Ag­ing in agony

El­der abuse is a taboo topic of­ten hid­den in shame. But a re­cent sur­vey re­veals that it is a prob­lem we can no longer ig­nore.

The Star Malaysia - Star2 - - FRONT PAGE - By S. INDRAMALAR star2@ thes­tar. com. my

Abuse of the el­derly is all the more in­sid­i­ous be­cause par­ents would rather suf­fer in quiet des­per­a­tion than re­port their chil­dren’s mis­deeds.

WITH his shoul­ders slumped, head hang­ing low and chin rest­ing on his chest, Bernard Matthews is a shell of the man he used to be. Up un­til a few years ago, the 82- year- old re­tired teacher used to read and write. A strap­ping man – he used to play hockey in his youth – Bernard would walk to the neigh­bour­hood coffee shop to dis­cuss cur­rent affairs and ex­change “war sto­ries” with his friends. Th­ese days, he doesn’t say much. He shuf­fles and mum­bles, and prefers to stay in his room. He was re­cently di­ag­nosed with de­pres­sion and de­men­tia, but his well- be­ing de­te­ri­o­rated rapidly be­cause he has been mis­treated at home.

The ver­bal and emo­tional abuse started four years ago.

Af­ter Bernard lost his wife, his son and fam­ily moved in with him. Bernard thought their com­pany would be good in his golden years. He didn’t ex­pect to be bul­lied. It was his house but Bernard was made to feel like he was in­vad­ing “their” space. He was yelled at for ev­ery lit­tle thing: for­get­ting to turn the TV off, not fold­ing his towel or even watch­ing “too much” tele­vi­sion. He was ac­cused of be­ing a “bur­den” even though most of his pen­sion went to­wards house­hold ex­penses, called a “nui­sance” and was con­stantly be­lit­tled.

All this be­gan to eat away at Bernard. Bit by bit, he be­came with­drawn and de­pressed. He stopped go­ing for his walks.

A con­cerned neigh­bour alerted the po­lice and two of­fi­cers came to check on him in his house in Labu, Jo­hor. Af­ter as­sess­ing the sit­u­a­tion, one of them dis­creetly ad­vised Bernard to file a re­port of abuse.

For the first time, Bernard felt he could do some­thing about his sit­u­a­tion. He called his daugh­ter who lived in Kuala Lumpur and they went to the po­lice sta­tion where Bernard shared about the abuse he’d been suf­fer­ing.

The po­lice said they’d help him get a pro­tec­tion or­der from the courts. But at the last minute, Bernard backed down.

“He is my son. I don’t know why he is like this but he’s my son,” Bernard told his daugh­ter. He also re­fused to move in with her be­cause he didn’t want to leave his own house.

El­der abuse is a grow­ing prob­lem in Malaysia’s fast- ag­ing so­ci­ety but it is a crime that is grossly un­der- re­ported. Just like do­mes­tic vi­o­lence, most view it as a “fam­ily mat­ter” that is best dealt within the fam­ily.

El­der abuse, as de­fined by the World Health Or­gan­i­sa­tion, 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.

“It’s hard to mea­sure, but if an el­derly per­son is yelled at re­peat­edly and it bears a neg­a­tive im­pact, then it is abuse or mis­treat­ment,” says Univer­siti Malaya’s Depart­ment of So­cial and Preven­tive Medicine lec­turer Dr No­ran Naqiah Hairi. She is lead­ing an on­go­ing study – called the Pre­vent El­der Abuse and Ne­glect Ini­tia­tive ( Peace) – with her col­league Dr Clare Choo.

Ac­cord­ing to the Women, Fam­ily and Com­mu­nity De­vel­op­ment min­istry, only 23 cases of el­der abuse were re­ported in the past three years. How­ever, the Peace study has re­vealed that the prob­lem is much more wide­spread.

In a sur­vey on ur­ban poor com­mu­ni­ties in Kuala Lumpur, Univer­siti Malaya re­searchers dis­cov­ered that one in 10 in­di­vid­u­als over the age of 60 have ex­pe­ri­enced one or more forms of abuse in the last 12 months. An­other sur­vey in a ru­ral com­mu­nity in Kuala Pi­lah, Ne­gri Sem­bi­lan showed a slightly lower fig­ure: one in 20 el­derly in­di­vid­u­als re­ported abuse by care­givers or fam­i­lies.

