In the last three decades, the events of elder abuse have increased greatly which leads to the increase in the needs of victims and further develops a need for having a sound policy combating this situation. Hence, a structure is required which can help in educating public, training professional specializing in this field, increasing necessary measures required for adult protection, increasing prosecution and reduction of barriers in promulgation of this policy.
In order to devise a policy for elder abuse, it is necessary to understand the definition of it:
"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"
As per the definition presented by police and prosecution, any crime involving the abuse of individuals exceeding the age of sixty. These cases are filed under the regime of general offenses, financial exploitation and criminal acts.
Financial exploitation is defined as the improper and unauthorized use of victims assets, be it o financial nature or physical form. Furthermore, the domestic violence is an act of violence done by any family member or the caretaker against the victim.
As per New York Penal Law,
"Elder abuse defines the acts comprising of felonies, demeanors, violence against the individuals of and exceeding the age of sixty."
Out of all these, felony is of most serious nature as it involves endangering the welfare of the elder citizen by possession of weapon, sexual abuse, stolen property, embezzlement etc.
As per the fact sheet presented by World Health Organization in 2011,
The elder abuse is a common problem in developing as well developed countries of the world; however this issue has been unaddressed globally. As per the findings of WHO, approximately 4-6% of elder citizens experience violence and abuse of different level domestically. This maltreatment has a tendency of causing serious physical harm and mental distress as well which may last for long-term. With the increase in the elder population, this population is expected to worsen (WHO, 2011).
As per WHO, from 1995 till 2025, the elder population of the world will grow twice its size. The number of elder generation by 2025 is estimated to be 1.2 billion.
MAGNITUDE OF ELDER ABUSE
As far as elder maltreatment is concerned, this sort of abuse usually takes place in a relationship based on trust. In such relation, repeated act or a single act of trust's violation or absence of suitable behavior can cause mental distress to the elder person. In case of maltreatment, general human rights are violated and the victim either goes through physical, sexual, financial abuse or is neglected which causes serious damage to one's dignity and self-respect.
The scope of this problem is difficult to determine. In public health programmes, maltreatment of senior citizens is of special significance. Since major global statistics are missing, it is estimated that in developed countries, there is about 4-6% of senior citizens who suffer from maltreatment domestically. However, most of these cases go unreported because the elders are mostly afraid of reporting them to the authorities. The instances of avoidance are even stronger where the abuser is also a caretaker.
Data extracted by various institutions regarding healthcare of these elder citizens. However, as per a survey conducted by WHO in 2011, involving a nursing home staff in USA showed following outcomes:
36% witnessed at least one incident of physical abuse of an elderly patient in the previous year;
10% committed at least one act of physical abuse towards an elderly patient;
40% admitted to psychologically abusing patients. (WHO, 2011)
In addition to domestic violence, patients in the institutions are also mistreated. These abusive acts may involve physical restrain of the patients, intentional deprivation of patients' self-respect, provision of insufficient care, mal-provision of medicine and emotional abuse. There are various reported cases where patients were forced to remain in soiled clothes or develop pressure sores.
This maltreatment can also lead to physical injuries. From minor injuries to serious one causes permanent disabilities. These may include broken bones and head injuries. Some of these events may cause psychological outcomes as well e.g., depression and anxiety. The consequences can be of highly serious nature as with older age, the immunity o f the older citizens become quite low. Therefore, even the minor injuries can have highly serious consequences.
Where the number of aged population is increasing greatly, the projections by WHO shows that that the number of global population of older people was 542 million in 1995 which is expected to grow twice its size by 2025. Due to resources scarcity, the basic needs of this aged population may not be fulfilled.
At various levels, these elder individuals are subjected to various risk factors at individual, communal and socio-cultural levels.
At an individual level, these elder citizens suffer from various disorders and addictions causing them mental distress. Where the elderly males are as much susceptible to abuse as women, in some cultures, women are inferior part of the society therefore they are more susceptible to elder abuse which can be of persistent and substantial nature. Furthermore, where the elder citizen is in a shared living situation, spouses and adult children can play the role of an abuser. Furthermore, where the family already has a history of poor relationship, over-dependence of an elder patient can further worsen the situation. Whereas, now the women are becoming an important part of the workforce, taking care of family's elder member has become rather problematic.
Another important risk factor that the elder people are subjected to is isolation from the community. Lack of support from friends and family members can substantially increase the stress and can further cause mental illnesses causing the elder citizens to become isolated. With weak social bonds with family and friends, consideration of elder members as weak part of the family, denial of youngsters to take care of the elder members of their families, insufficiency of the funds, are few socio-cultural factors which affect the well-being of the elder citizens and can cause maltreatment (Bonnie & Robert, 2011).
Furthermore, even in institutions, where staff lacks necessary training and are not paid sufficiently, healthcare standards are rather low, there is a deficiency in the physical environment and the policies support the interest of the institutions rather than the patients, maltreatment is likely to occur.
For the purpose of this paper, the elder abuse includes, "physical, sexual, and psychological abuse." Due to neglect and abuse, the elder citizens are at the increased risk of dying by 3.1 times. Where due to neglect of families and caretakers, the elders suffer; the society has to bear the cost of healthcare. In 2001, the prosecutors surveyed displayed that about 42% of them have handled elder abuse cases. And with the increase in elder population, this percentage is likely to increase. As per statistics, around 1.6 million of this elder population lives in 17000 nursing homes and others are residing in 45000 residential facilities.
The data although inaccurate has reported 1860,000 abused elders' cases in 1996. This violence took place in domestic settings. Among the perpetrators of this domestic violence and abuse, the perpetrators were family members in around 91% of the cases whereas around 70% of these were spouses and children. In institutional settings, the elder abuse (as per survey conducted in 2001), above 30% of the nursing homes in USA were reported of elder abuse having a tendency of causing substantial harm to the well-being of elder patients. From 1999-2001, around 9000 cases were filed in this respect. Furthermore, around 10% caused actual harm to these patients. This ratio of abusive treatment has increased twice since 1996 till 2000. Nationwide, more than 3,000 complaints about resident-nonresident abuse were lodged with state long-term care ombudsman programs in 2000, up from around 2,500 complaints in 1996."
STAKEHOLDERS IN ELDER ABUSE POLICY
In order to promulgate the policy against elder abuse successfully, all the stake holders in this regard should be identified and made fully functional (Mocilini, 2006). As the policy suggests,
PROVINCIAL OFFICES and POLICE STATIONS should be major coordination point for these elder abuse cases. Once reported, these cases must be forwarded to the respective service providers. These service providers will be responsible to ensure that all the necessary measures have been taken. Along with this, these provincial offices and police stations are required to have the relevant statistics of the cases reported. The prosecution in this respect is supposed to have the partnership with the relevant organizations. Where the prosecution takes the charge, the necessary gaps in the system will be identified through this partnership
POLITICIANS have a potential of affecting the policies in this subject greatly. A careful and thorough consideration by various political parties and their representation in parliament houses and senates can help in passing out major bills addressing this issue. With the support of these politicians, the elder abuse policy can gain substantial grounds.