Not every elderly person faces frailty or dependence; many stay independent and active in their communities. However, a significant percentage experiences frailty, dependence, and vulnerability, requiring support from families or professionals. Typically, this care is provided routinely and without significant concern. Unfortunately, in some cases, the relationship between dependent older individuals and their caregivers involves physical violence, emotional manipulation, neglect, or financial exploitation, collectively termed “elder abuse.” In a prior article, we explored elder abuse within care settings.
This article explores the suffering of older individuals as victims of physical, psychological sexual, or financial abuse, primarily at the hands of family members or those in a duty of care relationship. Violence is particularly reprehensible when directed at vulnerable members of society, such as the elderly. Elder abuse manifests in both care establishments and private domestic settings, each presenting distinct challenges and necessitating unique policy responses. The focus here is on older people living in their own house, primarily relying on support from informal care networks. The article delves into the nature of the abuse, its perpetrators, frequency, reasons victims may avoid seeking help, and the impact on those affected.

  • Judith S Parnes, Sowmya Lakshmi

54-year-old Anuradha, who escaped an abusive marriage, is now experiencing a brighter chapter after the stormy days of her previous marriage. She has found happiness in a live-in relationship with a former colleague, Praveen. While her two sons from her first marriage are working and settled, Anuradha decided to venture into dating again, driven by a desire for companionship.

Praveen, who lost his wife, shares a similar longing for companionship, especially since his daughter is married and settled in Australia. We believe there’s nothing wrong with finding love multiple times, but it’s crucial not to overlook familial responsibilities. Unfortunately, in this case, Anuradha’s newfound joy unexpectedly affected her obligations toward her elderly parents, Ammuamma and Sridharan.

Ammuamma and Sridharan, both in their early 80s, had health issues and now dependent on a caregiver for everything. Sridharan, who used to be healthy and strong, is now in a wheelchair due to weak legs, and Ammuamma, slightly demented is also dealing with arthritis, required constant care. All these days Anuradha was their prime support as her only brother, Sandeep lives in Germany. Despite being a close family, Anuradha’s new romance took up all her time, making her parents feel neglected.

Anuradha’s brother, Sandeep, living in the UK, got worried about their parents’ well-being. Video calls revealed that Anuradha wasn’t keeping a close eye on them, and her visits were irregular. Sandeep, a caring son from afar, felt his parents were left alone while his sister was wrapped up in her new relationship. Seeing the need for a change to ensure his parents’ safety and quality of life, Sandeep decided to take responsibility and that’s how he called us.

As part of assessment our team visited the house. We cannot blame the caregiver person as managing both patients at the same time becomes overwhelming for her and it shows in the quality of care. Inexperience and lack of additional support is taking a toll as Ammuamma developed a bed sore. Also because of the lack of monitoring the caregiver is taking a lackadaisical approach thus ignoring the very facets of caregiving like hygiene, nutrition, and administration of medication.

Upon our team’s inspection, it became evident that she was dehydrated, unkempt, and visibly unwashed. The condition inside the house was notably poor, and we discovered Ammuamma in a state of ill health. Sridharanmama faced challenges in maintaining the cleanliness of their two-bedroom flat, leading to the accumulation of trash left unattended for several days. When questioned about the bedsore, the caregiver was unable to provide a satisfactory explanation.

After many conversations with Anuradha, where he shared his worries and stressed the significance of their parents’ well-being, Sandeep suggested the idea of moving their parents to a long-term care facility. Recognising the intricacies of the situation, he acknowledged that his sister’s life was heading in a different direction. Nevertheless, he strongly felt that their parents deserved specialised care and attention, particularly considering their fragile health.

Anuradha initially resisted the idea, feeling defensive about her choices and independence. However, as time passed, she started recognising the wisdom in her brother’s suggestion. It dawned on her that her parents needed more care, especially with the current caregiver poorly managing things, including medication. Eventually, she agreed to the relocation plan, understanding that it was in the best interest of her parents.

Imagine, despite living just a few kilometers away, Anuradha couldn’t find time to visit her parents for 22 days because she was busy. This amounted to nothing less than neglect and abandonment, constituting elder abuse. Sandeep’s timely intervention, even from a distance in Germany, spared the parents from this neglect. The transition to our advantAGE assisted living faced challenges, but with Sandeep’s support, it turned into a positive change for everyone involved. The facility provided essential medical care, a supportive community, and engaging activities for Sridharanmama and Ammuamma. Freed from constant worry about her parents’ well-being, Anuradha could now focus on her blossoming relationship while maintaining a connection with her family.

