Hearing the silent scream

The elderly woman who lies awake at night in fear of her alcoholic son's return home. The father-in-law who sees his savings frittered away by his neglectful daughter-in-law. The woman who is ashamed to say that her elderly husband beats her. Elder abuse is truly the silent abuse. While the media focus is on child abuse and domestic violence, some older people are being abused in hidden ways, both by their families and by care institutions.

Abuse includes threatening behaviour, slapping, depriving victims of food, clothing and general care, and misuse of their money. Typical abuse in institutions includes verbal abuse and neglect of residents' needs.

In many cases, the abuser may not even realise what he or she is doing. One care worker reported a case in which an elderly woman was being cared for by her sister, who was a psychiatric patient. The sister was giving her more and more medication to keep her quiet, with the result that her speech had become slurred.

"Elder abuse is not cut and dried," explains Anne O'Loughlin, a senior social worker who has researched this area. "People who suspect elder abuse face many dilemmas. Is the situation abusive or not? Does the person intend to be neglectful? Some older people who are being abused are not really able to tell what happened . . .One day, they will tell you that someone is not being good to them; another day, they will tell you that they can't live without that person. So what do you do? You try to keep an eye on the situation."

A study by O'Loughlin and Dr Joseph Duggan estimates that 3 per cent of older people - 12,000 people - are subjected to elder abuse. Abuse, Neglect and Mistreatment of Older People points out that the most common abusers are sons or daughters and that abuse is usually detected by medical professionals during routine visits.

The chairwoman of Age and Opportunity, Mamo McDonald, believes the media is not as interested in elder abuse as, say, child abuse. "You read very, very little about it," she says. A contributing factor is the reluctance of older people to admit the abuse. "They are afraid because the people who are abused are generally very vulnerable," McDonald adds. One care worker reported a case of a woman confined to a wheelchair whose husband tried to put her out of their home. "The way it is now at our age, it's not worth my while doing anything," she told the care worker.

There's an increasing incidence of parents suffering the fall-out from their children's broken marriages. "It's a growing phenomenon," says McDonald. "A man might be thrown out by his wife for his abusive behaviour, and he goes home to his elderly mother. Then she finds she is bearing the brunt of the abuse. It's not surprising that this is increasing because people are living longer now."

McDonald takes a broad interpretation of elder abuse, and sees taking advantage as a form of abuse. "So many elderly people are being used as child-minders by their families and, in many cases, it's well beyond their physical capacity," she says. She recalls one incident in which a woman who had just left hospital after a major operation was expected to take care of her six-month-old relative. "They do it because it is expected of them. So many people just don't have the gumption to say no," she says.

She has also heard of incidents in which a son or daughter commandeers a parent's money. "After a lifetime of work, the person can find that they have no control over their pension or money. That's very sad," she says.

Several such stories are to be found in the care workers' observations of elder abuse, as recorded by O'Loughlin and Duggan. One care worker recalled a situation in which a man's son and daughter-in-law took him into their house and commandeered his money. "They took his pension, isolated him in a room, a small box-room. They say it was because he would be dribbling at the table and the teenagers could not bring in their friends," the care worker said.

Another worker recalled a situation in which a woman had cancer and her family was trying to sell her house. "She wanted the house for her handicapped son and they did not want him to get it. One of the daughters appeared to be caring. It turned out that she [the older woman] had to pay her to look after her."

So what can be done? Until now, there have been no guidelines for care workers who suspect elder abuse. Unsure of the law, and afraid of accusations of interfering, many home helps and voluntary workers say nothing. But these guidelines will soon be in place, according to Dr Des O'Neill, consultant geriatrician and chairman of a new working group on elder abuse. The group was set up by the Department of Health, following recommendations from the elder abuse study.

New guidelines on dealing with elder abuse will be piloted in Southern and Mid Western Health Board regions this month, according to Dr O'Neill.

The working group is taking the job in two stages. The first involved establishing the guidelines, the second will be concerned with improving legislation and working with other institutions, such as banks, to ensure that assets are not being signed over to relatives against an older person's will. The working group will present its report to the Department of Health at the end of next year.

What else can be done? The study by O'Loughlin and Duggan calls for the setting up of a telephone helpline on a pilot basis, similar to those operated by Women's Aid and Parentline. It says that serious consideration should be given to the development of a shelter for victims of elder abuse. The report also recommends a campaign to raise public awareness of elder abuse.

"The message I want to give is that older people must take control of this. They must not see themselves as powerless," O'Loughlin says.

Meanwhile, the Irish Association of Social Workers has called for an amendment to the Protection for Persons Reporting Child Abuse Act to include reporting abuse of adults. "People who report the abuse of children are protected against legal repercussions but this does not apply to the abuse of adults," O'Loughlin says. "Why? That must be changed."