Elder abuse: our silent evil

“They separated me from my books, I kept silent/Then they kept me away from my wife, I still kept silent/They put me away from my home, I had to keep silent/My daily medicines provided me the only company/My ‘age’ was a ‘burden’ and I lived in silence.”

This excerpt was from the diary of a 78-year-old retired schoolteacher who spent the last years of his life in an old-age home, far from his family and his ‘self-built world’. Thankfully, his wife had given us her consent to read through his diary.

Else, like many others, his suffering, too, would have been lost in memories and unread pages. These incidents of suffering are, however, not uncommon in old age. As a practicing geriatric psychiatrist, I encounter such stories frequently.

Be it at home, or on the streets, or even at old-age care facilities and hospitals, the elderly face various forms of emotional, physical, psychological or social abuse. It might range from deliberate neglect to physical trauma, food-refusal to financial deprival, from a casual insult to being separated from the spouse. No matter what form it takes, the impact creates sustained mental trauma in the elderly person.

India is graying fast! A report by the ministry for statistics and programme implementation mentions that in 2016, the elderly (above 60 years of age) form 8.5% of the population. With the World Health Organisation (WHO) estimate that the elderly population is increasing by 3.5% per year, by 2050 around 20% of our country will be seniors. What these numbers do not predict is the consistent struggle the elderly face daily.

Historically, we Indians are perceived as being caring and respectful of our elders. It is a myth, as the International Network for Prevention of Elder Abuse (INPEA) in its 2016 report notes that India is the ‘leading’ Asian country in terms of elder-exploitation and abuse. The INPEA designated June 15 as ‘World Elder Abuse Awareness Day’ (WEAAD), mainly due to the increasing number of public awareness events held by WHO on this day for elder abuse prevention.

WHO defines 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/senior person.” Needless to say, “expectation of trust” forms an important part of the definition, as most perpetrators of the abuse are families or caregivers in old-age facilities. Neglect and abandonment of the elderly are rampant in India.

Besides financial exploitation of the elderly, casual humiliation, ridicule or criticism are common. It reminds me of how insulted a friend’s grandfather had felt when while travelling by bus, he suddenly felt sick and sat down, only to be ridiculed by a fellow passenger with sexual innuendo for sitting next to a young lady.

These are definitely not stray incidents, they occur daily. It is just that we choose to stay silent about it and our daily neglect keeps reinforcing this abuse. Sadly, most elders are unaware of senior citizens’ rights, legal options and the right forums to approach against abuse.

Warning signs

Abuse results in the elderly leaving their homes, overdosing on pills, refusing food and self-neglect. Mostly, they lose self-esteem and mental strength, eventually giving rise to disorders like depression, anxiety and insomnia. The National Mental Health Survey (NMHS) 2015-16 mentions abuse as an important risk factor for suicide and overall, the risk of death by suicide is double in the elderly compared to that in the younger population.

At times, abuse is subtle and chronic, difficult to recognise. However, certain general ‘warning signs’ of elder abuse are multiple injuries or fractures, poor appearance, frequent infections, isolation, multiple bruises at inaccessible parts of the body, unexplained weight loss, refusal to eat or speak, signs of dehydration (dry skin, lips and sunken eyes) and apparent lack of cleanliness. These signs often do not need a doctor but can be picked up by a sensitive family member or a caregiver, leading to early detection and consequent prevention of abuse.

Elder abuse is a ‘social evil’ and reflects badly on our mental health as well. Many countries like the UK, US, Australia and Canada have strict laws to curb elder abuse. It is high time policymakers in India, too, turned to some necessary legislation.

The Maintenance and Welfare of Parents and Senior Citizens Act, 2007, created an excellent impact on ‘care for elderly’ but fell short of combating elder abuse. Laws are confined mostly to paper and the inherent challenges in their implementation need to be addressed.

“No one asks, no one bothers, so no one tells…,” was the refrain of staff at one old-age home, and it cannot be over-emphasised. Awareness is the need of the hour, and all forms of medical, nursing, senior-care facilities need to be sensitive to this issue. Whatever the context, it is preventable if detected and dealt with early. Ultimately, old age awaits all of us. The question we need to ask is, “Do we want to be treated the same way?”

Eleanor Roosevelt once said, “Beautiful old people are works of art!” There is still time for us to appreciate the “work of art” in our own homes.

(The writer is with NIMHANS, Bengaluru)