Defined by the World Health Organization 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”, elder abuse is becoming an increasingly prevalent issue around the globe (Post et al., 2010). Researchers in the field of gerontology consistently report a 2% to 10% rate of elder abuse in Canada, Europe and the United States, with a multitude of cases going unreported (Abbey, 2009). Older adults in a state of vulnerability that experience abuse are more prone to high mortality rates, injury, mental suffering, physical illness and financial loss, depending on the type of maltreatment they are subject to (Post et al., 2010). The causes of elder abuse are widely researched and have been credited to being the effects of caregiver burden in homes and employee burnout in healthcare institutions.
One of the most common environments in which elder abuse occurs is surprisingly within the home itself. As Canada’s the life expectancy increases and shifts towards an epidemiological transition, a greater number of adults are living longer but with a high rate of chronic illnesses. Consequently, these vulnerable individuals often live under the care of others, such as their children of the baby boomer phenomenon who are now approaching midlife. According to Sev’er, “this may mean that these children, especially the daughters or daughter-in-laws who may still have responsibilities for their own growing families will feel increasingly ‘sandwiched’ by the needs of the previous generation” and often find themselves torn between helping their younger children and aging parents (2009). This relates to the concept of caregiver burden, which is defined to be the “problems and stress due to caregiving” (Novak, Campbell & Northcott, 2014, p 319). It is noteworthy that a study conducted by Majerovitz on 103 families who cared for nursing home patients revealed that they often felt burdened and depressed from their caregiving responsibilities (as cited in Novak, Campbell & Northcott, 2014, p 319). Furthermore, researchers have put a multitude of theories forward in order to explicate the causes of elder abuse, and one theory stated by Podnieks demonstrates that caregiver burden is indeed one of the primary factors leading to abuse among the elderly. This occurs due to the combination of stress, physical strain and fatigue on one’s body and mind that can trigger reactions that involve verbal or physical abuse, neglect and abandonment, among many others (2008).
Similar to abuse from caregivers at home, elder abuse can also occur in an institutionalized setting such as a hospital, nursing home or long-term care facility and according to Bužgová & Ivanová, it is one of the most common environments of elder abuse (2009). In fact, it was found that 10% of one American state’s nursing home personnel admitted to having performed at least one act of physical abuse themselves and four times as many admitted to having committed psychological abuse against a resident (Post et al., 2010). The major cause of elder abuse in institutional settings can be credited to being as a result of employee characteristics. Firstly, the caregiving job itself is a challenging one as it requires staff to constantly be on their feet and can often lead to a combination of physical, mental and emotional drainage. As the ageing population increases and demand for healthcare institutions grows, staff can become overworked and this leads to employee burnout (Bužgová & Ivanová, 2009). In the same journal article, one direct care employee is quoted, “Let’s be honest. The work is exhausting. It consumes people. The work really is not pleasant or joyful, does not bring any results or responses or signs of improvement; on the contrary, we see the opposite” which makes evident the hectic nature of the job and the general feeling of discontent amongst employees. Similar to the effects of caregiver burden that occurs at homes, employee burnout can trigger intense reactions in the form of abuse towards the elderly patients. Staff shortages in healthcare facilities can not only lead to employees being overworked but also devoting less time towards patients, leading to insufficient care and “time-saving approaches that often do not respect the residents’ choices or promote their independence” (Bužgová & Ivanová, 2009). Moreover, Bužgová & Ivanová also mention that employees sometimes expressed their feelings of anger stemming from personal issues onto patients, which often strained the relationship between the two parties (2009). This became even more of a concern when residents thought that they themselves were the source of problems, leading to psychological and self-esteem issues among them.
Elder abuse is a rising concern worldwide that needs to be addressed by individuals, organizations and society alike. In my opinion, the most critical action that individuals can take is educating themselves and the people around them in order to gain awareness of the topic of elder abuse. Moreover, people should be encouraged to stay in touch with the older adults in their life to lookout for any signs that may suggest abuse. In terms of organizations, I would suggest that healthcare institutions include policies for abuse prevention and ensure that proper protocol is in place when employing staff. Apart from making sure that candidates have proper degree requirements, hiring officials should conduct interviews and mock scenarios to evaluate a person’s bedside manner, character and morals. Screening tools, such as private interviews with patients, should be developed by the healthcare facility in order to identify any suggestive behaviours or negative comments that may have resulted from employee abuse, as well as to give patients the chance to speak out on any mistreatment they may have suffered. Furthermore, I believe changes within organizations should be made in order to guarantee an adequate number of staff are present at all times in order to minimize the chances of abuse due to employee burnout. On a societal level, we should work on removing the stigma attached to elder abuse by encouraging individuals to report any incidences of elder abuse that they witness or experience since it is a highly under-reported crime. Lastly, I strongly believe that the inclusion of mandatory courses about human rights, abuse and professional ethics in educational settings across the country will help to ensure that the new graduates that work in facilities that deal with elderly patients are well informed on relevant issues such as elder abuse and how to tackle them.
The experience of taking a Health, Aging and Society course at my university has challenged my assumptions and stereotypes on aging by allowing me to look at the process of growing old and everything that comes along with much greater depth and a positive perspective, as opposed to thinking about aging as an inevitable process that brings negativity, discontent and inconvenience into the last few decades of a person’s life. I am much more aware of the challenges the older adults I see on a day-to-day basis in public places face and the prevalence of ageism in our society today, whether it is subtle in the form of an insensitive crossroad sign to major issues such as the decrease in employability of older people. Before taking this course, I was uninformed about the extent of elder abuse in our society and it makes me contemplate the fact that there might be elder people in my neighbourhood or the nursing home that I volunteer at who are being abused and are afraid to speak up against the injustice they are suffering.
In a nutshell, research proves that abuse amongst older adults is a growing crime around the world that needs to be addressed urgently. The cause of elder abuse at home mainly comes as a by-product of caregiver burden from family members at home that are torn between the responsibilities on their growing children as well as their aging parents that need to be taken care of. Similarly, the primary source of elder abuse in healthcare institutions comes as a result of employee burnout due to the stressful nature of the job and overstraining from the shortage in staff. Changes need to be made on an individual, organizational and societal level in order to combat this issue of maltreatment towards vulnerable older adults.
Abbey, L. (2009). Elder abuse and neglect: when home is not safe. Clinics in geriatric medicine, 25(1), 47–60.
Bužgová, R., & Ivanová, K. (2009). Elder abuse and mistreatment in residential settings. Nursing Ethics, 16(1), 110–126.
Novak, M., Campbell L., Northcott, H.C. (2014). Aging and Society: Canadian Perspectives. Canada, Nelson Education Ltd.
Podnieks, E. (2008). Elder abuse: the Canadian experience. Journal of Elder Abuse & Neglect, 20(2), 126–150.
Post, L., Page, C., Conner, T., Prokhorov, A., Fang, Y., & Biroscak, B. J. (2010). Elder abuse in long-term care: Types, patterns, and risk factors. Research on Aging, 32(3), 323–348.
Sev’er, A. (2009). More than wife abuse that has gone old: a conceptual model for violence against the aged in Canada and the US. Journal of Comparative Family Studies, 279–292.