In the end, the story highlights the importance of recognising and addressing the evolving needs of elderly parents and finding solutions that balance personal pursuits with familial responsibilities. Sandeep’s caring and proactive efforts secured a better and more secure future for Sridharanmama and Ammuamma, providing the care and attention they rightfully deserved in their golden years and preventing any form of ‘elder abuse.’

This is another reported story from media. Left alone by her two sons, 80-year-old Gurmeet Kaur was saved from a pit on August 14 in a critical state, with maggots infesting her leg wounds. Unfortunately, Kaur, hailing from the Malwa region of Punjab, passed away two days after her rescue.

The irony in this tale is that she isn’t childless, and her sons reside nearby. Manender Singh, one of her two sons, is a local politician and businessman, while the other, Balwinder Singh, works in the State education department. Furthermore, Kaur’s granddaughter holds a position as a Punjab Civil Services Officer. In response to the summons from the Punjab State Commission for Women regarding this case, both sons appeared but allegedly provided absurd answers to the commission.

The son in politics, residing merely five kilometers from the location where his mother was rescued, claimed to have moved out over three decades ago following a dispute with his father. He asserted that he has been barred from entering the family home since then. Balwinder, the second son, explained that he had arranged for a caretaker to attend to their mother, given his residence in a different town. The women’s commission has advised filing criminal cases against both sons.

In a distressing incident, video clips of an 82-year-old Andalamma being ruthlessly assaulted by her daughter-in-law have circulated widely on social media. Andalamma, frail and shattered, informed the police that her husband was unwell, and she faced both physical and mental abuse from her daughter-in-law and son. She revealed, “They threatened me with severe consequences and to withhold my husband’s pension, who is in poor health. I was mistreated and coerced into performing household chores,” Andalamma recounted to the police.

Ammuamma, Gurmeet, or Andalamma could never have anticipated such cruel treatment from their own children, leaving them orphaned in the twilight of life. These harrowing incidents are not isolated; an increasing number of such cases are being brought to light, thanks to social media. Vulnerable elders are either abandoned to fend for themselves or subjected to mental and physical abuse by their selfish and insensitive relatives. Some in society argue that authorities display a lackadaisical attitude and are not taking sufficient measures to intervene.

In many instances, mistreatment stemmed from disputes over parental assets. Parents were either subjected to abuse for not parting with their money or abandoned after transferring property. Another aspect discussed in this narrative is ‘inheritance impatience,’ delving into the greed-driven actions of children eager to seize properties or savings.

In typical circumstances, informal care networks are commonly relied upon. While this reliance can signify strong family and community bonds, the quality and strength of these networks can vary. The demanding and stressful nature of caregiving roles, intricate family dynamics, and a loosely regulated support system create an environment conducive to abusive situations. The actual incidents of abuse, coupled with the fear of such occurrences, can profoundly impact the quality of life for older individuals, especially when vulnerability arises from physical frailty, dependency, or social isolation.

Elder abuse, also known as mistreatment, refers to the causing of physical, emotional, or psychological harm to an older adult. This can extend to the financial exploitation of an elderly person by their caregiver. Elder abuse, a term coined within the last 20 years, encompasses any behaviour or pattern of behaviour by an individual or individuals that leads to harm inflicted upon an older person.

Physical abuse spans from minor acts like slapping or shoving to more severe actions such as beatings and restraint using ropes or chains. Other forms include hitting, beating, pushing, kicking, pinching, burning, or biting. Additional forms of harassment involve over- or under-medicating, withholding food, or exposing the elderly person to extreme weather conditions.

Rosie, at 73, continues to earn a living by selling fish despite the challenges life has thrown at her. Tragically, she lost her daughter, and in the aftermath, she courageously raised her grandsons, Joel and Joshua. The burden became heavier as they grew into rogue teenagers, subjecting Rosie to both verbal and physical abuse. One particularly dire altercation involving her neighbour led to police involvement, resulting in Joel serving a six month prison term. However, upon his release, Joel’s return home took a dark turn when he, in a drunken state, assaulted Rosie. Forced to seek refuge with a neighbour, Rosie summoned the police once more, leading to Joel’s second arrest and Rosie’s hospitalisation.

The commonly accepted definition of emotional elder abuse is the “intentional infliction of anguish, pain, or distress through verbal or nonverbal acts.” This encompasses threatening, harassing, intimidating, and attempting to humiliate an elderly individual. Emotional abuse also involves socially isolating the senior. It ranges from name-calling to making disparaging remarks with the intention of causing emotional harm. When a relative or caregiver intentionally induces fear, emotional pain, or distress, such behaviour is considered abusive.

Reflecting on another distressing incident, Narsi Uncle’s story unfolds. Narasimhan, a 75-year-old retired public sector executive and widower for over 15 years, was placed in our advantAGE skilled nursing home due to early-onset dementia, arranged by his daughter from San Francisco, Ashwini. Moreover, Ashwini suspects frequent domestic fights between her father and her sister-in-law.

