CHAPTER ONE
Introduction
Background to the Study
Elder abuse is a major social and public health problem affecting the aged in the globe. Ola and Olalekan (2012) stated that elder abuse in domestic setting constitute a major social and public health problem suffered by men and women of sixty years and above across the boundaries of culture, religion, class and ethnicity. Elder abuse as observed by Bartley (2011) means harmful act toward the adult, such as physical abuse, sexual abuse, emotional or psychological abuse, financial exploitation, and neglect including self-neglect. The problem of elder abuse is largely hidden under the shroud of family secrecy. The signs of elder abuse are not recognized, leading to gross under reporting (Wyandt, 2004). As the population of the aged in both developed and developing countries continues to grow because of family planning and higher standard of living, elder abuse is still an issue that must not be ignored. Elder abuse is a growing social and public health problem that does not receive the level of concern it deserves in the light of the devastating effect on the aged and other family members.
Internationally there is under reporting of elder abuse. This statement is buttressed by Profile on Aging, (1998) who stated that globally, there is gross under reporting of elder abuse. The aged are being abused on daily basis because of their frailty and dependency on family members and caregivers (Chiskin, 2014). National Council on Ageing and Older People –NCAOP (2009) estimated after her study on elder abuse prevalence study in United States that elder abuse occurred in the communities between 1 per cent to 5 per cent of the population aged 60 years and older.
Locally, Nigeria is one of the countries where the elders are being abused. National Population Commission–NPC (2006), observed that Nigeria is not left out in elder abuse issue. Mudiare (2013) unveiled in her elder abuse incidence study carried out in Lagos, titled ‘Elders Also Cry’; that there is higher incidence of elder abuse in Nigeria despite the respect elders command. Though from 2006, there has been intensification of awareness of abuse as a public and social issue emanating in most Nigerian cities from the first World Elder Abuse Awareness Day, yet, elder abuse is still to receive the appropriate attention it deserves from the society and the government (NPC, 2006).
Elderly as unveiled by National Council on Ageing and Older People –NCAOP (2009) means people from 60 years and above. Hornby (2010) opined that the elderly is the person that is advanced in age and has influence and authority in the community. Fernandez, (2012) contended that the elderly means a person of a great age or seniority who has passed middle age. Contributing, Hansel (2009) viewed elderly as a member of a family, tribal group (Ethnic), or village who is advanced in years and has influence and authority within the community. The elderly as observed by WHO (2005) means a person that has clocked Sixty Years and above in age. Elder in this context means a person that is sixty (60) years and above.
The elderly people are found in different locations in the world. Such elders are possibly prone to abuse. In Nigeria, the elderly are also in different states. In Imo East Senatorial District which is in Imo State the elders are found in their homes, in the churches, pensioners meeting and Aladimma community meetings. These elderly persons, because of their frail nature, are commonly abused by family members or caregivers.
Abuse as observed by Fernandez (2012) means maltreatment, insult, use of foul language on somebody. Hornby (2010) defined abuse as use of force to inflict injury on another person. Howland (2007) defined violence broadly as any act that is harmful to the victims such as physical harm, emotional consequences, and measure of the severity of the harm. Abuse is a physical or verbal behaviour in which the aim is to harm, injure or destroy someone or something (Ene, 2004). Kirkpatrick (2007) defined abuse as great roughness and force often causing severe physical injury or damage. Violence as defined by Hornby (2010) means a behaviour that is intended to hurt or kill someone. Ali and Naylor (2013) defined violence as any unjust or cruel state of affairs or maltreatment of another human being. In the context of this study violence refers to the use of force in terms of power and control by caregivers over the elderly that is not socially accepted within a particular place or culture.
Violence is categorized into three. World Health Organization (2005) categorized Violence into three known as self-directed act or violence, nature of violence, and interpersonal violence. Continuing in explanation of the three categories of violence World Health Organization (2007) stated that self directed act embrace suicidal behaviours; nature of violence comprises of physical violence, sexual violence, psychological violence, financial deprivation or abuse, neglect and self neglect; while interpersonal violence is made up of family and community violence. Mudiare ( 2013) contributed by stating that family or partner violence is comprised of partner abuse, child abuse, siblings abuse and elderly abuse, while community or collection violence is made up of social, political and emotional violence. For the purpose of this study, violence focused on the elderly which is an aspect of family violence (National Center on Elder Abuse, 2005) will be studied. One could be abused verbally or physically using force (violence).Violence or abuse of the aged is called Elder Abuse by today’s researchers.
Elder abuse as a problem dates back to ancient times. Recognition of abuse as a health and human right violation problem was underscored and strengthened by agreement and declaration at key international conferences during the 1990s including the world conference on Human Right in Vienna 1993. Through these international agreements governments have increasingly recognized the need to develop broad multi-sectoral approaches for the prevention of, and response to abuse against elderly and have committed itself to implement the institutional and legislative reforms necessary to achieve this goal (WHO, 2005).
