Case 1

Mr G, 73, had a stroke and was unable to care for himself. Mr G moved in with his son’s family as they offered help. But Mr G’s son and daughter-in-law worked all day and were busy with their kids in the evenings. Mr G hated being a burden on them and tried to take care of himself. One day, Mr G’s friend Ms C came to visit. She was surprised to see food stains on his clothes and sores on his heels. His room smelled like urine, too. Mr G was low on mood and withdrawn — not at all the jolly, witty friend she’d known for years. Ms C worried that Mr G’s family was neglecting him.

Case 2

After his mother passed away, Mr V started to look after his 80-year-old grandfather, Mr J. Because of his poor vision, Mr J could no longer go to the bank. So, Mr J permitted Mr V to withdraw money from the bank every month for expenses. Lately, it seems the bank balance is lower than it should be. Mr J wonders if Mr V is keeping some cash for himself.

Elder abuse

The World Health Organization (WHO) recognizes 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.

In India, as per the 2014 multi-city (Tier 1 and Tier 2) HelpAge India survey, 50% of the older adults faced elder abuse and 78% of them co-habitat with their families. Son (60%) is the most common abuser as experienced by the older person. Abusive language (74.3%) is the most common form of abuse, and Delhi (76%) topped the survey for verbal abuse. In Chennai, the prevalence of elder abuse was a shade lesser (43%) than the national average, and the daughter-in-law (59.1%) followed by daughters (22%) were the most common abusers. Most of the abusers (44%) belong to the middle age (18-44 years) and elder abuse is widely prevalent (66.2%) in higher-income households. Physical abuse (11%) was the lowest in Chennai.

Types of elder abuse

Physical abuse

• Someone causes physical injuries, assault, pushing and shoving, inflicting body pain

• Inappropriate use of medicines, restraining or confinement or isolation other than medical reasons

Emotional or psychological abuse

• Threatening or scapegoating, hurling abuses, harassment or humiliation, intimidation, blaming, and verbal or non-verbal acts causing distress in mental health

Neglect and abandonment

• Passive neglect is withholding older adults from the needs of physical, emotional, psychological, financial and/or healthcare access.

• Willful deprivation of medications, healthcare devices, housing, and exposure to harm that can cause physical, social, and emotional deprivation.

• Self-neglect like lack of personal hygiene, being malnourished, being underweight, and living in unsanitary or dirty conditions. They will be unable to pay bills or manage their medications. It can be a sign of depression, grief, dementia, or other medical problem and refusal of medical assistance also. They may be in denial, feel ashamed about needing help, or worried about losing their independence.

Financial abuse

• Unlawful use of an older person’s funds, properties, identity, and other financial assets

Sexual abuse

• Nonconsensual activities are not limited to touching, fondling, intercourse, or any other sexual activity or when the older adult is unable to understand, unwilling to consent, threatened, or physically forced.

Signs of abuse

• Unexplained weight loss and unexplained physical injuries
• Broken visual aids or glasses and lacks medical aids (glasses, walker, dentures, hearing aid, medications)
• Unsanitary conditions and poor personal hygiene
• Has trouble sleeping, decreased daily activities
• Becomes withdrawn, increasingly isolated or acts agitated or violent or increased fear or anxiety
• Develops bed sores or other preventable conditions
• Has an unpaid rent or home eviction or any sudden unusual change in spending pattern
• Unable to pay bills or inadequate level of assistance or care despite having adequate financial resources

Prevention

Taking health as a caregiver
• To relieve stress and burnout practice yoga, meditation, or deep breathing exercises.
• Request help from friends, relatives, or local respite care agencies or find an adult day-care program
• Learn anger management techniques
• Eat a healthy diet, get regular exercise, and take care of your own medical needs.
• Seek help for depression
• Find a support group for caregivers of the elderly
• Get help for any substance abuse issues
• Get professional help by talking to a therapist.
As an older person
• Make sure your financial and legal affairs are in order and review your will from time to time
• Don’t divulge financial details over mobile and keep yourself your mobile
• Keep in touch with family and friends and avoid becoming isolated.
• Older adult should express their unhappiness if they feel the level of care they receive is inadequate either at their own home or assisted facilities.
• Attend support groups and seek professional help for depression, grief, loneliness

Legislation for the Protection of older adults

Maintenance of Parents Act (2007)

Two amendments wherein 2013 and 2018. The parents could complain against the sons and they could be held legally for not supporting their parents. In the 2018 amendment, daughters and sons-in-law were also held responsible for supporting their parents.

Parents and Senior Citizens Act (2007)

A bill that makes it a legal obligation for children and legal guardians to provide Older adults maintenance, and permits state governments to start and maintain old age homes in each district.

There is also provision for getting maintenance from children if they were not able to take care of themselves. The punishment could be paying a fine of Rs.5000 or three months in prison or both

Parents and Senior Citizens Amendment Bill 2019

The aforementioned bill under the constitution ensures the basic needs, safety, security, establishment, management as well the regulation of the institutions and the services provided by them for the senior citizens

It also talks about removing the ceiling of Rs10000 and also includes the appointment of nodal police officers for senior citizens at every police station and district-level special police unit with a helpline for senior citizens.

Article 41 of the Constitution the right of senior citizens to employment, education and public assistance.
It also ensures that the state must uphold these rights in cases of disability, old age or sickness.

Article 46 The state should protect the educational and economic rights of the elderly.

International elder abuse awareness day is celebrated on June 15th every year.