elder abuse in india- time to know what is it?
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ELDER ABUSE IN INDIA: TIME TO KNOW WHAT IT IS?
INTRODUCTION
Broadly defined, elder abuse10 covers any behaviour or pattern of behaviour by a
person or persons which results in harm to an older person11. Little consensus exists
on the range of harms which this broad definition should include. Definitional
categories are often diverse, including combinations of physical abuse, psychological
abuse, medical abuse, economic abuse, violations of rights, sexual abuse, neglect and
self-neglect. These categories are often further modified by distinctions between
intentional and unintentional acts, or passive or active abuse (acts and omissions);
those which focus on the trust and obligation of care or on the relationship between
the abused and the perpetrator; or which focus on the harm caused, regardless of
the intention of the abuser.
WHY DOES ELDER ABUSE OCCUR?
Elder abuse is also very often the result of long-term family conflict between parent
and child or between spouses. Increasingly, the relationship between domestic
violence and elder abuse is understood to be important. In the few studies which
examine the phenomenon as a specific category, domestic violence accounts for a
significant percentage of cases identified as "elder abuse". In many of these cases,
the abuse is the continuance of long-term domestic violence into old age. With the
onset of disability and the intervention of community services, behaviour which has
long been carefully concealed is exposed and labelled as "elder abuse". However,
once again, the relationship is not straightforward. In some cases, the situation is
reversed--the long-term perpetrator becomes dependent upon their victim and the
domestic violence victim now becomes the abuser under changed power relations.
As well as domestic violence, a history of other forms of family violence such as child
abuse plays an important role. An abusive carer may also be the victim of domestic
violence or the adult survivor of child abuse who is now in a position of power over
their past perpetrator.
A full understanding of elder abuse must also move beyond individual risk factors,
and concentrate upon the problem as a function of broader social structural issues
such as poverty, isolation, ethnicity and gender.
INFORMAL
As with other social problems, the ideal prevention strategy is to effect long-term
change in community attitudes which directly or indirectly sanction such behaviour.
Raising community awareness and creating a widespread intolerance to the
behaviour can be encouraged through a "social capital" approach--fostering social
bonds, social trust and mutual reciprocity. This perspective emphasises a "bottomup"
model--from self and community education/resolution, through increased
support services and ultimately to a
"last resort" legal intervention. Community education, initiatives which reduce
isolation of older people in their communities, the encouragement of the view that
elder abuse is a mainstream issue on a par with other forms of family violence, and
campaigns which emphasise more positive images of older people can all assist with
developing a broad based, active community intolerance to elder abuse. However
ideal such an approach, though, more immediate and formal responses are also
necessary.
FORMAL RESPONSES AND THE ROLE OF LEGAL INTERVENTIONS
Instances of elder abuse very often first come to the attention of health and geriatric
services and are mainly the responsibility of Aged Care Assessment Teams
(ACATs). Thus, the major emphasisin response tends to be located firmly within a
"care" model rather than a "violence" or criminal justice model12. This is in
contrast to the United States, where many states have statutes targeted specifically
to elder abuse as a discrete category many including the use of mandatory
reporting. In response to many criticisms and difficulties with this system13.
AUSTRALIA
Australia has adopted a more cautionary approach. Other than guardianship
legislation and disability acts in various Australian States, to protect the decision
impaired older person, no Australian legislation specifically deals with the abuse of
the elderly. Legal options are available within the existing criminal justice
framework: reporting directly to the police to be dealt with as crimes or obtaining
an Apprehended Violence Order (AVO) where there is immediate danger or threat
of danger. This absence of specific legislation in Australia is not an oversight, but
the result of considerable community consultation on the part of various
government inquiries and working groups. They have particularly recommended
caution in relation to mandatory reporting. Results from this strategy overseas have
been mixed; not enough is known to justify such an intrusive response, and one
which requires substantial resourcing. Also, there are ethical difficulties where a
victim is a competent adult. As an alternative, Australia has preferred to develop
protocols and guidelines that emphasise a multi-disciplinary approach and effective
cooperation between health services.
THE PROBLEM OF ELDER ABUSE IN INDIA
"An eighty four year old women living with her son and daughter- inlaw.
She was ill treated by her family members putting her in the corridor of the
house and she cannot go anywhere just like prisoner she was treated and also she
was forced to do all the work of the house. The cruel part of the story is that her
daughter-in-law was forcing her to bath by the toilet water14".
The existing research on elder abuse in Indian country is sparse and limited in
scope. A review of the literature conducted as part of this project15revealed that only
three of the 567 federally recognized tribes in the United States and one urban
population have been the subject of research studies. Even among these groups,
significant differences have been noted16. Establishing the extent and nature of
abuse in Indian country was beyond, however, several project activities provided
opportunities to explore participants' experiences with, and perceptions about,
abuse17.
EXAMPLES OF KEY INFORMANTS ELDER ABUSE IN INDIA
* An elderly woman was removed from a nursing home so that family
members could gain access to her income checks.
* Family members set up a methamphetamine lab in an elder's home.
* A non-ambulatory elder was left without water or food and was not taken to
her dialysis appointments.
* A son and daughter-in-law overmedicated a wealthy older woman in order
to hasten her death.
* An elder was taken off dialysis and had her medications withheld as
"punishment."