“Th­ese fig­ures cor­rob­o­rate the preva­lence rate in other Asian coun­tries. Very lit­tle is known about el­der abuse and ne­glect here in Malaysia as most peo­ple don’t talk about it. But we need lo­cal data as the num­ber and pro­por­tions of older peo­ple in Malaysia are in­creas­ing rapidly. We need to re­spond to the is­sues of this group, such as el­der abuse,” says Dr No­ran.

The Peace study is funded by Univer­siti Malaya’s Grand Chal­lenge pro­gramme and aims to not only mea­sure the in­ci­dence of el­der abuse but de­ter­mine its risk fac­tors and con­se­quences, and for­mu­late strate­gies to deal with the is­sue.

It takes a vil­lage

Strong com­mu­nity sup­port is in­te­gral in en­sur­ing the wel­fare of the el­derly, says

Univer­siti Malaya Med­i­cal Cen­tre med­i­cal so­cial worker Suri­ani Mo­hamad Hasim.

She shares a story of an el­derly pa­tient who was ad­mit­ted for var­i­ous chronic ill­nesses.

“Af­ter be­ing treated, she said she wanted to go home. She had no fam­ily as her only son had passed away some time back. The doc­tors sug­gested she stay in a nurs­ing home but she got an­gry. We learnt later that her hos­til­ity was be­cause she had a sis­ter who was mis­treated in a nurs­ing home,” shares Suri­ani.

The el­derly pa­tient as­sured the doc­tors and Suri­ani that her neigh­bours would take care of her and make sure she eats and takes her med­i­ca­tions.

“So, we con­tacted her neigh­bours and paid them a visit to as­sess the sit­u­a­tion. Amaz­ingly, they all said that they would take turns to visit and care for the old lady. They said they would draw up a ros­ter of du­ties such as chang­ing her di­a­pers and mak­ing sure she has food to eat. The en­tire com­mu­nity – el­derly peo­ple and their chil­dren and grand­chil­dren – all chipped in to help,” re­lates Suri­ani.

It is a heart­warm­ing story. How­ever, the med­i­cal so­cial worker points out that such com­mu­nity sup­port is more com­mon in ru­ral com­mu­ni­ties, and not in ur­ban ar­eas.

Deputy Women, Fam­ily and Com­mu­nity De­vel­op­ment Min­is­ter Datin Paduka Chew Mei Fun says the min­istry has ac­tiv­ity cen­tres for older per­sons ( Pusat Ak­tiv­iti Warga Emas or Pawe) around the coun­try, which are day­care cen­tres for se­nior cit­i­zens, where they can par­tic­i­pate in pro­grammes or sim­ply meet up with their peers.

There are 45 Pawes around the coun­try, with five more ex­pected to be ready soon.

“Ac­cord­ing to our fig­ures, more than 31,000 el­derly in­di­vid­u­als are us­ing th­ese ac­tiv­ity cen­tres. The cen­tres help them keep ac­tive and en­sure they are not iso­lated. They form bonds and look out for each other. If some­one doesn’t show up for a few days, the oth­ers will no­tice and alert the cen­tre ad­min­is­tra­tor who will then check on the wel­fare of the miss­ing el­derly,” she says in a re­cent in­ter­view.

The min­istry also ex­tends home help ser­vices, en­gag­ing vol­un­teers to pro­vide sup­port ser­vices to the el­derly, par­tic­u­larly those who live alone. So far, some 5,000 el­derly in­di­vid­u­als have ac­cess to the home help.

While th­ese pro­grammes are com­mend­able, they are in­suf­fi­cient to deal with the coun­try’s rapidly- ag­ing pop­u­la­tion.

Presently, se­nior cit­i­zens ( 60 and above) make up 9% ( 2.77 mil­lion) of the coun­try’s 30.49 mil­lion pop­u­la­tion. This fig­ure is ex­pected to shoot up to 15% by 2030.

