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.
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 Bit by bit, he became withdrawn and depressed.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.