Preventing Abuse in the Elderly

Elder abuse is a social problem that is devastating for victims and their families. It is fairly common and indeed a worldwide issue. Global organizations such as the World Health Organization and International Network for Prevention of Elder Abuse (INPEA) have brought worldwide interest to the issue of elder abuse. As adopted by WHO, elder abuse is defined as “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.”

The problem of elder abuse is pervasive, showing up in various ways and forms across cultures and nations. It can come from various sources, such as people the older person knows, or has a relationship with such as spouses, family members, neighbours or friends, and indeed people the senior relies on for support services. Regardless of the form of abuse, one thing is very typical among all manner of abuse, which is the use of control and power by an individual to affect the status and well-being of an older individual.

In Africa, nay Nigeria, the issue of elder abuse has been on the front burner for a while now.  Indeed it has become an important discourse, as family dynamics continue to change. In the past couple of decades, young economic migrants leaving their homes for other cities or countries in search of greener pastures, often keep their elderly loved ones in the care of other relations, paid domiciliary care or nursing homes. This has raised questions bordering on the quality of care and issues of abuse and neglect as it concerns their elderly loved ones.

Suffice it to say, the incidence of elder abuse in Nigeria is on the increase, although there seems to be no reliable data on this societal problem. The issue of elderly abuse continues to gain traction, especially with the advent of social media and the installation and use of monitoring equipments, like CCTV’s in private homes and elderly care facilities.

Abuse of older people comes in several ways, and these include:

• Physical abuse: e.g. punching, hitting, slapping, kicking, restraining etc.
• Psychological /emotional abuse: e.g. not treating an elder with respect, humiliating a senior with verbal means, such as yelling, criticizing etc or non-verbal means, such as withdrawing care and affection, shunning, silence etc.
• Sexual abuse: to coerce or force a senior to engage in any form of sexual activity without their consent. Also involves cases where the senior one has dementia and unable to give consent.
• Financial exploitation: This is another type of abuse which involves misuse of the senior’s financial resources, by family members, caregivers, strangers etc. It also involves use of financial means to control an elder or facilitate other types of abuse.
• Neglect: This involves both intentional deprivation of food, medical care, clothing, care and grooming, leaving a fall risk elder unattended etc. Neglect can be passive, when it springs from lack of knowledge or resources to take care of the senior.
• Institutional abuse: includes all forms of abuse and rights violations in a setting where care and support services are provided to dependent seniors, such as elderly care facilities or nursing homes.

Knowing the warning signs:

Recognizing the signs of abuse in the elderly is very key to preventing it and mitigating its effects through appropriate interventions. The different types of abuse have defining features associated with them.

• For physical abuse, the giveaways includes noticeable signs on the body such as scars, bruises, sprains , broken bones, and more subtle cues like rope marks on the wrists/ankles etc.
• The hallmark of emotional abuse is usually a change in the behavior or personality of the elderly person, being uncommunicative or unresponsive, being fearful, social withdrawal etc.
• Visible signs on the body, particularly the genital and/or breast area, torn underwear, bleeding and curious infections are obvious pointers to sexual abuse.
• Elder financial abuse can be very subtle and difficult to notice, and includes money and belongings missing at home, huge withdrawals from accounts, increasing bills etc.
• Neglect can be self inflicted or by caregiver(s). The tell-tale signs include dehydration and malnutrition, noncompliance to medications, poor physical appearance, poor hygiene and general unsafe conditions of living.

Asides knowing the signs of abuse, it is also important for families, caregivers and service providers (e.g nursing care homes) to know what risk factors can predispose a senior to abuse, or increase their chances of being abused.

Families and caregivers should be well adjusted, with positive attitudes about aging, good coping strategies and social support. In addition, their mental, financial and emotional health is important, as a deficiency of these essential components can set the stage for elderly abuse.

Service providers, such as nursing care homes should be mindful of factors that can predispose the seniors in their care to abuse.  These factors are multifaceted, revolving around operators (management) and staff. Meticulous hiring practices should be engaged at all times, to ensure adequate personnel, so that employees are not overworked, to prevent shoddy care, exhaustion and dissatisfaction. In addition, elderly care operators should guard against stressful working conditions for their personnel, high staff turnover rates and be wary of staff who act coldly or negatively towards the senior residents.

Preventing elder abuse may not always be possible at all times, but families and concerned adults can take proactive steps towards reducing the risk of abuse in the elderly, whether at home or in care facilities.

At home, abuse can stem from many reasons, and when the primary caregiver is stressed, overworked or untrustworthy, it makes abuse even more likely to happen. Therefore, it becomes imperative that families and friends should constantly reach out to both the senior and the caregiver. Families and friends can offer support in the following ways to reduce risk of elder abuse;

• Keeping seniors engaged in their communities, through club memberships, religious activities, sporting events etc. These will reduce isolation or loneliness, which are the factors that increase a senior’s risk of being abused.
• Helping to keep the elder active increases their overall health, this reduces their dependence and caretaker stress, and decrease the risk of abuse.
• Supporting the primary caregivers through shared duties and responsibilities, time off etc.
• Families and friends should protect elders from high-risk caregivers, such as those with history of violence, substance abuse or in financial difficulties. They should ensure that the primary caregiver(s) should be in good psychological, emotional and financial condition.

In an elderly care facility, families may not be able to monitor their elderly loved ones as closely as family caregivers, but they can still take steps to check abuse in such facilities. These steps include:

• An awareness of the different types and signs of abuse in the elderly.
• Regular visits and calls on their loved ones.
• Painstaking background checks on a potential elderly care facility, and checking for red flags. In addition, families should actively seek out facilities with zero tolerance for abuse or those with policies that reduce the risk of abuse.
• Promptly bringing concerns about an elder’s care to staff or management of an elderly care facility.

On their part, elderly care facilities can prevent elder abuse by:

(1) Installing quality monitoring systems.

(2) Creating policies that engender robust patient care and promote zero tolerance for elder abuse.

(3) Regular trainings for personnel on abuse and neglect issues in the elderly.

(4) Encouraging regular visits from social workers, volunteers and families.

In Nigeria, Rockgarden homes have been in the vanguard of elderly care services and a regular advocate against abuse and neglect in the elderly.

At Rockgarden homes, we pride ourselves as a home away from home for the elderly, and a trail blazer, when it comes to elderly care and support services. With our cutting edge elderly care services and support for families, Rockgarden homes, with its sister organization, Rockgarden Homecare Agency has carved a niche for itself  for their unrivalled and unparalleled elderly care and support services. With absolutely no tolerance for elderly abuse in any form, the Rockgarden Homecare Agency has a painstaking recruitment process, where thorough background checks of potential staff are carried out. Employees also undergo regular trainings on elder abuse and neglect issues. These, in addition to quality monitoring systems such as CCTV’s and its very innovative Care Control mobile app, easily accessible to families, ensures that  abuse and neglect are prevented from happening, as much as possible.