While family violence is more often understood as domestic violence focused mainly on women and children, much less is known by the public about violence committed towards the elderly in Singapore, now more commonly known as elder abuse. Elder abuse is the most under-reported type of domestic abuse worldwide, with its victims and witnesses often staying silent, says the World Health Organisation. It estimates that for every reported case in 2016, 23 others went unreported. According to the Ministry of Social and Family Development (MSF), Singapore sees an average of 200 reported cases of elder abuse every year from 2012 to 2016 but these numbers may well be the tip of the iceberg, given that there are more than 400,000 people aged 65 and above here.

TYPES OF ELDERLY ABUSE AND NEGLECT
Elder abuse can be described as any action or lack of action, by a person or a caregiver in a position of trust, which puts the health or well-being of an elderly person at risk. Elder abuse includes physical, emotional, psychological, sexual, abandonment, financial exploitation, medication abuse and neglect of their welfare by people who are directly responsible for their care.

• Physical
Infliction of physical pain including bodily assault and physical confinement.

• Emotional and Psychological
Verbal aggression like intimidation, humiliation, deliberate ignoring and making unreasonable demands. This also includes instilling fear of violence, isolation, harassment, threat, insults and feeling of shame/guilt.

• Financial
Exploitation and/or misuse of funds and resources including theft, misappropriation of money, valuables and/or property.

• Neglect
Deliberate refusal to meet the elder’s basic needs including financial support.

• Sexual
It includes, but not limited to, unwanted touching and all types of sexual assault or battery.

• Elder self-neglect
As more elderly people opt to live on their own, one of the most recent forms of elder abuse is self-neglect. Physical or mental impairment or diminished capacity can mean that an older adult is no longer able to perform essential self-care. They may lack basic personal hygiene, appear dehydrated, malnourished, or underweight, live in increasingly unsanitary or dirty conditions, and be unable to pay bills or properly manage their medications.

Self-neglect can be a sign of depression, grief, dementia, or other medical problem, and in many cases, the older person will refuse to seek assistance. They may be in denial, feel ashamed about needing help, or worried about losing their independence.

Elder abuse tends to take place where the senior lives and their abusers are often adult children, main caregiver, or other family members. Elder abuse can also occur in institutional settings, especially long-term care facilities.

WHAT ARE SOME RISK FACTORS FOR ELDERLY ABUSE?
A study has found that elderly victims with mental illness or failing cognition are especially vulnerable to psychological abuse, abandonment and financial exploitation.

Meanwhile, abusers who are mentally ill or dependent on the elderly for income or shelter are especially likely to abuse them financially and also subject them to psychological abuse by hurling taunts or insults. Madam Rohana (not her real name), a victim of elder abuse, described it quite clearly. Her unemployed son and his wife live with her in her three-room flat. In a teary interview, she spoke of how her daughter-in-law knocked her head against an iron gate till it bled. She also had her front tooth knocked out and fractured a finger. She said her son and daughter-in-law harassed her constantly for money.

 
The Abusers
As older adults become more physically frail, they are less able to take care of themselves, stand up to bullying, or fight back if attacked. Mental or physical ailments can make it challenging for those who live with them.

Abusers may be:

• Experiencing frustration due to the reversal of dependency roles.
• Facing caregiver stress – this can lead to mental and physical health problems that leave caregivers burned out, impatient, and more susceptible to neglecting or lashing out at the elders in their care.
• Lonely and cut off from society.
• From a family with a history of violence.
• Poor at communicating with elderly victim.
• Financially burdened or dependent on the elderly victim.

The Victims
Victims of elder abuse may refuse to admit that they are being mistreated. Some reasons are:

• They don’t know what to do.
• They are often reliant on their abusers.
• They lack the capacity or knowledge to reach out to social workers or the community.
• Shame & Self-Blame – Abusers tend to blame themselves, believing that they are not good parents.
• Worry that legal action might be taken against their abuser (unconditional love for family).
• They may not even recognise that they are being mistreated and/or may not be able to report the abuse.

Common characteristics of victims of elder abuse include:

• Highly dependent on their caregiver;
• Socially isolated;
• Physically/mentally impaired;
• Vulnerable/naïve.

The vast majority of cases go unreported. Because of denial, dependence or unconditional love, many elderly victims cover up signs of abuse and protect the perpetrators.

 

WARNING SIGNS AND GETTING HELP
If you suspect abuse, but aren’t sure, you can look for the following warning signs.