The ex­ist­ing sup­port ser­vices aren’t enough to cope with the cur­rent ag­ing pop­u­la­tion, let alone the surge in less than 15 years.

Some­thing needs to be done, says con­sul­tant geri­a­tri­cian Dr Ra­jbans Singh.

“We cur­rently have 20 geri­a­tri­cians in the coun­try. Sin­ga­pore has a much smaller pop­u­la­tion and they have about 100. In many coun­tries, geriatrics has be­come one of the largest ( area of ) spe­cial­i­sa­tion as they know they are deal­ing with an ag­ing pop­u­la­tion. We need to catch up,” he says.

State pro­tec­tion

The coun­try also needs to re- ex­am­ine its laws to en­sure the el­derly are not vul­ner­a­ble to abuse.

Thus far, the as­sump­tion is that the el­derly will be well cared for in their golden years be­cause fil­ial piety is a trait most Malaysians are brought up with.

It is, how­ever, not a value ev­ery­one sub­scribes to. The hard re­al­ity is that govern­ment health and so­cial ser­vices must play their roles in pro­tect­ing the el­derly from abuse or mis­treat­ment. Presently, there are no spe­cific laws to en­sure el­derly care, what more pro­tect the el­derly from abuse. The wel­fare of el­ders come un­der the purview of the Pe­nal code and the Do­mes­tic Vi­o­lence Act.

Doc­tors, so­cial work­ers and other front­line re­spon­ders now do not have clear guide­lines on han­dling el­der abuse.

“We found that most pri­mary care doc­tors and nurses have had no train­ing on han­dling el­der abuse cases and rely on the guide­lines that we have on child pro­tec­tion. With­out any clear guide­lines when it comes to el­der abuse, most said they were just guess­ing and didn’t know what they should do,” shared Dr No­ran, adding that they have so far trained 150 doc­tors and 350 nurses in Ne­gri Sem­bi­lan to deal with el­der abuse.

Dr Ra­jbans con­curs, point­ing out in­stances when so­cial work­ers wanted to re­move the el­derly from an abu­sive en­vi­ron­ment but had nowhere to place them.

“So, what do doc­tors do? Do we call the po­lice? We are not clear on the pro­to­col re­lated to el­der abuse. When it comes to chil­dren, the SOPs are clear as we have the Child Act, but not so with el­derly pa­tients.

“At present, what we do is talk to the fam­ily mem­bers and try to coun­sel the care­givers and dis­cuss prob­lems they may face,” he says.

He stresses that while we may want to be­lieve that as an Asian so­ci­ety we will look af­ter our el­derly, we need to ac­cept our chang­ing so­ci­ety and pre­pare for the fu­ture.

“An ag­ing so­ci­ety is our re­al­ity. Ev­ery­one is busy with their ca­reers or liv­ing abroad. We have to think of putting in place sup­port ser­vices – com­mu­nity nurs­ing homes and day­care cen­tres, com­mu­nity nurses and so on. “It’s not too late, but we have to act quick,” he says.

WHAT does it feel like to grow old?

A group of doc­tors from Univer­siti Malaya will soon run an in­ter­ven­tion pro­gramme to give care­givers a peek into the minds and bod­ies of the el­derly peo­ple un­der their watch.

“We’d give them sim­ple ex­er­cises to do – eat a sin­gle raisin with­out us­ing their teeth, per­form sim­ple chores while us­ing glasses or gog­gles that limit their vi­sion. Or pick­ing some­thing up wear­ing thick gloves. It’s hard but it will help them ap­pre­ci­ate what ag­ing is and how dif­fi­cult it is for an older per­son,” ex­plains Dr Farizah Mohd Hairi. She is one of the re­searchers of the Pre­vent El­der Abuse and Ne­glect Ini­tia­tive ( Peace) ini­ti­ated by the Depart­ment of So­cial and Pre­ven­ta­tive Medicine un­der the univer­sity’s med­i­cal fac­ulty.

Train­ing is ex­pected to be­gin soon, be­gin­ning with a group of care­givers from nurs­ing homes in Ne­gri Sem­bi­lan.