Many authors have defined elder abuse. National Center on Elder Abuse (2005) defined elder abuse as any intentional or negligent act by a caregiver or any other person that causes harm or a serious risk to a vulnerable adult. WHO (2005) defined 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 elderly person, or violates his or her human and civil rights. Coulin (1995) defined elder abuse as harmful act toward the aged, such as physical abuse, sexual abuse, emotional or psychological abuse, financial exploitation, and neglect including self-neglect. Elderly abuse means an omission or commission to inflict harm directly or indirectly on an elderly person to reduce his or her self-worth and self–esteem. It involves, but not restricted to acts to include passive neglect, verbal or emotional abuse and physical assault or physical abuse. In furtherance, Kelly, Albers, West and Baker, (1996) viewed granny battering, material exploitation, elderly castigation, use of the elderly as the family watch dog, violation of rights and neglect for the elder’s medication, feeding, shelter and all sorts of deprivation as forms of elderly abuse that are common these days. In this context, elder abuse will be taken 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 or violates his or her human or civil rights (WHO, 2005).
Abuses being perpetrated on the elders occur in different forms. National Population Commission (2006) indicated that abuses reigned on the aged are of different forms namely physical abuse, psychological abuse (emotional and or verbal aggression), financial abuse and neglect that results in unnecessary suffering, injury, pain, loss, and or violation of human right and decreased quality of life. The National Center on Elder Abuse, (2005) identified six categories of elder abuse known as physical abuse, emotional abuse, neglect or abandonment, financial exploitation, sexual abuse and self-neglect. Contributing to forms of elderly abuse O’loughlin and Delancy (2010) unveiled that elder abuse takes five forms known as physical, psychological, financial, sexual and personal abuse/neglect. Wyandt (2004) posited that elder abuse occurs under physical, emotional, sexual, financial exploitation and institutional abuse or neglect. The above forms of abuse are characterized by misuse of power and control by one person over another who have been or are in an intimate relationship. It can occur in mixed gender relationship and same gender relationships and has profound consequences on the lives of children, individual and families including communities in Imo state, Nigeria. Yu, (2007) stated that forms of abusive behaviors occur in one or both partners in an intimate relationship such as dating, marriage, family and friend or cohabitation. In the context of this study all forms of abuse as highlighted by National Center on Elder Abuse (NCEA, 2005), O’loughlin and Delancy (2010) and Wyandt (2004) such as physical abuse, sexual abuse, emotional abuse, financial abuse, institutional abuse or neglect and self-neglect will be incorporated.
Physical abuse involves contact intended to cause feelings of intimidation, injury, pain or other physical suffering or bodily harm to the elderly. Aihie (2009) stated that physical abuse means use of force in a way that it injures the elderly or puts him or her at risk of being injured. Physical abuse has many kinds including physical aggressions (hitting, kicking, biting, shoving, restraining, slapping and throwing objects) or threats thereof, controlling or dominating, intimidation, stalking, and passive or covert abuse (Yu, 2007). Mudiare (2013) observed that physical abuse include punching, beating, knocking, confinement and threats with object. Included as physical abuse are behaviours such as denying the elderly of medical care when needed, depriving him or her of sleep or other functions necessary to live, or forcing victim to engage in drugs or alcohol use against his or her will (United State Department of Justice, 2007). Inflicting physical injury onto other targets, such as pets or children in order to cause psychological harm to the victim is also perceived as physical abuse by Ageing and Development -AD, (2000). WHO (2005) noted that physical abuse has a range of physical symptoms (such as problem with walking, bruises, broken bones, head injuries, lacerations, and internal bleeding).The above-mentioned effect of physical abuse require medical attention and hospitalization (Jane, 1997). Arthritis, irritable bowel syndrome, ulcers, chronic pain, pelvic pains and migraines are some health conditions that are linked to victims of physical abuse (Ojo, and Briggs, 1983). Physical abuse of the elderly may be followed by sexual violence (Kelly, Alber, West and Baker, 1996).
Sexual abuse means sexual advances made to a person without his or her consent. National Committee to Prevent Elder Abuse-NCPEA, (2012) defined sexual abuse of the elderly as forcing the elderly to take part in a sex act when he or she does not consent. Sexual abuse of the elderly refers to sexual acts to which an older person has not or could not consent to (Working Group on Elder Abuse, 2002). Sexual abuse in this context means non- consensual sexual contact of any kind to the elderly. Sexual violence as explained by World Health Organization (2002) means use of physical force to compel a person to engage in a sexual act against his or her will, whether or not the act is attempted, completed, or uncompleted, such act involving a person who is unable to communicate unwillingness to engage in the sexual act, may be for reason of under-age, immaturity, illness, disability, or the influence of alcohol or other drugs, or because of intimidation or pressure. Sexual abuse has been linked to a range of negative health outcomes, such as vaginal injury, bleeding, sexually transmitted infections including human immune virus (HIV) and acquired immune deficiency syndrome (AIDS) (WHO, 2011). Sexual abuse is a severe violation of the elder’s basic right and bodily integrity, and may have profound emotional health consequences on them, both immediately and in the long- term.
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