Physical abuse warning signs:

• Caregiver’s refusal to allow you (helping professional/neighbour/relative/friend) to see the elder alone;
• Signs of being restrained, such as rope marks on wrists;
• Unexplained signs of injury, such as bruises, welts, or scars;
• Broken bones, sprains, or dislocations;
• Report of drug overdose or apparent failure to take medication regularly (a prescription has more medication remaining than it should).

Emotional abuse warning signs:

• Threatening, belittling, or controlling caregiver behaviour;
• Behaviour from the elder that mimics dementia, such as rocking, sucking, or mumbling to themselves.

Sexual abuse warning signs:

• Bruises around breasts or genitals;
• Unexplained vaginal or anal bleeding;
• Torn, stained, or bloody underclothing.

Elder neglect or self-neglect warning signs:

• Unusual weight loss, malnutrition, dehydration;
• Untreated physical problems, such as bed sores;
• Unsanitary living conditions: dirt, bugs, soiled bedding and clothes;
• Being left dirty or unbathed;
• Unsuitable clothing or covering for the weather;
• Unsafe living conditions (no running water, faulty electrical wiring, other fire hazards);
• Desertion of the elder at a public place.

Financial exploitation warning signs:

• Significant withdrawals from the elder’s bank accounts;
• Sudden changes in the elder’s financial condition;
• Items or cash missing from the elder’s household;
• Suspicious changes in wills, power of attorney, titles, and policies;
• Financial activity the elderly couldn’t have made, such as an ATM withdrawal when the account holder is bedridden;
• Unnecessary services, goods, or subscriptions;
• Healthcare fraud or abuse warning signs;
• Duplicate billings for the same medical service or device;
• Evidence of overmedication or under-medication.

 

PREVENTING ELDER ABUSE AND NEGLECT
If you’re a caregiver to an elderly person and feel you are in danger of hurting or neglecting them, there is help and support available. Perhaps you’re having trouble controlling your anger and find yourself lashing out at the person in your care? Or other people have expressed concern at your behaviour or the tension between the two of you? Recognising that there’s a problem is the biggest step to getting help.

As a caregiver, the following steps can help you prevent elder abuse or neglect:

• Take immediate steps to relieve stress and burnout. You can help reduce your stress levels by regularly practising stress-relieving techniques such as meditation or deep breathing exercises.
• Request help from friends, relatives, or local respite care agencies or find an adult daycare programme. Every
  caregiver needs to take regular breaks from the stress of caring for an elder and to attend to their own needs, if only for a couple of hours.
• Learn techniques for getting your anger under control.
• Take care of yourself. If you are not getting enough rest, you are much more likely to succumb to anger. Have a healthy diet, get regular exercise, and take care of your own medical needs Seek help for depression. Family caregivers are especially at risk of depression, but there are plenty of things you can do to boost your mood and outlook and overcome the problem.
• Find a support group for caregivers of the elderly. Sharing your concerns and experiences with others facing the same challenges can help relieve the isolation you may be feeling as a caregiver.
• Get professional help. If you can’t seem to stop yourself no matter how hard you try, it’s time to get help by talking to a counsellor.

 

If you’re a concerned friend or family member, the following can also help to prevent abuse of an elderly person:

• Call and visit the elder as often as you can, helping the elder to see you as a trusted confidante.
• Offer to stay with the elder so the caregiver can have a break—on a regular basis, if possible.
• Monitor the elder’s medications to ensure the amounts being taken correspond to the prescription dates.
• Watch for financial abuse by asking the elder if you can check their bank accounts and credit card statements for unauthorised transactions.
• Identify the warning signs of abuse or neglect and report them without delay.

 

HOW TO PROTECT YOURSELF AS AN ELDER

• Make sure your financial and legal affairs are in order. If they aren’t, enlist professional help to get them in order,
  with the assistance of a trusted friend or relative if necessary.
• Keep in touch with family and friends and avoid becoming isolated.

If you are unhappy with the care you’re receiving, whether it’s in your own home or in a care facility, speak up. Tell someone you trust or call any of the organisations or agencies that can help. ⬛

 

HELP – BE THE VOICE OF THE ELDERS
Elder abuse is likely to continue to occur and the sufferers often suffer in silence. No elderly person should have to live in fear. If you or someone you know is experiencing elder or family violence, get help immediately. You can also visit websites such as http://www.stopfamilyviolence.sg for more information.

 

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Book author and Coach Rasimah Jar has brought her more than 25 years of leadership experience and expertise in psychology and human development to thousands of professionals, organisations and families locally and overseas.

Coach Rasimah loves to write in her spare time and is now a weekly Resident Relationship Expert for Singapore MediaCorp radio channel 89.7FM with a strong of 30,000 listenership every week since January 2017.