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● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No.4/2016 ●
● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No. 4/2016 (7-11) ●
Can an elderly person be a victim of violence? –
literature review
(Czy osoba starsza pada ofiarą przemocy? – przegląd piśmiennictwa)
M Paszkiewicz 1,A,D, M Giezek 2,B,D, P Zabielska 1,F, M Bażydło 1,E, B Masna 3,C,
J Ciechowicz 2,B
Słowa kluczowe - przemoc, osoby starsze, czynniki ryzyka.
Abstract – As a result of population ageing and an increasing
number of problems among seniors, more and more researchers
deal with the issue of violence against elderly people. The aim of
the paper is to review the current literature on elder abuse.
Material and methods. The authors reviewed and analysed the
literature available in the field of violence against the elderly. The
analysis comprised the research papers in both Polish and English
published between 2008-2016 and found in the database by typing in words: violence, elder abuse, old age, and risk factors.
Results. The analysis of the literature confirmed the significance
of the problem of violence against the elderly and pointed to a
number of risk factors making an elder a potential victim.
Conclusions. It should be noted that the data is incomplete, which
is caused by, among others, the elders’ reluctance to admit experiencing violence.
Author Affiliations:
1. Department of Public Health of the Pomeranian Medical University in Szczecin
2. Municipal Family Assistance Centre in Szczecin
3. Community Mutual Aid House in Szczecin
Authors’ contributions to the article:
A. The idea and the planning of the study
B. Gathering and listing data
C. The data analysis and interpretation
D. Writing the article
E. Critical review of the article
F. Final approval of the article
Key words - violence, the elderly, risk factors.
Correspondence to:
Streszczenie – W związku ze zjawiskiem starzenia się społeczeństwa, a w następstwie narastającymi problemami w grupie seniorów, coraz więcej badaczy zajmuje się problematyką przemocy
wobec osób starszych. Celem pracy jest przegląd aktualnego piśmiennictwa dotyczącego przemocy wobec osób starszych.
Materiał i metody. Autorzy dokonali przeglądu i analizy zawartości dostępnego piśmiennictwa w zakresie przemocy wobec osób
starszych. W analizie uwzględniono prace w języku polskim i
angielskim, wyszukane w bazie poprzez wpisanie słów: przemoc,
przemoc wobec osób starszych, starość oraz czynniki ryzyka,
opublikowane pomiędzy rokiem 2008 a 2016.
Wyniki. Analiza piśmiennictwa potwierdziła istotność problemu
jakim jest przemoc wobec osób starszych oraz wskazała wiele
czynników ryzyka czyniących seniora potencjalną ofiarą.
Wnioski. Należy zwrócić uwagę na niekompletność danych, która
jest spowodowana m.in. niechęcią seniorów do przyznania się do
zaznawanej przemocy. Istnieje konieczność prowadzenia dalszych badań w celu zgromadzenia całościowych danych pozwalających podjąć działania umożliwiające wsparcie osób starszych.
Monika Paszkiewicz, Mieszka I 3F/74 Str., 72-010 Police, Poland, e-mail: [email protected]
Accepted for publication: October 11, 2016.
I. INTRODUCTION
A
ccording to Central Statistical Office forecasts, in
2035 the elderly, i.e. people aged 65 plus, will account
for approximately 25% of the Polish population [1],
whereas the number of people over 80 years of age will
make 7.2% of the total population [2]. Therefore, the phenomenon of population aging has become an object of interest of many specialists and different communities around
the world. This involves studies on various aspects of old
age.
7
The problem of elder abuse is one of the discussed but
still poorly recognised issues. The published statistical data
seems the key factor determining the interest in the topic.
According to the World Health Organization Report (June
2011), at least 4 million elderly people in Europe suffer
physical violence every year (beating, kicking, burning/scalding, mutilating or long-hour locking in a room), 29
million are subjected to psychological violence, i.e. bullying and threats, and 6 million become the victims of deception or theft. Moreover, approximately 2.5 thousand elders
are killed by family members [3]. However, one needs to
be aware that the data presented does not depict the real
scope of the phenomenon. According to the data published
by the National Center on Elder Abuse in the United States
reported instances of violence account for 16% of all cases,
and 84% of violence incidents remain unreported and unidentified [4].
II.
