Elder Abuse: An Introspection into an Invisible Reality amongst us

On the World Elder Abuse Awareness Day, today, CSES researcher Athul S.G. draws attention to this unacknowledged reality in our society. He discusses initiatives taken in the state and remarks on measures to be taken to ensure the security and protection of the elderly

Globally, the elderly, aged 65 years or above, are projected to more than double between 2019 and 2050 (UN Population Prospects, 2019). The elderly population in India constituted 8.6% of the total population in 2011 and is projected to increase to 20% by 2050. Even though this demographic trend represents an achievement in terms of increased longevity, it subsequently presents unpredictable challenges with profound implications on society, health, and the economy. The significant change in the demographic structure over time attest to the fact that with the burgeoning elderly population, their vulnerabilities and problems are likely to increase. Elder abuse and neglect are prominent among them that has profound human rights implications. 

Elder Abuse in India

Elder abuse remained a private matter hidden from public view and was seen as a social welfare issue and a problem of ageing until the advent of the initiatives to address child abuse and domestic violence in the last quarter of the 20th century. The World Health Organisation defines elder abuse 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”. At the outset, one would imagine that the situation of the elderly in Indian society to be safe and secure considering the value system of filial piety, conservative culture and the sustaining joint family and co-residence with their children. However, the shifts in demographic trends and changing social values brought in by the neoliberal ideas during the twentieth century have given rise to challenges and concerns for the older population in developing countries, including India.

A report in 2016 by the International Network for Prevention of Elder Abuse (INPEA) mentions India as the leading country in Asia in terms of elder exploitation and abuse. Elder abuse in the Indian context is classified into physical abuse, emotional or psychological abuse, financial abuse or exploitation, neglect, sexual abuse, abandonment, isolation, intimidation, fiduciary abuse, extortion, unreasonable confinement, active versus passive neglect and coercion. The increasing population of older women compared to older men, more widows than widowers, higher levels of illiteracy, labour force participation, living arrangements, migration of children, different types of disabilities and morbidities, failing mental health status, lack of social security measures are some of the significant factors that contribute to the abuse and neglect of elderly. 

According to the Longitudinal Ageing Survey in India (2020), at least 5% of the elderly population (60 years and above) had reported ill-treatment. The experience of ill-treatment among the elderly is relatively higher in Bihar (12%), Karnataka (10%) and West Bengal (8%). A higher proportion of the elderly who live alone, from urban areas and those who were divorced/separated/deserted experienced ill-treatment. Elderly women experience more ill-treatment than their male counterparts, as per the study. The feminisation of ageing occurs in most countries, and ageing women and widows are more vulnerable to abuse and neglect as many women lose support and are dependent on caregivers who are primarily family members as they lose their partners to old age.

The elderly need attention and care, and more importantly, time, efforts and money need to be devoted to providing care for them. However, the working-age group is caught in a crossfire between the demands of the elderly and that of their children and other household responsibilities. Their inability to confront stress and challenges on multiple fronts results in them venting their anger towards the elderly, often manifested as abuse, neglect and abandonment. While earlier research on elder abuse and neglect by family members indicated caregiver stress as the cause for the problems, further studies have revealed many other characteristics of perpetrators, like mental health and behavioural problems, drug abuse, family disputes, intimate partner abuse, etc. In contrast, the non-family abusers are primarily untrained and unscrupulous caregivers, financial tricksters and exploiters and petty criminals. Additionally, prevailing ageism devalues and exploits older people, leading to abuse in various situations within the community.

The exact magnitude and nature of abuse are lesser-known in India. However, the LASI survey found that more than 77% of the elderly who encountered abuse experienced verbal/emotional ill-treatment, 24% experienced physical abuse, 27% experienced economic exploitation, and more than half experienced neglect. The survey also confirmed that elder abuse or ill-treatment is often perpetrated by those supposed to take care of the elderly. It was found that 38% of the elderly who experienced abuse were ill-treated by their sons or daughters and 36% by sons-in-law or daughters-in-law, and 7% by the spouse. 

It is clear that the impact of elder abuse is manifold, and it creates mental trauma and loss of self-esteem among the elderly, who are already grappling with various difficulties associated with old age. This eventually leads to disorders like depression, anxiety and insomnia. In addition, the National Mental Health Survey 2015-16 mentions abuse as a significant risk factor for suicide, and the overall risk of death by suicide in the elderly is double that of the younger population.