Adding to the complexity, Ashwath and his sister have maintained a strained relationship for several years, stemming from his marriage to a girl from a lower caste. Ashwath Narayan, the only son, attempts monthly visits to check on Narsi Uncle. However, during the last visit, a verbal dispute escalated into Ashwath physically assaulting Narsi Uncle. Kavyaa, a care attendant, intervened upon hearing Narsi Uncle’s distress, discovering marks on his face.

Unable to articulate the incident, Narsi Uncle was left in distress. Kavyaa promptly reported the incident to supervisors, who then informed Ashwini, Narasimhan’s daughter. As a result, Ashwath was banned from visiting due to concerns about potential violence, exposing a troubling narrative of familial discord and elder mistreatment.

Sexual abuse, though infrequently reported, can manifest in various forms of elder abuse. This ranges from sexually explicit conversations to exhibitionism and includes inappropriate touching, photographing the person in suggestive poses, forcing sexual contact with a third party, or even sexual assault.

Financial exploitation stands out as one of the most commonly recurring crimes against elders, spanning from the misuse of funds to outright embezzlement. Proximity often leads relatives to engage in financial embezzlement more frequently than professional caregivers, with some assuming they have a legal right to do so. Financial abuse encompasses fraud, forgery, deceitful property transfers, purchasing expensive items without the older person’s knowledge or permission, or restricting access to their own money. It also involves the improper use of legal arrangements, such as powers of attorney.

Following in the spectrum of abuse is neglect, encompassing the failure to meet the basic needs of the senior, such as food, shelter, and medical care. This category includes withholding proper attention, frequent abandonment by a caregiver, and neglecting health management responsibilities, which involves skipping medical appointments, denying treatment, or withholding medications. Neglect extends to financial matters, involving the failure to pay bills or responsibly manage the elder person’s finances.

Now, let’s explore additional instances of elder abuse by relatives that have come to our attention. In the first case, a 76-year-old lady with severe arthritis limiting her mobility and self-care abilities, resides with her son, who grapples with bipolar disorder and a chronic drinking problem. In this case, the abuse is perpetrated by the woman’s own son, who consistently assaults her, demanding money for alcohol and frequently misappropriating her pension without her consent. If money is denied, he will resort to violence.

Janet, a 68-year-old former dance teacher, endured emotional and physical abuse from her own husband. Struggling with respiratory distress, frailty, and malnutrition due to her illness, she lived with a husband with a history of domestic violence, verbally and physically assaulting her. Accusing a neighbour of having an affair, Janet lacked independent financial resources and felt compelled to endure the abuse from her husband.

These above mentioned incidents highlight that the majority of elder abuse incidents occur within the homes rather than in nursing homes or other institutional settings. Elder abuse is more prevalent in homes, with family members or professional caregivers often being the perpetrators. We’ve come across numerous cases, but many times, we’ve felt powerless to intervene.

While it’s known that most abusers are family members, reporting an abusive family member to law enforcement requires courage. Information from law enforcement and the Department of Elder Affairs indicates that instances of abuse are seldom reported. The question arises: Why aren’t more cases reported to the authorities tasked with preventing such abuse? And even if reported, how effective is law enforcement in halting this inhumane crime?

It appears that many family members are reluctant to report abuse within the family, even when they are aware that it’s happening. Elders themselves, grappling with shame, embarrassment, and lingering affection for the relative or grown child, often hesitate to take action, fearing potential retaliation. This hesitation becomes evident in our experience when discussing the possibility of legal action.

81 year old Ahamed Khan, was lured into giving money to his grand daughter-in-law and the guarantor was none other than his son. After the initial two instalments of repayment she didn’t pay a single penny to Khan. Khan felt cheated and whenever he ask for the money, they dodge him. Despite sponsoring his grandson’s engineering fees and the grand daughter in law obtained a loan, the likelihood of being repaid was uncertain. In this case approaching police is no solution as he fear alienation and retaliation.

It’s likely that someone reading this is aware of a family with a financial abuser or a case of physical abuse. We encourage you to speak up. Reporting can be done anonymously, similar to reporting any crime, as most states now have 24/7 elder helplines. Whether or not they intervene or prove the crime is not your responsibility. Consider it a social obligation, as one day, you could be the one facing victimisation.

As our loved ones grow older, it becomes crucial to safeguard them from various harms, including elder abuse—a complex issue impacting millions of older adults annually. This abuse manifests in diverse forms, encompassing physical, emotional, financial, or sexual mistreatment. This distressing reality can result in substantial physical and mental health consequences, contributing to a decline in the well-being of our elderly family members.