DEFINITION OF VIOLENCE
In order to show the significance and extent of violence
against the elderly, the definition of violence ought to be
presented. One of the definitions presented was coined by
Mazur, who defined the term “violence” as “a deliberate
and instrumental behaviour whose aim is to enslave the
victim, to deprive them of their independent thoughts and
actions, and to make them succumb to the demands and
needs of the perpetrator” [5]. On the other hand, according
to the law on preventing domestic violence, “domestic violence is a single or repeated wilful action or inaction that
violates the rights or the personal interests of family members, in particular, the action that endangers these people's
lives or health and violates their dignity, bodily integrity,
freedom (including sexual freedom); the action that causes
damage to their physical or mental health, as well as inflicts
suffering and moral damage to the people affected by violence” [6]. According to the World Health Organization,
elder abuse is a single or repeated act, which “becomes the
cause of injury or carries a risk of injury (regardless of
whether the action is intentional or not) of an elderly person remaining in the carer's protection, or from other people staying with them in the relationship which should provide confidence and trust but which, in fact, becomes the
source of injury or distress for an elderly person” [7]. And,
according to Encyclopaedia of Interpersonal Violence elder
abuse should be understood as the infliction of harm or the
risk of harm done to the elderly by the people whom they
trust [8].
III. FORMS OF VIOLENCE
The literature classifies violence into: physical, mental
and emotional, financial, sexual and symbolic violence; the
classification includes also neglect and abandonment
[8,9,10]. Physical abuse is a non-accidental use of physical
force resulting in injury, e.g. hitting, beating, kicking, pushing, shaking, pinching, strangling, overpowering and throwing objects at a person. Experiencing such instances of violence may cause bruises, fractures, sprains, cuts, as well as
instigate fear, anxiety, and depression [9,10,11]. Emotional
abuse involves exerting pressure on the elderly person by
verbal abuse, insults, threats, and mockery. These are all
actions undertaken with the intent to inflict pain, mental
suffering or distress [10,12,13]. Financial abuse is the illegal and inappropriate use of funds, property or other resources of an elderly person, as well as their exposure to
the loss of valuable objects or property. This form of violence includes, among others, stealing, forgery, appropriation of property, deprivation of pensions and other property, as well as enforcing changes to the will [11,13,14]. Sexual violence is defined not only as a direct or indirect interference with an elder's sexual activity without their consent,
but also as imposing conversations about sex [11,12].
Symbolic violence consists in forcing elderly people to
behave in the ways convenient for the dominant groups
(e.g. a demand to wear proper clothes and to use an appropriate language) and results not only in violation of the
rights, but also evokes the feeling of loneliness and isolation in the elderly person [11]. Neglect is the lack of compulsory care and help a senior may need in important daily
activities. This form of violence usually manifests itself by
the lack of food, shelter, clothing or medical care provision,
as well as by an inability to meet many other vital needs,
which results in, among others, malnutrition, dehydration
or pressure sores [9,10,11] .Abandonment is the extreme
form of neglect, which means an elderly person left by the
carer, causing injury and suffering to the elderly person
[7,11].
IV. RISK FACTORS
Hopelessness, deteriorating physical fitness, weakness,
dependence on others, loneliness and exclusion from an
active lifestyle can be main reasons for elder abuse. All
these features are typical of the elders and make them perfect victims. In addition, the elderly are often the owners of
property that the perpetrator would like to take over [7,10].
The literature mentions further risk factors on the side of
victims, such as age, sex (for women), mental diseases,
8
psychological problems, poor physical health, ailments,
disruption of family relationships, and low income or capital [7,10,15-20]. Another group of factors comprises the
characteristics of the offender and, in this case, an excessive burden put on the person looking after
an elder may be of great significance. Apart from everyday
tasks there is also frustration caused by the lack of time to
fulfil the carer's own needs and often the lack of support
from other family members. In consequence, it may lead to
defiance and aggression directed towards the elder [7]. The
risk factors on the side of the perpetrator may also include
mental illness, stress, the environment they live in and
family relationships [21]. Another factor instigating violence against elderly people can include addiction of either
a perpetrator or a victim. As for the perpetrators, they need
funds to satisfy the addiction and, additionally, are in a
state of irritability and mood swings. If the victim is addicted, violence may stem from the carer's attempt to control
the addiction [22]. A difficult family history can be another
factor determining occurrence of violence against the elderly. Here, attention should be paid not only to the negative
feelings caused by long-drawn misunderstandings, but also
to the way of upbringing. If, in their childhood, someone
was taught that violence is the best way to resolve conflicts,
there is every likelihood that violence will be part of the
care over the elder [23]. This factor seems very important
due to the fact that violence and other forms of ill-treatment
of elders usually take place in the immediate family [24].
