Understanding elder abuse: a social rights perspective.

Elder abuse is generally understood in terms of the types of abuse that older people can be subjected to – financial, physical, psychological, sexual, and neglect. However, these definitions often fail to take into account the broader social context in which elder abuse is allowed to occur. Older people are rarely asked about what elder abuse means to them but when they are, they define it in societal terms – social exclusion, the belittling of their views and contribution, and violation of their rights. An effective approach to elder abuse requires intervention at a societal level to combat ageism and age discrimination. Much progress has been made in identifying and attempting to prevent elder abuse since the concept was first described in the 1970s (Baker, 1975), and these efforts have resulted in wider recognition, understanding, and regulation of the issue. In recent years there has been greater recognition of the complexity of elder abuse as a social problem (van Bavel et al., 2010). There is an increasing understanding that elder abuse needs to be approached on a societal level, not just an individual one, and a move towards a public educative approach that encourages social cohesion and solidarity across generations (O’Brien et al., 2011; WHO, 2011) is required. However, government responses still mainly focus on the individual and familial aspects of the problem (van Bavel et al., 2010), and there is only limited research examining possible links between societal ageism and elder abuse as experienced by individuals (Phelan, 2008; O’Brien et al., 2011). The most widely accepted definition of elder abuse or maltreatment is “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” (WHO/INPEA, 2002). It is usually seen as having various manifestations including psychological, physical, financial, sexual, and social abuses, as well as neglect. Regulatory bodies and policy-makers in countries such as Australia, the UK, and the USA use the above definitions (with slight variance) when considering how best to identify and prevent incidents of abuse, and to support those who are victims of maltreatment. Defining elder abuse as the occurrence of specific acts has encouraged better regulation and, in many cases, more direct support, but it risks limiting responses to being only interventions at an individual or family level. At this level, the focus is mainly on carer stress or family dysfunction and thereby fails to address the systemic context in which elder abuse is allowed to occur. This focus also encourages an acceptance of the victim– perpetrator dichotomy, and does not take into account the complexity of relationships between two adults, or the societal pressures and assumptions that affect individuals. The danger of limiting understanding of abuse to include only those actions that are perpetuated at the individual level upon vulnerable elders is that it runs the risk of also limiting our view of older people. Rather than seeing older people as having distinct identities and a variety of valuable roles that they fulfill in society, elders are seen only in regard to the aspects of their self that may be protected from or suffer abuse. In a circular manner, this serves to promote negative stereotypical beliefs that society holds about older people, which manifest as ageism and are felt in the withdrawal of respect and recognition deemed abusive by older people (O’Brien et al., 2011). Biggs and Haapala (2010) note that elder abuse always involves interpersonal relationships negotiated between adults where the abuse is directed at someone over a certain age (generally 65 years, or the age of retirement). However, the circumstances surrounding each individual occurrence of elder abuse can be very different. The circumstance of a person experiencing dementia and their carer (Cooney and Mortimer, 1995; Sadler et al., 1995; Cooney et al., 2006; Selwood et al., 2009) is very different to that of an older person facing the continuation of family violence experienced at earlier life stages (Penhale, 1999; 2003; Lundy and Grossman, 2004). It would be a mistake, considering the complex and ambiguous nature of the care relationship, to assume that elder abuse is a consequence of dependency. It is important to note that elder abuse occurs in only a minority of care relationships and not only those older adults who are in a position of direct care dependency experience elder maltreatment. The view of dependency as negative, and as a failure of autonomy and independence, must be challenged (Nolan, 2001). A broader response to elder abuse should highlight the interdependency of people