Overt abuse of the elderly is obvious, but the more subtle forms - paternalism, stereotyping and ageism - must also be recognised, writes Amanda Phelan
Elder abuse is one of three strands within the spectrum of family violence, the other two being child abuse and domestic violence.
Abuse of older people was formally recognised in 1975 by a British doctor, Alex Baker. The original focus centred mainly on the area of physical abuse.
This has changed manifestly over the years and now psychological, financial/material, sexual abuse and age discrimination are all recognised as types of elder maltreatment. Elder abuse can range from implicit abusive activities such as continually speaking for the older person (when that person can communicate, even if this takes some time), or taking pension money to the extreme of fatal injury.
The definition of abuse has been refined and debated in academic, political and social spheres.
In 2002, Ireland adopted the definition of elder abuse articulated by the British charity, Action on Elder Abuse, and used by the World Health Organisation in the Toronto Declaration on the Global Prevention of Elder Abuse (2002).
This pivots on issues such as an expectation of trust, a violation of human and/or civil rights through active perpetration of abusive acts or neglect. Neglect may be considered in terms of omission, where the needs of the older person are overlooked due to a lack of knowledge of the particular need, or commission, where the older person's need is known but is disregarded.
However, even within this definition, there are global differences in interpretations. For example, the Department of Health and Human Services in the United States recognises self-neglect as a form of abuse, which is not seen as such in, for example, Ireland or Britain.
New understandings of elder abuse are articulated in the US in terms of the abandonment of older people at shopping centres or accident and emergency units, or the enforced situation of grandparents becoming custodial guardians of their grandchildren.
In legislative terms, the imperative nature of addressing this issue is underpinned in jurisdictions such as the US by specific protective laws, with many states also incorporating mandatory reporting of elder abuse.
In Ireland, we do not have any recorded elder abuse figures. However, statistics from other westernised countries indicate that between 2-5 per cent (12,500-20,000) of older people may be subject to abuse in the community.
US figures indicate that any statistical figures are underestimates, as they are generally based upon reported cases to health and social care and/or the criminal justice system. For every one case detected or reported, it is estimated that just over five cases are unreported.
The RTÉ expose of nursing-home deficits in care provision last year highlighted abuses that can occur in long-term care. Systems of care can be abusive in terms of attitudes, practices and actions. It is important that standards in care environments are of the highest quality and maintained within the context of appropriate legislation for monitoring and whistle-blowing.
There should also be significant punitive recourse for unaddressed poor care. Practices such as the creation of advocacy groups, continuous quality improvement systems and a comprehensive complaints procedure within the care facility should be encouraged.
It is also important to remember that only 5 per cent of older people in Ireland are in long-term care and the overwhelming majority of elder abuse occurs in the home environment, by a person known to the older person, such as a spouse, child or neighbour.
The Government produced a policy document to address elder abuse in September 2002, Protecting our Future. This report outlined a blueprint to respond to elder abuse in both the community setting or older person care environment.
Recommendations include the establishment of special response teams which would be responsible for accepting and investigating elder abuse reports as well as generating and implementing intervention plans. Case management would acknowledge issues such as self-determination, the possible legal implications of abuse and the issue of mental competency of the older person.
However, despite having a policy document presenting best practice and specific funding, the recommended response teams have been hampered in their inception due to issues such as a bar on employing new people in the health service.
While politicians point to the policy document, the Health Service Executive has responded with excuses such as employment ceilings or problems with job specification. This exacerbates the marginalised position of older people in society, leaving exasperated advocates for older people frustrated with bureaucracy and politicians.
The legal position in relation to older people, within the context of vulnerable adults, has been reviewed by the Law Reform Commission in 2003 and 2005, which recommended legislative changes to address the inadequacies of archaic laws such as those concerning the ward of court, which dates back to 1871.
It will take some years for these reforms to materialise into legislation. However, elder abuse is a complex societal issue and requires more than just the involvement of health and social care sectors and the legal domain.
Successful intervention and amelioration is fundamentally dependent on a comprehensive multi-disciplinary and inter-sectorial approach, with other governmental departments' input as well as that of voluntary agencies and communities.
Next Thursday is World Elder Abuse Awareness Day. So what is it about? It is about actively reflecting on interactions with older people.
Overt abusive activities are easy to recognise but the more subtle forms, such as paternalism, stereotyping and ageism, can be difficult to acknowledge and can be considered an acceptable compromise for what is often seen as a difficult population subset within society.
It is about refocusing attention back to the aspect of respect and dignity for older people. Older people do not want to be treated differently - they want to be treated the same as everyone, with equal human and civil rights. Therefore, everyone has a moral, social and ethical responsibility to be proactive to end all forms of maltreatment of older people. Elder abuse is everybody's business and there is no alternative, either individually or as a society, to preventing and stopping it.
The Irish Strategy Group for World Elder Abuse Awareness has organised activities to mark the day. The main event is the public lecture by Prof William Binchy of Trinity College Dublin, which will be held in the Camden Court hotel, Dublin 2, on Thursday at 11am.
Amanda Phelan is a lecturer in the school of nursing, midwifery and health systems at University College Dublin and chairwoman of the Irish Strategy Group for World Elder Abuse Awareness Day.