Breaking the taboo: talking about elder abuse

June 15 represents World Elder Abuse Awareness Day as decreed by the International Network for the Prevention of Elder Abuse (INPEA). Elder abuse is 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.

Abuse occurs in many forms, including verbal, psychological, sexual and financial abuse, as well as neglect, humiliation and even extra sedation. Incidents occur mainly in older persons' own residences but also in residential care homes, nursing homes and hospitals.

Many will perhaps question the necessity of highlighting such a campaign on our Maltese shores. Reports of abuse of older people are minimal. Cases that succeed to come to light are often dismissed as a familial issue - in a way that domestic violence and child abuse once were - rather than being related to wider issues of discrimination requiring action at all levels.

However, local research demonstrates clearly that elder abuse in Maltese society is much more widespread than public entities, non-government agencies, and the general public like to believe. Suffice to say that a recent study found as many as 92 typical incidences of elder abuse in a local residential home.

Other research concluded that most professionals come into frequent contact with cases of elder abuse, older women are more vulnerable to abuse than older men, that misappropriation of financial funds and psychological abuse were the most dominant types of abuse facing Maltese older persons, and that most professionals find they are helpless in dealing with cases of elder abuse as they are not aware of any official guidelines to deal with elder abuse.

Such data imply that elder abuse is far from an isolated and localised problem involving a few frail older persons and their pathological offspring. It exists as a full-scale problem and has a frequency that few have dared to imagine.

However, incidents of elder abuse go unreported because many older people are unable, frightened, or even embarrassed, to report it. A significant percentage of abuse of older persons takes place within family circles as children and nephews or nieces take advantage of their aging parents and uncles or aunts.

This makes elder abuse more difficult to detect since many elders value the family over individuality, fear family shame and wish to avoid conflict among relatives.

Often carers take no action because they lack training in identifying abuse or may be unaware of the reporting procedure. Moreover, since it is the most dependent sectors of the older population - especially housebound and institutionalised elders - that are most vulnerable to abuse, victims may actually be physically unable to report their experiences.

It is hoped that this World Elder Abuse Awareness Day acts as a catalyst for the further recognition of the significance of elder abuse as a public health and a human rights issue, the need for people to understand elder abuse and how it can be prevented, and the necessity for policy-makers and non-governmental organisations to kick off initiatives to reach this goal.

After all, the Maltese government is signatory to the United Nations International Plan of Action on Aging (2002), which states that "government representatives have committed themselves to eliminate all forms of discrimination, and to create enough support services to deal with elder abuse and mistreatment cases".

The prevention of mistreatment and neglect of vulnerable adults and their carers might be achieved by taking the context and circumstances in which abuse occurs, by eliminating the causes of abuse, and by providing a properly managed and monitored environment for carers and care workers. More specific prevention measures for elder abuse may include:

• educating older people about their rights, informing them of ways to access services and adequate places in case of need;

• ensuring that information is not denied to elders, so that they have the possibility to make their own personal choices;

• applying shared decision-making that takes in serious consideration the perceptions and aspirations of older people;

• including information about aging throughout the educational process, starting in primary school, into the university curricula;

• ensuring that comprehensive knowledge about elder abuse reaches potential caregivers and other professionals working with older people;

• encouraging the media to promote positive images of aging and provide responsible coverage of the issues surrounding elder abuse and neglect; as well as

• creating new agencies to deal specifically with elder abuse and promote collaboration between other agencies to prevent duplication and wasting of resources.

It is time to break the taboo and start to acknowledge the prevalence of elder abuse. One possible way to start the ball rolling is to start implementing these measures so that Maltese society starts to recognise the rights of older persons as human beings as stipulated in the international covenants of civil, political, social and cultural rights, and acknowledging the diversity of the world population.

There is surely an obligation for society to appreciate the contribution of older persons and address the violation of their rights, including abuse, in whatever settings they occur, so that the later years of life will be productive, enriching and free from mistreatment and discrimination.

As an INPEA member, Malta will for the first time be collaborating with international organisations in raising awareness of elder abuse. This year's theme is 'Moving forward'.

A Working Group on Elder Abuse (WGOEA) has been set up within St Vincent de Paul Residence (SVPR) to sustain and move elder abuse awareness forward. The group is holding a half-day seminar on June 28 to explore and promote elder abuse awareness.

The seminar is open to health care professionals, interested individuals, organisations and agencies. Registration is free. For registration forms and further information contact the Office of Medical Superintendent at SVPR (tel: 2122-4461 or e-mail: ronald.fiorentino@gov.mt).

Dr Formosa is a lecturer at the European Centre of Gerontology of the University of Malta. He can be contacted on tel: 2340-3103 or at marvin.fornosa@um.edu.mt