One of the con­tribut­ing fac­tors to el­der abuse cases, says con­sul­tant geri­a­tri­cian Dr Ra­jbans Singh, is a lack of aware­ness, knowl­edge and un­der­stand­ing about el­derly care and sup­port.

“In my 20 years as a geri­a­tri­cian, I have come ac­cross many cases. A lot of the times, the abuse oc­curs not be­cause the car­ers or fam­ily want to in­ten­tion­ally hurt or harm the older per­son but be­cause they do not know how to care for the el­derly.

“It’s dif­fer­ent with chil­dren, where you are in charge and you can set the rules. With the el­derly,

they can make up their own minds. We have to re­mem­ber that th­ese older peo­ple were once ‘ some­bod­ies’ – they were the head of house­holds, they were pro­fes­sion­als or had jobs and were de­pended on for many things. But, the roles have now changed and that’s not an easy thing to deal with,” ex­plains Dr Ra­jbans.

Things get more chal­leng­ing if the older per­son is no longer alert be­cause of Alzheimer’s or de­men­tia, dis­eases that cor­re­spond largely to ag­ing.

“Emo­tional and psy­cho­log­i­cal abuse is very com­mon es­pe­cially if the pa­tient ( older per­son) has de­men­tia. Many car­ers re­ally don’t un­der­stand the na­ture of the dis­ease and don’t know how to deal with some­one with de­men­tia,” says Dr Ra­jbans.

He shares his child­hood ex­pe­ri­ence of deal­ing with the el­derly.

“My grand­fa­ther had de­men­tia. At the time, I was quite young ... I wasn’t a doc­tor yet. He would just walk out and talk about things that didn’t make sense to us. Some­times, he would go to the road out­side our house and take a leak. I re­mem­ber my cousins would get very up­set with him. They took his ac­tions per­son­ally, as if the old man was out to make things dif­fi­cult for them on pur­pose.

“What we didn’t un­der­stand at the time was that he was suf­fer­ing from de­men­tia. It was only years later when I be­came a doc­tor did I un­der­stand his be­hav­iour at the time,” he shares.

How­ever, as im­por­tant as it is for care­givers to em­pathise, it is also cru­cial for them to have a sup­port sys­tem to lean on.

“Most fam­i­lies think about the wel­fare of the older per­son so much they for­get about the carer. In many fam­i­lies, the re­spon­si­bil­ity of car­ing for the older per­son falls on the shoul­ders of one child or one sib­ling.

“The oth­ers may con­trib­ute fi­nan­cially or oc­cas­sion­ally, but the re­spon­si­bil­ity is largely on one per­son. It can take a heavy toll, es­pe­cially if the el­derly per­son is not well.

“The carer’s life now is cen­tered around this older per­son. Af­ter some time, with no sup­port or help, he or she may find it hard to cope and that is when the abuse starts – by tak­ing out the stress on the el­derly per­son,” says Dr Ra­jbans.

When it comes to car­ing for the el­derly, fam­i­lies need to come to­gether and sup­port each other.

“If it gets too stress­ful, care­givers can hire pri­vate nurs­ing help for a few hours eve week just to al­low them so time to do their own thing.

“Or, find suit­able day­care fa­cil­i­ties that are com­fort­able for the el­der per­sons and al­low them to meet and talk to their peers, while giv­ing care­givers some time for them­selves,” sug­gests Dr Ra­jbans.

Treat older peo­ple with em­pa­thy and kind­ness.

Not a bur­den:

Of­ten times, el­der abuse oc­curs not be­cause the car­ers or fam­ily in­ten­tion­ally want to hurt or harm the older per­son, but be­cause they do not know how to care for the el­derly. Dr Ra­jbans Singh

Strong com­mu­nity sup­port is an in­te­gral part of en­sur­ing the wel­fare of the el­derly. Suri­ani Mo­hamad

Hasim

Very lit­tle is known about el­der abuse and ne­glect in Malaysia. We need lo­cal data to for­mu­late pro­grammes for the el­derly as the num­ber and pro­por­tions of older peo­ple in Malaysia is in­creas­ing rapidly. Dr No­ran Naqiah Hairi

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