Elder Abuse in Kerala

The share of the elderly population in Kerala is more than 12 % of the state’s total population (Census, 2011). In Kerala, 3% of people fall victim to abuse after 60 years (UNFPA, 2011). The primary reasons for the same are the shift in filial piety values, dwindling joint family structures, migration, a rise of dual-career families, increasing life expectancy, which leads to a prolonged old age characterised by poverty, degeneration, dependency. Furthermore, health problems such as heart diseases, arthritis, urinary infections, lifestyle diseases, falls leading to disability make older adults vulnerable to abuse, neglect, or even abandonment by family members when they require greater care and attention. It is also found that older adults who are bedridden are the ones who suffer the most. The Kerala Aging Survey (2013) reports that most commonly elderly face difficulties such as those related to vision (79%), chewing (44.3%), hearing (23.6%) and walking (34%), which put them at a more significant disadvantage and risk for abuse and neglect. In addition, there is an increasing trend of children forcefully dumping older parents in old age homes against their will. Due to the increased out-migration and emigration in Kerala, people are now more likely to leave behind their old parents who are left alone, wrestling with functional disabilities, loneliness, and sometimes with no money.

World Elder Abuse Awareness Day

The World Elder Abuse Awareness Day is celebrated across the globe every year on June 15. The theme for this year is “Access to Justice ”, which serves as a reminder in realising the importance of addressing the needs of the elderly who may seek recourse. The Indian parliament passed the Maintenance and Welfare of Parents and Senior Citizens Act in 2007, which allows the elderly (60 years and older) who are ‘unable to maintain themselves to take legal action against adult children or grandchildren who fail to provide them with basic necessities and medical care. Although this act codifies the basic rights of older adults and is particularly germane to vulnerable sub-populations such as widows, low-income individuals, and other adults who may be subjected to elder abuse, neglect, or ill-treatment. However, the law is difficult to enforce, contains no assurances for childless adults, and does not address what, if any, are the responsibilities of the Indian government towards its ageing citizens. Such family-centred social welfare measures must be supported by appropriate government initiatives such as robust pension and healthcare delivery programs. 

Kerala is among the few states that have an old age policy, and the state has constituted Maintenance Tribunals at the revenue division level and Appellate Tribunals at the district level to exercise the powers and discharge the functions granted under the Maintenance and Welfare of Parents and Senior Citizens Act, 2007 and the Rules framed by the state government. However, a study undertaken by CSES on the functioning of tribunals in Kerala in 2014 reveals that even though tribunals have helped the senior citizens in a significant way to establish their right to proper maintenance, they are marred by issues like high pendency of cases, multiple hearings, delayed disposal of cases, procedural difficulties. The study suggested early assessment of complaints, involvement of police officials in executing and monitoring awards of the tribunals as some of the measures to strengthen the functioning of the tribunals to benefit the elderly.

Way Forward

The general perception and attitude of people towards old age and the elderly is one of the explanatory variables of elder abuse. Furthermore, the prevailing stereotypes and notions of the role and status of elderly in the society influences how they are treated in the family and community. Hence it becomes imperative to develop positive attitudes about the elderly and their care among family members, especially the younger generation.

Further, there is a paucity of research studies on elder abuse and neglect in India, and an imminent need to undertake studies to elicit the incidence and prevalence of elder abuse from the community (non-institutional) and institutional settings in the Indian context to enable evidence-based decision making by policymakers and programme implementers.

The legislations in India needs to be strengthened and implemented across states. In India, self-neglect, where the elderly cannot provide for their health and safety and where no perpetrator is identified, is an unrecognised field, along with a lack of mandatory reporting laws. The community health workers and other health care providers should also be equipped with pertinent information on the concept, scope and dynamics of elder abuse and trained to provide suggestions for appropriate responses that are applicable across a wide range of health and social services and to respond to the needs of both the abused and the abusers. An updated screening and reporting protocol for elder abuse for primary health care workers are also necessary.

It is high time we realise the gravity of this issue and identify that neglect and abuse perpetrated on the elderly are often ignored and normalised in our household settings and surroundings and proactively indulge in taking steps to mitigate the same. In light of the Covid-19 pandemic, there have been numerous reports of abuse and neglect of the elderly. A helpline number to assist the elderly was initiated and is operational in Kerala, and an official involved in this project said, “Most elderly who call in this helpline do not need any solution; instead, they need to be heard by someone. So, on this World Elder Abuse Awareness day, let us begin by listening to what they have to say.