Understanding Elder Abuse – The Straits Times

Everyone has a part to play in protecting the elderly.

World Elder Abuse Awareness Day was first launched in 2006, but it remains a concern in many societies across the world.

Wandering around aimlessly with no footwear, Mr Chew (not his real name) wonders when his next meal will be. He used to have a house and some savings until he lost them all to his children. Yet, the elderly man silently endured the mistreatment for the sake of kinship. He thought that by keeping quiet, he could keep his family together.

The last straw came when his son repeatedly punched him in the left eye, leaving him with partial visual impairment. Only then did Mr Chew agree to be admitted to a sheltered home when approached by social workers.

June 15 marks World Elder Abuse Awareness Day, but cases of elder abuse, similar to that of Mr Chew’s, are still taking place.

In 2017, the Ministry of Social and Family Development (MSF) received 77 cases of elder abuse. In 2019, the number of cases increased to 127. An elder refers to those aged 65 years and above.

Ms Cherylene Aw, Centre Director of TRANS SAFE Centre, explains that elder abuse can take various forms, and there can often be co-occurring forms of abuse.

Ms Cherylene Aw, Centre Director of TRANS SAFE Centre, a Family Violence Specialist Centre (FVSC), shares that elder abuse can take various forms, including physical attacks, being on the receiving end of prolonged verbal abuse, having their basic needs like food and clothing neglected, or being deprived of necessary medical care. Restricting the movements of the elderly or causing sexual harm also constitute elder abuse.

“Oftentimes, there are co-occurring forms of abuse, such as a combination of physical and/or emotional or psychological abuse amongst the cases of elder abuse we encounter,” she says.

Impact of elder abuse

Dr Kenny Cheong, a clinical psychologist in the Clinical and Forensic Psychology Service, MSF, explains that for most cases, the person who caused harm is known to the victim, with most of these perpetrators being the children, step-children or spouse of the elderly victim.

The reasons for elder abuse are often complex. Some reasons include caregiver stress, a history of strained relationships within the family or a family background marred by violence.

Regardless of the cause, the elderly have the right to feel safe and respected. Dr Cheong highlights that elder abuse can result in serious and permanent physical and psychological damage, and even death. Furthermore, the elderly victims are often not the only people affected by the abusive acts.

“Witnessing violence in the family could cause post-traumatic stress in children or even result in violent behaviours being normalised and perpetuated in the future,” adds Ms Aw.

Ms Cheung Siew Li, Director of Care and Integration at St Luke’s Hospital, says that violence is a problematic response to a stressful situation: “Violence never solves a problem satisfactorily. Changing the caregiver’s perspective may be more effective than raising a hand against someone.

Dr Kenny Cheong, a clinical psychologist in the Clinical and Forensic Psychology Service, MSF, says that by engaging the elderly more often, they may be more willing to turn to you should they need help.

“Seeking support or advice on how to cope better, as well as enhancing problem-solving abilities are also effective ways to resolve issues.”

Eyes and ears on the ground

“With ageing, older adults may suffer a decline in cognitive ability, physical mobility and health, making it harder for them to protect themselves,” says Ms Aw. They are particularly vulnerable to abuse.

Ms Aw continues: “They may not know how to ask for help, and may be unaware that they are victims. As such, the help of neighbours, friends and the public is key to early detection and intervention.”

According to Dr Cheong, some tell-tale signs of physical abuse include bruises, burns and unusual abrasions. Withdrawal from social activities and interaction, avoidance of eye contact and signs of depression or anxiety could also be indicators of emotional or psychological abuse. Signs of emotional abuse could also include the caregiver refusing visitation, a strained or tense relationship between the caregiver and the elderly, and threatening, belittling or controlling caregiver behaviours.

Indicators of neglect could include bedsores, unattended medical needs, poor hygiene, unusually low weight and unsafe or unsanitary living conditions such as having no access to electricity or running water, soiled bedding and clothes.

Ms Aw highlights the importance of flagging suspected cases of elder abuse to relevant agencies. These include the FVSCs, Family Service Centres (FSCs) and the police. These agencies can then mobilise the appropriate resources to render help to the affected parties as soon as possible.

As Singapore’s population ages, we anticipate an increase in the number of vulnerable elderly who are unable to protect or take care of themselves. MSF’s Adult Protective Service and our partners have been collaborating closely to provide holistic support and intervention for vulnerable seniors. and will continue to step up such efforts. All of us can play a part to keep our seniors safe from abuse or neglect. If you suspect a case of an elderly facing harm or neglect, do not hesitate to report it. 

Assoc Prof Dr Muhammad Faishal Ibrahim, Senior Parliamentary Secretary, Ministry of Social and Family Development

Encouraging the elderly to seek help

However, some victims like Mr Chew would rather suffer in silence than seek help, especially when the perpetrator is a family member. They may fear shame or judgment from others for washing their dirty linen in public. They may also be worried about their families being torn apart when the abuse is reported to the authorities.

