and then relocation to a new residence. For many seniors this
is not an option. Whether they own or rent, many senior women
will stay in abusive situations rather than leave a home they
have known for many years. If this is a woman's preference,
then the onus is on the service providers to help her find
ways of removing the offender from the home and securing her
right to stay there.
Government Supports
Particularly in the area of finances, seniors will be dealing
with different government systems than younger women. It is
important for service providers to be knowledgeable about
these systems, particularly since financial abuse is so often
a part of how a senior is being controlled by an abuser. Women
are more often better off financially once they reach age
65 than at other times in their life. If a woman does not
know about all the benefits available to her, she may be staying
in an abusive situation incorrectly thinking she does not
have the means financially to move.
Medical Conditions
While older people are generally healthy, the chances of
developing medical conditions do increase with age. Some conditions
(and sometimes medication or misuse of medications) can affect
a person's cognitive ability or their ability to communicate.
Some conditions may promote bruising. This has several implications
for intervention. First, service providers, particularly if
they are not medically trained, need to inform themselves
about physical and medical conditions which may change the
way they do intervention. Second, service providers may need
to learn new skills to deal with women who have cognitive,
mental, or physical impairments which impact intervention.
Third, medical intervention may need to be explored as one
part of the abuse intervention.
Access
While the percentage of seniors with physical disabilities
and chronic disabling illnesses is not as high as the public
is led to believe, the chances of these conditions developing
does increase with age. This means that there are seniors
who are isolated due to medical conditions but are not able
to reach out for help. If abuse is present, these conditions
can enhance the abuser's ability to isolate the older woman.
This situation has been exacerbated because of the policy
of many services for abused women to only see women in the
office and to not make home visits. Reporting laws have been
one response to this condition. Many health care professionals
have felt powerless when abuse has been suspected and they
are not able to gain access to a woman to speak with her.
In British Columbia, mandatory reporting has been rejected.
However, the Guardianship Legislation, once it is implemented,
will give designated community agencies the power to apply
for a court order to gain access to someone who is isolated
and unable to seek help for abuse. The whole issue of how
best to serve abused adults of any age who do not fit the
mandate and policies of existing services is one which needs
to be brought forward, discussed and changes in practice implemented.
References
Gordon, R.M.; Tomita, S. "Reporting of Elder Abuse and Neglect:
Mandatory of Voluntary?" From R. Roesch et al, eds., Family
Violence: Perspectives on Treatment, Research and Policy,
P 135-15, BC Institute on Family Violence, 1990.
Ageism and Battering Project,.Old Women Breaking the
Silence. Minnesota Coalition for Battered Women, 435 Aldine
Street, St. Paul, MN 55104, 1987.
Friedan, Betty. The Fountain of Age, Simon & Schuster,
1993.
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