* A woman was "beaten black and blue" and sexually molested by her
children.
* An elderly woman's home was taken over by younger people on the
reservation who are alcoholic. They financially abused the woman and
placed her in a nursing home.
* An elderly woman allowed her nephew and his family to move into her
home. The nephew got his aunt to sign a quitclaim deed, transferring
ownership of the property to him. She did not understand what she was
signing and did not want to give up her home.
* An elder signed over her paid-off Mutual Help home to her grandson,
expecting that she would be allowed to continue living there until she died.
The grandson subsequently evicted her.
* An 85-year-old woman reported to a domestic violence program that her son
had raped her.
An elderly woman reported to her physician, whom she had known for many
years that she had been the victim of domestic violence for 15 years.
WORLD HEALTH ORGANIZATION WORKING ON ELDER ABUSE
Elder abuse, the mistreatment of older people, is now achieving due
attention. However, prevalence studies concerning this type of abuse have so far
been restricted to developed nations, resulting in a dearth of evidence about the
prevalence of abuse, neglect, and financial exploitation of elders in developing
nations. In response to this problem, the World Health Organization (WHO) has
worked to develop a global strategy for the prevention of elder abuse, beginning
by conducting a study in eight countries (Argentina, Austria, Brazil, Canada,
India, Kenya, Lebanon, and Sweden)18.
Finally, implications of the study and strategies for the prevention of elder
abuse are presented. Strategies proposed by the focus group participants. For
example, recommendations for actions include:
* Development of a screening and assessment tool for use in primary health
care settings
* Development of an education package on elder abuse for primary health
care professionals
* Development and dissemination of a research methodology 'kit' to study
elder abuse
* Development of a Minimum Data Set concerning violence and older
people
* Dissemination of the research findings through scientific journals
* Development of a global inventory of good practice.
* Mobilisation of civil society through raising awareness of the widespread
magnitude of elder abuse.
TYPES OF ELDER ABUSE
* Physical abuse - the infliction of pain or injury, physical coercion, or physical
or drug induced restraint.
* Psychological or emotional abuse - the infliction of mental agony.
* Financial or material abuse - the illegal or improper exploitation or use of
funds or resources of the older person.
* Sexual abuse - non-consensual sexual contact of any kind with the older
person.
* Neglect - the refusal or failure to fulfil accrediting obligation.
This may or may not involve a conscious and intentional attempt to inflict physical
or emotional distress on the older person.
TRADITIONAL SOCIETIES AND THERE PRACTISES
Many traditional societies of the past considered family harmony to be an important
factor governing family relationships. This reverence for the family was reinforced
by philosophical traditions and public policy.
In Chinese society, it was embedded in a value system that stressed ''filial piety''.
Mistreatment of older people was unrecognized and certainly unreported. These
traditions are still influential today.
Studies in the United States of attitudes towards elder abuse revealed that citizens of
Korean origin believed in the primacy of family harmony over individual well-being
as a yardstick for determining whether a particular behaviour was regarded as
abusive or not19 Similarly, people of Japanese origin considered the "group" to be
paramount, and that an individual's well-being should be sacrificed for the good of
the group20 .
In some traditional societies, older widows are abandoned and their property
seized. Mourning rites of passage for widows in parts of Africa and India include
practices that elsewhere would certainly be considered cruel, for example sexual
violence, forced levirate marriages21 and expulsion from their homes22. In some
places, accusations of witchcraft, often connected with unexplained events in the
local community, such as a death or crop failure, are directed at isolated, older
women23.
In sub- Saharan Africa, accusations of the practice of witchcraft have driven many
older women from their homes and their communities to live in poverty in urban
areas. In the United Republic of Tanzania, an estimated 500 older women accused of
witchcraft are murdered every year24. These acts of violence have become firmly
entrenched as social customs and may not be considered locally as "elder abuse".
WHAT ARE THE RISK FACTORS FOR ELDER ABUSE?
Most of the early work on abuse of the elderly was limited to domestic settings and
carried out in developed countries. In seeking explanations for elder abuse,
researchers drew from the literature in the fields of psychology, sociology,
gerontology and the study of family violence. To accommodate the complexity of
elder abuse and the many factors associated with it, researchers have turned to the
ecological model, which was first applied to the study of child abuse and neglect25
and has been applied more recently to elder abuse2627. The ecological model can take
into account the interactions that take place across a number of systems28.
THE CONSEQUENCES OF ELDER ABUSE
For older people, the consequences of abuse can be especially serious. Older people
are physically weaker and more vulnerable than younger adults, their bones are
more brittle and convalescence takes longer. Even a relatively minor injury can
cause serious and permanent damage. Many older people survive on limited
incomes, so that the loss of even a small sum of money can have a significant impact.
They may be isolated, lonely or troubled by illness, in which case they are more
vulnerable as targets for fraudulent schemes.
CONCLUSION
The problem of elder abuse cannot be properly solved if the essential needs of older
people for food, shelter, security and access to health care are not met. The nations
of the world must create an environment in which ageing is accepted as a natural
part of the life cycle, where anti-ageing attitudes are discouraged, where older
people are given the right to live in dignity, free of abuse and exploitation, and are
given opportunities to participate fully in educational, cultural, spiritual and
economic activities .
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