As a general rule, Dr Cheong advises to first broach the issue with the affected elderly privately and build rapport with the elderly by chatting about hobbies or past occupations before moving on to topics on their living condition, well-being and relationships.

“An older person is also more likely to accept help if they think their family’s needs will be considered and addressed,” says Dr Cheong. “Reassure them that there is always help available.”

In some cases, some perpetrators may be suffering from a mental health condition, experiencing high stress levels, abusing drugs or alcohol, or just lack knowledge and skills on how to care for the elderly. The elderly may be more willing to report abuse if they know that their family members can receive the help they need, which will lead to better family ties in the long run.

For the affected elderly, offer emotional support and share contact details of available agencies such as FVSCs, FSCs, the nearest hospital and the neighbourhood police post. It is also helpful to encourage them to have a social network so that it will be easier for others to step in and lend a helping hand should there be suspected abuse.

Montfort Care’s GoodLife! @ Telok Blangah Program Manager Herman Lim says that the agency is still providing counselling and consultation services through video calls to help the elderly in need during the circuit breaker period.

“However, if you suspect the elderly could be facing immediate danger, it’s important to intervene immediately and accompany the elderly to the police post or hospital,” says Dr Cheong.

Caregivers need help too

For weeks, 75-year-old Madam Lim (not her real name) had been staying up in the middle of the night, banging on the bedroom doors of her children repeatedly. It became so unbearable that her family felt that they had no choice but to lock her in a room. It was only when Madam Lim’s daughter brought her to see a doctor did they realise that her mother was suffering from dementia.

Montfort Care’s GoodLife! @ Telok Blangah Program Manager Herman Lim explains that some seniors may act differently or display strange behaviours due to physical or mental health issues. Some of these actions could even be side effects of certain medications.

Understanding the signs and symptoms of elderly illnesses as well as how some medications can affect the elderly will prepare caregivers to care for them effectively. This will also help prevent misunderstandings, as in the case of Madam Lim and her children, and avoid potential conflict.

“It’s important to speak with professionals, be it a doctor, counsellor or psychologist and involve the care recipient in the communication process as well,” says Mr Lim.

Ms Han Yah Yee, Group Director of Montfort Care, says that caregivers should not feel guilty or incompetent for seeking assistance or support, and that it’s good to tap on external help and available resources when necessary.

Ms Han Yah Yee, Group Director of Montfort Care, adds that caregivers should not feel guilty or incompetent for seeking assistance or support: “Caring for the elderly is not easy, and sometimes it’s good to tap on external help and available resources.”

Respite care is one such option, where a caregiver can seek temporary short-term help to care for the elderly. Caregivers can also register under the Go Respite programme ahead of time. This way, they can plan and apply for the respite care when needed and temporarily place the elderly in a senior care centre or nursing home.

Working together towards reconciliation

Ms Jane Lan (not her real name), who was in her 50s, was the main caregiver in her family. Her mother had passed away and her elder sister has intellectual disability. Her father had begun to show behavioural and psychological symptoms of dementia. Having quit her job to care for her family, Ms Lan also worried about her dwindling finances.

One day, Ms Lan needed to be admitted to a hospital to undergo a surgery and could not leave her father and elder sister unattended. She turned to a community hospital for help. It was then that the hospital noticed bruises on the face of Ms Lan’s father and bite marks on her elder sister.

They discovered that the angry outbursts and physical attacks had started a year ago as the mounting stress of her caregiver duties overwhelmed Ms Lan. She did not fully understand that the dementia and intellectual disability were affecting her family members’ cognitive abilities.

Ms Cheung Siew Li, Director of Care and Integration at St Luke’s Hospital, says that violence never solves an issue and is often a problematic response to a stressful situation

After the abuse came to light, Ms Lan’s father and sister were given medical treatment and rehabilitation. With the help of medical social workers, they were eventually placed in a nursing home and medical care facility respectively. After her surgery, Ms Lan also received counselling, education and support. These interventions enabled everyone in the family to receive the care that they needed and helped them work towards reconciliation and a healthy relationship with one another.

Like in Ms Lan’s case, some of the ways that medical social workers can help include risk assessment, counselling, caregiver support and working with the elderly and their family on a care and safety plan. Where necessary, they can also contact community services, such as an FVSC to provide further support, or to secure temporary shelters for the elderly in high-risk situations.

Ms Cheung from St Luke’s Hospital explains: “Caregivers are encouraged to seek help early. Not all victims can speak up for themselves. Hence, it is important that the community steps in to look out for the vulnerable elderly in the neighbourhood and offer help.”Source: The Strait Times © Singapore Press Holdings Ltd. Reprinted with permissionRetrieved from: https://www.straitstimes.com/singapore/understanding-elder-abuse