V. DISCUSSION
PolSenior survey entitled “Medical, psychological, sociological and economic aspects of people aging in Poland”,
carried out in 2011 shows that violence affected 5.9% of
people over 65 years of age [25]. Another study conducted
in Portugal on a group of 135 people aged 65-95 shows that
23.5% of respondents have experienced some form of violence [26]. The results of Abuse and Violence against Older Women in Europe (AVOW-study) survey conducted in
five EU countries, i.e. Finland, Austria, Belgium, Portugal,
and Lithuania in 2010. which encompassed coverage of
2,880 elderly women (not living in institutions) showed that
28.1% of women in total were exposed to violence [1].
The forms of violence such as insults, teasing, mockery,
and contempt (5.4%) were most frequently reported in the
PolSenior survey. 2.1% of respondents experienced intimidation and blackmailing; 0.4% experienced physical violence, e.g. beating, kicking and strangling, while 1.1% experienced pushing or prodding. Neglect by relatives was
signalled by 14% of the respondents, including 2.5% of
those who felt neglected often and 11.8% – sometimes
[20]. According to Halicka, aggressive behaviour toward
elders most often include arguments (12.8%) and insults or
invectives (9.5%); 3.1% of the elderly were pushed, poked
or beaten. Almost 3% of seniors were expelled from the
apartments and 2.4% experienced intimidation; 1.1% got
their freedom limited [27]. Further research showed that
almost half of the surveyed elders (48%) experienced psychological violence in the form of insults, threats, screams
or being sworn at. 10% of respondents experienced physical abuse (including beating, prodding, pushing). Also one
in tenth experienced economic violence such as stealing or
pension deprivation [14]. On the other hand, according to
study “Domestic violence against the elderly and disabled”,
conducted by the Institute of Psychology, Polish Academy
of Sciences, 48% of respondents indicated the isolation of
elderly people as the most common form of physical violence. As for economic violence, the largest number of respondents (52%) indicated taking and using the elders’
money whereas, when it comes to psychological violence,
49% mentioned pointing out physical or mental disability
[28]. Studies conducted in the United States on a group of
5,777 respondents showed that 4.6% of elders experienced
emotional violence, 1.6% – physical violence, 0.6% – sexual violence, and 5.2% – financial abuse. Additionally,
5.1% of elders felt neglected by family members [29]. Research Abuse and Violence against Older Women in Europe shows that 2.5% of women were exposed to physical
violence, 3.1% – to sexual violence, 5.4% – to negligence,
6.4% – to the violation of their civil rights, 8.8% – to financial abuse; but most of them were victims of emotional
violence (23.6%) [1]. On the other hand, the research conducted in Portugal shows that the most common form of
violence experienced by the respondents was physical and
emotional violence, as well as neglect. Persons under 75
years of age were most often victims of financial abuse
[26]. The Swiss research also confirms that violence
against
the
elderly
is
a serious problem. Of the 150 cases, where some form of
violence occurred, nearly 30% involved neglect, 47% –
psychological abuse, 35% – financial abuse, and
30% – physical violence [30].
VI. CONCLUSIONS
Despite the growing number of studies in the field of elder abuse the phenomenon still remains unrecognised. The
fact that findings of conducted studies and analyses are still
incomplete results from many factors, and the fact that the
victims, i.e. elders, are reluctant to admit experiencing vio9
lence is probably one of them. This happens when the perpetrator is a family member or a close person, or in the case
where an abuser is a stranger [14]. Elders are often afraid
of the repercussions from the family’s side, e.g. being
placed in a nursing home, or they simply do not know
where to seek help. In addition, a limited number of elderly
people’s social contacts means that people from the immediate surroundings do not know about the carried-out acts
of violence and, consequently, they are unable to take remedial actions [9,25].
Due to deteriorating fitness and limited mobility, the elderly are at higher risk when it comes to all forms of violence. The analysis of the conducted studies shows that
mental and emotional violence is the most common form of
violence used against elders. It should be noted that not
only suffering or physical pain are the effects of violence,
but also the increase of mortality [9].
The analysis confirms how important is the problem of
violence against the elderly. It is necessary to conduct further studies that will broaden the knowledge in the field
and, consequently, will enable development of comprehensive measures to protect elders.
VII. REFERENCES
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