As stated by Simone, Wettstein, Senn, Rosemann and Hasler (2016), identifying abuse within an elderly community is considered challenging, as the topic is quite taboo and many cases remain unreported. Though, upon occasion cases as such do rise to the surface. While participating in a clinical rotation at a state hospital within Cape Town South Africa, I had been referred to a patient who required physiotherapy. Throughout this writing piece, I will refer to the patient as Bob. Bob was a 72 year old male, who had previously sustained two cerebrovascular accidents (Right and Left hemiparesis). After the second cerebrovascular accident (CVA), Bob had been discharged into the care of his daughter and her boyfriend at the time. Furthermore, due to a lack of attendance to the prescribed out-patient health care facility, he deteriorated in his functional ability.

Picture this

After initial assessment by medical staff and social work, probable abuse was speculated, as Bob had multiple bruises throughout, was dehydrated, his figure emaciated in appearance and the presence of multiple bed sores strengthened this theory. Social work reported that Bob’s daughter stated he had multiple “falling” spells, this being her reasoning behind his physical presentation. When addressing Bob, one was able to identify a sense of fear, as he flinched every time he had been physically touched. Speech fall-out after sustaining the CVA resulted in a communication barrier, as he mumbled incoherent words in response and refused to open his eyes when addressed. Due to this, I was unable to perform a thorough subjective assessment at the time. Amidst the obstacle, I acknowledged and explained my role as a physiotherapy student and continued to perform an objective assessment on Bob. After a few moments, my assessment required me to address the lower extremities and I was appalled to witness the extent of Bob’s injuries, so much so that I felt dreadful regarding the fact that I need to perform manual therapy on him.

As a physiotherapy student, I had never experienced bed sore(s) as big and I’ll forever be able to visualize the specific shark bite-like sores Bob had sustained. Nonetheless, I continued to treat Bob, but his story really had an emotional effect on me. I hereby decided to delve into literature to identify the prevalence of elderly abuse and whether or not there are laws put into place against it specifically.

Substantive findings

As with many other populations, abuse of older adults is a growing problem (Mouton and Southerland, 2017). A study compiled by Burnett, Jackson, Sinha, Aschenbrenner, Murphy, Xia and Diamond, 2016 reports abuse of the elderly increases the likelihood of early mortality, but little research specifies which types of abuse may cause the greatest mortality risk. Bezuidenhout and Booyens (2018) reports that within a South African context, being an “older person” implies that an individual, who in the case of a male surpasses or is 65 years of age, and where females are concerned, is at the 60+ year old mark. Bezuidenhout and Booyens further state that when it comes to protecting the rights of the most vulnerable in our society, focus is commonly drawn toward cases of women and children. However, society tends to forget that with age, the elderly become dependent again. Hereby, resulting in them (the elderly) becoming soft targets for abuse in different forms, as well as easy targets for criminals. The elderly are also often abused because of their weakened physique and many a time, mental degradation. The World Health Organisation defines elder abuse as, “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”. Elderly abuse is said to present in a multitude of ways, i.e. financial abuse, physical abuse, psychological abuse as well as sexual abuse. Additionally, it may to, be the result of intentional or unintentional neglect (World Health Organization, 2018).

The study by Burnett et al., (2016) included 1,670 cases of substantiated abuse of the elderly and estimated the 5-year all-cause mortality for five types of elder abuse, namely:  caregiver neglect, physical abuse, emotional abuse, financial exploitation, and polyvictimization. Caregiver neglect and financial exploitation had the lowest survival rates (Burnett et al., 2016). According to Frisoli (2016), the South African government provided minimal consideration toward support for the elderly. Abuse of the elderly often stems from the hands of those who have been tasked with caring for them in the home or in institutions (Bezuidenhout and Booyens, 2018). In addition, a study by Simone et al., (2016) found that nursing home residents were significantly less likely to suffer from abuse than neglect compared to persons living at home.

Mouton and Southerland (2017) identify certain risk factors to abuse within the elderly population, to include and not be limited to:

• cognitive and physical impairment,
• social isolation,
• lack of resources
• widowhood
• psychiatric conditions

South African Legislature for the Elderly

Frisoli (2016) reports that previously, the institution of Apartheid shaped the regulations on the elderly and it is the effects hereof that are still evident at present. Frisoli elaborates that with the introduction of the National Welfare Act of 1965, all social services to older persons became part of the institutionalised apartheid. Additionally, the Domestic Violence Act of 1998 is applicable in cases of abuse of older persons. The act states that protection orders are available to victims of abuse with or without their consent. Furthermore, the act provides protection from family members besides spouses, such as children, grandchildren or other family members. Frisoli further expresses that although this Act is a comprehensive one, majority of the time it fails to reach the elderly population that needs it the most, as few elderly people are aware of the protection it can provide them with.

The Aged Persons Amendment Act of 1998 stipulated certain conditions regarding the use of subsidies, monitoring compliance regarding conditions for registration of homes, requiring reporting of cases of abuse and the setting up of a national register on abuse of the elderly. The regulations facilitated investigation by designated bodies and established the use of warrants for the removal of older persons to places of safety in cases of abuse. The elderly gained protection from physical abuse, sexual abuse, psychological, emotional and verbal abuse, financial/economic abuse or exploitation, active/passive neglect or intentional neglect, violation of human rights, as well as witchcraft. Unfortunately, due to the lack of implementation of this Act, minute change has taken place to improve the circumstances of elderly people (Frisoli, 2016).

Conclusion

In a developing South Africa with growing urban/modern trends, traditional values of respect for the elderly are vastly dissolving. Also, with older people living in environments with limited social and economic resources, in addition to having no means of economic support create a recipe for elder abuse and neglect (Mouton and Southerland, 2017). As a student I strongly feel that further studies regarding the elderly population is required to better understand the specific patterns identified in literature, in addition to the varying implications for public health and clinical management of elder abuse victims. Health practitioners who often know the most intimate details of patient’s lives should also be more vigilant in identifying certain risk factors to prevent and identify cases of suspected elder abuse or neglect.

 

Reference List

Bezuidenhout, C. and Booyens, K. (2018). The Elderly Offender and the Elderly Victim of Crime: A South African Overview. Kratcoski P., Edelbacher M. (eds) Perspectives on Elderly Crime and Victimization, [online] pp.79-97. Available at: https://link.springer.com/chapter/10.1007/978-3-319-72682-3_5 [Accessed 6 Oct. 2018].

Burnett, J., Jackson, S., Sinha, A., Aschenbrenner, A., Murphy, K., Xia, R. and Diamond, P. (2016). Five-year all-cause mortality rates across five categories of substantiated elder abuse occurring in the community. Journal of Elder Abuse & Neglect, 28(2), pp.59-75.

Frisoli, A. (2016). “The South African Elderly: Neglect, Social Contribution and the HIV/AIDS Epidemic.” CUNY Academic Works, [online] 1(1), p.1. Available at: https://academicworks.cuny.edu/gc_etds/1294 [Accessed 6 Oct. 2018].

Mouton, C. and Southerland, J. (2017). Elder Abuse in the African Diaspora: A Review. Journal of the National Medical Association, 109(4), pp.262-271.

Simone, L., Wettstein, A., Senn, O., Rosemann, T. and Hasler, S. (2016). Types of abuse and risk factors associated with elder abuse. Swiss Medical Weekly.

WHO (2015). Elder abuse. [online] World Health Organization. Available at: http://www.who.int/ageing/projects/elder_abuse/en/ [Accessed 6 Oct. 2018].