This Families Commission report on elder abuse and neglect examines what makes older people vulnerable to abuse and neglect, and what reduces their risk. This is the first study to gather the views of a wide range of different organisations, individuals and experts on how and why elder abuse and neglect occurs and what can be done to prevent it.
In many cases, the abuse is carried out by someone the older person has loved and trusted, and cared for all their lives. As with other family violence the behaviour includes psychological, physical, sexual and emotional abuse as well as financial betrayal. Strong themes that emerged were valuing and respecting older people, developing strong and healthy families and preparing for positive ageing.
The objectives of this project were to ascertain what factors may increase the risk of abuse or neglect and protective factors that may prevent abuse or neglect from occurring or recurring.
Qualitative methods were used to capture data about elder abuse and neglect from a range of stakeholders. The sampling frame was designed to ensure that a wide range of expertise and knowledge was accessed. The sample consisted of:
- older people, some of whom had experienced elder abuse, health professionals and representatives of non-governmental organisations and other providers of services for older people
- representatives from various ethnic groups
- representatives from multiple regions.
Data were collected through face-to-face, focus group and telephone interviews. Interview guides were developed after consultation and reviewing the literature. The interview guide was designed to collect data from all ecological levels, from the individual to the societal. Data analysis took a generally inductive approach.
The results are based on the perspectives of the informants in the study, and they identified the risk and protective factors discussed.
Individual level: Isolation and the increasing physical (and sometimes mental) challenges associated with ageing emerged as individual-level risk factors for elder abuse and neglect. They were compounded in people who had experienced other adverse events such as other forms of abuse and poverty.
Family level: Supportive families were recognised as protective against all types of elder abuse and neglect. Threats to families’ ability to be supportive were varied, from longstanding abuse within families, to overburdened or greedy family members. Each of these strands is likely to require different prevention strategies, some of which are already being used (such as initiatives addressing child abuse, partner violence or caregivers’ stress).
Institutional level: Risk factors in residential care settings concerned staffing issues, which were closely linked with training, funding, staff-to-resident ratios and organisational culture. Informants suggested that high numbers of well trained and well paid staff was a protective factor ensuring high-quality care. It was also noted that various institutions other than care facilities play important roles in protecting older people from abuse and neglect. Some of the suggested prevention strategies involved banks, lawyers, churches and faith communities and police.
Community level: Many of the factors identified by informants at this level indicated the necessity of social connectedness, which was regarded as a protective factor. Multiple factors were seen as contributing to it, including accessible public transport, community facilities and housing policy. The availability of services was a particular issue in rural communities.
Societal level: Strong themes emerged about the undervaluing of older people in society as a whole. This was linked to the perceived ‘lack of productivity’ associated with people who are no longer in paid employment. Informants in this study overwhelmingly endorsed the need to promote more positive images of older people, and develop a culture of respect that valued the unique contribution of older people.
High-level societal issues such as the cost of living and unavailability of care were seen to contribute to pressures on families, creating environments where elder abuse and neglect are more likely to occur. In particular,pressures on adult family members to take paid employment limit the opportunities for families to provide care for their older members.
Beliefs about love and respect within families are challenged by other ideologies about families and individuals. For example, ideas about the intergenerational transfer of wealth may contribute to elder abuse and neglect into the form of financial abuse; and ideologies about family loyalty and personal independence contribute to the silence about abuse.
Cultural level: Mäori perspectives on elder abuse in New Zealand were described in terms of the stresses and pressures of life on the whänau. The problem was most likely to be framed as being unloved, or lack of aroha, which was seen as putting the whole whänau at risk. Urbanisation was also considered to have played a role in the fragmentation of Mäori values, by disrupting links to tribal lands and cultural norms. This was also thought to contribute to isolation.
Cultural diversity notwithstanding, common factors contributing to abuse and similar solutions emerged across Pacific, Indian, Chinese and mainstream communities. Someone from a Pacific community remarked, “abuse is a human thing, not an ethnic thing. When we are kind and loving we are all the same. The abuse issue is the negative aspect of being human.”